From Loneliness to Solitude in Person-centred Health Care (Routledge Advances in the Medical Humanities) [1 ed.] 1032039469, 9781032039466

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From Loneliness to Solitude in ­Person-​­centred Health Care

This innovative book provides a new conceptual analysis of l­oneliness – ​­a condition associated with severe health consequences, including increased morbidity and early death. Arguing that social connection is not the only answer, it explores pathways for transforming loneliness to healthy solitude. The first part of the book draws on the humanities and arts, including psychology, philosophy, and literature to analyse the common, and potentially serious, problem of loneliness. It makes the case that the condition is less a deficiency than a state of s­ elf-​­disconnection that modernity feeds through social forces. The second part of the book looks at how ­person-​­centred health care can help educate persons to transform loneliness into healthy solitude. It provides an analysis of ­self-​­connection and spiritual connection, discussing how these forms of contact can mitigate risks associated with both lack of social connection, and social connection itself, such as ­self-​­disconnection and rejection by others. It goes on to demonstrate that connection to the self and spirit can make aloneness a resource and facilitate access to benefits of connecting with others. This ­thought-​­provoking book provides students, scholars, and practitioners from a range of health and social care backgrounds with a new way of thinking about, researching, and practising with lonely people. Stephen Buetow is Associate Professor of General Practice and Primary Health Care at the University of Auckland, New Zealand. He is Associate Editor of the Journal of Evaluation in Clinical Practice and the European Journal of Person Centered Healthcare.

Routledge Advances in the Medical Humanities

A Whole Person Approach to Wellbeing Building Sense of Safety Johanna Lynch Rethinking Pain in Person-Centred Health Care Around Recovery Stephen Buetow Medical Education, Politics and Social Justice The Contradiction Cure Alan Bleakley Poetry in the Clinic Towards a Lyrical Medicine Alan Bleakley and Shane Neilson Critical Humanities and Ageing Forging Interdisciplinary Dialogues Edited by Marlene Goldman, Kate de Medeiros and Thomas Cole Palliative Care Nursing as Mindfulness Embodying a Relational Ethic through Strong Emotion, Uncertainty and Death Lacie White From Loneliness to Solitude in Person-centred Health Care Stephen Buetow

For more information about this series visit: www.routledge.com/RoutledgeAdvances-in-the-Medical-Humanities/book-series/RAMH

From Loneliness to Solitude in Person-centred Health Care

Stephen Buetow

First published 2023 by Routledge 4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 605 Third Avenue, New York, NY 10158 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2023 Stephen Buetow The right of Stephen Buetow to be identified as author of this work has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library ­Cataloguing-­​­­in-​­Publication Data A catalogue record for this book is available from the British Library Library of Congress ­Cataloging-­​­­in-​­Publication Data A catalog record has been requested for this book ISBN: ­978-­​­­1-­​­­032-­​­­03946-​­6 (­hbk) ISBN: ­978-­​­­1-­​­­032-­​­­33088-​­4 (­pbk) ISBN: ­978-­​­­1-­​­­003-­​­­18987-​­9 (­ebk) DOI: 10.4324/9781003189879 Typeset in Goudy by codeMantra

For my wife, Esther Buetow (née Zeland).

Contents

1

Illustrations

ix

Introduction

1

PART I

Debunking myths about loneliness

21

2

Loneliness and isolation

23

3

Variation in experience of loneliness

41

4

Loneliness and social pain

57

PART II

Moving forward

73

5

Loneliness and person-centred health care

74

6

Self-love

96

7

Solitude

116

8

Privacy

137

9

Closing words

149

Index

151

Illustrations

Figures 1.1 Loneliness management: Conventional versus p­ erson-​­centred health care approach 1.2 Samuel Van Hoogstraten, Old man looking through the window, 1653 2.1 Teona Swift, Shopper in sanitary mask applying sanitizer in bakery, 2021 5.1 Edvard Munch, Evening on Karl Johann Street, 1892 5.2 Domains and attributes of p­ erson-​­centred health care 5.3 ­Person-​­centred health care for loneliness 6.1 Lorado Taft, The solitude of the soul, ­1901–​­1904 6.2 Frida Kahlo, The two Fridas, 1939 7.1 Adriaen van der Werff. Saint Madeleine meditating in solitude, ­1675–​­1725 7.2 Antonello da Messina, Jerome in his study, circa 1474 7.3 Édouard Boubat. Rémi listening to the sea, 1995

5 8 29 76 81 82 98 102 118 122 126

Table 5.1 Comparing conventional and p­ erson-​­centred approaches to loneliness

82

1

Introduction

Since 2020, governments worldwide have mandated lockdowns and other social restrictions in an effort to eliminate or contain coronavirus 2019 (COVID-19) and its variants. Individuals have sometimes been confned to their homes if they have not been essential workers or have not needed to make short outings for food or other basic supplies. There is widespread concern that such measures have increased the risk of loneliness1 as an embodied cluster of negative emotions,2 amplifying a pre-existing “loneliness epidemic.”3,4 Especially disconcerting is the loneliness whose persistence and intensity have activated neurobiological and behavioural pathways to adverse health outcomes.5 Anxiety has grown that the steps taken to manage COVID-19 have most increased loneliness among vulnerable social groups, including young adults and persons with relative socioeconomic deprivation.6 COVID-19 has made their loneliness more publicly visible. In theory, information and communication technologies, such as video-conferencing and social networking, have helped to compensate for the loss of direct physical contact.7 However, nationally representative longitudinal studies are needed to ascertain how these networking systems impact loneliness.8 Limited and variable research evidence is available for the effectiveness of most of the common social prescribing approaches for loneliness.9,10 In groups like young persons, the loneliest persons most resist the social interventions11 targeting loneliness.12 Nevertheless, research, policy, and practice continue to treat loneliness by building human sociability, including community integration. Social ties are cultivated from perspectives like structural functionalism and social network theory. They frame loneliness as a product of institutional arrangements limiting persons’ control over their social lives.13 This approach traces to Aristotle’s perspective that persons are social and political creatures in their natural state: “He [sic] who is unable to live in society… must be either a beast or a god.”14 Persons are assumed to affliate with others to gain and reciprocate support and develop a sense of self-identity serving society’s best interests. This book questions this construction of loneliness as, foremost, a social problem. It suggests that the solution to loneliness is not simply to cultivate friendships. It is to learn to feel comfortable being alone, to reconceptualize aloneness as a potential asset. From this perspective, psychological treatments show promise for alleviating persistent loneliness. Small to medium positive effects have been

DOI: 10.4324/9781003189879-1

2

Introduction

reported across the lifespan.15 Most common are interventions for maladaptive social cognition16 through cognitive behavioural therapy.12 However, beyond social processes in cognition is a need for novel psychotherapies to include interventions that build the virtues like self-love. They could help persons develop as fourishing wholes in states like aloneness and loneliness, complementing social approaches to loneliness and a social trend to pharmaceuticalize life.17–19

Scope Through a conceptual review,20,21 this book synthesizes and refects critically on research on loneliness to embrace these opportunities. I begin with the observation that, although widely used in everyday language, the term loneliness “has received little scholarly attention, at least in terms of its defnition.”2 Modern society continues to try to measure and manipulate loneliness it inadequately understands, based on taken-for-granted but contestable assumptions about loneliness and human nature. Recognizing loneliness as a complex, ambiguous phenomenon that commonly resists social intervention, the book seeks to elucidate fundamental concepts and their interrelationships in unchecked social discourse. This introduction begins the task of enhancing conceptual clarity. It looks at extant knowledge about what loneliness means before suggesting how aloneness differs from loneliness. Destabilizing the social foundations of a “rhetoric of togetherness that may be more seductive than ameliorative,”22 it constructs aloneness as a resource to use sustainably rather than dump. This resource is a source of energy that person-centred health care can harness to empower persons to ameliorate their attitude to being alone. The chapter introduces how this care circumvents limitations of social policy and utilizes positive psychology, for example, to reconstruct biological pathways. More specifcally, person-centred health care is suggested to support the development of self-love that can transform aloneness and loneliness into healthy solitude as an essential part of life. Before outlining the book’s chapter structure, I document my experience of this journey.

Defnitions A recent, comprehensive literature review found that various defnitions of loneliness emplace loneliness centrally in social relationships. The defnitions conceptualize loneliness as a complex emotion (cluster) and social problem associated most commonly with a discrepancy between actual and desired social relationships, including connectedness to the community.23,24 Some authors25 have emphasized cognitive aspects of this approach, but still focus on beliefs and thoughts about feelings of loneliness in social life. There has been a conspicuous emphasis on social cognition, as demonstrated by studies that defne loneliness as perceived social isolation26 or desolation,27 a felt defcit in emotionally satisfying, social contact.28 This defciency has been attributed to situational factors, such as signifcant life transitions, the early development of insecure emotional bonds

Introduction 3 29

(attachment theory), and personality traits (characteriological or behavioural approach).30 As Valeria Motta insightfully points out, this scholarship perpetuates an “excessive focus on the nature of humans as social beings and loneliness as social disruption.”31 Although loneliness is socially conditioned, persons can experience and relieve it independently of social interaction. Loneliness is felt when persons feel alone, yet being alone and lonely are different. Research on loneliness among young persons exemplifes this distinction.

Aloneness Young persons have a more extensive social network than late-middle-aged adults.32 They spend the least amount of time alone (persons fll more time alone as they age33) yet are also the loneliest age group.34,35 Therefore, persons can feel alone and lonely despite others nearby. In turn, young persons enjoy passing their time alone as much as with others.36 However, if reduced social contact lessens loneliness, persons need to know how to spend more time healthily on their own. Most importantly, they should understand that although they may lack control over facets of their environment, such as restrictions on their ability to be with others, no one can remove their liberty to choose their attitude to being alone.37 There are different ways for persons to be alone, and they are not inherently problematic. This observation undercuts the conventional approach to understanding and managing isolation and loneliness as problems of unmet social needs38 in “an ever-expanding and increasingly connected global social community.”39 Rather than increase social contact to develop socially satisfying relationships and avoid spending time alone, society has an opportunity to establish and implement a different approach: Empower persons to mentally reframe their time alone in positively meaningful terms.25 Use events like COVID-19 to expose this break for psychology so persons can learn to value periods of isolation.40 I don’t deny that spending no end of time alone risks loneliness that can harm health.41 However, aloneness is a neutral quality, such that I even dare to question God’s proclamation from the Book of Genesis (2:18) that “It is not good for man to be alone.” Because sometimes it is. Persons can be solitary without feeling lonely.42 A large, nationally representative German study43 found that living alone reduced loneliness across the lifespan compared to living with others, after controlling statistically for covariates, such as income. This result implies that social connectedness introduces costs. Persons may compromise values, like selfdetermination, to please others.44 In contrast, persons comfortable on their own do not let society decide when they are enough or expect others to make them feel complete. They already know they are whole and can use this self-knowledge to circumvent loneliness. From this perspective, persons can embrace periods of isolation as a potentially healthy component of everyday, modern life. There is also scope to transform loneliness into healthy solitude as a voluntary state of aloneness. Crucial for wellbeing,45 solitude is as legitimate as building social networks to relieve loneliness.

4

Introduction

CS Lewis46 acknowledged this point in a sermon 80 years ago. He noted that persons live “in a world starved for solitude, silence, and private: and therefore starved for meditation and true friendship.” Taking time out from the bustle of everyday life gives them space to develop the internal resources to be happy on their own. So, while rejecting the injunction “Learn to be lonely” in the flm The phantom of the opera, I like the line, “life can be loved alone” in solitude or with others. To release solitude’s benefts with or without such change, persons need to avoid feeling in “bad company” when alone.47 They can fnd meaning in aloneness by cultivating virtues, such as self-love. In groups like young persons, low selfworth is a big issue that worsens and is increased by anxiety48 and loneliness,49 mediated by variables like social media use.50 Fortifying persons’ relationship with themselves could help manage loneliness by repairing maladaptive cognition.51 Under these conditions, personal growth may convert loneliness into solitude that complements rather than replaces social connectedness. Therefore, I am not trivializing social connectedness. Being part of social groups or communities can generate reciprocal feelings of joy and belonging. A 2009 International Commission, including fve Nobel laureates, identifed some forms of social connection as critical indicators of quality of life and progress in modern societies.52 It cited empirical evidence that strongly positive social relationships reduce broad-based morbidity and mortality risk.53,54 These relationships improve health outcomes throughout the life course.55 They buffer stress indirectly via mechanisms like sharing and helping and directly by modelling healthy behaviour.56 Social interaction may help to manage loneliness even in introverts who, without lacking others in their life, sometimes face an unmet need to connect with a specifc other. Yet, sociality is not suffcient to manage loneliness. Paradoxically, the prevention and treatment of loneliness require persons to experience periods of healthy aloneness or solitude in which they have space to self-develop. Inner-directed growth releases their dependence on others. It enables them to be emotionally self-suffcient on their own or in their relationships with other persons.57 The poet and novelist Rainer Maria Rilke58 spoke to the latter context. He recognized that each partner in a good marriage dignifes the other by appointing them guardians of their solitude. This shared commitment to solitude develops both parties emotionally.59 Meanwhile, outside social relationships, persons may form other meaningful connections, for example, with nature, machines, or a divine presence. Emotionally isolated persons can use this state to become emotionally independent. On their own, they can take the time to cultivate virtues like self-love and even welcome emotional separation from others.

Person-centred health care Person-centred health care provides scope for persons to use aloneness to help manage loneliness. Figure  1.1 distinguishes this counterintuitive approach from conventional care for loneliness. Chapter 5 elaborates on my model. It discusses how person-centred health care puts frst the nature of each whole person in whom

Introduction 5

Feel lonely

Take conventional management approach

Adopt a person-centred health care approach

Develop existing and new social relationships with others

Self-develop and self-love to use aloneness as a resource

Feel valued and loved by others

Experience meaningful and healthy solitude within social life

No longer feel lonely

Figure 1.1 Loneliness management: Conventional versus person-centred health care approach

loneliness can be one aspect. Their care can be customized to cultivate virtues, including self-love, whose exercise gives meaning to solitude (Chapters 6 and 7). Self-love is emphasized because lonely persons less need “important others”60 than a sense of self that is suffcient for them to be content alone.47 This realization reconceptualizes loneliness as a state of mind arising from the failure of persons to develop the most critical relationship they always have  – their relationship with themselves here and now. I am defning persons as all humans and other entities whose attributes, such as human-likeness, warrant moral standing, including rights. If persons cannot love themselves as an integral part of being relationally human, they dispose themselves to experience loneliness.

6

Introduction

They do not feel fully present in a world in which they belong, not realizing they are already the person they are looking for. In strengthening a positive sense of personal identity, this problem does not diminish close social relationships. Instead, it calls for persons to master solitude as aloneness with an education. This learning emphasizes that real power lies within persons to decide their attitude to spending time alone.37 In creating their life, they can expect to enjoy this time. They are always free as moral agents to accept the challenge and responsibility to spend more rather than less time alone thinking for and being themselves amid life’s stresses.61 Promoting dignity and equality in opportunities to self-care,62,63 this personcentred perspective puts the meaning and management of loneliness in each person’s hands. However, while recognizing the co-determination of persons and society, it focuses on persons rather than loneliness, challenging the suffciency of social solutions for loneliness. It views persons as more fundamental than society because “Persons are developmentally and contextually, but not ontologically dependent upon the social.”64 Critics may respond that this prescription revives Friedrich Nietzsche’s ubermensch or overman.65 They may say that despite paying lip service to social interaction, I prize neoliberal hyperindividuality. However, that understanding would be a mistake. I regard social life as important but insuffcient for a good life. I acknowledge that global increases in individualism,66 including more persons living alone today than in previous times, may crowd out some virtues, such as sociability.67 Yet, especially in regions like Europe and North America, many persons freely choose to live alone. They value their independence and self-expression.68 Person-centred health care emphasizes their moral agency and responsibility to develop new virtues and self-care in advance of individual-level tests69 and situationism. From a transdisciplinary standpoint that spans the humanities and sciences, the rest of this chapter backgrounds my approach that the book develops. The chapter begins by discussing states’ current policy emphasis on managing loneliness as a social problem. It seeks to help balance this discourse with increased attention to psychological variables. Detaching persons from dependence on social structures and processes, like social prescribing, the chapter focuses on their freedom as moral agents to fnd meaning within themselves, alone and with others. Shifting attention from social determinants,70 it highlights the capability of persons for self-care through taking a positive attitude to their life circumstances and themselves. They choose rather than need others, then, to feel relationally complete. Thus, the chapter centres loneliness management within persons’ mental processing, frst noting how governments worldwide approach loneliness socially.

Social policy intervention Rather than empower persons to transmute loneliness into healthy solitude, states have been intervening through public policy to increase social interactions. The United Kingdom Government has led this development of a “connected society,”71 implementing social policies to counteract barriers to forming meaningful,

Introduction 7 71

interpersonal relationships. Its England-wide 2018 strategy has provided national leadership in coordinating stakeholder action to bring communities together. It emphasizes social prescribing as the referral of persons to a range of services to meet their social, emotional, and practical needs. Other objectives are to: Strengthen community infrastructure, target support for groups like younger persons, and tackle the stigma associated with isolation and loneliness. Scotland72 and Wales73 have published complementary strategies, other countries following this lead. In 2021, Japan created its own Ministry for Loneliness after witnessing rising rates of suicide among women, and kodokushi, lonely death, during the COVID-19 pandemic. Around the world, policy statements acknowledge social isolation and loneliness as public health concerns in groups such as older adults.74 Interventions to lessen loneliness include social support,38,48 increasing opportunities for social interaction, and social skills development.

Limitations of social connectedness Through social networks, persons impact others and themselves across all aspects of life and can moderate the experience of loneliness in ways that individuals might not accomplish alone. However, not everyone wants to spend most of their time with others or fnds that social connection cures loneliness. Some persons enjoy time with themselves and savour solitary exploration. This preference seldom refects a defcit in social skills.75,76 Although persons, such as hikikomori,77 may lose the motivation or ability to socialize, even socially competent and connected persons can feel lonely. Their loneliness may result from cognitive dissonance when social interaction does not ft their need for personal meaning. For example, in England, women report more loneliness than men despite having more regular social contact and support across different modes of communication with family and friends.78 Similarly, objective social isolation and loneliness correlate weakly in groups such as older persons.79 Socially isolated adults at the end of life are mostly not lonely, and those who report loneliness are seldom socially isolated.80 As noted above, the young are the loneliest age group despite spending the least time alone.34,35 Thus, social connectivity is at best a partial solution to loneliness and may contribute to loneliness when persons wear a social mask in bad faith to please others. The discourse on loneliness still emphasizes this social or intersubjective self to the relative neglect of the subjective self. It also distracts attention from the existential challenges to the social management of modern loneliness. All persons anxiously face the loneliness of fnitude, constantly threatened by non-being. At the same time, they are “absolutely isolated” as bodies “separated from other bodies. And being separated in this way means being alone.”81 They serve a life sentence in a world that Arthur Schopenhauer compared to a penal colony that no one chooses to enter or can quickly leave.82 COVID-19 has exacerbated this sense of imprisonment. Required to self-isolate, Israeli residents of continuing care retirement communities became “prisoners of our own age” severely distressed emotionally.83 This risk included loneliness as a mental prison to escape, just as the captive man in Figure 1.2 looks out to inwardly review his

8

Introduction

Figure 1.2 Samuel Van Hoogstraten, Old man looking through the window, 1653. Source: Wikimedia Commons.

isolation. Social connectedness is not necessarily the best way to manage this predicament. To cope, persons need the space of aloneness to accept their fnitude. In this space, they may take perverse comfort from knowing they are not alone in their aloneness. Others share the same predicament. As Bertrand Russell,84 the philosopher, observed, “the discovery in others of the same loneliness makes a new strange tie.” Persons may also recognize that to feel lonely, as quipped Don Quixote in Camino real, would “be inexcusably selfsh.”85 Thus, they can use time on their own to focus on becoming who they wish to and can be. They may expand themselves through others, but social interaction cannot directly and permanently heal existential loneliness because “each subjective existence is absolute to itself.”86 As Nietzsche stated in Schopenhauer as educator, “No one can construct for you the bridge upon which precisely you must cross the stream of life, no one but yourself alone.”87 Frightened to stand alone, most persons choose to join the crowd. They subordinate themselves to intersecting group identities only to discover that conforming to social norms is a timid act that stifes their authenticity and erodes their independence, weakening them spiritually. Exhausted, they continue

Introduction 9 to experience loneliness as a form of disconnection from the world. The writers Virginia Woolf and Sylvia Plath exemplifed such loneliness arising from the pressure of being women in a gendered world. Recently, gender has taken a turn that confuses the categories of man and woman.88 With the emasculation of male identity and androgenization of women, “each category is generalized to the greatest possible extent so that it eventually loses all specifcity and is reabsorbed by all the other categories.”88 “Non-binary people” and “pregnant people” are terms that exemplify the displacement or disappearance of the categories of women and men. The term “pregnant people” includes persons who do not identify as women but can still get pregnant. However, it erases cisgender women as a category of identity, disrespecting their personhood. Accordingly, it would be surprising if, lost in the crowd of out-ofcontrol political correctness, many women and men today did not feel some loneliness. Meanwhile, they also know that no one else understands their exact feelings. Owing to limitations of the ability of language to express loneliness without diminishing it, each person’s inner experience of life is never directly and entirely available to others (and vice versa), limiting comparisons and support. I cannot know your loneliness, nor can you know mine. “At best, we can develop empathy for one another and imagine what it is like to be the other.”89 Everyone knows the truth of what Val Xavier declares in Tennessee Williams’ play Orpheus descending: “Nobody ever gets to know nobody! We’re all of us sentenced to confnement inside our own skins, for life!”90 The Greek Titan Atlas symbolizes the grief from an awareness of this unbridgeable rift between separate consciousnesses. Sometimes, another person’s loneliness seems obvious. A person may share their feelings and ask for help from sources including health care providers, social media, and online fora. However, persons may instead communicate indirectly, alluding to feeling lonely in ways that others cannot easily comprehend or confrm. As Rinaldi tells Frederik in Ernest Hemingway’s91 A farewell to arms, they are so bravely quiet that others forget they are suffering. Across settings,92 these others underestimate the loneliness around them.93 Communication walls unavoidably create “a split between the lived and the represented experience,” diminishing the public meaning of and social response to loneliness. As René Magritte’s painting, The son of man, depicts, everything visible hides something. Concealing loneliness worsens it. Still, persons might not feel safe disclosing their loneliness.94,95 They may worry that others will view their complaint of loneliness as a sign of personal weakness they ought to be able to manage independently. They may also feel undeserving of receiving care from others or that to solicit their help will require too much time or money. Thus, limitations to the social management of loneliness include persons wanting to avoid social stigma, trivialization, and making others feel guilty or otherwise adrift by taking up their time. Lonely persons may further fear that – like the Gorgon Medusa – they may harm those to whom they become close. And, as Schopenhauer’s Hedgehog’s dilemma adds, persons may stay apart from each other to avoid mutual harm.96

10

Introduction

From Dante’s Inferno, the epitaph to The love song of J Alfred Prufrock speaks to this concern of mutual vulnerability. It idealizes the listener as someone who is as lost as the narrator.97 Further reasons for persons not reaching out for social support may include the sober realization, whether valid or not, that, on the broader scheme, most other persons are too busy navigating their stressful lives to have more than scant interest in the concerns of others. They may recognize themselves as not dissimilar, being mainly indifferent to others for whom there is a reciprocal lack of empathic understanding.98,99 In this context, ineffable isolation is fundamental to what the philosopher Martin Heidegger called our way of being-in-the-world. Social isolation increases consciousness of this existential experience.

Psychological infuences Understanding and managing loneliness require going beyond concern to strengthen the socio-cultural environment, including the development of social networks. This environment impacts loneliness mostly indirectly through the mediated infuence of psychological processes that impact physiological or biological pathways. As James Joyce’s novel, Ulysses insists, the mind is where persons live most of their lives. Sociality is less immediately crucial than the mental attitude that persons choose to take in their circumstances. The Stoic Epictetus explained nearly two millennia ago that “It is our attitude toward events, not events themselves, which we can control. Nothing by its own nature is calamitous.”100 I defne “attitudes” as ways of thinking and feeling about things. The social order shapes rather than determines attitudes since persons, by defnition, are moral agents whose perspectives vary across different states of consciousness.101 As the American philosopher Williams James102 wrote, “My frst act of free will shall be to believe in free will.” In turn, emotions infuence attitude formation toward objects, including emotions and behaviour. However, maladaptive emotion regulation strategies, such as blame attribution, predict loneliness. Reduced loneliness depends on a cognitive reappraisal or thought reframing of conditions like aloneness,103 underpinned by self-esteem and a personal sense of control and belonging.104 Giving positive meaning to being alone expands choice-making as persons consolidate a strong sense of internal purpose in their everyday lives. Carl Jung105 applied these ideas to his capacity for personal growth: “I am not what happened to me. I am what I choose to become.” A similar message is evident in the never delivered Oration on the dignity of man, in which the philosopher Giovanni Pico della Mirandola106 (bridging the medieval and Renaissance eras) claimed that freedom of choice and honour enable persons to mould and make themselves. Rather than turn individuals into persons, their circumstances reveal them as persons already. Their free will confers moral freedom to cultivate virtues for contentment and dignity-protecting control over their lives. They become their own hero. Jewish psychiatrist and neurologist Viktor Frankl37 applied this philosophy to survive terrifying predicaments during the Second World War.

Introduction 11 Interned in Nazi concentration camps, including Auschwitz, Frankl cultivated the creative will of persons to strengthen and sustain themselves by searching for meaning as the central motivational force. The freedom to fnd meaning at any given time is daunting. Persons may distrust the freedom to which they have been condemned, according to Jean-Paul Sartre.117 The responsibilities that accompany freedom can frighten them no less than their social situation. Nevertheless, Frankl was a remarkable testament to the human ability to exercise will-tomeaning. He remained resilient in the most dreadful conditions, healing intense emotional and mental distress to preserve individual sovereignty. He embraced his own and others’ unique potential and concern to (re)create themselves and freely choose how to live their lives. Recognizing this freedom as an achievement, a blessing rather than a curse, he found meaning in what life expected. The same freedom applies to the meaning that individual persons give their conception and embedded experience of loneliness in the world. As Robert Cummins107 states, “each individual – not society or religion – is solely responsible for giving meaning to life.” This responsibility comes from personal freedom. Inspired by self-determination theory,44 the cognitive theory of goal setting108 recognizes the freedom of each person to set and implement specifc and challenging but attainable goals. These goals include building relational skills for meaning construction, which go beyond social connectedness. This will-to-meaning drives the autonomous motivation of all persons to face rather than avoid time they may be reluctant to spend alone (a process Frankl termed paradoxical intention109) and organize resources to manage loneliness. From this vantage, I wish to question Karen Dahlberg’s60 belief that loneliness is something that happens to persons. Loneliness is chosen as much as healthy solitude. What matters – reiterating my argument above – is the attitude that persons take to being alone. This decision is crucial because, explained Nietzsche, “A thought, even a possibility, can shatter and transform us.”110 This book builds on that notion. It suggests that, as a dynamic process of interaction between persons and their environment, loneliness and its management depend most proximally on psychological mechanisms, independent of social connections. Persons become lonely when they weaken and fracture the symbolic meanings and signifcance of their connections with themselves as much as others. Person-centred health care attempts to heal these connections. Without diminishing the importance of social interaction as one way to construct meaning and manage loneliness, it elevates self-care by persons who sometimes want to spend time alone. It helps them fnd meaning in aloneness through healthy solitude.

My story To feel less alone, persons may still look to others for acknowledgement and approval. However, this outward gaze involves social acquiescence or acting in socially desirable ways that others view favourably. It gives power away, and it is unsatisfying for persons when the pressure for group conformity requires them to hide their inner face to save their outer face. I know from experience the

12

Introduction

destabilizing and lonely pain of separateness that such bad faith produces. Even though my current demographic of “married homeowners in good health” is the least lonely group,111 I have faced loneliness in my personal and work lives. I recall my limited dating opportunities as a young Jewish man committed to endogamy but living frst in Auckland and then in Canberra’s tiny diaspora communities. Feeling physically unattractive did not help, while my academic nature further isolated me socially from others. In my mid-30s, I moved to the United Kingdom to look for a Jewish partner. Fortunately, I succeeded in marrying a wonderful Jewish woman with whom I repatriated to New Zealand. However, a new form of work loneliness then developed as I found myself navigating the sealed but unsafe highways of New Zealand’s tertiary education system. Negotiating the left-leaning camber of this system’s academic path has continued to feel uncomfortable. My Jewish upbringing inculcated an ideational commitment to counter-steer through frank expression and argument.112 However, tertiary education pays weak homage to its theoretical commitment to robust scholarly debate, including a critic and conscience of society role. It continues to favour staff who “ft in” by promoting its left-wing beliefs, especially to students.113 It perpetuates in practice an intolerant determination to shut down and banish independent thinking that threatens this system. Senior colleagues have rebuked me, for example, for questioning the certainty of evidence-based medicine that, especially in its early constitutions, depersonalized medical care by putting more epidemiology into medical practice. From their majority position, my opponents have been disinclined to help me when my research funding and job have been threatened. It has mattered little that, as culture warrior Jordan Peterson explained in a 2018 interview with journalist Cathy Newman, “to be able to think, you have to risk being offensive.” Denied argumentation as an interactional style – a cultural form of sociability based on open disagreement112 – I came to feel that I had become a nuisance to my peers.107 Being devalued as a non-clinician in a clinical department added to my sense of professional and social isolation and cast me as “l’étranger,” the Cassandran-like outsider. Fearful of continuing to defy the system in good faith, I endeavoured to keep my views to myself on campus.98 I understood Carl Jung’s105 experience that “Loneliness does not come from having no people about one, but from being unable to communicate the things that seem important to oneself, or from holding certain views which others fnd inadmissible.” My isolation became preferable to spending time with others who made me feel self-indulgent.

Self-love Further lessening my loneliness was the awakening that social isolation from local peers was not its root cause. My loneliness originated within me. It said less about my lack of approval by others than not accepting myself. No other person made me lonely. I made myself lonely by not feeling confdent in who I was or valuing myself enough at work to cope with feeling isolated. As the political philosopher and Holocaust survivor Hannah Arendt explained,114 I missed the “redeeming

Introduction 13 grace” of self-companionship. I had become frustrated with my own company while expecting others to reconstruct my sense of worth even though, at best, camaraderie offered a band-aid without addressing the cause of my loneliness. To escape, I needed to develop the confdence to love myself as a lone wolf, a private but assured introvert comfortable leading others by humble example in independent pursuits. Redeeming this prescription has worked for me. I discovered that, in isolation, I could be the person I wanted rather than whom others expected, although deliberately suppressing my beliefs among them was sometimes effortful and stressful.115 I moved from the social sciences into the humanities to work solo on projects that interested me and like-minded others around the globe. From this independent scholarship, I recovered my confdence. I worried less that potential readers might disagree with me or, worse, ignore what I wrote. For I learnt from Victor Hugo’s116 Les misérables, in which Fauchelevent kept speaking once Jean Valjean stopped listening because the fact “That one is not listened to is no reason for preserving silence.” From self-compassion and self-love, I have continued to advance my academic career. Learning to speak in prudent good faith, I have gradually become more comfortable challenging social narratives, as in this book. Even though “no writer long remains incognito,”117 I have gained satisfaction from writing to “inform and shape life… [in ways] that provide inspiration and guidance and challenge.”118 I continue to write as a liberating act of rebellion to free myself and others. As Albert Camus119 observed, “I rebel; therefore we exist.” In rebellion, I now recommend person-centred health care that can help persons be alone without feeling lonely. This approach recognizes that the complex assignment of modern society is less to deliver the lonely from isolation than enable them to spend time alone or with others to optimize well-being. Their time alone is important because persons need space to actualize their potential. José Ortega y Gasset120 compared human beings to “a kind of ontological centaur, half immersed in nature, half transcending it.” To self-love through meaningful life projects, they need solitude no less than social interactions as their choice in different circumstances.

Chapter structure Two parts divide this book. Part I speaks to a need for change in how loneliness is conceptualized and managed, while Part II suggests how to meet this need. Comprising Chapters 2 to 4, Part I debunks common myths about loneliness as a social problem. Chapter 2 distinguishes loneliness from social and physical isolation, before Chapter 3 speaks to variation in experience of loneliness. Chapter 4 then confronts the conventional belief that loneliness is a social problem. Part II suggests a relational rather than narrowly social perspective to move forward. It emphasizes building and applying “person-al” capabilities121 to manage loneliness. Chapter 5 constructs a person-centred health care approach to meet this need. It construes lonely persons as whole persons with the moral agency to imbue

14

Introduction

loneliness with meaningful, creative possibilities through independent and interdependent developments, such as character building. Subsequent chapters focus on elements of this approach that make living worthwhile even in the presence of loneliness. Chapter 6 discusses self-love as a precursor for persons to manage time alone through healthy solitude (Chapter 7) that states like personal privacy can facilitate (Chapter 8).

Conclusion Loneliness is less conditional on any external factor than the attitude that persons take to being alone. Aloneness is a resource that can be squandered, leading to loneliness, or used to facilitate movement into periods of healthy solitude. From this perspective, loneliness and solitude are psychological states that persons feel deep inside themselves. Social connectedness, the standard treatment for loneliness, offers respite. However, it cannot suffce as a remedy. It distracts attention from what underlies loneliness without healing the way in which persons experience aloneness. Undervalued in managing loneliness is a person-centred approach that facilitates self-love to open the gate to being healthily alone.

References 1 Pai N, Vella S. COVID-19 and loneliness: A rapid systematic review. Australian and New Zealand Journal of Psychiatry. 2021;55(12):1144–1156. 2 Bound Alberti F. This “modern epidemic”: Loneliness as an emotion cluster and a neglected subject in the history of emotions. Emotion Review. 2018;10(3):242–254. 3 Maheshwari S, Bronsther R. COVID-19 in the era of loneliness. Current Psychiatry. 2020;19(5):31–33. 4 Buecker S, Horstmann KT, Krasko J, et al. Changes in daily loneliness for German residents during the frst four weeks of the COVID-19 pandemic. Social Science and Medicine. 2020;265. doi: 10.1016/j.socscimed.2020.113541. 5 Campagne DM. Stress and perceived social isolation (loneliness). Archives of Gerontology and Geriatrics. 2019;82:192–199. 6 Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020;186:31–34. 7 Valkenburg PM, Peter J. Social consequences of the Internet for adolescents: A decade of research. Current Directions in Psychological Science. 2009;18(1):1–5. 8 Hajek A, Konig HH. Social isolation and loneliness of older adults in times of the COVID-19 pandemic: Can use of online social media sites and video chats assist in mitigating social isolation and loneliness? Gerontology. 2021;67(1):121–124. 9 Akhter-Khan S, Au R. Why loneliness interventions are unsuccessful: A call for precision health. Advances in Geriatric Medical Research. 2020;2. doi: 10.20900/agmr 20200016. 10 Reinhardt GY, Vidovic D, Hammerton C. Understanding loneliness: A systematic review of the impact of social prescribing initiatives on loneliness. Perspectives in Public Health. 2021;141(4):204–213.

Introduction 15 11 Dixon M, Ornish D. Love in the time of COVID-19: Social prescribing and the paradox of isolation. Future Healthcare Journal. 2021;8(1):53. 12 Eccles AM, Qualter P. Review: Alleviating loneliness in young people  – A metaanalysis of interventions. Child and Adolescent Mental Health. 2021;26(1):17–33. 13 Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Social Science and Medicine. 2000;51(6):843–857. 14 Aristotle. Politics. New York: Penguin; 1981. 15 Hickin N, Käll A, Shafran R, Sutcliffe S, Manzotti G, Langan D. The effectiveness of psychological interventions for loneliness: A systematic review and meta-analysis. Clinical Psychology Review. 2021. doi: 10.1016/j.cpr.2021.102066. 16 Masi CM, Chen H, Hawkley LC, Cacioppo JT. A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review. 2011;15(3):219–266. 17 Abraham J. Pharmaceuticalization of society in context: Theoretical, empirical and health dimensions. Sociology. 2010;44(4):603–622. 18 Cacioppo S, Grippo AJ, London S, Goossens L, Cacioppo JT. Loneliness: Clinical import and interventions. Perspectives on Psychological Science. 2015;10(2):238–249. 19 Cacioppo, S. Effects of Pregnenolone on perceived social isolation. Clinical trial NCT02826577. Registered 2017. Estimated completion 2022. Chicago: University of Chicago. 20 Ayala RA. Thinking of conceptual reviews and systematic reviews. Nursing Inquiry. 2018;25(4). doi: 10.1111/nin.12264. 21 Hulland J. Conceptual review papers: Revisiting existing research to develop and refne theory. AMS Review. 2020;10(1):27–35. 22 Sagan O, Miller E, eds. Narratives of loneliness: Multidisciplinary perspectives from the 21st century. Oxford: Routledge; 2018. 23 Weiss RS. Loneliness: The experience of emotional and social isolation. Cambridge: MIT Press; 1973. 24 Perlman D, Peplau LA. Theoretical approaches to loneliness. In: Peplau LA, Perlman D, eds. A sourcebook of current theory, research, and therapy. New York: Wiley Interscience; 1982. Pp. 123–134. 25 Rodriguez M, Bellet BW, McNally RJ. Reframing time spent alone: Reappraisal buffers the emotional effects of isolation. Cognitive Therapy and Research. 2020;44(6):1052–1067. 26 Hawkley LC, Cacioppo JT. Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine. 2010;40:218–227. 27 Townsend P. The family life of old people: An investigation in East London. Sociological Review. 1955;3(2):175–195. 28 Svendsen L. Philosophy of loneliness. London: Reaktion Books; 2017. 29 Bowlby J. Attachment and loss: Vol. 1 Attachment. New York: Basic Books; 1982. 30 Hojat M. Loneliness as a function of selected personality variables. Journal of Clinical Psychology. 1982;38(1):137–141. 31 Motta V. Key concept: Loneliness. Philosophy, Psychiatry, and Psychology. 2021;28(1):71–81. 32 Child ST, Lawton L. Loneliness and social isolation among young and late middleage adults: Associations with personal networks and social participation. Aging and Mental Health. 2019;23(2):196–204. 33 Larson RW. The solitary side of life: An examination of the time people spend alone from childhood to old age. Developmental Review. 1990;10(2):155–183.

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34 Schultz L, Laverty A. The loss of loneliness in emerging adults. In: Harris D, ed. Non-death loss and grief: Context and clinical implications. New York: Routledge; 2020. Pp. 157–169. 35 Lin W, Chiao C. Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology. 2020;20(3):243–252. 36 Coplan RJ, Hipson WE, Bowker JC. Social withdrawal and aloneliness in adolescence: Examining the implications of too much and not enough solitude. Journal of Youth and Adolescence. 2021;50(6):1219–1233. 37 Frankl V. Man’s search for meaning: An introduction to logotherapy. Boston, MA: Beacon Press; 1963. 38 Yang K. Loneliness: A social problem. Oxford: Routledge; 2020. 39 Coplan RJ, Bowker JC. All alone. Multiple perspectives on the study of solitude. In: Coplan RJ, Coplan RJ, eds. The handbook of solitude. Psychological perspectives on social isolation, social withdrawal, and being alone. Chichester, West Sussex: Wiley Blackwell; 2014. Pp. 3–13. 40 Moghaddam FM. The shark and the octopus. In: Wagoner B, Moghaddam FM, Valsiner J, eds. The psychology of radical social change. From rage to revolution. Cambridge: Cambridge University Press; 2018. Pp. 275–290. 41 Leigh-Hunt N, Bagguley D, Bash K, et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017;152: 157–171. 42 Fischer CS, Phillips SL. Who is alone? Social characteristics of people with small networks. In: Peplau LA, Perlman D, eds. Loneliness: A sourcebook of current theory, research and therapy. New York: Wiley; 1982. Pp. 21–39. 43 Luhmann M, Hawkley LC. Age differences in loneliness from late adolescence to oldest old age. Developmental Psychology. 2016;52(6):943. 44 Deci E, Ryan R. Intrinsic motivation and self-determination in human behaviour. New York: Plenum; 1985. 45 Long CR, Averill JR. Solitude: An exploration of benefts of being alone. Journal for the Theory of Social Behaviour. 2003;33(1):21–44. 46 Lewis CS. Weight of glory and other addresses. New York: HarperCollins; 1980. 47 Sartre J. Essays in aesthetics. New York: Open Road Media; 2012. 48 Nguyen DT, Wright EP, Dedding C, Pham TT, Bunders J. Low self-esteem and its association with anxiety, depression, and suicidal ideation in Vietnamese secondary school students: A cross-sectional study. Frontiers in Psychiatry. 2019;10. doi: 10.3389/fpsyt.2019.00698. 49 Geukens F, Maes M, Spithoven A, et al. Changes in adolescent loneliness and concomitant changes in fear of negative evaluation and self-esteem. International Journal of Behavioral Development. 2020. doi: 10.1177/0165025420958194. 50 Yang C. Instagram use, loneliness, and social comparison orientation: Interact and browse on social media, but don’t compare. Cyberpsychology, Behavior, and Social Networking. 2016;19(12):703–708. 51 May R. The discovery of being. Writings in existential psychology. New York: WW Norton and Company; 1983. 52 Stiglitz J, Sen A, Fitoussi J. Report by the Commission on the Measurement of Economic Performance and Social Progress. Paris: Commission on the Measurement of Economic Performance and Social Progress; 2009. 53 House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988;241(4865):540–545.

Introduction 17 54 Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science. 2015;10(2):227–237. 55 Umberson D, Crosnoe R, Reczek C. Social relationships and health behavior across the life course. Annual Review of Sociology. 2010;36:139–157. 56 Cohen S. Social relationships and health. American Psychologist. 2004;59(8):676–684. 57 Ost-Mor S, Palgi Y, Segel-Karpas D. Exploring gaps in positive solitude perceptions: Older adults vs. gerontology professionals. International Psychogeriatrics. 2020;33(12):1253–1263. 58 Baer U, ed. Rainer Maria Rilke. Letters on life. New prose translations. New York: Penguin; 2006. 59 Yum Y. The relationships among loneliness, self/partner constructive maintenance behavior, and relational satisfaction in two cultures. Communication Studies. 2003;54(4):451–467. 60 Dahlberg K. The enigmatic phenomenon of loneliness. International Journal of Qualitative Studies on Health and Well-being. 2007;2(4):195–207. 61 Ben-Zur H. Optimism and loneliness: Literature review and explanatory models. In: Sha’ked A, Rokach A, eds. Addressing loneliness: Coping, prevention and clinical interventions. New York: Routledge; 2015. Pp. 155–170. 62 Hilton S. More human. Designing a world where people come frst. London: WH Allen; 2015. 63 Haque O, Waytz A. Dehumanization in medicine: Causes, solutions, and functions. Perspectives on Psychological Science. 2012;7(2):176–186. 64 Smith C. To fourish or destruct. Chicago, IL: University of Chicago Press; 2015. 65 Nietzsche F. Thus spoke Zarathustra. London: Penguin; 2003. 66 Santos HC, Varnum ME, Grossmann I. Global increases in individualism. Psychological Science. 2017;28(9):1228–1239. 67 Graafand JJ. Do markets crowd out virtues? An Aristotelian framework. Journal of Business Ethics. 2010;91(1):1–19. 68 Klinenberg E. Going solo: The extraordinary rise and surprising appeal of living alone. New York: Penguin; 2013. 69 Dennett D. Brainstorms. Philosophical essays on mind and psychology. Cambridge: MIT Press; 1981. 70 Appiah K. Experiments in ethics. Cambridge, MA: Harvard University Press; 2008. 71 UK (Her Majesty’s) Government. A connected society. A strategy for tacking loneliness – Laying the foundations for change. London: UK Government; 2018. 72 Scottish Government. A connected Scotland: Our strategy for tackling social isolation and loneliness and building stronger social connections. Edinburgh: Scottish Government; 2018. 73 Welsh Government. Connected communities. A strategy for tackling loneliness and social isolation and building stronger social connections. Cardiff; Welsh Government; 2020. 74 National Academies of Sciences, Engineering. Social isolation and loneliness in older adults: Opportunities for the health care system. Washington DC: National Academies Press; 2020. 75 DiTommaso E, Brannen-McNulty C, Ross L, Burgess M. Attachment styles, social skills and loneliness in young adults. Personality and Individual Differences. 2003;35(2):303–312. 76 Jones WH, Hobbs SA, Hockenbury D. Loneliness and social skill defcits. Journal of Personality and Social Psychology. 1982;42(4):682–689.

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77 Maglia M. Hikikomori: A systemic-relational analysis. Health Psychology Research. 2020;8(2). doi: 10.4081/hpr.2020.9068. 78 Department for Digital, Culture, Media, and Sport. Community life survey 2019/20. London: Department for Digital, Culture, Media, and Sport; 2020. 79 Perissinotto C, Holt-Lunstad J, Periyakoil VS, Covinsky K. A practical approach to assessing and mitigating loneliness and isolation in older adults. Journal of the American Geriatric Society. 2019;67(4):657–662. 80 Kotwal AA, Cenzer IS, Waite LJ, et  al. The epidemiology of social isolation and loneliness among older adults during the last years of life. Journal of the American Geriatrics Society. 2021. doi: 10.1111/jgs.17366. 81 Tillich P, Tillich P. The eternal now. New York: Scribner; 1963. 82 Plato (Dodds ER). Gorgias. Oxford: Clarendon Press; 1959. 83 Ayalon L, Avidor S. ‘We have become prisoners of our own age’: From a continuing care retirement community to a total institution in the midst of the COVID-19 outbreak. Age and Ageing. 2021;50(3):664–667. 84 Russell B. Autobiography. London: George Allen and Unwin; 1975. 85 Williams T. Camino real. London: Secker and Warburg; 1953. 86 Cioran EM, Cioran ÉM. On the heights of despair. Chicago, IL: University of Chicago Press; 1992. 87 Nietzsche F. Nietzsche: Untimely meditations. In: Breazeale D, ed. Schopenhauer as educator. Cambridge: Cambridge University Press; 1997. Pp. 125–194. 88 Baudrillard J. The transparency of evil. London: Verso; 2009. 89 Knafo D. Alone together: Solitude and the creative encounter in art and psychoanalysis. Psychoanalytic Dialogues. 2012;22(1):54–71. 90 Williams T. Orpheus descending: A play. London: Secker and Warburg; 1958. 91 Hemingway E. A farewell to arms. New York: Scribner. 1995. 92 Andy A. Studying how individuals who express the feeling of loneliness in an online loneliness forum communicate in a nonloneliness forum: Observational study. JMIR Formative Research. 2021;5(7). doi: 10.2196/28738. 93 Jordan AH, Monin B, Dweck CS, Lovett BJ, John OP, Gross JJ. Misery has more company than people think: Underestimating the prevalence of others’ negative emotions. Personality and Social Psychology Bulletin. 2011;37(1):120–135. 94 Gerson AC, Perlman D. Loneliness and expressive communication. Journal of Abnormal Psychology. 1979;88(3):258–261. 95 Andy A. Understanding user communication around loneliness on online forums. PLoS One. 2021;16:e28738. doi: 10.1371/journal.pone.0257791. 96 Schopenhauer A. Parerga and paralipomena. New York: Cambridge University Press; 1851. 97 Eliot TS. Collected poems 1909–1962. London: Faber and Faber; 2009. 98 Jaspers K. The phenomenological approach in psychopathology. British Journal of Psychiatry. 1968;114(516):1313–1323. 99 Tournier P. Escape from loneliness. London: Westminster Press; 1962. 100 Epictetus, ed. The Enchiridion. Raleigh, NC: Generic NL Freebook Publisher; 1996. 101 Abbs P. The development of autobiography in Western culture: From Augustine to Rousseau. Brighton: University of Sussex; 1986. 102 James H, ed. The letters of William James. Boston, MA: Atlantic Monthly Press; No. 1; 1920. 103 Preece DA, Goldenberg A, Becerra R, Boyes M, Hasking P, Gross JJ. Loneliness and emotion regulation. Personality and Individual Differences. 2021;180. doi: 10.1016/j. paid.2021.110974.

Introduction 19 104 Thoits PA. Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior. 2011;52(2):145–161. 105 Jung C, Jaffé A. Memories, dreams, refections. New York: Vintage; 1989. 106 Della Mirandola P. Pico Della Mirandola: Oration on the dignity of man. A new translation and commentary. Cambridge: Cambridge University Press; 2012. 107 Cummins RA. Loneliness through the lens of psychology, neurology and philosophy. International Journal of Community Well-Being. 2020;3:273–276. 108 Locke EA, Latham GP. A theory of goal setting and task performance. Englewood Cliffs, NJ: Prentice-Hall; 1990. 109 Frankl V. On the theory and therapy of mental disorders. An introduction to logotherapy and existential analysis. New York: Brunner-Routledge; 2004. 110 Nietzsche FW. The complete works of Friedrich Nietzsche: The frst complete and authorized English translation. Vol 15. Edinburgh: TN Foulis; 1924. 111 Offce for National Statistics. Loneliness – What characteristics and circumstances are associated with feeling lonely? Analysis of characteristics and circumstances associated with loneliness in England using the Community Life Survey, 2016–17. London: Offce for National Statistics; 2018. 112 Schiffrin D. Jewish argument as sociability. Language in Society. 1984;13(3):311–335. 113 Hargittai I. The loneliness of the scientifc discoverer. Structural Chemistry. 2007;18:1–3. 114 Arendt H. The life of the mind: The groundbreaking investigation on how we think. London: Harcourt; 1971. 115 Uysal A, Lee Lin H, Raymond Knee C. The role of need satisfaction in self-concealment and well-being. Personality and Social Psychology Bulletin. 2010;36(2):187–199. 116 Hugo V. Les misérables. Newburyport: Open Road Integrated Media; 2017. 117 Strunk W. The elements of style. London: Penguin; 2007. 118 Plimpton GA, Crowther FH. The art of the essay, I: EB White. Paris Review. 1969;48(Fall):65–88. 119 Camus A. The rebel: An essay on man in revolt. New York: Vintage Books; 1956. 120 Otega y Gasset J. Toward a philosophy of history. New York: WW Norton; 1941. 121 Entwistle V, Watt I. Treating patients as persons: Using a capabilities approach to support delivery of person-centred care. American Journal of Bioethics. 2013;13(8):29–39.

Part I

Debunking myths about loneliness

Persons live by stories to integrate life events and create what is meaningful about them at that time. These stories map and shape these persons’ changing beliefs about who they are and how they ft into the world.1 They become the stories they tell themselves and others.2 As the default (narrative) mode of social cognition, the stories give them a form of personal identity. They help them build and assemble from tools of social knowledge and normativity a kind of compass to navigate the landscape, including the experience of loneliness. The constructed nature of these stories makes them mythical. As symbolic narratives, the myths are worthy of respect because they model and explain the world. They make sense of and shape life from both personal experience and the portrayal of social life by assemblages of social institutions, such as the media. This understanding tends to frame loneliness as a social problem whose management requires building social capital for individual and shared action. The social value created by, and resources found in, social networks constitute this capital, including information and opportunities. The capital signifes scope for persons to improve social structures, attitudes, and practices, such as investment in social relationships. It can de-stigmatize loneliness as an embarrassing, debilitating condition but has severe limitations. Yet, taken-for-granted myths about loneliness perpetuate misinformation that is neither accurate nor complete. In fairness, they do not always seek to be because myths are not necessarily concerned with facts. They are told and envisaged to help decipher the mysteries of complex truths by providing “a more-or-less unifed vision of the cosmic order.”3 Their sacredness in this role protects them from critical scrutiny even though they are prone to oversimplify states such as loneliness. Nevertheless, myths about loneliness have become stale and need revitalizing. They perpetuate preconceptions and misconceptions that misdirect action and stife scholarly debate. These costs are implicit in a lack of evidence for the effectiveness of most approaches to managing loneliness as a multifaceted issue that defes easy solutions.4

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Keen to explore new ideas to make progress in managing loneliness, I believe loneliness has become misunderstood, making the solution counterintuitive. Loneliness is not simply a social defcit. It is not enough for persons to grow their social network to relieve unwanted isolation. Persons may beneft from spending more rather than less time by themselves if they take a positive attitude. Thus, loneliness is a state of mind that can transform time alone into healthy solitude. Persons can explore in solitude their inner terrain and construct a sense of self that can participate in authentic social interactions. Still, combatting myths is diffcult. Attempts to debunk myths draw attention to them. They may entrench existing beliefs and even strengthen misperceptions,5 although this “back-fre effect” appears relatively rare.6 Consequently, attempts to counter misinformation should not stop despite the need to halt its momentum and help persons become more critical consumers of information on loneliness. So, before developing my model of loneliness in Part II of this book, the following chapters in Part I confront myths about loneliness that appear false.

References 1. Smart N. Beyond ideology. London: Collins; 1981. 2. McAdams DP. The stories we live by: Personal myths and the making of the self. New York: Guilford Press; 1993. 3. Cupitt D. The world to come. London: SCM Press; 1982. 4. Akhter-Khan S, Au R. Why loneliness interventions are unsuccessful: A call for precision health. Advances in Geriatric Medical Research. 2020;2. doi: 10.20900/agmr20200016. 5. Nyhan B, Reifer J, Ubel PA. The hazards of correcting myths about health care reform. Medical Care. 2013:51(2):127–132. 6. Caulfeld T. Does debunking work? Correcting COVID-19 misinformation on social media. In: Flood C, MacDonnell V, Philpott J, Thériault S, Venkatapuram S, eds. Vulnerable: The law, policy and ethics of COVID-19. Ottawa: University of Ottawa Press; 2020. Pp. 183–200.

2

Loneliness and isolation

In the tragedy Hamlet, Polonius, the lord chamberlain of the King, Claudius, implores his daughter Othelia to “Read on this book, that show of such an exercise may colour your loneliness.”1 This usage of the term “loneliness” indicates a physical state of aloneness.2 Othelia is beseeched to pretend to read from a prayer book to defect any suspicion about why she walks on her own. Not until the late 18th century did loneliness enter the lexicon as an experience associated not only with aloneness but also with feeling socially alienated. This construction of loneliness strengthened from the 19th century onwards as the sovereignty of the secular, rational individual established itself. The continuing development of capitalism reinforced this change amid a decline in community, and concern for the autonomy and well-being of the individual pitted against society. Fay Bound Alberti2 further suggests that loneliness expresses not simply a shift in linguistic framing but a modern emotion that came into being as a mental problem. If emotions have a history, loneliness has changed throughout history. Yet, Alberti idealizes the premodern era, radically denying any place for loneliness amid religion and persons’ embeddedness in communities.3 My concern is with loneliness as it presents today. The popular imagination often still treats loneliness as synonymous with social contact defcits. The myth that aloneness indicates loneliness permeates the public consciousness rather than scholarly discourse since loneliness researchers agree that isolation is not the same as loneliness. Nevertheless, the difference is not always clear, perhaps because history shows that persons seldom tolerate involuntary isolation without feeling lonely. So, if persons can be alone but not lonely, loneliness arises less from isolation’s voluntariness than its chosen meaning. This chapter distinguishes isolation from loneliness. It discusses how social isolation, physical isolation, and emotional isolation are each changing in ways that can contribute or not to loneliness.4

Social isolation “Loneliness” is different from actual and perceived “social isolation.”5,6 These terms cannot be appropriately interchanged despite them intersecting.7 Whereas loneliness is a sad, embodied feeling of disconnection, social isolation is a state of

DOI: 10.4324/9781003189879-3

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Debunking myths about loneliness

not being in contact with others. It is commonly constructed as an objective defcit in social connectedness, which may lead to loneliness or not. In small social networks, socially isolated persons lack social integration with others, including family and friends. The number of their social connections and the frequency of their communication are too small for persons to feel part of a supportive, functioning network. More frequently, the isolation is qualitative.8 Social relationships lack density in that network members connect weakly and want for the sense of belonging that fourishing requires.5 Resulting social isolation may motivate withdrawal from available social opportunities, exacerbating isolation in a vicious circle. Social isolation can then spread through large social networks via clusters, especially at the periphery of the networks.9 To avoid loneliness, socially isolated persons are widely encouraged to develop social connections and participate in society as fully as possible, for example, through community involvement and access to services.10 However, social isolation is not necessarily a problem. Persons do not always feel lonely if they lack human company. They may choose to limit social connections and feel healthily alone (Chapter 7). Meanwhile, some persons experience loneliness when others make them feel alone. Still, social isolation is a risk factor for loneliness when persons experience unmet social needs for reasons including personal characteristics, the environment or both. They may lack social capital11 as trusted networks of relationships to negotiate challenges, including language and fear of scrutiny. They may be socially anxious and lack specifc social attributes, including – in urban slang – “social face.” This term broadly translates to social acceptability and confdence in developing social attachments and a sense of identity. Therefore, in social settings, persons may be isolated and either lonely or not, depending on how they feel about others excluding them or not appearing to notice them,12,13 or whether or not they choose to shut others out. They may decide not to belong to certain social groups or may prefer to be alone, for example, in navigating life transitions such as a relationship breakup. They may choose then to distract themselves from feeling lonely. Independent of loneliness, social and mental inertia can also isolate persons.14 Persons may accept such isolation to reap educational and economic opportunities. Social connections with family and friends may weaken as a price of striving to elevate social mobility.15,16 Physical relocation can still produce new situation loneliness and adversely impact the persons uprooted and those staying behind.17,18 However, longitudinal data from Germany indicate a tendency to overestimate loneliness from children living outside the households of adults aged 40 and over.19 All of this said, social isolation – independent of loneliness – is associated with adverse health effects, including cognitive decline in older adults.20 Indeed, a recent longitudinal study concluded that, among older Americans, social isolation rather than loneliness predicts cognitive decline.21 Still, social isolation is changing. Many persons isolated by social restrictions can connect through advances in information and

Loneliness and isolation

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communication technologies that introduce both opportunities and challenges for loneliness.

Modern technology Along with policy initiatives for digital inclusion, such as digital skill-building,22 these advances continue on a global scale to increase Internet and mobile phone usage.23 They enable persons to distract themselves from idleness and social isolation through staying connected in large social networks. However, online social interaction and its integration with offine worlds have not delivered the “technotopia” predicted by HG Wells in his novel, The shape of things to come. Forward leaps in technology are not stopping the experience of social alienation. One reason is problematic Internet use.24 Another is that even when social contacts exceed the number desired,25 no optimum number of friends is the same for all persons. Accumulating large numbers of contacts online also tends to compromise their quality. Low-grade interactions proliferate, sometimes leaving digital users feeling lonely. A systematic review26 reported inconclusive effects of technological interventions on loneliness in older persons. The effects are mixed because the setting and nature of social isolation are changing rapidly within new digitally mediated relational spaces. Although a digital divide persists between persons with and without Internet access, the progressive democratization of the Internet has impacted social connectedness through not only an “information revolution” but also a pervasive “relationship revolution.” As EM Forster predicted in his dystopian tale, The machine stops, persons increasingly develop social contacts through virtual interactions across bounded social group structures and space and time. These interactions yield digital socialization patterns in which instantly gratifying hyperconnectedness makes social contact more extensive and varied than ever before but also weaker and more elastic. Digital users become disciples of a new religion of fuid and superfcial social interaction that replaces deep interpersonal connection. Most social contacts shrink to strangers with whom virtual relationships are impersonal, shallow, or both. Left alone together in this condition,27 persons continuously move on28 through disposable relationships that destabilize opportunities to develop mutual trust and intimacy. Cyberloneliness29 can result as dizzying freedom from technological change30 puts a constant responsibility on persons to defne who they are.31 For two reasons, a vicious circle can develop that transforms the meaning of friendship and the nature of intimacy. First, online interactions reduce to a simulacrum of digital pixels. Without access to nonverbal cues and senses such as touch, this curated representation of reality becomes, in its own right, a truth that weakens persons’ ability to interact online, face-to-face. Second, online connectedness can disrupt major life activities offine, particularly at younger ages.32 The semblance of intimacy cultivated through online social networking is often illusory when it replaces rather than complements offine relationships.33 When persons notice this illusion, including increasingly disposable relationships

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in a throw-away world, they may have nowhere to turn. Loneliness or fear of loneliness can keep them online. This behaviour may perpetuate social alienation, for example, through phubbing (snubbing someone present by attending to a digital device) for rapid stimulation and multiple connections. The constant availability of persons on the Internet feeds an appetite for “social snacking”34 that temporarily distracts them from feeling empty, bored and frustrated. This behaviour may appear relatively consequence-free in providing social sustenance. However, it lacks nutrient content and can become compulsive when genuine social connections are unavailable. It can become addictive and fail to relieve psychosocial concerns. Reduced opportunities to develop and apply social skills in “real-world” interactions add to the face-to-face interactional challenges35 motivating social media use in the frst place.36–38 Other risks further characterize social interaction online, such as feeling out of place. Persons may experience victimization through harassment, doxing, and cyberbullying within social networks. Adolescents face such dangers at a time of psychological vulnerability. In adolescence39 and other periods of life, such as old age,40 concurrent or sequential exposures to victimization exacerbate the problem across physical and digital spaces. Meanwhile, mass communication feeds digital users’ learnt helplessness by inundating them with messages on why and how they need to improve themselves to garner others’ respect. In the digital mirror of social media, persons can quickly feel they are not “good enough.” Social comparisons can leave them feeling “stigmatised as ‘losers’ in a super-connected, how-many-friends-have you got, Facebooked, Tweeting, Instagrammed culture.”41 Pressured to conform to normative social ideals, online users may spin disinformation.42 They adopt fake personas to be popular and overlook concern that social surveillance systems compromise their online privacy and security, even though the Internet appears to offer anonymity. In a lucrative marketplace that has lost control of their details, they default to embellished snapshots of their social lives. They continually self-monitor and self-recalibrate their public face, such as revealing personal information they would never contemplate sharing in the real world offine.43 Exhorted to try to be something they are not, they feel vulnerable. They fear dropping their mask and regret acting in bad faith. Estranging themselves from their instincts, they become what they pretend to be. Still, persons can use digital connectivity to pursue benefts, such as social loneliness mitigation. First, digital technologies facilitate social contact, for example, among persons living alone36 and older persons.37 Compensating for attributes like disabilities, digital users can use their relative anonymity online to present themselves in the best light possible. This activity promotes social independence in social and public settings. Second, virtual platforms, such as the Internet, mobile technologies, social media and video-calling software, produce a semblance of companionship. Although brittle and often short-term, they promote confdence in experimenting with convenient social exchanges44 to fashion connections with others who share their activity preferences. These opportunities may help persons share problems, such as loneliness, fnd online

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support in virtual spaces like teletherapy sessions, and modulate negative moods.46 Third, persons enjoy expanded and quick access to information and other online content. Weakly regulated digital platform algorithms connect them to customized media selections, reinforce or re-engineer their behaviour,47 and help them connect with like-minded groups. These opportunities can entertain them, facilitate learning in settings like schools,48 stimulate cognitive functioning in groups like older persons,49 and meet commercial needs to trade products and services.

Physical isolation Physical isolation occurs when persons are physically separated from other persons. This partition limits freedom of movement and physical contact between persons. In that sense, it shrinks life-space by restricting physical interaction. This experience may contribute or not to collateral damage, such as social isolation.50 It may, but does not necessarily, lead to loneliness. For example, in the poem, This lime-tree bower my prison, the Romantic poet Samuel Taylor Coleridge describes resigning himself to remaining beneath a lime tree while his friends explored the countryside. He vicariously shared their experience and rejoiced in it, exemplifying how a person can decide to be comfortable with their own company.51 I want to discuss fve situations in which physical isolation need not cause loneliness even when the isolation is not freely chosen.52,53 These situations are: Urban life, quarantines and COVID-19, incarceration, remote working, and touch deprivation. These circumstances illustrate how different persons respond differently to physical (among other forms of) isolation, depending on how they perceive and experience them over time and space. They may even welcome physical isolation that strains or loosens their social relationships. Urban life The physical isolation associated with independent, solitary living has become a signifcant feature of modern urban life in developed countries over the last century. Of all households, single person-households or “solitaries” have come to constitute at least 60 per cent in some European and North American cities with a culture of individualism.54 Many persons choose or not to live – and age – alone, frequently occupying small spaces, such as studio apartments. Although their living alone can undoubtedly contribute to the experience of loneliness, these conditions are distinct. Persons living alone do not always lack company. On average, persons who live alone are less socially isolated than married persons.55 They may also enjoy happy repose, as the original version of Vincent Van Gogh’s painting, Bedroom in Arles, portrays. Writing to his brother Theo in October 1888, the Dutch artist explained that “a look at the picture ought to rest the mind, or rather the imagination.”56 The image embodies a refuge, a place where the artist chose to live. Respite there from pressing social demands strengthened his independence and freedom.

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Today, such experience speaks to how modern communities have turned from small, intimate and stable groups of interconnected persons into progressively loose and mobile collections of self-suffcient individuals. Delaying partnering, increasing proportions of young persons can now afford to live alone, for example, to study or work.57 Later in life, persons – especially widows – continue to prefer the independence of living alone for as long as their health permits. Living on their own, they can, for example, pursue hobbies and interests. The opposite of living alone, residential crowding, may similarly elicit different responses. Actual or perceived loss of personal space may feel stressful, weaken social relationships, and contribute to feeling lonely in the crowd. However, crowding can become normalized and liked. Persons may feel in harmony with others nearby whose proximity facilitates valued, social interaction. Living arrangements do not cause (or protect) against loneliness. Quarantines and COVID-19 Physical isolation may also be self-chosen or socially imposed to manage risks associated with physical contact. It can stop social networks from serving as vectors for transmitting infectious diseases, especially when vaccination and effective treatments are unavailable. For example, persons may abstain from sex to remove any possibility of getting or passing on a sexually transmitted disease, or undergo quarantine during outbreaks like COVID-19. The practice of quarantine is a legacy of scientifc work by the 11th-century polymath, Avicenna, or Ibn Sina, who popularized isolating persons for 40 days to control the spread of contagious diseases. This approach of al-Arba’iniya (the 40)58 foreshadowed the introduction in Italy of the quarantina during the 14thcentury bubonic plague.12 The quarantina denoted 40 days during which ships entering Venice had to stay in isolation pre-disembarkation. Although such quarantine sessions could feel like house arrest, history has demonstrated persons’ ability to be highly productive during them. Either these persons were not lonely or their loneliness stimulated rather than hampered their outputs. For example, feeing the bubonic plague to his family estate in southwest France, Michael de Montaigne59 published in 1587 his fnal book of essays on coping with self-isolation, among life’s other travails. In or around 1605, William Shakespeare wrote, in quick succession, King Lear, Macbeth, Antony and Cleopatra, Timon of Athens, and Pericles, when the bubonic plague closed London’s theatres.60 When the plague returned in 1665–1666, Isaac Newton escaped Cambridge to spend 20 months in self-quarantine at his family estate in Lincolnshire, a period he subsequently described as his most intellectually productive. In 1666, the Year of Wonders or Annus Mirabilis, the 23-year-old laid the foundations of his theories on calculus, optics, and the laws of motion and gravity.61 Centuries later, in 1919, Edvard Munch transformed his confnement with the Spanish fu into his painting, Self-portrait with the Spanish fu. Seven years afterwards, Frida Kahlo painted her frst self-portrait from bed after being severely injured in a bus accident. Most recently, the COVID19 pandemic has necessitated global populations’ mass, physical isolation.

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Before looking at how physical isolation during the pandemic has impacted loneliness, I want to review the form this isolation has taken. To slow the spread of the virus and protect communities from COVID-19, governments worldwide have implemented unprecedented closures and other restrictions. To prevent closeness as the vector for disease transmission, they have increased the proportion of the world’s population already homebound. Public health restrictions have included orders ranging from self-isolation, through shelter-in-place, to managed isolation in a quarantine facility. Individuals have similarly found themselves alone outside the home, navigating deserted streets like those depicted in Louis Guglielmi’s 1939 painting, Town square. Closed and empty stores, redolent of Edward Hopper’s painting Sunday, turn them away. When others are near, there is an expectation to “social distance,” a confusing term requiring everyone to “distance socialize” from a minimum distance rather than stop socializing.62 Governments have further encouraged the public to adopt other public health measures like wearing face coverings and using hand sanitizers (Figure 2.1). These isolating interventions prevent infections but can feel stressful and make persons sick. Impacted worst have been the most vulnerable social groups.

Figure 2.1 Teona Swift, Shopper in sanitary mask applying sanitizer in bakery, 2021. Source: Pexels.

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They include persons living alone,63 persons with reduced self-rated health,64 older adults,65 the homeless,66 racial and ethnic minorities,67–69 and females.64 Still, it has been diffcult to disentangle the effects of physical isolation from those of potential confounders. I am referring here to lost opportunities for paid work;70 domestic pressures, such as expectations (disproportionately among women) to increase housework71 and unpaid care;72 and disciplinary and regulatory limits on rights and civil liberties,73 including freedom of assembly and health care access.74 Adherence to isolation orders has varied amid exacerbations of health inequalities;75,76 compliance fatigue; and uncertainty about the future, including the duration of confnements.77 While potentially increasing the risk of COVID-19 transmission, personal and social mitigation behaviour (including defance)78 has functioned as a safety valve for negative attitudes toward the disease threat and need for confnement.79 It has helped to relieve psychological outcomes such as low mood and new situation loneliness. Some studies53,77 have not detected mean-level increases in overall loneliness before or during the outbreak. A review and meta-analysis of longitudinal studies and natural experiments found that the impact of the lockdowns on mental health has been small and highly heterogeneous.80 Indeed, some studies81 report that loneliness decreased during the early stages of the lockdown, perhaps refecting the kind of shared humanity that Albert Camus portrayed in his existentialist novel, The plague. The lockdowns have also meant different things to different persons. Some have acted on their freedom to choose their response. Recall the Jean-Jacque Rousseau’s82 opening statement in The social contract: “Man is born free and everywhere he is in chains.” Rousseau suggested breaking the chains of alienation from within. Persons can use the “general will” to enter into a contract with themselves to beneft all in a civil society. During COVID-19, some persons have done that. Adapting to and even welcoming the break in routine, they have chosen to see self-isolation as a kind of “beloved mother.”83 Those with ample personal resources, such as vitality84 and psychological fexibility79 (Conservation of Resources theory85), have adapted to isolation at home. Their emotional connection with this familiar and meaningful place of attachment86 has helped them construct a bulwark against loneliness. They have valued the opportunity to stop commuting to work and escape air pollution. They have welcomed the chance to slow down and witness courage and kindness at home and in the community. Refecting on their life, they have explored new dimensions of themselves and made positive life changes like increasing their time with household members and learning new parenting skills.87 Embracing her COVID-19 lockdowns, celebrity food writer and television cook Nigella Lawson has described using her time living alone to make solo dining special. Incarceration Locked up rather than locked down, some persons experience forced confnement in jail. Cut off from the world, their incarceration may take different forms.

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For example, physically isolated prisoners may experience living arrangements ranging from overcrowding to extended periods of solitary confnement in small, single cells. These different conditions can lead to sensory deprivation and loneliness that persists, even after release from prison,88 prompting debate on the morality and legality of prolonged solitary confnement in places like US jails.89,90 The psychological harm from such isolation is likely worst for mentally ill or suicidal inmates. However, the hypothesis that isolation causes suicide is unproven.91 Some inmates prefer seclusion and the privacy it confers to placement with cellmates. Choosing their attitude to isolation may turn being alone to an advantage. History gives many examples of prisoners adapting successfully to long periods of physical isolation. Robert Stroud, the “Birdman of Alcatraz,” educated himself in Leavenworth prison, Kansas. This self-taught ornithologist spent 42 of his 54 years of incarceration in solitary confnement.92 Sentenced to ten years in prison, Malcolm X taught himself there to read and write.93 Both men transformed their lives by gratifying their thirst for knowledge through a prison education. In jail, prisoners may also receive other benefts including health care and time to fnd meaning through creative activities, such as writing. There is a rich tradition of prison literature, with many historical fgures, since at least the time of the Roman statesman-philosopher Boethius,94 writing about their time alone in prison. For example, Fyodor Dostoevsky’s novel, The house of the dead, thinly disguises a prison memoir. Other famous prison texts include two scientifc books on bird diseases by Stroud.92 Egon Schiele’s “Prison Drawings” are among his most important works. After release from prison in the early 1970s, the Turkish artist Gülsün Karamustafa produced from memory her “Prison painting” series of 15 acrylic works on paper. Such creative activity could have made such persons less conscious of their isolation. All these opportunities help to explain why some inmates prefer prison to community sentences95 and decline parole or early release. A minority even choose to be arrested for a new crime to return to jail. They prefer incarceration to facing challenges of successful re-integration, such as securing housing and employment on re-entry to society. Remote working In the community during COVID-19, many physically isolated workers have taken advantage of digital technologies and tools, like virtual meetings, to work remotely from the relative comfort and convenience of their homes. They have saved time and money by not commuting to work every day and have used “task-technology ft” within home workspaces to be as productive as in the workplace. The new arrangements for work-at-home, including fexible hours, have not necessarily increased worker loneliness.96 Indeed, since the lockdowns, many workers have continued to incorporate periods of work from home.97 New geographies of work have developed around the home as a onestop shop.

32 Debunking myths about loneliness Even before COVID, some workers have become “digital nomads,”98 whose work-life is location-independent across multiple sites. The Latin term solivagant describes a number of these persons. Although they can feel lonely,99 they have chosen to move around in their work to enjoy benefts such as a lifestyle of freedom. Frequently, they keep to themselves, especially when managing new challenges. Meanwhile, even conventional offce workers use technology to connect with the outer world while isolating physically and maintaining their privacy. They use tools, like noise-cancelling headphones, to retreat from distractions in open-plan offces while emailing and Zooming with colleagues even short distances away. Touch deprivation Lastly, I want to focus on touch deprivation as a form of physical isolation that can arise from restrictions on physical contact among nearby others. In common with the situations of physical isolation discussed above, physical isolation through loss of touch is suffcient rather than necessary for loneliness. Touch deprivation can contribute to persons feeling lonely because humans are neurobiologically wired to touch and be touched for social and emotional bonding.100 The loss of human touch has become a daily casualty of modern life, for example, as hugs and stroking have become less common over time.101 A “crisis of touch” has emerged as a feature of the global emergence of modern social life and low-touch economies. Remote forms of digital culture limit close physical contact to aid business effciency and productivity.102 In domains like health care, low touch technologies risk introducing “skin hunger” or “touch hunger,”103,104 losing the healing potential of ritual touching. Recognition of the problem has prompted the development of innovative alternatives to human touch.101,105 However, no causal link has been established between loneliness and touch deprivation, mediated by the human need for physical connection. While most persons enjoy mutual touching, not everyone does. Persons increasingly forego human touch to achieve benefts like reduced surface pathogen spread in modern social life. COVID-19 physical distancing has reduced some opportunities for physical contact, such as accessing public places to meet a sexual partner. However, whether sexual activity moderates loneliness is uncertain.106 Even though touch deprivation during the pandemic has sometimes been associated with greater loneliness,107 studies have reported reductions in sexual desire and partnered sexual behaviour over this period.108–110 As Alain Giami notes, confnement may increase eroticization in some couples while reducing it in others.111 This fnding exemplifes variation within and between persons over time in the amount and type of touch they like and the meaning of the touch.112 Some persons desire less touch than they receive. Their personality may be more introverted.113 Avoidantly attached persons crave less touch than anxiously attached ones.107 So too do persons raised by “non-huggers.”114 Meanwhile, most persons dislike a stranger touching them,115 and no one wants to experience invasive touch that compromises their personal space and right to self-determination.116

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Therefore, instead of increasing loneliness, physical distancing frees them from unwanted touch. It can also reduce risk-taking, which could help to explain evidence of rising sexual inactivity in recent decades, especially among younger men.117 Lastly, some nationalities and cultures are less open to touching in social spaces than others.118 In low contact (e.g., Anglo-Saxon) cultures, a high need for physical contact indicates dependency or weakness. Self-reliance reduces the need for such contact.119

Emotional isolation Emotional isolation is a perceived absence of stable objects of intimate attachment just as or more signifcant as social approval.120 It can characterize even functioning social networks, especially when social relationships lack depth, causing persons to keep their deepest feelings to themselves.121,122 Although emotional isolation is conducive to loneliness as a sorrowful feeling of disconnection, persons may feel emotionally separated from others without feeling miserable or lonely. They may value this disengagement because it gives them space to be or become emotionally self-suffcient as a form of inner resilience. This need for freedom has never been more critical than now. With secularism rising,123 persons can struggle to fnd spiritual connection beyond themselves amid contemporary challenges, such as those the LBGTQ communities face in confronting heteronormativity. Without trusted others to confde in, check emotional responses, and share guidance,5 they may turn inward. There they can develop their self-esteem and learn to depend on themselves. Consider the following two examples. First, Salvador Dali claimed that as a student, his social peers described him as “morbidly shy and literally sick with timidity.”124 His uncle advised him to act like an extrovert, whereupon Dali became what he pretended. Greek mythology offers my second example: Penelope, the queen of Ithaca, waited two decades during and after the Trojan war to recover her idealized relationship with Odysseus, her absent husband. Penelope rejected all 108 suitors by employing deceptions. Not knowing whether Odysseus was alive, the loyal queen put her son and island home at risk. Drawing only on the comfort provided in her dreams by the goddess Athena, Penelope made use of her emotional isolation to cultivate the virtue of fdelity and maintain hope.125

Conclusion This chapter has discussed social, physical, and emotional isolation as similar to but different from loneliness. It has attributed social isolation to forces including rapid technological advances, and related physical isolation to loneliness in fve situations. Emotional isolation was noted to give scope for personal development that can offset loneliness. The key message is that persons can be isolated in various ways without feeling lonely. Giving positive meaning to their social, physical, and emotional isolation paves the way for them to transform aloneness and loneliness into solitude as well as meaningful social interactions.

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58 Abu-Asab M, Amri H, Micozzi MS. Avicenna’s medicine: A new translation of the 11thcentury canon with practical applications for integrative health care. New York: Simon and Schuster; 2013. 59 Frame DM, ed. Michel de Montaigne. The complete works: Essays, travel journal, letters. New York: AA Knopf; 2003. 60 Shapiro J. The year of Lear: Shakespeare in 1606. New York: Simon and Schuster; 2016. 61 Palter R, ed. The Annus Mirabilis of Sir Isaac Newton 1666–1966. Cambridge, MA: MIT Press; 1971. 62 Pandi-Perumal SR, Vaccarino SR, Chattu VK, et al. ‘Distant socializing,’ not ‘social distancing’ as a public health strategy for COVID-19. Pathogens and Global Health. 2021;115(6):357–364. 63 McQuaid RJ, Cox SML, Ogunlana A, Jaworska N. The burden of loneliness: Implications of the social determinants of health during COVID-19. Psychiatry Research. 2021;296. doi: 10.1016/j.psychres.2020.113648. 64 Philpot LM, Ramar P, Roellinger DL, Barry BA, Sharma P, Ebbert JO. Changes in social relationships during an initial “stay-at-home” phase of the COVID-19 pandemic: A longitudinal survey study in the U.S. Social Science and Medicine. 2021;274. doi: 10.1016/j.socscimed.2021.113779. 65 Stolz E, Mayerl H, Freidl W. The impact of COVID-19 restriction measures on loneliness among older adults in Austria. European Journal of Public Health. 2021;31(1):44–49. 66 Bertram F, Heinrich F, Fröb D, et al. Loneliness among homeless individuals during the frst wave of the Covid-19 pandemic. International Journal of Environmental Research and Public Health. 2021;18(6):1–10. 67 Kumar A, Roy I, Karmarkar AM, et al. Shifting US patterns of COVID-19 mortality by race and ethnicity from June–December 2020. Journal of the American Medical Directors Association. 2021;22(5):966–970. 68 Shah GH, Rochani HD, Telfair J, Ayangunna E, Skuraton G. College students’ experiences of race-related bias or hatred in their lifetimes and COVID-19 era. Journal of Public Health Management and Practice. 2021;27(3):258–267. 69 Do DP, Frank R. Using race- and age-specifc COVID-19 case data to investigate the determinants of the excess COVID-19 mortality burden among Hispanic Americans. Demographic Research. 2021;44(29):699–718. 70 Webster RK, Brooks SK, Smith LE, Woodland L, Wessely S, Rubin GJ. How to improve adherence with quarantine: Rapid review of the evidence. Public Health. 2020;182:163–169. 71 Yildirim TM, EslenZiya H. The differential impact of COVID-19 on the work conditions of women and men academics during the lockdown. Gender, Work and Organization. 2021;28(Suppl 1):243–249. 72 Xue B, McMunn A. Gender differences in unpaid care work and psychological distress in the UK Covid-19 lockdown. PLoS ONE. 2021;16(3 March). doi: 10.1371/journal. pone.0247959. 73 Foucault M. The history of sexuality: 1: The will to knowledge. New York: Pantheon B; 1978. 74 Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child and Adolescent Health. 2020;4(5):e10–e11. doi: 10.1016/S2352–4642(20)30108-5. 75 Bakhtiar M, Elbuluk N, Lipoff JB. The digital divide: How COVID-19’s telemedicine expansion could exacerbate disparities. Journal of the American Academy of Dermatology. 2020;83(5):e345–e346. doi: 10.1016/j.jaad.2020.07.043.

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76 Zolnikov TR, Clark T, Zolnikov T. Likely exacerbation of psychological disorders from Covid-19 response. Journal of Primary Care and Community Health. 2021;12. doi: 10.1177/21501327211016739. 77 Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet. 2020;395(10227):912–920. 78 Jones P, Menon A, Hicken A, Rozek LS. Global adoption of personal and social mitigation behaviors during COVID-19: The role of trust and confdence. PLoS One. 2021;16(9). doi: 10.1371/journal.pone.0256159. 79 Constantinou M, Gloster AT, Karekla M. I won’t comply because it is a hoax: Conspiracy beliefs, lockdown compliance, and the importance of psychological fexibility. Journal of Contextual Behavioral Science. 2021;20:46–51. 80 Prati G, Mancini AD. The psychological impact of COVID-19 pandemic lockdowns: A review and meta-analysis of longitudinal studies and natural experiments. Psychological Medicine. 2021;51(2):201–211. 81 Bartrés-Faz D, Macià D, Cattaneo G, et  al. The paradoxical effect of COVID19 outbreak on loneliness. British Journal of Psychology Open. 2021;7(1). doi: 10.1192/bjo.2020.163. 82 Rousseau J-J. The social contract. Harmondsworth: Penguin; 1968. 83 Tolmachova O. For one it is a self-isolation, but for another it is a ‘beloved mother’: Research and thoughts of an existential therapist during the quarantine period in France. Existential Analysis. 2021;32(1):113–124. 84 Merino MD, Vallellano MD, Oliver C, Mateo I. What makes one feel eustress or distress in quarantine? An analysis from conservation of resources (COR) theory. British Journal of Health Psychology. 2021;26(2):606–623. 85 Hobfoll SE. Conservation of resources: A new attempt at conceptualizing stress. American Psychologist. 1989;44(3):513–524. 86 Tuan Y-F. Topophilia: A study of environmental perception, attitudes, and values. New York: Columbia University Press. 87 Carpi Lapi S, Fattirolli E, Pini MG. ‘We’ in quarantine: Working with groups of parents from in-presence to remote. Journal of Child Psychotherapy. 2020;46(3):405–412. 88 Haney C. The science of solitary: Expanding the harmfulness narrative. Northwest University Law Review. 2020;115(1):211–256. 89 Guenther L. Solitary confnement: Social death and its afterlives. Minneapolis: University of Minnesota Press; 2013. 90 Metzner JL, Fellner J. Solitary confnement and mental illness in U.S. prisons: A challenge for medical ethics. Journal of the American Academy of Psychiatry and the Law. 2010;38(1):104–108. 91 Felthous AR. Does “isolation” cause jail suicides? Journal of the American Academy of Psychiatry and the Law. 1997;25(3):285–294. 92 Gaddis TE. Birdman of Alcatraz: The story of Robert Stroud. 1955. San Francisco, CA: Comstock Editions; 1989. 93 Haley A. The autobiography of Malcolm X. Vol 1965. New York: Ballantine Books; 1964. 94 Bioethius. The consolation of philosophy. Book 4. Harmondsworth, UK: Penguin; 1969. 95 Crouch BM. Is incarceration really worse? Analysis of offenders’ preferences for prison over probation. Justice Quarterly. 1993;10(1):67–88. 96 Abelsen SN, Vatne S, Mikalef P, Choudrie J. Digital working during the COVID-19 pandemic: How task–technology ft improves work performance and lessens feelings of loneliness. Information Technology and People. 2021. doi: 10.1108/ITP-12-2020-0870.

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97 Florida R, Rodríguez-Pose A, Storper M. Cities in a post-COVID world. Urban Studies. 2021. doi: 10.1177/00420980211018072. 98 Makimoto T, Manners D. Digital Nomad. New York: Wiley; 1997. 99 Thompson BY. The digital nomad lifestyle: (Remote) work/leisure balance, privilege, and constructed community. International Journal of the Sociology of Leisure. 2019;2(1):27–42. 100 Banerjee D, Vasquez V, Pecchio M, Hegde ML, Ks Jagannatha R, Rao TSS. Biopsychosocial intersections of social/affective touch and psychiatry: Implications of ‘touch hunger’ during COVID-19. International Journal of Social Psychiatry. 2021. doi: 10.1177/0020764021997485. 101 Tejada AH, Dunbar RIM, Montero M. Physical contact and loneliness: Being touched reduces perceptions of loneliness. Adaptive Human Behavior and Physiology. 2020;6(3):292–306. 102 Vieira de Jesus, Diego Santos, Kamlot D, Correia Dubeux VJ. Innovation in the ‘new normal’ interactions, the urban space, and the low touch economy: The case of Rio de Janeiro in the context of the COVID-19 pandemic. International Journal of Social Science Studies. 2020;8(5):17–27. 103 Durkin J, Jackson D, Usher K. Touch in times of COVID-19: Touch hunger hurts. Journal of Clinical Nursing. 2021;30:e4–e5. 104 Renshaw DC. Touch hunger – A common marital problem. Medical Aspects of Human Sexuality. 1984;18(5):63–70. 105 Eckstein M, Mamaev I, Ditzen B, Sailer U. Calming effects of touch in human, animal, and robotic interaction-scientifc state-of-the-art and technical advances. Frontiers in Psychiatry. 2020;11. doi: 10.3389/fpsyt.2020.555058. 106 Zhang Y, Huang L, Luo Y, Ai H. The relationship between state loneliness and depression among youths during COVID-19 lockdown: Coping style as mediator. Frontiers in Psychology. 2021:3350. doi: 10.3389/fpsyg.2021.701514. 107 Von Mohr M, Kirsch LP, Fotopoulou A. Social touch deprivation during COVID19: Effects on psychological wellbeing, tolerating isolation and craving interpersonal touch. 2021. PsyArXiv. 2021. doi: 10.31234/osf.io/vkzft. 108 Amerio A, Lugo A, Bosetti C, et al. Italians do it … less. Covid-19 lockdown impact on sexual activity: Evidence from a large representative sample of Italian adults. Journal of Epidemiology. 2021;31(12):648–652. 109 Stavridou A, Samiakou C, Kourti A, et al. Sexual activity in adolescents and young adults through Covid-19 pandemic. Children. 2021;8(7). doi: 10.3390/children8070577. 110 Delcea C, Chirilă V, Săuchea A. Effects of COVID-19 on sexual life  – A metaanalysis. Sexologies. 2021;30(1):e49–e54. 111 Giami A. COVID-19 and sexualities: The emergence of a new paradigm of sexualities. Sexologies. 2021;30(1): e1–e7. 112 Wu R, Liu M, Kardes F. Aging and the preference for the human touch. Journal of Services Marketing. 2020;35(1):29–40. 113 Prather Z, Bates J. Personality types and physical touch. Undergraduate Research Journal for the Human Sciences. 2015;14(1). Available at: https://www.kon.org/urc/v14/ prather.html. Accessed 27 January 2022. 114 Forsell LM, Åström JA. Meanings of hugging: From greeting behavior to touching implications. Comprehensive Psychology. 2012;1. doi: 10.2466/02.17.21.CP.1.13. 115 While A. Touch: Knowledge and considerations for nursing practice. British Journal of Community Nursing. 2021;26(4):190–194.

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116 Svennevig J, Marstrand AK. A preference for non-invasive touch in caregiving contexts. Social Interaction. Video-Based Studies of Human Sociality. 2018;1(2). doi: 10.7146/si.v1i2.110019. 117 Ueda P, Mercer CH, Ghaznavi C, Herbenick D. Trends in frequency of sexual activity and number of sexual partners among adults aged 18 to 44 years in the US, 2000–2018. JAMA Network Open. 2020;3(6). doi: 10.1001/jamanetworkopen. 2020.3833. 118 Suvilehto JT, Glerean E, Dunbar RI, Hari R, Nummenmaa L. Topography of social touching depends on emotional bonds between humans. Proceedings of the National Academy of Sciences of the United States of America. 2015;112(45):13811–13816. 119 Sorokowska A, Sorokowski P, Hilpert P, et al. Preferred interpersonal distances: A global comparison. Journal of Cross-Cultural Psychology. 2017;48(4):577–592. 120 Yum Y. The relationships among loneliness, self/partner constructive maintenance behavior, and relational satisfaction in two cultures. Communication Studies. 2003;54(4):451–467. 121 Baumeister RF, Leary MR. The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin. 1995;117(3):497–529. 122 Lodder GMA, Scholte RHJ, Goossens L, Verhagen M. Loneliness in early adolescence: Friendship quantity, friendship quality, and dyadic processes. Journal of Clinical Child and Adolescent Psychology. 2017;46(5):709–720. 123 Campbell DE. Non-religiosity, secularism, and civil society. In: Heft J, Stets JE, eds. Empty churches: Non-affliation in America. New York: Oxford University Press; 2021. Pp. 172–193. 124 Michalska M. All by myself, a lonely story of solitude in painting. Daily Art Magazine, 25 March 2020. Available at: https://www.dailyartmagazine.com/all-by-myself-alonely-story-of-solitude-in-painting/. Accessed 16 February 2022. 125 Helgason AR, Dickman PW, Adolfsson J, Steineck G. Emotional isolation: Prevalence and the effect on well-being among 50–80-year-old prostate cancer patients. Scandinavian Journal of Urology and Nephrology. 2001;35(2):97–101.

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This chapter suggests that loneliness is not always wholly terrible and undesirable. Nevertheless, experienced by every person at specifc times in their life, loneliness is unpleasant. It leaves persons feeling unwanted and trapped. In the words of a Jewish proverb, it “breaks the spirit,” draining persons of energy and quality of life.1 Emptiness chokes the life from who they are and could be. It consciously increases their information-processing demands, slowing experience of time and loneliness.2 These conditions intensify suffering3 and increase the need to understand and cope with or transform loneliness. Yet, each person’s loneliness is unique. Owing to personality traits, life circumstances and attributes of the loneliness, its meaning shifts within and between persons. After discussing variation in how persons experience loneliness, this chapter discusses how loneliness can have a silver lining and is not unquestionably an epidemic. It will also debunk the myths that loneliness mainly affects older persons and females.

Variations in loneliness Loneliness shifts in meaning according to its type. Beyond differences, for example, between social, physical, and emotional loneliness, loneliness varies according to its frequency, duration and severity. Most loneliness is occasional and situational, a widespread and temporary biographical disruption, a normal part of life. It may occur at specifc times, such as the night.4 In England’s nationally representative Community Life survey 2019–2020,5 almost half of all respondents aged at least 16 years self-reported some loneliness. Obtained mainly before the onset of COVID-19, this research fnding upheld results from the earlier Community Life surveys conducted since 2013–2014, indicating that loneliness had become a stable feature of everyday life. Persons tolerated loneliness from life circumstances, believing it was transient and would not produce long-lasting, negative consequences. More problematic is debilitating loneliness that is frequent or lasts. Persistent or chronic loneliness is a stable trait associated with not meeting high expectations of interpersonal relationships.6 It fuctuates around set-points7 in persons who may struggle to manage a range of ill-effects. Animal models and human longitudinal studies link this loneliness to adverse health behaviour, such

DOI: 10.4324/9781003189879-4

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as substance use proclivity.8 Other sequelae include long-term interpersonal diffculties9 and life-changing social stressors, such as international migration10 and unemployment at the working ages.11 Mediated by biological factors like circulating stress hormones that impair immune function12,13 and promote infammation,14 feeling persistently lonely contributes to poor health and well-being. Without adequate or effcient physiological repair and maintenance,15 the health-damaging, “transdiagnostic” effects of loneliness include raised rates of chronic health conditions, such as cardiovascular disease16 and mental health problems including anxiety17 and depression.18 Persistent loneliness also accelerates cognitive decline and incident dementia.19 In groups such as young persons, the duration more than the intensity of loneliness challenges mental health.20 However, the causal pathways remain unclear. Loneliness, including situational loneliness,21 appears to act synergistically with actual and perceived social isolation, both to reduce healthy behaviour, including COVID-19 preventative behaviour,22 and to operate as a mortality risk factor.23–26 The evidence base for this understanding is mainly observational, with experimental studies neither practical nor ethical to conduct. For example, public health analysis of longitudinal studies exemplifes how methodological challenges render a relationship between loneliness and dementia inconclusive.27 Meanwhile, light shines at the end of the tunnel. There is scope for managing loneliness as a mental state that, like other pain,28 has some redeeming qualities.

The silver lining of loneliness John Milton’s29 masque Comus linked a “sable cloud” to “her silver lining on the night … [to] cast a gleam over the rufted grove.” These lines speak to the consolation that a woman, left alone in a forest, could draw from faith and hope. This silver lining has become proverbial. Its optimism applies to the potential for loneliness to prompt persons to fnd meaning in life. As Victor Frankl30 argued, “if there is meaning in life at all, then there must be meaning in suffering.” Indeed, Fydor Dostoevsky’s31 underground man suggested that persons are “sometimes extraordinarily, passionately, in love with suffering.” It heightens their consciousness of life and innate human freedom, which benefts them as much as a state of well-being. Hence, suffering can contribute to well-being. Suffering is sometimes enjoyable and accentuates happiness by contrast and through direct psychological benefts. These gains include persons receiving sympathy, or something else wanted. For example, they may get out of what they do not desire, such as performance demands, without losing social face.32,33 Feeling alive A line in the Carly Simon song, Haven’t got time for the pain, helps explain the inverse relationship between loneliness and well-being: “Suffering was the only thing … made me feel I was alive.” Persons can feel alive in loneliness because, as the 14th-century Persian poet Hafz explained, it will “ferment and season you.”34

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Without going so far as to feel grateful to be lonely, persons may see that loneliness makes them “productively unhappy.”35 CS Lewis36 went further. He noted that “pain, below a certain level of intensity, was not resented and might even be rather liked.” Noticing others’ discomfort can also feel oddly attractive.37 The Romanian philosopher Emil Cioran38 suggested a reason for both paradoxes. Pain, such as loneliness, “links us to metaphysical realities which the healthy, average man [sic] cannot understand.” They include appreciating life’s inescapable transience. Under such conditions, loneliness can be a source of inspiration, a muse animating creative action and empathy. Jorge Luis Borges39 spoke to this role in the second of his Two English poems about love: “I can give you my loneliness … I am trying to bribe you/with uncertainty, with danger, with defeat.” What John Keats40 called the “negative capability” to accept uncertainty without reason creates space for hope and courage. Character development Other benefts that loneliness stimulates include character development and, paradoxically, a sense of feeling alive. The Greek hero, Philoctetes, embodied this descriptive narrative. Philoctetes was exiled to live alone on a deserted island because of the stench of his wounded left heel. After ten years, the Greeks dispatched a small force to fetch Philoctetes and recover the magical bow and arrow gifted by Heracles (without which the Greeks could not capture Troy). Philoctetes agreed to help. Arguably, loneliness and pain stirred him to honour his obligation to return to help capture Troy and become whole again. Therefore, benefts such as duty can survive loneliness while persons can accept loneliness as an experience that can catalyse noble action to make them fully human.41 For Philoctetes, but more commonly when short-lived, loneliness and the need for healing signify a forceful alarm system that prods persons to take swift moral action for safety. Loneliness serves as their protective ally, an energetic force. Better conceived as a challenge than a threat, it animates them to fx something important lacking in their life. It calls on them to draw on their inner strength to address concerns that may otherwise go unnoticed and fester. For example, they can strengthen qualities, such as self-control.42 Loneliness here is a gateway through which persons can discover virtues as stable traits of good character. The virtues to cultivate and exercise include gratitude amid empathetic recognition43 that, since no-one bears precisely the same burden during most of their life,44 other persons may be worse off. Their time alone may feel even more disagreeable. Lonely persons may also appreciate learning lessons that include the importance of exploring their spirituality34 and living in the moment rather than in the past or fearing the future. Such gratitude can breed other virtues like self-compassion. It can boost the courage needed to manage loneliness and problems in social interactions, including performance anxiety.45 Such courage is critical to persons freeing themselves from social pressure to conform in bad faith to societal norms. Free to be creatively undisciplined away from the gaze of social gatekeepers, persons can become authentically themselves.

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They can fll the space of loneliness with creative expressions of courage, such as humour. As the song, Learn to be lonely recommends, “Laugh in your loneliness.” Such bold behaviour may protect mental health by stimulating repose and repairing emotional defcits.46,47 However, loneliness does not explicitly indicate poor social skills that require development and is not a character faw. Wisdom may protect against loneliness across the lifespan,48,49 supporting persons to refect on and realize moral goals, such as personal growth and well-being. Strength in weakness Implicit in the capacity for practical wisdom is discovering strength in weakness. Most persons think of weakness and strength as opposites, but I see them as interconnected and frequently inseparable. From this perspective, loneliness is neither wholly negative nor positive. It mixes context-dependent elements of each quality whose balancing produces wholeness and unity. This holistic development aligns with the Daoist principle of yin-yang and philosophies including Hindu linga, Yoni symbolism and ancient Greek thinking about the unity of opposites. Persons become one in being alone by embracing life in every respect. Ceasing to care about failure, they may also achieve strength in weakness through the Daoist principle of wu-wei or effortless action. In the West, the backwards or reversed effort law stipulates that strength comes from such passive acceptance of weakness. A variation of this principle is the “law of least effort” introduced by the American linguist George Kingsley Zipf. This law applies to the mental strategy man muss imer umkehren, meaning “one always has to turn back” or, more commonly, “invert, always invert” and then seek to justify the inversion. This strategy implies that persons can disavow loneliness, passively but positively reframing their time alone to palliate its strain. They work backwards to assess how loneliness has contributed to identifed benefts. The mathematician Carl Gustav Jacob Jacobi promoted such reverse thinking to address complex problems. Immanuel Kant, Georg Wilhelm Friedrich Hegel, and Karl Marx similarly revived interest in using dialectics as a dynamic relationship between apparent opposites. However, these intellectual giants sought to resolve rather than tolerate contradiction among complementary opposites. In contrast, my interest is in returning to what I have previously termed “ambiopia,”28,50 a kind of rounded vision associated with “seeing” different sides of something simultaneously. From opponent-process theory, this concept accommodates the oxymoronic notion that loneliness can signify “constructive wallowing.”51 Persons can experience nonthreatening, melancholy pleasure during loneliness and upon relief since loneliness saliently contrasts with and raises the intensity of subsequent contentment. Persons may decide for themselves that when “the social sphere contains immense risk  … loneliness is a safe option, even if it is painful.”52 Putting their life in perspective, they may value the redemptive power of loneliness to punish themselves for and relieve feelings of shame or guilt; broker passage to an improved personal identity; or relish dependency from loneliness for its access to support from others. They may also perceive the private experience of loneliness

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as less toxic than public threats, such as social anxiety. Meanwhile, they stay awake to the risks that loneliness objectively poses to their health and well-being. These potentially alarming risks from loneliness include all-cause early death53; increased health service use54–56; and excess health care costs for persons and society.57 Such awareness frees and motivates persons to care for and safeguard themselves. Although self-recognition of their freedom can make them hypervigilant, it can also engender growth and make them better persons. When President of South Africa, Nelson Mandela reported that “I came out mature” from years in prison. Isolation and loneliness gave him reasons and room to deepen his humanity and reconnect to his life’s larger meaning and purpose.

There is an epidemic of loneliness No one is alone in their loneliness because loneliness afficts ordinary persons.58 However, as late modernity transforms how persons develop and maintain connections, has endemic loneliness reached “epidemic” proportions? The mass media would have everyone believe so, as Ling Qui and Xin Liu59 illustrate from their qualitative content analysis of mainstream media coverage in China during 2006–2017. Authority fgures, including a former Surgeon-General of the United States,60 have added credibility to the claims of a loneliness epidemic, as have statements made in leading academic and professional journals.61 Meanwhile, there are reports,62–64 despite dissent,65 that COVID-19 has expanded loneliness as a contagion transmitted intergenerationally and in social networks.66 Persons have become more aware than ever of loneliness amid growing neoliberalism, the commercialization of almost everything, and grim threats, like COVID, to planet Earth.67 Many persons have been ill-equipped to manage the dangers and may underrepresent them because characterizing oneself as lonely still carries negative connotations.68 Yet, there is inconsistent evidence that loneliness has virally spread through populations. According to a recent, rapid systematic review of 24 studies,69 it is unclear whether COVID-19 has increased loneliness in the general adult population. Growing public awareness of loneliness and attention to managing it as a disease70,71 may signal the “psychiatrization of society.”72 Conducive to overdiagnosis and overtreatment, these developments refect media campaigns that exaggerate indications of global loneliness into an “age of loneliness.”73 Such hyperbole and infammatory rhetoric mobilize a moral panic to fx the alleged surge in loneliness as a modifable risk factor for human harm.74,75 Lonely persons are publicly encouraged to discipline their behaviour in socially appropriate ways. Underpinned by a theory of moral regulation, this appeal to manage loneliness as a social and welfare concern feeds a hungry paradox: The persons who resist social pressure to conform to the dominant narrative of sociality can quickly feel marginalized and experience increased loneliness. This vicious cycle continues amid alarming claims made without compelling research evidence. Different ways of defning and measuring loneliness obscure the search for this evidence. The number of lonely persons has risen because population increases

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and ageing populations have put more persons at risk. However, self-rated scores on measures of subjective well-being have remained relatively stable over the lifespan despite environmental change and health-related losses.76 Moreover, loneliness has not spread at epidemic rates or unquestionably increased over time. This fnding comes, for example, from cohort studies. Hawkley and colleagues77 found no evidence of loneliness worsening in the United States (US) 2005–2016 among cohorts born during 1948–1965 compared with 1920–1947. A Dutch study found that from 1992 to 2016, older adults were less lonely in later-born than earlier-born cohorts, although the effect size was small.78 In adolescents, the same picture has emerged. In large samples of successive cohorts of US high school seniors between 1976 and 2006, recent youth were no more lonely than past generations.79 While COVID-19 has focused attention on loneliness, salient increases in overall loneliness have not been consistently reported cross-nationally. According to Thomas Hansen and colleagues,80 “cross-sectional and longitudinal fndings are about evenly divided between those fnding stability and those reporting increasing loneliness in response to COVID-19.” Any epidemic appears less one of loneliness than of a fear of loneliness. This fear has become manifest in an outbreak of media headlines about a loneliness epidemic. Also widespread is anxiety over recourse to risky behaviour, such as drug abuse and unhealthy intimate relationships,81,82 to escape feeling lonely.83 The loneliness eschewed is the loneliness of the Titan, Promethean, for whom it was better to endure terrible pain than be alone. Such issues continue to demand serious attention. Whether reaching the global scale of an epidemic or not, loneliness directly poses a severe threat to health and quality of life.

Loneliness is a condition of old age Risk factors for loneliness may include age. It is sometimes suggested that loneliness is associated with later life, a theme explored as far back as King Solomon’s Book of Ecclesiastes. However, anyone can feel lonely. A U-shaped association has occasionally been found between age and loneliness.44 Still, other research has reported a different type of relationship characterized by no statistically signifcant differences in loneliness by age.84 The BBC Loneliness Experiment85 found that compared with older persons, the middle-aged respondents reported more loneliness (based on questions from the UCLA Loneliness Scale86). Possible reasons included identity transitions associated with disappointment and pessimism triggered by challenges, such as adult children leaving home (empty-nest syndrome).87 Meanwhile, loneliness prevalence estimates also vary among older persons. Not consistently elevated in the youngest old,69 the prevalences of loneliness are highest among the oldest old, those aged 80 and over.88,89 They have been stable in recent decades90 in a world where loneliness is not simply a problem of old age or a natural part of ageing. Nevertheless, although not chronically lonely,91 most older persons face multiple risk factors for loneliness.92

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The number and frequency of social contacts tend to decline with age, and older persons grapple with relinquishing valued social roles, such as paid work. These persons commonly also contend with disintegrating family ties and lost and unfulflled social relationships as family members and friends age, move on or die. Sex differences in age at marriage and mortality consistently produce a preponderance of women caring for older, infrm men, and widows missing their husbands.93 Often living alone and painfully aware of their creeping mortality, these women recognize little prospect of fnding love again or even a close male companion. Under such bleak conditions, they may question their relevance and purpose as additional challenges, like worsening health, limit their functional capacity and mobility and increase their care needs.94 At the same time, older persons have advantages in responding to social isolation. As social interactions contract at the oldest ages, older persons may already deal with physical isolation. Even when dependent on family and community services, these persons have been as well prepared as any other group for isolation worsening during the COVID-19 lockdowns. Expecting less for themselves, they have had a lifetime to understand the human condition and accumulate personal resources to manage it with resilience. Thus, a potential coping mechanism is a positive attitude, associated with a younger subjective age95 and higher ratings of the quality of their relationships.89 Death awareness reminds them to live life to the full every day. In this context, older persons have reported less loneliness and faced lower risks of psychological sequelae than younger age groups during COVID-19.65,96 The young may also beneft more than middle-aged adults from solitude.97 Without diminishing the problem of loneliness among older persons, both persistent and occasional loneliness affect persons across all ages and stages of the life course.98 As noted above, most persons feel lonely, at least sometimes in facing life’s challenges. Prevalences range from 7 per cent68 to 49 per cent99 depending on the defnitions and assessment methods used and the populations and settings studied. The period in which loneliness appears most common and intense is early adolescence. Loneliness then inhibits achieving normal development expectations for personal identity and meaning100 and can predict loneliness up to age 35.101 The reasons for loneliness in youth are multifactorial. Society expects young persons to be gregarious and full of life. However, the young social brain is still developing in facing new challenges. Biological and social transitions from childhood to adulthood are critical physical and cognitive maturation periods. These stages vary as young persons fnd themselves, balancing emergent needs for individuation against ftting into social groups and feeling normal.102,103 Amid peer pressure and media infuences, the young face new questions concerning how they regard themselves and want others to perceive them. As social relationships fashion their expanding sense of self, they seek to cultivate social skills and social (including intimate) connections to minimize unwanted, actual or perceived differences from others. Edgar Allan Poe’s poem,

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Alone, speaks to the unsettling sense of difference with which many young persons continuously grapple104: From childhood’s hour I have not been As others were – I have not seen As others saw – I could not bring My passions from a common spring. Young persons develop complex thinking processes to regulate changing emotions in this situation and be socially accepted for who they are. Yet, they commonly struggle to meet social expectations87 while their prime external agents of socialization transition from parents to peers. When the young do not ft in amid growing personal agency,105 they may socially withdraw, repressing aspects of themselves.106 For example, unsettling physical changes lead to body image dissatisfaction and loneliness, more strongly in school-aged girls107 and younger adults than older adults.108 Spiritual questioning may occur, especially in response to sudden, unexpected and traumatic changes. They include relocating to a new geographic area, moving between schools, and losing a loved one when a romantic relationship ends, a (grand)parent dies, or some other family breakdown takes place.109 In turn, opportunities for social interaction diminish when young persons begin paid employment and need to work hard, both to get on and climb the property ladder and start a family. Such life events tend to increase the sensitivity and vulnerability of young persons in an environment in which they may feel misunderstood, scrutinized and judged, and poorly equipped to handle rejection and victimization. They may also experience low-quality social ties110 including parental confict,111 low maternal involvement112 and parental use of technology to interrupt everyday interpersonal communication.113,114 These conditions exacerbate a lack of coping skills, undermining a sense of self-worth and belonging.107 Perceived isolation then has a cumulative effect. During adolescence and at other ages, lonely persons tend to avoid or disengage from social contact and be hypervigilant to perceived social threats. This fear can become self-fulflling and entrench loneliness.115,116 From a life course perspective, it sets up pathways from loneliness to physical and mental states of ill-health like anxiety, depression and even suicidal thinking and behaviour.117

Loneliness is a female experience Contradictory results characterize investigations into the relationship between loneliness and sex or gender. Although some studies118,119 suggest that loneliness is more prevalent in women than men for reasons such as sexism,120 other research reports the opposite fnding.85 One reason for this variation could be the use of different measures of loneliness. For example, a 2014 Norwegian study of persons aged 18–81 years121 found that loneliness assessed by a direct self-rating question (that allows persons to decide the meaning of loneliness for themselves) was more common among women. In contrast, loneliness measured on an indirect scale was more prevalent among men.

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Including studies that used standardized loneliness measures, a recent metaanalysis concluded that females and males experience similar mean levels of loneliness across the lifespan.88 Nonetheless, some risk factors for loneliness are gender-specifc. One is culture. In Japan, the most lonely are middle-aged men.122 Other variables conducive to male loneliness include widespread emasculation of male identity. Taught that intimacy signals weakness, men may struggle to maintain close interpersonal relationships.123 Meanwhile, current social conditions indicate why the positive relationship between loneliness and all-cause mortality is slightly stronger in men than women.25 On average, men die earlier than women and are less likely to become widows living alone. However, when their partner dies, or a long-term relationship ends,88 men may struggle to adapt. They have frequently become accustomed to their partner managing the home and maintaining inclusive social networks. Thus, losing their partner removes a strong social lubricant. Women and men also differ in how they construct and manage loneliness. Compared with men, women generally express greater loneliness83 and have more intimate (and more extensive) social networks88 in which, on average, they are willing to share their emotions.124 Social norms associated with masculinity can leave men uncomfortable admitting to feeling lonely and vulnerable, especially to other men and persons other than their romantic partners. Consequently, single men tend to be disproportionately lonely. Oriented more to achievement than relationships, they may avoid reaching out in friendship to other men. This behaviour helps them avoid feeling emasculated or being perceived as needy or gay. Concealing feelings of distress,125 these men commonly disown a need for social connection or help. Through digital connection126 and opportunistic socialization in shared activities, they stoically manage feeling lonely and personally inadequate.

Conclusion Loneliness is not wholly undesirable. It is a personal and highly subjective experience, lacking a recognized clinical form. Persons have different setpoints for feeling lonely, around which they fuctuate with changes in circumstances, including the frequency, duration and severity of the loneliness. Indeed, loneliness can even have redeeming qualities. It can help persons feel alive, develop their character, and discover “strength in weakness.” Ubiquitous worldwide, loneliness does not clearly constitute an epidemic in studies whose defnitions, theories, and measures of loneliness vary, undermining direct comparisons between studies. Moreover, loneliness cannot be reduced to a condition of old age and a female experience.

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understood and loneliness as sequential mediators. Journal of Nervous and Mental Disease. 2020;208(6):510–513. 126 Seidler ZE, Wilson MJ, Rice SM, Kealy D, Oliffe JL, Ogrodniczuk JS. Virtual connection, real support? A study of loneliness, time on social media and psychological distress among men. International Journal of Social Psychiatry. 2020. doi: 10.1177/0020764020983836.

4

Loneliness and social pain

As a distinctive and distressing psychological experience,1 loneliness is most commonly attributed to unmet social needs, such as attachment. Persons are assumed to feel lonely when consciously or unconsciously, their actual or perceived level of social contact is lower than the level they desire.2–4 This discrepancy arises because their social relationships are insuffcient in number, type, or quality.5–7 To fx this social dislocation and garner social acceptance,6,7 society spurs them to cultivate new social relationships and strengthen existing ones. Assuming persons can only achieve self-fulfllment in society, this strategy increases access to social resources, such as social support, to buffer or reverse loneliness. Events such as COVID-19 have given impetus to this approach. Exposing the challenges of physical distancing, COVID has been interpreted to highlight “an opportunity to recognize the fundamental health importance of social connection.”8 However, this chapter questions this conventional perspective. It challenges the taken-for-granted construction of loneliness as a social problem.9,10 It suggests that although almost all persons participate in social systems that confer the benefts of social connection, many persons happily minimize their social life. Humans do not need more than a basic level of interpersonal connectedness. Rather than being inherently social animals, they cooperate when it is in their self-interest. They remain free to use healthy aloneness to manage loneliness, less as a social defciency than a state of self-disconnection that modernity feeds through social forces.

Loneliness is not simply a social defcit Loneliness overemphasizes the importance of social relationships. Looking outside persons to social support and validation reduces loneliness to defcient sociability,11 and confuses sociality and relatedness. Persons have a fundamental need for relatedness, a requirement for “being-with” that presupposes connectedness and closeness. However, attachment to another person or group is merely one way to meet this need. Looking to escape loneliness through interaction with others asks too much of them, is insuffcient without self-love, and is not always feasible. Consider the loneliness that can even attend personal fame.

DOI: 10.4324/9781003189879-5

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In 1948, late in his life, Albert Einstein revealed to the photographer Yousuf Karsh that “It is strange to be known so universally and yet to be so lonely.”12 Einstein liked to portray himself as a loner who valued isolation. However, it seems he was also a “fundamentally social person… who valued individual freedom within a polity.”13 His appreciation of liberty and independence expressed itself in his work in the scientifc community but also in adulterous liaisons. Einstein’s life exemplifed loneliness when other persons were nearby. That Einstein could not expunge loneliness through others or his work speaks to the nature of his self-relationship.14 Einstein, observed Helen Keller,14 was “a genius all to himself.” It appears that neither his aloneness nor sociality overcame a sense of emotional separateness, a self-absence15 born from feeling disconnected from whom he wanted to be. Although loneliness correlates negatively with selfesteem and life satisfaction,16 it is safer to understand Einstein’s loneliness in the context of his being “gentle, quiet, almost shy”14 in paving a conscientious path through periods of political unrest to promote social justice. Despite, if not in part because of, his moral failings as a philanderer and absent father, Einstein is cited17 as claiming that, “The most important human endeavour is the striving for morality in our actions. Our inner balance and even our very existence depend on it.” In this context, loneliness may emerge when persons feel they deserve failure as the price for getting what they desire in moral terms. Without others, they fear they are not good enough to be what they want. Unable to act authentically, they shroud their individuality in a uniform of social conformity.18 In this conceptualization, self-love is “psychologically primary”19 and low self-love predicts loneliness, even in the absence of social isolation.

Persons are not social animals I want to step back now to explore the strong  – and, I believe, excessive  – construction of loneliness as a social issue. I say “excessive” given established assertions in the media and scholarly discourse about persons’ social nature. Psychotherapist Tom Ormay, for example, argues that each person’s psyche or personality has a social side, nos (“we” in Latin) that the superego (the moral conscience and ideal self) bridges with the ego, such that “one person is no person.”20 The root of this perspective is the widely accepted belief that humans are a social species, a unique type of organism. They are “social animals”21 dedicated to social cognition and part of or inclined to attach to groups or social units. These groups signify a social space for members to forge close, interpersonal relationships. Recognition of the human need to socialize is sociology’s basic insight. It gains credibility from the fact that few persons opt for long-term isolation. The historical reason is that groups and social relationships have been adaptive to human needs for survival and growth. In the absence of social contact, loneliness alerts persons that these needs are unmet. It catalyses them to connect with others and identify with social groups for support and security. However, while personal identity is partly socially determined, I want to suggest that persons are

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not necessarily social beings. Some persons are less voluntarily social than others, and even defning the term “social animals” remains a challenge. Two main interpretations of human sociality arise. The frst is that, as part of the natural world, persons are social by nature. According to social baseline theory,23 their fundamental dispositions and traits are fxed or innate. Persons are biologically hard-wired to group together. Their social instincts and behaviour come from genes or genetic similarities expressed in interaction with the environment.20 In this context, group selection and kin selection have enabled extended families to protect each other from intruder threats,24 such as violence and trauma, and sustain economic benefts. At least partly for genetic reasons, persons retain the trait of sociability, triggering interbrain synchrony in social interactions.25 The second perspective is that sociality is not an inherent and inevitable part of being human. It is less collective than personal, operating through decisions rather than instincts or drives. Not social by nature,26 humans have learnt to band together in social groups. The social evolution of humans to abide in tribal settings increases their ftness to survive and thrive. Accordingly, human brains have been wired, rather than are hard-wired, to be sociable. Changing human habitats are rewiring human capabilities to function as increasingly autonomous agents with only a basic need for social connection.27 With reduced opportunities to put down social roots, persons are discovering new ways to reconcile their individuality with sociality. Being alone together is one way.28,29 Part II of this book will discuss how and why persons can redeem this prescription to manage loneliness. For now, I want to explore six interrelated reasons for not viewing loneliness primarily in social terms. Persons are self-interested Persons are less inherently social than self-interested in being social beings when that helps them live a good life. Here I adopt an enlightened view of self-interest that varies within persons over time. Persons’ concern and motivation to act alone or not for their own advantage strongly overlaps the interest of others, including unrelated persons, to elicit personal beneft. From this perspective, self-interest and other-interest are not alternatives. Within social systems, persons protect self-interest in ways that include learning to be alone and interacting with others rather than at their expense. Benefts of developing these capabilities include avoiding confict when resources are plentiful.29,30 When resources are scarce, persons may choose to stay apart to compete, survive and reproduce. When sociability becomes risky, persons set high standards for the closest forms of cooperation. One reason is “contact with natures, the great majority of which are bad morally, and dull or perverse intellectually.”30 However, the line between competition and cooperation blurs too. Etymologically, to “compete” is to aim together. Competition can lead persons to cooperate in a minimal form.31 Group selectionists assume they act to improve the survival and reproductive chances of the group. Yet, most biologists now believe that persons work mainly to favour their genes (inclusive ftness theory).

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Either way, persons form groups when it is in their self-interest to increase the effciency of production processes. Despite objections,32 I suggest that persons are more cooperative (see below) than eusocial. The groups into which persons organize do not exhibit the most advanced level of social organization (eusociality). They include unrelated families, lack a reproductive division of labour since adult humans are generically reproductive, and tend to promote reasoned choices by group members to achieve personal goals across the life span.33,34 These self-interested options may include asocial behaviour or anti-social behaviour. Whereas antisocial behaviour contravenes accepted social standards, asociality is characterized by personal behaviour that deliberately shuns or minimizes social interaction. Asociality is not a nursery of antisocial behaviour or an eccentricity in a world of conformists. It is a self-interested preference by persons for their own company. Having culturally evolved (for example, through what Richard Dawkins35 calls “memes” or catchy ideas) beyond a group survival response to negative social pressures, these persons avoid or selectively limit social interaction. Their behaviour illustrates, as CS Lewis36 observed, how “friendship is unnecessary … It has no survival value” while being appropriate in giving value to survival. Therefore, in the absence of gross evolutionary pressure, persons have been moving away from dependence on strong social circles and other social and community resources. Aided by advances in technology, they have become increasingly independent and, as “morally self-enclosed, self-encompassing animals,”37 they opt more and more often to live alone. At the same time, persons are relational beings whose social, asocial or antisocial behaviour coexists with self- and spiritual connections.38 Therefore, it is far from clear that loneliness is a necessary feature of their life and that the human world is reducible to the natural order. Humans are not hard-wired to be lonely Loneliness appears only modestly heritable. Characterized by a high level of situational variability, heritability decreases during developmental periods like adolescence.39 Unknown is the extent to which persons are wired to feel lonely as a normal response to perceived vulnerability,40 independent of their experience and external infuences. Indeed, the concept of human nature is limited and partial. At least two factors limit evolutionary selection for loneliness. The frst is situated variability in persons’ sensitivity to social isolation. The second is natural selection’s failure to weed out introversion that is less evolutionarily adaptive than extroversion.41 Scores on personality traits such as introversion (a term introduced by the Swiss psychiatrist Carl Jung42) tend to be normally distributed across human populations. This fnding suggests some ftness-related advantages to introversion. For example, introverts report reduced loneliness.43 Consider a recent, within-person longitudinal study involving frst-year students at a US university. During the early part of the COVID-19 pandemic, usual mood ratings improved slightly in the introverted students but dropped in the extroverted ones.44 This research

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fnding seems plausible because introverts tend to be self-aware persons who, at the risk of oversimplifcation, prefer to live in their heads. More sensitive than extroverts to the neurotransmitter dopamine, introverts are pleased to avoid social contact that, however enjoyable, overstimulates and drains them.45 In their own company, they increase control of their time, avoid interruptions, and satisfy their need to be alone. Escaping the pressures of daily life, including uncertainties in interpersonal relationships, they quietly and privately focus on meaningful tasks like work. Stimulating their imagination, these persons recharge and feel fully alive as themselves. They function then as independent and autonomous beings rather than separate entities. When social isolation is not possible, introverts may feel lonely because they cannot be themselves in others’ company. Meeting a social expectation to perform particular social roles makes them uncomfortable. It can feel draining if not exhausting and increase their risk of having accidents.46 Relative to extroversion, introversion also carries evolutionary-relevant costs, producing a healthy balance of personality trait variants across populations. In this context, genes seem unlikely to account directly for loneliness. However, they appear to have a modest effect on the biological expression of persons’ inherited disposition to experience loneliness through factors like introversion or have loneliness triggered by calamities, like losing a social partner.47 Where to position sociality concerning the nature versus nurture debate remains unclear. But heritability estimates range from 14 per cent to 55 per cent across diverse populations.48 Through gene-culture coevolution,49 personality factors and social forces, such as attachment styles, appear to interact over time. They shape combinatorial opportunities including, but not limited to, cooperation to manage loneliness. The environment’s infuence is also evident in the public acknowledgement of loneliness becoming a social issue only in modern times.50 Although loneliness has always characterized human life, only since the Late Renaissance – and especially the time of the Industrial Revolution – has loneliness in everyday life become a serious focus of secular inquiry. With the introduction of the modern individual, “oneliness” – an unsettling state of being alone – has turned into loneliness as a response to and cause of isolation. This transformation has accompanied a change in the concept of community. Forces of modernity, including technological advancements, are turning small groups of interconnected persons into progressively loose collections of independent individuals. These human beings cluster together yet can feel lonely navigating myriad social sites. Persons are both individual and cooperative beings Many types of interpersonal relationships and groups remain essential to human well-being. However, there are work and leisure activities where persons choose to act alone or with others. Persons decide to cooperate from self-interest when they are not self-suffcient and wish to exercise their moral right to be free. Individuals collaborate to beneft each other, although according to Adam Smith’s51 concept

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of the invisible hand, self-interested behaviour may unintentionally promote social and economic benefts in the public good. For example, the need for social order disciplines selfsh behaviour to increase feeling safe. Enforcement mechanisms regulate self-interest. They invoke rewards and sanctions that enable persons to beneft themselves without harming others.52 These conditions motivate persons to relinquish some of their freedoms and rights. They may affliate with social groups under the protection of the state’s authority, generally adhering to agreed moral and political rules for the sake of civil behaviour and stability. This pragmatic conception of social behaviour is implicit in the social contract theory underpinning modern liberal democracies. Adherence to society’s rules and norms has historically conferred individuals advantages like fnding a mate and buffering risks of morbidity and premature death.53 Yet, at no time in history have persons less needed groups to achieve these outcomes than now. As modern populations experience increased access to education, technological advances and other resources, they strengthen their ability to solve problems without dependence on others. Thus, more and more, persons have become reluctant to subordinate their individual interests to those of society. They prefer to manage issues alone and be self-suffcient. Able to exhibit self-interested yet cooperative behaviour, they seek safety and dignity on their own. As a precondition of equity, dignity makes them ends in themselves.54 Alone, they can free themselves from the power of the state and obligations to, and distractions from, strangers. There is no risk of others making them feel alone by not understanding them, looking the other way or hurting them through rejection and exclusion.55 Hence, Charlie Chaplin reputedly said, “The mirror is my best friend because when I cry, it never laughs.” Self-interest embodies social cooperation A limitation and strength of modern social groups and networks is a sometimes excessive and unnatural expectation on group members to conform to socially approved forms of behaviour. Obedience and conformity are powerful social forces restricting persons’ moral autonomy, including their agency and authenticity. Needing social acceptance to feel complete, individuals feel compelled to act according to the group narrative. Following the group lead can be instructive, and both avoid harm and gain rewards.56 Nevertheless, social interest does not preclude self-interest through social cooperation. Rather, enlightened self-interest, as defned above, tends to embody qualifed forms of social cooperation. As a reincarnation of Hobbesian theory,57 Bernard Mandeville’s58 The fable of the bees suggests how rational self-interest can promote cooperation for the common good. However, group membership may diffuse moral responsibility for private vice.59 Concerned also about a loss of civic spirit, Mandeville became sceptical of reducing self-interest to selfshness. Self-regarding action and the public interest often coexist such that, as Immanuel Kant60 put it,

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persons frequently exhibit a tendency for “unsocial sociability.” They express a “propensity to enter into society, bound together with a mutual opposition which constantly threatens to break up the society.”60 While seeking connection with others, their wariness of social interaction compels them to spend time alone and risk loneliness. This tension is evident in Schopenhauer’s30 fable comparing persons to porcupines who huddle together for warmth in cold weather but, in so doing, can hurt each other. Some persons are so afraid of being alone that, like the Titan Prometheus, they forego it for a toxic relationship. However, most persons strive to avoid mutual harm. For shared improvement, they feel driven to live with others yet are pulled apart. This tension can destabilize their identity management and weaken their relationships. They risk isolation and loneliness for the sake of self-interest and out of consideration for others until they have become like porcupines and “discovered the proper distance from which they could best tolerate one another.” Schopenhauer added that “a great deal of internal warmth” facilitates this separation.30 The result is what Kant called spontaneous order, and Adam Smith’s invisible hand incentivizing cooperation and promoting the public good. Social interaction has limitations Persons have historically looked for safety in numbers and intimacy in trusted groups that provide role models and opportunities for social relationships, information gathering, and emotional disclosure. Such groups further offer a collective sense of self and belonging, which can facilitate mental health by providing security and meaning.61 For example, the lonely may identify with similar others to gain a semblance of alignment and solidarity.62 However, most persons do not let others quickly into their lives and limit access by those outside the groups they identify with. Even the lonely may push others away. Conducive to social minimalism, this guarded approach to social interaction is salient in modern public spaces where persons mostly choose to keep to themselves and avoid engaging with strangers.63 For example, urban public transport commuters enact a shared, implicit understanding to avoid interacting. Travellers typically do not sit next to, let alone start speaking with, unfamiliar persons when empty seats are available.64 This tendency to privatize public space could refect fear of judgment or social rejection, or wariness of incivility,62 especially among women.65 Such concerns persist even though most strangers are benign and persons commonly enjoy conversations with them more than expected.63,66 In comparison, social relationships with neighbours are diverse and tend to involve a sense of connection rather than friendship, especially in cities.67 Friendship is no less challenging.68 For example, taught to be independent and self-suffcient, many men disavow a need for friends.69 More generally, barriers to developing friendships include introversion and social anxiety. The lifting of COVID-19 lockdowns has added the phenomenon of HOGO, the Hassle of Going Out. Hospitality and event venue no-shows exemplify persons skipping

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social engagements owing to lethargy, loss of routine, or fear of facing danger in social life. Other barriers to friendship and friendly social interaction include aversion to prejudice.70 Diffculty trusting other persons can confrm negative expectations and increase hypervigilance to social threats.71 This mistrust persists as persons project weaknesses onto others.72 They dredge experience of aversive outcomes, such as the agony of past rejection and loss of meaningful connection.73 Nevertheless, neediness can lead persons to overshare and enter toxic relationships for the sake of being with someone. Cross-sex friendships can be especially challenging when they introduce unwanted sexual tension in one or both parties, while some persons feel unready for social attachment and intimacy.74 Such obstacles characterize how modern social life has become increasingly complex as forms of social organization, such as cities, progressively substitute secondary for primary contacts.75 Even secondary associations within social groups can feel daunting. Social attachments can make signifcant demands on members, such as spending scarce resources. Socializing requires persons to give up free time, along with money and energy, while accommodating others’ needs. Sacrifcing authenticity to avoid interpersonal confict and belonging to a group can destabilize personal identity. It can make persons unhappy even though they may choose to stay in manipulative and abusive relationships. Meanwhile, mainly based on exclusion, group identity can feed interpersonal rivalry and confict that reduce social capital via overall declines in civic, political and religious forms of affliation.76 This development has prompted calls for cooperation, yet people disagree on what makes society cooperative. Many organizations group workers into physical spaces like open-offces to assist opportunistic and information collaboration. With low or no physical dividers between workers, the workspaces are designed to turn strangers into colleagues who can feed off each other and make associative leaps to meet shared goals. However, social facilitation effects include unexpected challenges. Despite removing internal walls, the open spaces can encourage social withdrawal. These spaces reduce face-to-face collaboration while increasing email and messaging interaction.77 The reasons include loss of the privacy that workers need to reduce stress and be quietly productive without distraction.78,79 As offces reopen after the COVID-19 lockdowns, open foor plans appear likely to wane to facilitate physical distancing. At the same time, there are other barriers to working in groups per se. Groups may let only one person be active at a time. This limitation invites social loafng and free-riding by persons with a low preference for group work,80 and frustration with non-contributing group members.81 Some persons also dislike workgroups because of perceived social pressure for conformity and groupthink. These phenomena require persons to set aside and stage-manage their beliefs to make dysfunctional decisions for the sake of harmony and consensus.82 Groups may expect assent from their members and enforce it through mechanisms such as humiliation and embarrassment.83 Some persons are critical and

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unforgiving of others whose resistance to social norms appears self-indulgent. Then, as Jean-Paul Sartre84 observed, “L’enfer, c’est les autres.” “Hell is other persons.”85 Increased choices for personal independence Limitations to being in social groups push persons to establish their autonomy and independent living. Reasons and opportunities to live and work productively alone have never been greater than among current generations. Many persons enjoy developing their independence without human interaction. For example, they use home delivery services and streaming media services for home entertainment. They book their own travel and manage work tasks once reserved for “pink-collar” secretarial and administrative assistant workers. Amid a global rise in individualism, they demonstrate cosmopolitan sociability,86 cooperating (and competing) for success through novel living arrangements across multiple sites. Earlier, I mentioned the digital nomad working remotely, while solitary-but-social living has increasingly become a positive social norm in modern, urban societies. Persons often prefer to work alone or travel in private vehicles rather than public transport.64 Living arrangements have also changed. There has been a decline in traditional families, with single-person households (or “solitaries”) rising as a form of family structure since especially the 1960s.87 These householders are free to do what they most value. For example, they can cook and eat alone to please themselves without worrying about satisfying others. They can choose what they eat, when, and how. Books such as Solo: The joy of cooking for one88 present this experience as a simple, therapeutic pleasure. When living alone, “nobody else lives in the same living space or routinely shares everyday domestic life.”89 Demographers are projecting this phenomenon to increase, with population ageing raising the proportions of older persons as a disproportionately female demographic. Factors such as declining intergenerational coresidence indicate the ascendance of values like freedom and selfexpression amid transitions into and out of living alone. Increasing solitariness occurs across all ages in wealthier cities and regions, such as Eastern and Southern Europe.90 In comparison, loneliness is lower in many North-western European countries like Sweden. A welfare system of state individualism has given rise to communal housing as an alternative to small studios to avert the most expensive accommodation. Amid shallow kin networks, this pattern enables persons to live alone for long periods, especially in early adulthood and old age. It helps them optimize friendships, among other forms of social involvement,91 to combat the risk of loneliness.92,93 Rising female participation rates in labour markets and climbing real incomes further contribute to persons’ fnancial independence. And living alone has become less daunting as opportunities to socialize expand in cities, and digital connectivity and education lift the freedom and fexibility to be socially interdependent. Single persons are the most likely to live alone.

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In Western countries, most persons eventually marry. However, “there is little evidence that marrying transforms single people into a loneliness-free couple.”94 Indeed, married persons are often less socially active and connected than young and middle-aged singles,94 who progressively continue to vote with their feet to delay or forego marriage. An exception to this postponement of marriage is Sweden, where the last two decades have seen marriage grow in popularity, parallel to the increase in persons living alone.95 Elsewhere, the general decline in marriage rates has been associated with an increasing proportion of persons remaining single for longer or all their lives. The age at frst marriage has increased96 along with a decoupling of marriage and parenthood in the context of reduced fnancial incentives to raise children.97 Busy persons have shown reduced willingness to commit to intimate relationships that demand compromise, require signifcant time investments, and deeply wound them if relationships end. Partner loss is positively associated with loneliness in most studies.98 Alternatives to marriage for intimacy have also been continuing to develop. These alternatives include increasing cohabitation, while social mores have become progressively liberal. Single parenting has gradually become acceptable over time. Meanwhile, so-called solitary arousal activities have become less likely to elicit personal feelings of guilt or shame. Such behaviour ranges from parasocial relationships to masturbation and “one-way access to or production of sexually explicit stimuli.”99 Although seldom unsafe or problematic, pornography use invites concern when it interferes with human intimacy.100 However, loneliness is not simply the product of liberal individualism and independence. As noted above, older persons are typically less lonely in individualistic northern Europe than family-oriented, southern Europe.101 And individuals vary in their desire for self-suffciency. Some persons best live by minimizing their group involvement.

Conclusion This chapter has challenged the taken-for-granted belief that persons are social animals who typically experience loneliness as an unmet need for social connection. Pointing to modern persons’ reduced need to attach to social groups, the chapter has repositioned loneliness as less a social defcit than a pain of selfdisconnection. It has suggested that persons are not hard-wired to be lonely. They learn increasingly to function independently and cooperate with others amid awareness of the limitations of social interaction. Accordingly, health care interventions to reduce loneliness should look beyond developing social interaction. The problem confronting loneliness and its management is less one of too much social isolation than of health care not helping persons enjoy healthy solitude.

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70 Williams CT, Johnson LR. Why can’t we be friends?: Multicultural attitudes and friendships with international students. International Journal of Intercultural Relations. 2011;35(1):41–48. 71 Cacioppo S, Bangee M, Balogh S, Cardenas-Iniguez C, Qualter P, Cacioppo JT. Loneliness and implicit attention to social threat: A high-performance electrical neuroimaging study. Cognitive Neuroscience. 2016;7(1–4):138–159. 72 Jung CG. The undiscovered self. Princeton, NJ: Princeton University Press; 2012. 73 Ly V, Roelofs K. Social anxiety and cognitive expectancy of aversive outcome in avoidance conditioning. Behaviour Research and Therapy. 2009;47(10):840–847. 74 Firestone RW, Catlett J. Fear of intimacy. Washington, DC: American Psychological Association; 1999. 75 Wirth L. Urbanism as a way of life. American Journal of Sociology. 1938;44(1):1–24. 76 Putnam RD. Bowling alone: The collapse and revival of American community. New York: Simon and Schuster; 2000. 77 Bernstein ES, Turban S. The impact of the ‘open’ workspace on human collaboration. Philosophical Transactions of the Royal Society B: Biological Sciences. 2018;373(1753). doi. 10.1098/rstb.2017.0239. 78 Kim J, De Dear R. Workspace satisfaction: The privacy-communication trade-off in open-plan offces. Journal of Environmental Psychology. 2013;36:18–26. 79 James O, Delfabbro P, King DL. A comparison of psychological and work outcomes in open-plan and cellular offce designs: A systematic review. SAGE Open. 2021;11(1). doi: 10.1177/2158244020988869. 80 Stark EM, Shaw JD, Duffy MK. Preference for group work, winning orientation, and social loafng behavior in groups. Group and Organization Management. 2007;32(6): 699–723. 81 Hall D, Buzwell S. The problem of free-riding in group projects: Looking beyond social loafng as reason for non-contribution. Active Learning in Higher Education. 2013;14(1): 37–49. 82 Solomon M. Groupthink versus the wisdom of crowds: The social epistemology of deliberation and dissent. Southern Journal of Philosophy. 2006;44(Suppl.):28–42. 83 Cain S. Quiet. The power of introverts in a world that can’t stop talking. New York: Crown; 2012. 84 Sartre J. No exit and three other plays. New York: Vintage International; 1989. 85 Kant I. The metaphysics of morals. Cambridge: Cambridge University Press; 1996. 86 Schiller NG, Darieva T, Gruner-Domic S. Defning cosmopolitan sociability in a transnational age. An introduction. Ethnic and Racial Studies. 2011;34(3):399–418. 87 Snell KDM. The rise of living alone and loneliness in history. Social History. 2017;42(1):2–28. 88 Johansen S. Solo: The joy of cooking for one. London: Bluebird; 2018. 89 Jamieson L, Simpson R. Living alone: Globalization, identity and belonging. Basingstoke: Palgrave Macmillan; 2012. 90 Yang K, Victor C. Age and loneliness in 25 European nations. Ageing and Society. 2011;31(8):1368–1388. 91 Sarkisian N, Gerstel N. Does singlehood isolate or integrate? Examining the link between marital status and ties to kin, friends, and neighbors. Journal of Social and Personal Relationships. 2016;33(3):361–384. 92 Törnqvist M. Living alone together: Individualized collectivism in Swedish communal housing. Sociology. 2019;53(5):900–915.

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93 Swader CS. Loneliness in Europe: Personal and societal individualism-collectivism and their connection to social isolation. Social Forces. 2019;97(3):1307–1335. 94 DePaulo B. Single in a society preoccupied with couples. In: Coplan RJ, Coplan RJ, eds. The handbook of solitude. Psychological perspectives on social isolation, social withdrawal, and being alone. Chichester, West Sussex: Wiley Blackwell; 2014. Pp. 302–316. 95 Ohlsson-Wijk S. Sweden’s marriage revival: An analysis of the new-millennium switch from long-term decline to increasing popularity. Population Studies. 2011;65(2):183–200. 96 World marriage data 2019. https://population.un.org/MarriageData/Index.html#/ maritalStatusData. Accessed February 24, 2021. 97 Cohen A, Dehejia R, Romanov D. Financial incentives and fertility. Review of Economics and Statistics. 2013;95(1):1–20. 98 Dahlberg L, McKee KJ, Frank A, Naseer M. A systematic review of longitudinal risk factors for loneliness in older adults. Aging and Mental Health. 2021. doi: 10.1080/13607863.2021.1876638. 99 Byers ES, Shaughnessy K. Attitudes toward online sexual activities. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. 2014;8(1, Article 10). doi: 10.5817/CP2014-1-10. 100 DeArmitt P. The right to narcissism: A case for an im-possible self-love. New York: Fordham University Press; 2014. 101 Dykstra PA. Older adult loneliness: Myths and realities. European Journal of Ageing. 2009;6(2):91–100.

Part II

Moving forward

Part I, Chapters 2–4, focused on debunking myths and misinformation about the common conceptualization of loneliness as a social problem. Chapter 2 discussed the myths that equate loneliness with the distinct but overlapping concepts of social, physical, and emotional isolation. It discussed how loneliness and isolation in these realms are related but different concepts. Chapter 3 challenged the fctions that loneliness is wholly undesirable, has reached pandemic proportions, and primarily characterizes older persons and females. Chapter  4 interrogated the conventional belief that loneliness arises from the unmet needs of persons as social animals and demands a social rather than a psychological solution. Comprising Chapters 5–8, Part II now builds on Part I to craft a new narrative about persons’ capabilities to manage feeling alone in ways that include more time in solitude. Part II attributes loneliness less to rampant individualism and a lack of social support than to the often neglected need of persons to be sovereign in their self-chosen response to feeling alone or lonely. Persons require this freedom in order to fnd positive meaning in their life. Systems of care can help them meet such needs and avoid the debilitating effects of loneliness on their health. Thus, Chapter 5 introduces a person-centred approach to loneliness. It de-emphasizes social connectedness as suffcient or always necessary. Reconciling impulses for individuality and cooperation, it construes persons as independent and interdependent moral agents capable of imbuing aloneness with creative possibilities. It then characterizes person-centred health care as having eight overlapping attributes that span fve domains. Subsequent Chapters focus on selected elements of this approach, including self-love (Chapter  6) that enables solitude to complement social connectedness (Chapter 7). Chapter 8 discusses how personal privacy facilitates solitude, while Chapter 9 closes the book with comments on what the book adds and the implications.

DOI: 10.4324/9781003189879-6

5

Loneliness and person-centred health care

Chapter 4 suggested that some persons are less voluntarily social than others. For reasons associated with nurture and nature, they forego opportunities for social interaction. Relishing their own company, they focus on living life on their terms. They exercise their autonomy to minimize role-playing that carries behavioural expectations, such as to wear a social mask.1 Allergic to shallow social exchange2 and social approval,3,4 they keep to themselves and stay quiet around others to avoid being disingenuous or rattling the social cage. In contrast, other social actors want meaningful social connections. They may struggle to meet this need. To escape isolation, they like to interact with others. However, they can become their masks. They become estranged from themselves,5 losing their individuality. As the Irish poet and playwright, Oscar Wilde6 put it, the self-contradiction arises that “Most people are other people. Their thoughts are someone else’s opinions, their lives a mimicry, their passions a quotation.” Therefore, they too feel alone. As socialite Celia witnesses in TS Eliot’s play, The cocktail party,7 “Everyone’s alone – or so it seems to me. Persons make noises, and think they are talking to each other. They make faces, and think they understand each other. And I’m sure they don’t. Is that a delusion?” Celia observes that neither she nor anyone else can escape unwanted aloneness. Yet, persons can avoid feeling lonely. Since persons vary in their need for and comfort with social attachments, social connectedness is not always the answer to loneliness. They can develop a self-concept to feel comfortable alone and in the company of others. This concern for self-development moves away from the social identity perspective that lonely persons need to escape inner emptiness and adopt the identity of the social group. It recognizes that the space they occupy is not necessarily a hole to escape and move beyond. Persons can embrace and use it to activate a capacity for self-realization. What the spiritual teacher Eckhart Tolle calls the “form” of persons, such as their sex, includes this space for relatedness. The Samoan concept of vā (or wā in Māori and Japanese) is also relevant here. Vā describes “not empty space, not space that separates but space that relates, that holds separate entities and things together in the Unity-that-is-All.”8 Within as much as between persons, the space is already meaning-full when it connects persons as authentic, relational beings. Embracing vā in good faith removes the need

DOI: 10.4324/9781003189879-7

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to be flled. For example, persons can be complete in managing their time alone. The Japanese concepts of honne, true feelings, and tatemae, public face, exemplify the complexity of good faith. They signify honourable reasons for persons not being entirely truthful with others. While breaching good manners could be baka shoujiki, stupidly honest in destabilizing social needs for politeness and cohesion, such semblances of inauthenticity are culturally inscribed. Thus, the ability to tolerate wearing a social mask for others is individual and varies across persons. Individualization puts human individuals centre-stage in society. I wish to discuss the concept of the individual and suggest why it is better to focus on persons instead. This analysis leads to my consideration of person-centred health care for states like loneliness.

Individuals Individuals are different from persons, although they share much in common. Individuals and persons each have intrinsic worth and, as the critical locus of suffering and responsibility, are entitled to receive respect for their moral interests, including freedom over collective control and self-realization. As moral agents, their rational choices for self-interested action underpin social phenomena. At the same time, the differences between individuals and persons warrant consideration, as follows. Critics of classical liberalism have claimed that individuals are atomistic or asocial beings. Yet, individuals are not necessarily isolated. Living in society, they interact with other individuals for the beneft of individuals. Nevertheless, individualism faces challenges. It has tended to reduce persons to their social role or function, such as patient or clinician. It has also neglected the moral or spiritual vocation of individuals, who have become moral strangers9 and struggle to protect their identities against groups’ social categorization. As a 69-year-old Rudyard Kipling explained for Readers digest in 1935,10 The individual has always had to struggle to keep from being overwhelmed by the tribe. To be your own man [sic] is hard business. If you try it, you will be lonely often, and sometimes frightened. But no price is too high to pay for the privilege of owning yourself. The sociologist Dalton Conley11 went further in perceiving the “intravidual” to replace the individual in ways that risk compromising the ability of individuals to maintain a particular, integrated sense of self. Expected to please society ahead of themselves, intraviduals fragment into multiple inner selves. The word individual originally meant indivisible12 yet now it divides into discrete parts that compete for attention with pervasive external stimuli and can feel out of control. Intrinsically motivated to embed their distinctiveness in positive social identities, these selves negotiate information streams that may drive them to work toward unrealistic social standards. These norms fy high enough for broken individuals to defne themselves and others increasingly in terms of the social groups to which they belong or aspire to belong. Society effectively reduces these individuals to the status of group members. Rather than look within themselves, they depend for their identities on narratives

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of the group. These stories colonize their sense of self.13 Many persons are content to be part of the herd. For others, the erosion of personal identity produces a visceral form of embodied incarceration. They put up with it for the security it offers. George Orwell used the biblical story of Jonah and the whale as a metaphor for this beneft.14 In the belly of the whale that Orwell likened to society, Jonah felt safe, unable to imagine a better life. Nevertheless, individuals may struggle to balance their individuality against competing demands of group membership. On the one hand, society endorses social difference and encourages individuals “to be someone ‘special’ or to be perceived as such… [and] stand out from the crowd.”15 On the other hand, social and cultural differences, such as language varieties, can weaken social cohesion and challenge social solidarity. For the sake of social order and effciency, society seeks to hold itself together by creating a pack mentality into which individuals socialize. Through groupthink,16,17 society deindividuates its members to comply with regulated social norms while social groups lose specifcity. Differences between the groups dilute, which can create a confusion of social types.18 Social pressure to adopt gender-neutral language exemplifes this relentless movement toward a one-size-fts-all model of social action. Valued group membership confers empathy and community, but uncomfortable obedience to the changing social norms invites loneliness for the sake of social order. Squeezing into social groups with which they don’t easily ft, they hide their inner face from others who might criticize them. Edvard Munch’s 1892 painting Evening on Karl Johan Street (Figure 5.1) expresses this anonymizing experience

Figure 5.1 Edvard Munch, Evening on Karl Johann Street, 1892. Source: Wikimedia Commons.

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via the trope of the lonely, urban crowd. Individual human fgures with vacuous stares move herd-like along the main street toward the viewer. Physically close yet mentally remote, they embody social isolation. Their uncommunicative and emotionally fat forms become a collective “they.” In the pale, artifcial light, the silhouette of a dark somebody walks away. Disconnected from the crowd and us as viewers, this anonymous fgure deepens the image of human separateness whilst offering, in its withdrawn movement, a glimpse of the possibility of lonely resistance against universal identity. At the same time, the fgure reminds others of who they are not – yet. As the traditional Chinese saying succinctly puts it, “Greatest hermit in a crowded street.”19 As the streets of the metropolis today become ever more crowded, the recalcitrant hermit tires of mask-wearing that feels phoney and uncomfortably displaces them in an undifferentiated, faceless mass. Healthy solitude escapes the loneliness of the crowd born from superfcial social contact. Solitude replaces the illusion of collective living by discrete, anonymized individuals wandering as strangers unlikely to pass one another by again. It maintains a safe distance from the sovereignty of the fragile collective that modern society contrives from individuals denied their full potential as persons. It looks to conserve the social fabric woven loosely from the separate, broken threads of individuality. This approach covers up the problem that the singular threads of this fabric have become frazzled and bare under stress. Under mounting pressure to satisfy social norms, they have continued to lose the strength and integrity needed to be purposefully themselves. They have become too weak constitutionally to integrate, as far as possible, conscious and unconscious elements of the psyche and defne their whole self. Feeling incomplete, they interact with others to complete themselves.18 As Arthur Schopenhauer20 stated, “They become sick of themselves … which drives them to intercourse with others.” Yet, they are “too ‘thin’ to sustain an adequate love” of themselves and others.21 Consequently, I wish to suggest that managing loneliness requires focusing not on individuals or the intersecting social groups they identify with but on developing whole persons at the centre of care.

Personhood Loneliness today expresses a crisis of humanity. Individuals feel disconnected from themselves and an alienating social order, experiencing unwanted consequences like ill-health. Reconceptualizing individuals as persons addresses this problem, although the process of depersonalization can become a challenge. The term “person” avoids the misconception that individuals are necessarily isolated. It speaks to the qualities of wholeness and moral independence rather than functionality. It emphasizes the relatedness of individuals to themselves and each other as sovereign in society. Coming from the Latin persona, the word person developed via the Old French persone to mean human being. But I wish to defne persons as all humans and other beings possessing attributes, such as perceived human-likeness, that warrant moral privileges, rights and responsibilities.

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Humans are persons because they have inherent worth or dignity in themselves.22 This reality stands in advance of individual displays of, or any capacity to demonstrate, specifc, normatively valued characteristics,23 such as consciousness, self-awareness, reasoning and a moral sense.24 Although the courts and legislature are yet to defne what being human means, membership of the biological species Homo sapiens is suffcient for personhood, the status of being a person. From this existential perspective, personhood does not depend on individuals’ moral standing and functioning in consistently meeting criteria for independence and interdependence. Personhood excludes no human from social protections like care for loneliness. Yet, while all humans are persons, persons need not be separable or human. Persons may comprise more than one human, as where a symbiotic union constitutes a singularity retaining its members’ integrity. For example, the expectant mother and her fetus “are two, and yet one … [since] they need each other.”25 And, as one, Adam and Eve made their “solitary” way out of Eden. In the Victorian honeymoon poem Dover beach by Matthew Arnold, the couple unites sicut unus, but alone as lovers faithful to each other in a confusing world without “help for pain.” Meanwhile, persons are not necessarily human. Being human is a suffcient rather than necessary condition of personhood as an emergent concept given the potential for persons to exist in states other than human. Distrusting human exceptionalism within the wider tapestry of nature and social life, the following section explores these new and evolving forms of  personhood. Across social settings, they destabilize the assumed association of person-centredness with humanism, or at least the boundary between humans and non-humans, as a defning feature of person-centred health care. Generalizing the concept of personhood to the greatest possible extent does not accelerate dehumanization by lessening humans’ dignity and place in the chain of being.26 To the contrary, it expands the boundaries and determinacy of personalism. It looks to map not only the “logical geography” of current uses of the language of personhood,27 but also emerging uses, allowing differentiation among an enlarged range of person-types.28 Legal personhood Legal fctions around the world exemplify the growing practice of recognizing some non-human entities as persons. Refecting cultural normativity, these laws confer legal personality by an “unnatural” or “artifcial” process. For example, in United States (US) law, a person is a legal entity capable of doing what a natural (or physical) person can do. The US Supreme Court ruled that corporations can be legal persons with constitutional rights and protections, including freedom of speech and religion.29 Legal personifcation also goes beyond properties’ corporate personhood to include natural resources, such as land.30 In some countries, such as Ecuador, governments have enacted laws that recognize nature’s fundamental rights and obligations.31 Extending this development in the Rights of Nature movement is the growing acknowledgement of

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environmental personhood. Natural phenomena warrant state protection and respect as legal persons rather than commodities subject to property rights. For example, since 2014, under New Zealand law,32 the former national park Te Urewera (sacred to the indigenous Māori population that identifes with the iwi or tribe of Ngāi Tūhoe) has held customary title to itself with the legal status of a person. Recognizing the land as ancestral and having a distinct life, the title respects the Māori worldview in identifying a spiritual connection between humans and nature. Driven by indigenous advocacy, the title further recognizes that human persons have a duty of kaitiakitanga or guardianship as part of nature. Following this lead, India granted two rivers the legal rights of a human minor, and in 2019 Bangladesh gave all its rivers the legal status of humans. These developments attempt to be responsive to global ecological crises. Artifcial intelligence These developments foreground the potential to apply Martin Buber’s I-You33 relation to other non-human domains, specifcally artefacts and continuously improving technology.34 Advances in genetics, biotechnology, and intelligent machines are leading the concept of personhood into a posthuman future, one in which persons could include machines with strong artifcial intelligence indistinguishable from the human mind. Within health and social care, the distinction between machines and persons collapses if mechanical bodies qualify as persons and hence as independent ends in themselves worthy of moral treatment.35 This possibility revises the concept of the “person as organism” by giving new meaning to artifcial life. The philosopher Thomas Hobbes, among subsequent others like Julien Offray de la Mettrie,36 viewed man and all of human society as machines.37 However, in 2017, the Kingdom of Saudi Arabia granted the legal status of citizenship to a female-looking humanoid robot named Sophia, and in 2021 the company behind her construction released an ultra-lifelike robot called Grace for the health care sector. As a health care assistant, her appearance and demeanour engender trust and engage emotionally with older persons through talk therapy. Plans are afoot to mass-produce social robots like Grace. They could help meet global demand for health care in response to developments like COVID-19, climate change, and population ageing associated with rising chronic illness and eldercare. Philosopher William Lycan38 imagined treating such person-like machines as persons. Some persons already treat robots less as machines than companions. Robopsychology and robotherapy promote relationships between persons and, in particular, interactive simulation robots.39 Perceiving such robots as persons may commodify intimacy but speaks to how the scope of a person-centred health care for loneliness is already changing. The development of social robots is still in its infancy. Yet, these machines take on supportive roles ranging from personal assistant to relational peer and intimate buddy.40 Entrepreneurs are introducing animal-like robot companions while collaborative robots (cobots) simulate human characteristics to aid social connection in

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the workplace. Humanoid sexbots offer physical pleasure, for example, in brothels in South Korea, Japan, and Spain. Other technological advances include virtual robots, like Gatebox. This Japanese projection tube summons a holographic waifu (fctional female character) to hold conversations and provide companionship and assistance to lonely male otakus. All these technological developments aim to stimulate affective relationships. Their hyperreality is blending what is fake and real, limiting apprehension of where one starts and the other begins.41 New technologies now foretell the development of machines as autonomous agents that could do everything, and more, that a human being does. Robots could exercise free will and judgment, hold rights, and be morally (and legally) responsible.42 It is conceivable that they could eventually become conscious and have a human-like sense of self. Although they might still not exist for themselves, they could become indistinguishable from humans (passing the Turing test, or imitation game),43 or eclipse humanity and be impossible to stop from entering the gateway to personhood. With continuing advances in robotic touch-sensing, they could even suffer as sentient beings caring about themselves and others. In theory, they could feel lonely or incorporate moral bioenhancements that protect against loneliness but challenge the suffciency of humanity as a criterion for personhood. Novel possibilities arise for personhood. Beyond human exceptionalism, they include legal fctions and new technologies that require a philosophical restatement of the meaning of personhood. Humans like to put themselves at the centre of life. Yet, they have no special, moral claim to personhood when, for example, other beings share the same interest in self-preservation, including self-love. Selflove drives persons to maintain and value their self-identity that is neither socially determined nor dependent on them being human.

Person-centred health care Person-centred health care for loneliness, among other conditions, responds to the capacity of persons as moral agents to relate to themselves and others in forms including, but not limited, to social interaction. It manages loneliness as less a social problem than a biopsychosocial challenge amenable to mental reframing by each person. As a philosophy and methodology facilitating quality of care, this approach to health care has revitalized over the last two decades to overcome the limitations of two competing movements: Evidence-based medicine and patient-centred health care. By integrating their respective strengths, person-centred health care responds to calls for their coalescence44,45 to put an end to their confict.46 Its stable and robust commitment to speak una voce has struggled with inconsistent defnitions of person-centred health care, including overlap with patient-centred health care.47 But I have highlighted broad differences between them.13,28 Figure 5.2 depicts how person-centred health care groups eight overlapping attributes into fve domains (Figure 5.2). Figure 5.3 applies this model to loneliness. The following discussion suggests how each domain, in turn, contributes to persons learning to transform time alone and loneliness into solitude amid or outside

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Figure 5.2 Domains and attributes of person-centred health care.

meaningful social relationships. These positive outcomes arise most proximally from person-centred health care care cultivating virtues, such as self-love, whose value gives personal meaning to aloneness through solitude. Table 5.1 indicates how this approach differs from the conventional one. Person-frst Consistent with the ethic of respect for persons,48,49 person-centred health care puts persons frst. It views the person as the primary and most valued unit of reality. In the context of how persons live, feel, and interpret their lives, it respects their moral standing as a basis for conditions like self-love. It provides for such moral interests in ways that have intrinsic value independent of each person’s particular capabilities. This care values persons as more than calculable commodities in society as a collection of persons.

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Figure 5.3 Person-centred health care for loneliness.

Table 5.1 Comparing conventional and person-centred approaches to loneliness Approach

Conventional

Emphasis Impulse Energy

Loneliness-frst Potential

Model Biopsychosocial Orientation Socialpsychological Goal Therapeutic

Person-centred Reductionist Universalist Position-relative

Person-frst

Integrative Interpersonal

Enactive Relational

Lonelinesspausing

Person-enabling

Kinetic

Holistic Particularistic Motion-relative and emergent Agentic Intimacy-focused Meaning-oriented Characterbuilding Self-actualizing

When ministering to persons who are lonely, person-centred health care attends to them as whole persons living with loneliness and what it means to them. One reason is that persons are more than their loneliness. Their loneliness does not defne them. At the same time, person-centred health care acknowledges that no-one realizes their full personhood painlessly. A second reason is that personhood exists ontologically at a lower level than the emergent social structures in which persons enact care-seeking roles, such as the lonely patient.50 These structures depend on personal activity, whereas “persons are only contextually and

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developmentally dependent upon the social structures and institutions that nurture and sustain (or perhaps exclude, exploit, and destroy) them.”50 In this context, person-centred health care differs from patient-centred health care that makes personhood implicit. Indeed, patient-centred health care’s assumption of the primacy of patient welfare neglects the personhood and well-being of other social actors, such as clinicians. Research reports mixed effects of patient-centred care on patient satisfaction and health.51–53 A possible explanation is that patient-centred care “gives only the illusion of challenging professional autonomy, while in fact leaving that authority largely intact.”54 If so, the respect it displays for personhood exposes itself as little more than a charade. Holistic A holistic conception of person-centred health care guides the whole practice of care that persons produce alone and with others, for themselves as whole entities.55 When a self-alienating condition like loneliness fractures the wholeness of persons, person-centred health care acts to heal the biographical rupture. It does not focus narrowly on their loneliness, which society mistakenly reduces to a sickness requiring social intervention. Instead, it treats them as whole persons always in transition. It aids their desire and “volitional necessity”56 to adapt internal regulatory workings, reintegrating their whole relationship to themselves and their external environment in the gestalt of their lives. Person-centred health care helps them recognize this need and care about their care because they are more than their loneliness and the other aspects of themselves, they dislike. This acceptance frees them to value and love themselves wholeheartedly. Restored self-love empowers them to self-develop in ways that include constructing time alone as healthy solitude.57 By becoming complete in this situation, this rethinking helps them be alone amid other problems and opportunities in their lives. Whether they are on their own or have others nearby, it strengthens their capacity to become who they would be if – as whole persons – they loved themselves despite and because of their imperfections.58 Longitudinal rather than episodic and transactional,59 this care simultaneously integrates the multiple aspects of each person, including their body, mind, and spirit.60,61 Harmonization addresses their full range of needs and interests since problems, such as loneliness, emerge in the context of particular life infuences on well-being. Therefore, person-centred health care maximizes the total good of each person as a multi-layered moral agent who need not look to others to feel whole amid conditions like loneliness.62 Such care balances each person’s independence and interdependence.63 In managing states like loneliness, it also fnds strength in weakness (see Chapter 3) and uses resources effectively by coordinating services across sectors. This organization of activities is essential since many countries, such as New Zealand, fragment loneliness care across government ministries.

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Particularistic As hinted above, person-centred health care claims the quality of particularism. Individualism is a more transparent term than particularism but is not used here for two reasons. The frst is my distinction (above) between individuals and persons. Second, I wish to distance individualism from individualization as a process unifying conscious and unconscious aspects of the psyche. Thus, I use the term particularism, not to deny universal moral principles but to mean that personcentred health care is sensitive to valid differences among persons. Embodying a respectful interest in adaptively responding to each person’s values, interests and needs looks to harmonize universalism and particularism.64 Eschewing a standardized one-size-fts-all approach to managing conditions like loneliness, the care situationally designs and weaves care as a custom-made garment. In these terms, person-centred health care is not a mass outftter, but a tailor dedicated to and skilled in crafting distinctive clothes for challenging situations. These clothes are made to ft, insulate, and protect persons as unique, complex and continually changing beings worthy of self-love and appreciation by others. Since the best ft that any person can achieve is with themselves, their habiliment carefully attends to their specifc requirements, expectations, and experiences over time. For example, health care to treat loneliness is personalized rather than detached and unvarying. It matches trusted materials and methods to each person’s characteristics, so they feel comfortably safe and capable of appointing themselves to embrace solitude.65 Confdent their garment will last, they don it to look and feel good as whole persons.66,67 In being potentially available for everyone, this personalized care avoids negative connotations of so-called luxury care or concierge care.68 Kinetic Since persons and their needs continue to change, person-centred health care is a journey taken to help acclimatize in a fast-moving world. In this passage, persons perceptibly move through space and time to manage problems, such as loneliness. Their movement harnesses the potential energy stored in them, their condition, and systems of care. It utilizes this energy to power work by creating positive possibilities from states like aloneness, for example, through self-love. Motion is integral to this adaptive process whose precise form is not entirely predictable because each situation is unique. Therefore, persons continue to mobilize as dynamic beings whose kinetic management of conditions like loneliness remains a central feature of their lives. Their movement originates with inward action since they can only temporarily escape themselves, whether through turning to others or by running away to pause rather than fx their problems. Consequently, in Ernest Hemingway’s The sun also rises,69 the journalist Jake Barnes advises his college friend, Robert Cohn, not to go to South America to get more from life because “You can’t get away from yourself by moving from one place to another.”

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Managing loneliness similarly requires movement within persons. It requires their mental mobility, their ability to respond to pressing demands without delay. This response expects them to set and face challenging but achievable goals in order to self-develop and transform loneliness. Their goals set direction so that rather than withdraw from feeling alone to obtain relief, they keep going to meet them head-on. As a creative embodiment of becoming, they march forward to fnd and love themselves and navigate pathways through loneliness or, from aloneness, around loneliness. This movement to realize goals, such as valuing their well-being and time alone, need not be gradual and involve natural attrition. Rather than resist change, it can apply explicit and implicit attitudes evolving through low cognitive effort, for example, to disavow ill-effects of unchosen isolation during events like COVID-19.70 Attitudinal movement may then quicken through the adoption and spread of a radical psychology that assaults and breaks through loneliness. Such a Blitzkrieg would shatter social defcit constructions of loneliness. Persons thrust ahead to fnd inner meaning in acting alone. Paradoxically, this kinetic care depends on momentary stillness of mind. Such care embraces the Japanese concept of seijaku, serenity amid activity. In confronting challenges like loneliness, this energized calm promises to reveal personal meaning in everyday life. Person-centred health care utilizes this freedom from agitation to construct loneliness as “suffering towards” growth,71 or transform time alone into fulflling social interaction or solitude. Each step moves persons forward and upward. Thus, person-centred health care lets them relinquish some social activity, release loneliness and hold on to solitude. They can move alone to fnd tranquillity in settings like nature. David Caspar Friedrich’s Wanderer above the sea of fog visually expresses this idea whilst indicating a path to clear inner vision and self-inquiry. The movement toward an uncertain future creates meaning-giving possibilities, like hope, to recover spontaneity and feel fully alive. Persons also aim to move in good faith even when that distinguishes them from others. Following their true path gives them calm, meaningful, energized confdence or euthymia. As the poet Robert Frost wrote in his poem The road not taken: “Two roads diverged in a wood, and I I took the one less travelled by, And that has made all the difference.” Such authenticity animates persons to run their own race. They centre themselves, harnessing experiences like aloneness as a source of potential energy to be true to and value who they believe they are. Releasing negative emotions, such as regret, they realize their moral interest in acting well. In this movement, they go beyond relieving distress from the loneliness that, in the poem I(a, EE Cummings compares to the feeting motion of a falling leaf. Cumming places “a leaf falls” parenthetically within the word loneliness, but persons can fall upward72 since falling can catalyse them to fourish rather than languish.

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Emergent Implicit in this discussion is the concept of emergence. It characterizes the kineticism of person-centred health care and the full development of personhood to overcome states like loneliness through emergent cognitive structures, such as solitude. Thus, the concept of personhood continues to develop as its changing parts interact. As noted above, a related need is emerging to stop reducing person-centred health care to humanistic care.73 Although all human beings or humans meeting specifed criteria are persons,44 not all persons need to be human. Developments in the law and biotechnology are advancing understanding of what it means to be a person. Reviewing their elevated status in the world, human beings cannot avoid confronting the concept of personhood as an entity moving person-centred health care beyond humanism. This expansion occurs through proactive emergence since persons can take actions, such as cognitive reappraisal, to help self-development overcome unwanted states like loneliness.74 Enactive Expanding the concept of emergence is the enactive nature of person-centred health care. Compared to a biopsychosocial approach to loneliness, this care enacts or brings forth persons and their capabilities. It constructs them not as entities in the world but as moral agents, inseparable from and shaping their life world. This world affords them opportunities to make ecological sense of and give signifcance to experiences like being alone or lonely amid prevailing social norms. Their embodiment in the world makes this experience possible. Aloneness then becomes more than an inner experience. It is a material way in which persons give form and meaning to their life world. Loneliness is one result. Persons may express it in and through their bodies, for example, as tiredness, withdrawal and emptiness.75 In contrast, aloneness can rejuvenate the body, reinforcing the value of solitude. These conditions infuence the potential to interpret isolation meaningfully.76 Agentic The enacted nature of person-centred health care existentially constructs persons as being what they freely choose to believe and do in life from the present moment forward. As far as their consciousness permits, this care informs their capability to exercise this choice as causal beings who can shape future events. They can make positive decisions, such as continuously to self-develop and loosen their grip on the meaning of aloneness, reinterpreting it as a resource rather than something necessarily condemning them to loneliness. Systems of constraint, including human drives and elements of the social and historical environment, infuence rather than determine this decision-making and behaviour. Thus, rather than reduce persons to automated puppets in structured social interactions,77 I see persons as socially conditioned agents capable of relating to

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their lives on their terms. They can confront aloneness and loneliness by trusting in and drawing on their freedom to regulate the emotional impact of these conditions. They can accept what they cannot change about themselves and their lives while refecting on preferences they control, such as loving themselves and taking the most affrmative attitude feasible in their situation. Being alone then acquires productive meaning as persons happily reframe it and apply reason to achieve coherence, purpose, and signifcance as disciplinary forces.78,79 When they feel lonely and view their existence as meaningless, personcentred health care offers liberating relief. It shows them how they can decide to be alone as fully as possible.80 It helps them settle on what their experience means so they can direct the present and future as much as possible to honour their deep values, protect themselves, and fourish.81 This prescription requires them to take responsibility for moral decisions on issues they care about,56 such as independently embracing rather than avoiding their own company and not letting loneliness rule them. Each person is ultimately responsible for managing their life, though others may help. For example, consider the Greek Titan, Atlas. Zeus condemned him for eternity to carry the heavens’ weight on his shoulders. This weight separated Atlas from the sky and earth. Yet, as the world changed, Atlas was not wholly disconnected from it. Heracles temporarily relieved him of his burden without becoming responsible for it. Relational From this perspective, person-centred health care moves beyond the socialpsychological approach of conventional loneliness care. Person-centredness facilitates cognition as a relational process that is personal, rather than necessarily interpersonal or social, in respecting each person’s values, preferences, and capacities to form deep relationships. This respect emphasizes and dignifes persons’ connections with themselves, others, or both. Hence, person-centred health care adds intrapersonal care to the health care in which persons fully realize their capabilities on which they depend to be who they are.82 It respects the integration of their inner and outer selves at the same time as it supports their fuid and porous relationships with others, redolent of the Nguni Bantu concept of ubuntu. Conceiving of loneliness as estranging persons from themselves as much as those nearby, person-centred health care relationally mends this detachment. To make persons complete, it blends individual and shared moral interests. They include managing loneliness83 within and between persons, including the possibility of mutual loneliness. Typically emphasized is the capacity of this care to fortify social connections, beginning with shared decision-making by persons in trusted relationships, such as patient-clinician dyads and person-centred public health.44 Some authors84 vindicate this social focus by claiming that persons are “essentially directed towards other persons” with whom they can choreograph a dance and move synchronously. However, in prioritizing the personal and relational over the social, person-centred health care needs to begin with each person strengthening their inner spirit. It

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conceives of their psyche and soul as resources for self-compassion and self-directed care that empower them to appreciate and be their best self with or without others (see Character-building below). To these ends, Chapter 6 focuses on self-love as a neglected foundation for managing loneliness in solitude (Chapter 7).85 Intimacy-focused More than relational, person-centred health care facilitates persons’ intimacy with themselves and others. The word intimacy derives from the Latin intimus, which means interior or inmost. It speaks to what lies within persons to stay strong during challenging times. Thus, person-centred health care promotes intimacy as an adhesive that attaches persons to their uniqueness and the meaning they fnd in conditions like being alone or lonely. As a deeply personal experience, intimacy means different things to different persons, but its forms include emotional, intellectual, spiritual and physical connectedness. These forms offset feeling isolated by helping persons express and meet a need for closeness in their relationships, for example, with other persons, nature, machines, or a divine presence. Erik Erikson’s86 stage theory of psychosocial development emphasized the social context needed to develop fulflling, interpersonal relationships. Person-centred health care still recognizes the importance of social connections yet adds that persons’ most intimate and trusted relationship is with themselves. This relationship critically conditions their ability to care for themselves and others28 in interaction with the environment.76 Enabling Through these mechanisms, person-centred health care helps persons decide that although they are enough because of their personhood, they can continually improve themselves and their lives.87,88 Person-centred health care supports them by identifying or creating opportunities to develop “person-al” strengths and capabilities.89 Without needing others to make them feel complete, they can turn these valued resources into (sometimes complex) functionings for fourishing and achieve a “good soul,” which Aristotle called eudaimonia. This process enables persons to grow by optimizing their subjective wellbeing.90 They can fourish even alone as a whole living presence and opportunity, a creative feld. As noted above, any semblance of emptiness is full of positive possibilities to deepen thinking and recover spirituality in modern living. The preSocratic Greek philosopher Parmenides went further. He exemplifed the Monist perspective that there is no emptiness to fll with meaning. He reasoned that if nothing can come from nothing, what flls the void already exists in some form, such as nostalgia to savour within an indivisible unity of being. Meaning-oriented Recognizing loneliness and care of the lonely as personal matters,91 personcentred health care responds to each person’s instinctive need to fnd meaning

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in their life beyond impulses like pleasure. Victor Frankl suggested that persons fnd meaning in their lives through three sets of values: Creative, experiential, and attitudinal.78 Experiential values include the value of participating in an experience like love. Frankl survived Nazi concentration camps by clinging to the image of his beloved wife.92 By extension, I highlight self-love as a virtue with the same power to help persons (re)create a concrete purpose unique to them and set future goals, for example, in managing constructively the way they feel alone. Persons strengthen their capability to choose their attitude to and experience aloneness as solitude, a nutrient-rich staple whose satisfying digestion feels meaning-full. Thus, person-centred health care helps them extract energy from and harness the power of aloneness to stimulate everyday life. They feel complete in discovering and accepting a suffcient why for being as they are at that moment – and how to work with this existential condition. Accepting they are ultimately responsible for embracing these discoveries is meaningful. Character building Accordingly, person-centred health care engages with the nature of each person. It cultivates the virtues as deep, stable traits of good character. Habitual practice of the virtues enables persons to fourish. This virtue-ethical approach makes life worthwhile, even amid loneliness. Based on an inward model of meaningful self-development, it empowers rather than restricts persons to choose well for a good life. It locates nobility, explained WL Sheldon,93 in the importance not of being better than others but of “being superior to your former self.” Person-centred health care develops virtues (in defcit94) as areté, or inner resources capable of managing with excellence unwanted conditions like loneliness. This care constructs loneliness less as a threat than a challenge to surmount.95 Virtue can transform it into solitude because, as Schopenhauer96 observed, “Great minds are like eagles, and build their nest on some lofty solitude.” They become signifcant when they cultivate virtues that, formidable to integrate and apply in the world, hail to the joy of moral education and practice.97 As ideals, these virtues matter for their own sake while helping persons internalize and reach demanding goals and become better than they have been. Despite their predicament, they rise to these challenges and fourish, even when alone, by taking care to do good (the right thing) for the right reasons. To live as fully as their circumstances permit, they act like persons with the desired character traits.22 The tide of loneliness goes out, providing space for them to grow in personally fulflling ways. In developing the psychological fexibility to appreciate even what loneliness has given them, persons escape self-pity.98 They respond to loneliness with selflove that commands humble wonder at, and gratitude for, what is meaningful in their life.99,100 They expand and fnd contentment in what the world has given them rather than what they lack, even if taking this attitude requires them to be generous and act graciously. Negatively associated with loneliness, especially

90 Moving forward among young women,101 gratitude may also stimulate persons to fnd and show the courage and self-compassion to respond cathartically to loneliness. Coming from within, this courage to manage loneliness forms in the heart where persons fnd the strength needed to accept themselves as worthy of love. Thus, as the ancient Athenian historian Thucydides stated, “The secret of freedom is courage.”102 Persons demonstrate nobility in exercising the confdence and courage of warriors to be optimistic about the future, realize their potential, integrate themselves, and become happily whole. In describing the steps needed to fnd true freedom, Nietzsche suggested that after embodying the spirit of camels who bear the burden of loneliness, persons can develop the courage of lions who challenge the dragon of societal norms. They act with integrity to embolden themselves to treat the experience of loneliness as a site of transformation. Loneliness and isolation then are spaces in which persons can foster or bolster qualities such as practical wisdom, love, and low prudential sensitivity to fear. In good faith, they can review how they represent and value being with or apart from others. In moving toward new spaces of potentiality, they joyfully connect with their soul, including their wild side.103 In humble good faith, they feel worthy of being alone. Rather than tolerate aloneness, they patiently refect and act on its possibilities to move into conditions like solitude (Chapter 7). Self-actualizing Informed by science but functionally integrating it with the arts, person-centred health care is a hub of transformation. Through facilitating character-building, among other things, this care strives to help persons overcome obstacles, including discomfort, and maximize their potential. The care emphasizes these persons’ strengths,104 including paradoxically the capacity to apply the principle of “least effort” to gain power over themselves and transform being alone or lonely into self-loving and life-affrming states like solitude.105 Without losing awareness of their circumstances and limitations in the world, they understand that solitude extricates them from the crowd. It enables them to recover authenticity and courageously and joyfully become who they are and can be. Without struggling for others’ approval, they self-realize psychological and spiritual self-understanding, taking full advantage of their capabilities in accord with nature. Anne Frank expressed this perspective as well as anyone. In her diary’s fnal entry on 1 August 1944 (three days before her arrest), Anne wrote, “I keep trying to fnd a way to become what I’d like to be and what I could if … if only there were no other people in the world.”106 Even when persons feel unready to actualize themselves, person-centred health care creates conditions conducive to them acting as if they do.107 For example, it can help them apply a cognitive state called “alief” that habitually disposes them to act positively despite negative beliefs.108 Under such conditions, they fourish, engaging time as a resource for everyday living and feeding their appetite for self-acceptance and self-development. Relative to the opportunities in their

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environment, they use the energy in states like aloneness to move toward, above, around, and beyond recovery from conditions like loneliness. Hence, personcentred health care is more than a restitution narrative. This care helps persons progressively suffuse their life with symbolic signifcance. Life feels good (hedonic well-being) as they become their ideal self. Positive functionings infuse their everyday life with personal meaning and value (eudaimonic well-being). Becoming continually better persons, they use solitude to transform the time they might otherwise spend unhappily alone into a state of purposeful contentment. Even when suffering from momentary loneliness, they discern ways in which their life is still fulflling,109 and thrive in relationships. These persons love and feel loved, most critically by themselves, by being and doing good. In solitude, they fourish, less by overcoming aloneness than embracing it.

Conclusion All persons spend some time alone. To avoid becoming lonely individuals, they need to embrace and develop themselves as persons with an innate need and capacity for relatedness to who they are as much as to others in living their everyday lives. This chapter has discussed the implications of shifting meanings of “persons”, whom I have also distinguished from “individuals.” It has considered person-centred health care with reference to loneliness across fve domains comprising eight attributes. This care puts persons frst to restore their wholeness and help them choose to fourish. They become the best persons possible by actualizing their situated agency to develop virtues like selflove. These traits help them self-develop and enjoy solitude as much as their time with others.

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The previous chapter suggested how a person-centred health care approach to loneliness looks beyond developing social connectedness. It creates conditions conducive to developing the virtues that give scope to persons creating positive meaning from time alone and framing it as healthy solitude. This chapter elaborates on the most central of these virtues, self-love as an art 1 that intersects with other stable traits of good character. Facilitating love, coping and fourishing, these traits include courage, compassion, generosity and dignity-conserving gratitude for life’s blessings. The chapter focuses on self-love because what persons do from self-love does not come from constraint or duty. Moreover, self-love is a virtue without enough of which persons cannot desire solitude. They believe they are in “bad company when they spend time alone”2 or their own company is insuffcient to avoid loneliness. This negative thinking makes persons consciously or subconsciously conclude they are not suffcient. It trumps their attainment of extrinsic benchmarks of success. Self-critically ignoring or rejecting their achievements devalues who they are and what they can do. They seek validation from others, with whom social narratives – for example, around achievement standards – enculturate them to compare themselves poorly.3,4 In settings such as their peer group5 or relative to their same-sex parent,6 these comparisons are unhealthy amid claims that everyone deserves and is owed the love of close others.7 When love from others is not forthcoming, persons may claim to love themselves yet mask feelings of self-deprecation that ill-equip them to be alone and connect meaningfully with others. They fear isolation even though their aloneness is not the problem. They are. While disposing them to report a positive semblance of self-worth, social conditioning destabilizes their inner self, their felt sense of personal identity, and value. Researchers continue to debate the concept of low self-esteem, but low self-worth appears widespread. It originates within persons in response to external pressure to deny their right to love themselves.8 Many persons do not claim that right (or responsibility). They may not know what self-love means, or they may feel undeserving of it. They may even dislike or loathe themselves. In literature, examples include the inner monologue of TS Eliot’s J Alfred Prufrock. Afraid of rejection by women, the timid, ineffectual Prufrock likens himself to an insect “pinned and wriggling on the wall.”9 Kafkaesque comparisons aside, Prufrock is not unique or unfamiliar. He is not alone in feeling alone,

DOI: 10.4324/9781003189879-8

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believing he is inadequate and unlovable for reasons including unresolved trauma in his life. Without social support, fgures like Prufrock respond maladaptively to their loneliness and stressors like body dissatisfaction.10 Struggling to be with themselves and sometimes others, they despise spending time on their own.11,12 Meanwhile, they may infate their level of self-esteem in communicating with others. These explicit statements of self-esteem correlate weakly with implicit measures13 that seldom vary culturally.14 This discrepancy is concerning because felt estrangement of persons from themselves and others15 weakens protection against mental health threats.16 Self-esteem is negatively associated with loneliness, especially during adolescence17,18 and late adulthood.12,19 Persons may take one of two paths in response.20–22 First, they may avoid spending time alone. For example, buying into modern consumer culture enables persons to purchase others’ attention and validation. They may dramatically alter their physical appearance, social behaviour, or both. This path is problematic when it makes them feel ashamed and phoney in the absence of aligning their inner and outer selves. Self-doubt can even make them reject those who display the bad taste to approve of them. Unconsciously, persons self-sabotage the desired relationships they feel they don’t deserve. Alternatively, they may become codependent,23 needily hanging on to others without progressively repairing themselves from within as works in continuing progress. Second, low self-esteem and loneliness may instead prompt social avoidance through self-isolation. Expecting a lot from themselves, the persons taking this route forego social interaction to pursue success in other life domains, such as work. Uncertain how to connect authentically with others to whom they feel inferior and unworthy of closeness, they keep their distance because they fear rejection and anticipate being a burden. Carl Jung24 attributed such social withdrawal and isolation mostly to “man’s (sic) progressive alienation from his instinctual foundation,” the self they would be if they hid nothing from themselves.

Lack of trust Both paths are built on low trust. Persons may lack generalized trust25 as refected in brain changes.26 The negative relationship between social isolation and trust contributes to loneliness because, as Edward Casaubon mused in George Eliot’s Middlemarch, “what loneliness is more lonely than distrust?”27 Persons may distrust themselves, but they can better trust themselves than others. Lorado Taft’s sculpture, The solitude of the soul (Figure 6.1), suggests why. It depicts a central stone that partly captures four human fgures to reveal “the eternally present fact that however closely we may be thrown together by circumstances … we are unknown to each other.”28 Moreover, as Sartre adds, to depend on these others contradicts the core of our being as persons condemned to be free and responsible for ourselves. Thus, there is something in Friedrich Nietzsche’s29 overstated injunction to exercise physical reason and “Dare only to believe in yourselves.” Modern Western society makes space to take such a leap of faith in the capability for independence. This prescription cannot test whether other persons are less

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Figure 6.1 Lorado Taft, The solitude of the soul, 1901–1904. Source: Wikimedia Commons.

trustworthy than they and may vie with advice to search for external sources of comfort. However, it promotes the development of internal resources that respect persons’ moral agency and responsibility to follow their moral values and satisfy themselves from within. As the philosopher Ralph Waldo Emerson30 wrote in his essay Self-reliance, persons need to trust in themselves on their terms, preparing themselves as a surface on which to bond with others. The reason, explained Emerson, is that “nothing can bring you peace but yourself.”

The promise of love This chapter tempers this acclamation of individualism by applying the universal notion that love, including self-love, overcomes all obstacles, including loneliness. Caravaggio’s Amor victorious gives visual expression to this message. It depicts a

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line from Virgil’s Ecologues X.69, Omnia vincit amor et nos cedamus amori: “Love conquers all; let us all yield to love!”31 The symbolic implication of the painting is that defeating or avoiding loneliness requires developing the kind of love that a child embodies. Think the Nietzschean child, an innocent and joyful creator whose “spirit now wills its own will.”29 Although dependent on love from others, the child learns to love itself as an aspect of healthy functioning and self-care. It comes to value who it is, more than what it has.32 This attitude protects it against loneliness, especially when opportunities for meaningful social activity are sparse. More prone than others to regard themselves and others negatively,33 lonely persons need love, including self-love, to build themselves up. Love is an adhesive that (re)connects them to life to develop a more robust, kinder, more selfcompassionate and resilient sense of self. To the extent that loneliness refects defcits in self-love, a remedy is self-care that rehydrates desiccated emotions and swells the spirit to achieve fullness and self-unifcation. In saturating themselves with love’s fuidity and confdence, they nurture the strength and autonomy to achieve healthy stability and thrive in a realistic and self-gratifying manner. This satisfaction is critical to cultivate because loneliness increases the likelihood of persons lacking self-worth, fnding their environment threatening,34 and reporting a discrepancy between who they are and wish to be.35 In turn, lack of self-love disposes persons to be lonely. Self-love, by contrast, frees them to love and be loved by others. This chapter frst introduces the concept of self before suggesting what self-love is not. Then, it indicates how self-love can extinguish loneliness. It reveals that to feel complete, persons do not require others to whom they must relinquish power. They can develop self-love by being more merciful and kinder to themselves through self-care that unifes self-knowledge, self-commitment, selfdesire, and self-intimacy, and enables them to be content alone.

Selfhood Persons generally believe they have a self. It is the inner voice expressing what it is like to be them. They hear and feel it inside them as a continuing, irreducible whole in which they ponder their thoughts. According to Jung,36 at the centre of this conscious part of themselves is the ego or “I” entity. It converses with itself at the core of their personality to assimilate unconscious elements of who they are and self-regulate their cognition and behaviour. Herbert Mead37 constructed the “I” as a response to the “me” where the “me” is the social self, determined by the organized attitudes of others. However, persons may discover the “I” is a fction created and protected through narrativization at an existential level. To perceive reality rather than this story they tell themselves, persons may choose to relinquish and go beyond what they believe to be their true, singular, unchanging self at any given moment. This self-transcendence may reveal “no-self” (called anattā in Buddhism), organizing their functioning parts such as thoughts, sensations and emotions. No independent conductor orchestrates these operations distinct from or identical to their function. As with the bundle theory of the self, put forward by the

100 Moving forward 18th-century philosopher David Hume,38 the parts act together to give persons their identity as a state of mind. This arrangement exemplifes Gilles Deleuze and Felix Guattari’s concept of an assemblage whose “only unity is that of cofunctioning.”39 Cognitive neuroscience concurs that the different mental processes do not all merge in a single brain structure. Different brain regions mediate different processes.40 Rather than view the ego as a single entity that persons need to jettison or move beyond, this insight braces its reconceptualization as a “sophisticated matrix of structures, functions and representations.”41 Discovery of the matrix radically transforms the person and their potential to refne perceptions and thoughts and internalize an integrated, storied self. Letting go of the illusion of having within the ego a fxed, unitary self reveals personhood as a process of becoming part of the whole of life rather than a thing in which they are inseparable from others – a singularity. As Basho’s haiku describes, “My horse, clip-clopping over a feld … oh ho! I’m part of the picture!”42 Western society, including much of European philosophy, has long been sceptical of the notion of the person loving the self they feel they have. Humanity has been prone to sacrifce self-love on the altars of empathy and altruism. These offerings hinge on the false premise that self-love diminishes other-regarding virtues.43 That argument fails because self-love and other-love are not alternatives. Both forms of love imply and need each other. In this context, self-love is a condition that persons need to shape for goodness. Rather than a vice to atone, it is a virtue to cultivate with discernment and enact for the right reasons, including its power to manage loneliness. Persons better manage states like loneliness by loving than not loving themselves. Without self-love, they become anxious and endeavour to be lovable to others. Fundamentally, they misunderstand self-love. Thus, consider what self-love is not before considering what it is and why it treats loneliness.

What self-love is not Self-love is not solipsism or navel-gazing.44 Contrary to the 16th-century French theologian John Calvin,45 it is not a “pest” disposing persons to judge and look down on others. Although positively related to self-interest, it is also not synonymous with egocentrism or narcissism as pathologically self-absorbing love styles. When persons care less about documenting their surroundings than snapping selfes that feature themselves46 and posting them on social media,47 they exhibit narcissism rather than self-love.48 Although some narcissism may protect against negative psychological states, such as loneliness,49 narcissists do not love themselves. They overexhibit exclusively agentic traits50 in a perverse game-like effort to make others respect and love them.51 Going beyond a search for self-acceptance, they cannot distinguish themselves from their refection in others whom they nevertheless consider inferior and endeavour to use as healing instruments to bolster and compensate for their brittle self-image. Believing their specialness is unseen, they manipulate others to receive the adoration they feel they deserve and are unjustly denied.

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As Jean Jacque Rousseau described, they reduce self-love to amour-propre that weaponizes their fragility. To elevate their standing above others, they mask their insecurities to seek social approval of a false, grandiose self.52,53 Self-love is also not a weakness like self-indulgence, naked selfshness,54 or excessive humility. It is none of these things. Forms of bad or incorrect “self-love”55 are not self-love at all. However, what of the perspective that the tone of selflove is neutral? Philosophers ranging from St Augustine of Hippo56 to the German philosopher Immanuel Kant have put forward this perspective. According to Kant, self-love is ethically indifferent57 to the natural striving of persons for happiness and must be kept in check to fulfl their moral duty. However, Kant considered all persons inherently worthy of the respect and self-love that predispose them to satisfy the human will to meaning and purpose in life.58 Within a shared moral community, rational self-love frees persons to follow moral rules that honour the good and affrm who they are in their daily lives. From a virtue ethics perspective, self-love is at least fair-minded based on the principle of equal consideration of equal interests.59

Self-love Having suggested what self-love is not, I now wish to elaborate on what self-love entails. My starting premise is that all love, by defnition, is more than mere passion. Love is a basic moral relationship, a part of being a person.60 Moreover, independent of each person’s goodness, love is the starting point and pinnacle of the virtues, a spontaneously joyful gift.61,62 Its value gives meaning to life, connecting virtue and situations such as aloneness. It functions as a life force that commands and energizes persons’ conscious and unconditional acceptance of who and how they and others are as they exist here and now. Without love, persons lose themselves in states like loneliness. Those who cannot love squander their capacity to grow and choose a positive attitude in situations like aloneness.63 Going beyond self-interest, their love begins with them loving themselves unconditionally. They continue to develop self-love as a skill by effortfully developing knowledge to become their best version of themselves. Thus, there are two main forms of self-love. The frst is spontaneous. Arising existentially and unconditionally from being human is this natural state of self-love based on a person’s innate need for self-preservation and growth. The second form of self-love is evaluative. Through careful and patient practice, persons can develop it from subjective experience and self-evaluation of their identity and worth.29 As a form of learning, it fnds ideal expression in amour de soi, a state in which persons love themselves by accepting and valuing how they see themselves rather than how others perceive them. This self-acceptance depends on them loving truth as much as themselves64 and acknowledging that what they dislike about themselves is merely one (perhaps familiar) aspect of who they are, not all of themselves. These persons can then accept and maybe even approve of who they sense themselves to be and what they can try to become.

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Figure 6.2 Frida Kahlo, The two Fridas, 1939. Image, 1992. Retrieved from https://library-artstor-org.ezproxy.auckland.ac.nz/asset/ASCHALKWIJ KIG_10313992050

Figure 6.2 embodies this spirit. The double self-portrait of Frida Kahlo depicts two seated versions of the artist on a bench. They tenderly clasp hands while a bleeding vein connects and reconciles their past and present selves. Despite or because of a lonely, broken heart, they struggle inwardly to understand themselves against a stormy sky. Dripping resilience, Kahlo surgically clamps their bleeding duality to sustain their underlying union in self-love. Born from self-acceptance, this self-love is critical because, according to the psychologist Carl Rogers,65 “The curious paradox is that when I truly accept myself as I am, then I can change.” Whether real or an illusion, the self requires and is capable of acceptance because all persons are morally valuable. The sanctity of human life assures this value and its dignity. From the perspective of the Abrahamic religions, each human person is created in God’s image with specifc faculties or properties, even if they are not always evident.50,66 Therefore, throughout their lives, all persons inherently have absolute moral worth

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independent of their acts of omission or commission. Whether they have equal relative worth or value is a separate, moot point.67 Figures as different as Adolf Hitler and Nelson Mandela lack equal moral merit, but, as human beings, they share equal moral interests,59 including a love of self and the opportunity to be loved by and love others. Self-love is the only proper way for persons to relate to themselves. It is the purest source of the meaning and purpose they search for in their lives at a given moment.61 Characterized by intimacy, it is irreducibly subjective and complex. But it is not to be distrusted68 when persons cultivate it in good faith63 via a nonlinear process that motivates them to look after, nurture and harvest what they care most passionately about:58 Themselves. In so doing, they respect themselves and open the door to giving and receiving love. While it is good to love others, it is not wrong for persons to love themselves. As the great Jewish sage Hillel the Elder reputedly said in the last century of the Common Era,69 “If I am not for myself, who will be for me?” Self-interest rejects selfshness because the needs of the self do not negate others’ needs. As Hillel added, “if I am only for myself, who am I?” Thus, self-love is a structural precondition for offering and receiving love. Persons can only love others by loving themselves, which they cannot do by not loving others.70 Self-love is modelled when persons sacrifcially demonstrate selfess altruism or at least practise self-interested altruism and generalized reciprocity for the common good.71 Other philosophies such as “interbeing,” Thich Nhat Hanh’s concept of interconnectedness, bring these ideas together,72 reasserting no contradiction between self-love and love for others. Therefore, contra Calvin, Kant and Nietzsche, these forms of love are not mutually exclusive. They are inseparably connected in an expanded self-concept. However, self-love is distinctive. More fundamental than the union achieved through loving other persons, its unity extends the self.61 Self-love nurtures the inner life of persons as a gift worth offering themselves and those nearby. These others include any persons or presence whose wholeness constitutionally expands them as living systems of shared characteristics. Now I want to explore self-love in relation to self-care, including reference to loneliness.

Self-care The self is fragile. Self-love motivates persons to protect it and strive for their good. These tasks are effortful. However, rather than wait for and depend on others to liberate them,73 persons need to try to self-care.74 Through taking care of themselves, persons prevent loneliness and optimize both their physical health, through activities such as exercising and eating healthily, and psychological health, including self-love. Indeed, self-love obligates persons to self-care according to their capacity and opportunity.75 Lack of self-care contributes to conditions like loneliness, in groups such as older persons,76,77 by squandering opportunities for self-determination. It denies basic needs to develop competence, relatedness, and autonomy for optimal functioning with or without others.78

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Isolation may facilitate self-care. For example, Frida Kahlo was lonely but hopeful. She painted herself so frequently “because I am often alone and I am the subject I know best.”79 Her art provided respite by opening herself to the love and self-knowledge already present in her. Such is the backwards law. Persons feel intact by processing and accepting their limitations without necessarily approving them. For example, they avoid or let go of feeling alone by acknowledging and embracing its reality. Focusing on what they can control in themselves and their environment, they fnd meaning that reinforces their self-love. Similarly, without devaluing voluntary social interaction, persons can self-care by understanding they are enough on their own. They do not need someone else in order to feel complete because what they are looking for lies already in them. Indeed, others may prevent them being who they are. Hence, self-care comes frst, to empower them in inner dialogue80 to discern relational wholeness. With this vision, they appreciate and protect themselves to be and do what they love on their own or with others. This self-care can be represented as a healthy version of the self-love indicated by the ancient Greek concept of philautia. Beyond philia, or deep friendship, it constructs self-love as a centred wholeness that enables persons to value their uniqueness and ft into the world. Without idealizing themselves, they preserve their integrity and enliven self-care. Still, self-care benefts from friendship. Aristotle identifed self-love as the core of friendship, and the Buddhist concept of maitri denotes the unconditional friendliness of persons to themselves.81 However, persons are more than their best friend, and friendships with others, while contributing to self-care, cannot substitute for self-love. As Sigmund Freud apparently said, “friendship is an art of keeping distance while love is an art of intimacy.” In self-love, persons approve of themselves and conditions like self-aloneness, not as solid but as a transparent stream of ever-fowing perceptions and feelings that fow like water. These feelings are not facts that determine self-worth. They are a fuid phenomenon irrigating life as the mind-stream blends and stabilizes experiences into meaningful interpretations that can develop. By not taking themselves too seriously, persons liberate themselves from the certainty that aloneness makes them lonely. With humility, they orient themselves to new possibilities and use time positively. Therefore, such self-care animates what it means for persons to love themselves even in conditions that could destabilize their sense of self. They commit less to knowing than caring about themselves.82 This commitment transforms the Cartesian dictum “I think; therefore I am” into “I am because I care about myself.” Ceasing to need social relationships to validate their function and place, persons (re)create themselves. By refning and settling positive meaning in themselves in their environment, they heal states like loneliness from within, reinforcing self-love. Modern expressions of this behaviour include public self-partnering or self-marriage (sologamy), mainly by single women. This new social development honours independence as a lifestyle choice, playfully defying social stereotypes and heteronormative timelines.83 Similarly, self-care is a necessary, though not suffcient, condition for developing the capacity to love others. Without self-care, including self-compassion and self-kindness,84 persons qualify poorly to fnd love outside themselves, as noted above.

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From this perspective, self-care empowers persons to love and be loved by others as much as themselves and let others take the same attitude. However, such self-care includes self-restraint and self-responsibility.85 The innate decency of self-love is immutable and incontrovertible, removing any potential rivalry between self-love and morality. As morally signifcant beings, all persons deserve and are entitled to love themselves as a moral ideal. It is in their nature to self-care as a precursor to growing self-knowledge and self-worth. Thus, self-care is a benevolent stance that can develop over time through virtuous practices. This personal development can prevent loneliness by unifying four interrelated conditions: Self-knowledge, self-commitment, self-desire, and self-intimacy.1 Self-knowledge Self-love is based on self-knowledge, to which Socrates86 added that “the unexamined life is not worth living for man.” In Fyodor Dostoevsky’s Crime and punishment, lonely Raskolnikov would not have let his alienation from society drive him to commit a double murder if he had known himself better. Nevertheless, being closest to themselves, persons know their thoughts and feelings better than others know them and they know others, even if less well than they may believe. At the same time, there are limits to what persons can know about themselves to avoid moral and metaphysical illusions. The Delphi injunction to “know thyself” alludes to knowing the self-limitations that require acceptance.87 These constraints on persons include their past, expectations, and state of being. For example, Raskolnikov’s split personality (his name in Russian, meaning schism) stifes his ability to prevent disintegration, understand himself and take responsibility for his malevolent behaviour. Even “human reason [struggles] rationally to comprehend its own limitations.”88 Therefore, from wisdom, Socrates admitted self-ignorance, and his student Plato subsequently explained that persons live in a world whose reality is a shadow of its ideal-form. This reality is the form (or ideas) appearing in the conscious mind to which persons cannot reduce themselves. Millennia later, Johann Wolfgang von Goethe concurred89: “I do not know myself, and God forbid that I should.” The tale of Narcissus hints why. The Theban seer Tiresias prophesied that the handsome hunter Narcissus would live to old age so long as he did not come to know himself, closing a past form of existence. Despite Goethe’s wry wariness of self-knowledge, knowing oneself is a primordial drive stimulated when persons realize how opaque they are to themselves. Whilst ignorance can be bliss, self-knowledge of rejected or repressed aspects of the self is power. Expanding the boundaries of possibility, self-knowledge or selfwisdom empowers and frees persons to embrace curiosity and face uncertainty through prudence and savoir vivre. Welcoming discovery, persons become more transparent to themselves (and others). They renewably apprehend who they are and can become when no-one else is looking. Self-knowledge thus empowers them to decide in good faith to embrace the truth to which otherwise they would be blind. From self-knowledge, recalls the Buddha’s fnal message to his disciples,

106 Moving forward persons become a lamp unto themselves, illuminating their values, strengths, and limitations. Goethe believed that the path to self-knowledge was knowing the world, rather than inner contemplation. In contrast, Jung24 pressed persons rigorously to examine themselves, including the Shadow self of their dark, hidden aspects. This self-examination of buried elements, such as immoral urges, requires painstaking effort to make the unconscious conscious. Even then, as symbolized by the Ouroboros, the snake that eats its tail, self-discovery never ends and persons never fully know themselves as themselves.57 Their knowledge is conjecture.90 Still, only when persons practise coming to terms with their Shadow side can they develop self-love and empathize with and accept other persons. Accordingly, no constraint to self-knowledge should deter persons from wanting and trying to know and extend themselves as best they can. Michel Foucault91 suggested using the “technologies of the self.” Tools and practices, such as reading and writing, equip persons to confront their potential and actively constitute and master themselves as subjects. Different approaches include mindfulness as a way of life, or a particular activity like meditation.92 Mindfulness builds the ability of persons to focus on being deliberately and actively aware of experiences in the moment without judging them. Concentrating and selfregulating attention decouples it from any tendency to project negative thoughts or feelings.93 Persons decentre their attention from what being alone means to them. Decreasing emotional reactivity80 reduces their stress levels94 and aids adaptive functioning.95 Self-commitment Self-knowledge supports persons to take a decisive stance in life, which commits them to a way of being that deliberately embraces a whole-hearted, authentic existence. From a non-negotiable attitude of self-acceptance, they dedicate themselves to promoting and concretely realizing their moral interests. For example, they look to fnd meaning in their time alone by using that time to realize their potential to be distinctly themselves. To these ends, they humbly acknowledge their strengths and develop their possibilities while forgiving themselves for their imperfections. Thus, self-commitment builds on self-compassion before and through compassion for others.96 As a robust predictor of psychological health,97 self-compassion is not selfishness or self-pity. Born of weakness, self-pity embodies separation, whereas self-compassion mitigates negative, self-conscious emotions like shame and embarrassment for past or current misdeeds.98 For the sake of psychic unity and self-development, it fuses actual and desired self-idealizations. As whole beings, persons can learn to love themselves for what they strive to become, without projecting onto others what they dislike about themselves. Paradoxically, not forgiving themselves indicates they still care enough about their importance to sustain

Self-love  107 s­ elf-​­blame. If their w ­ ell-​­being is unimportant to them, then the further problem can arise that other persons and their destinies also matter very little. Radical ­self-​­love facilitates a positive s­ elf-​­orientation toward conditions such as isolation and loneliness. It does not focus on persons altogether avoiding the mistakes and failures that might have made them lonely, and nor is it tantamount to s­ elf-​­complacency. Instead, people let go of what they cannot control, such as the past, and attend to what they can control: Their attitude toward conditions like spending time alone. They can then ­self-​­apply the same gentle consideration they would show a friend,99 ­even – ​­if not ­especially – ​­when others are unkind.80 With forgiveness and hope, this s­elf-​­commitment revitalizes them by appreciating their uniqueness and strengths and doing what they believe is right at the time. They can source this behaviour from the spirit the Japanese call ­wabi-​­sabi: The quiet, satisfying understanding that life is imperfect and challenging, and their own and others’ imperfections and mistakes in life are shared and impermanent. Imperfection is not a defect but a resource, a marker of individuality. It is fragile and beautiful to embrace in everyday life because it is necessary for learning and sprouts personal growth and improvement. In these terms, s­ elf-​­commitment is an emancipatory project. In merciful, good faith, it frees persons to affirm and appreciate who they are and what they have achieved, despite and because of their limitations and mistakes. They can always invest in their relationship with themselves, recognizing how their personality and life experiences create space to live life forwards. This movement may involve setting and implementing goals that start with what they wish to change quickly to feel more ­self-​­accepting. As a counterpoint to shallow social connections, like those that tend to develop and proliferate online, this commitment to personal growth is grounded in healthy desires. For example, persons aim to manage loneliness in good faith to dignify their sense of self. As Polonius tells his son, Laertes, in Hamlet, “­To thine own self be true… Thou canst not then be false to any man.” Laertes was speaking about the importance of s­ elf-​­interest, but over time the meaning of his words has expanded to embrace a commitment to and honesty in one’s relations to oneself. As a dimension of autonomy, acting according to personal values strengthens self-commitment. In Nietzchean terms, persons transition from a camel to a lion with the courage to express their freedom and responsibility to act as they must. They take care not to betray their moral principles or allow others to define who they are and how they should act. With integrity, they embrace savoir être as an existential competence to assess who they are and “­know (­how) to be.” Although sometimes translated as interpersonal skills, savoir être is the ability of persons to commune with themselves as much as others. ­Cross-​­sectional research has found that, in American undergraduate students, such authenticity mitigates a negative relationship between loneliness and mental, physical and behavioural health outcomes.100 A possible reason is that authenticity mediates the relationship between loneliness and meaning.101 Persons

108  Moving forward gain meaning through the beautiful thinking (­or eunoia) to which authenticity is conducive. They prudently give themselves as much as they need for physical, psychological, and spiritual growth.102 ­Self-​­desire Persons love desire, no less than getting what they desire. Nevertheless, desire can control them unless what they want comes from good reasons. This healthy desire is a moral preference that may relate to something valuable missing in their lives or to opening up possibilities for improvement. The choices made are motivational when persons believe that satisfying them will terminate states like loneliness. However, loneliness may feed on wanting more than is needed or ­attainable – ​­until frustration tempers ­self-​­expectations. Paradoxically, to seize the desire to escape loneliness, persons do best to relax their grip on it. Rather than desire not to be lonely, they need to release such longing or lighten their hold on it to let life flow naturally. The pressure of attachment lessens when, rather than think effortfully about how to resist and escape loneliness, they notice what feels right for them.103 Without conscious mental will, they exercise watchful intuition104 based on tacit knowledge.105 Paradoxically, ceasing to preoccupy themselves with avoiding loneliness increases their odds of not feeling lonely. John Stuart Mill106 made the similar observation that finding happiness depends on not trying too hard and, once found, on not holding on to it so tightly that it disintegrates. Accordingly, ­self-​­desire best reduces loneliness by not focusing directly and exclusively on the ­self-​­interested negation of the loneliness. Persons need to concentrate on other intrinsically worthy activities to satisfy the innate desire for an integrated self. For example, they can restore memories and link them to the present. Inseparable from the environment, this rekindling of their whole self, like a lamp, illuminates their possibilities for personal being, including the love that, more than satisfying desire, is central to their identity. Part of love is s­ elf-​­love by persons who affirm moral values to nurture w ­ ell-​­being, climb ladders of competence, and be their best for themselves and others. Centring themselves in the moment, persons who love themselves then feel, with clarity, a sense of enlivened connectedness to the world. However, they free themselves from unreasonable, ­culturally-​­bound expectations. They stop the shame and embarrassment associated with making futile comparisons with others. This freedom conditions persons’ values and goals, including not desiring what they cannot change, since to be human is to be imperfect and experience things outside their complete control. At the same time, persons can be grateful to imagine and realize desired and achievable goals without loving themselves to excess. They can acknowledge what they achieve without clinging to success or admonishing themselves for failure. Such acceptance is not resignation or apathy. It accepts restraints on behaviour while welcoming the freedom to improve themselves amid conditions like loneliness for a healthy sense of self and ­well-​ ­being. S ­ elf-​­love constructs desire then as a balloon to hold lightly and let float

Self-love  109 to overcome the gravity of loneliness. This balloon flies above such burdens, affording a panoramic view of life as a finite experience offering opportunities for personal growth. ­Self-​­intimacy Intimacy begins within persons. ­Self-​­intimacy is a particular state of closeness that persons feel toward themselves. It is a condition of inward familiarity in which, drawing on self-knowledge, persons are willing to put themselves first. They feel safe and comfortable enough to respect and act on their moral s­elf-​ ­interests. Capable of mitigating loneliness, these interests include self-intimacy that is emotional, physical, and social. Emotional ­self-​­intimacy includes persons’ appreciation of who they are and that who they are is good enough for now. This perspective promotes ­self-​­esteem rather than negative ­self-​­talk. Instead of wallowing in ­self-​­doubt, persons trust their decisions. In touch with and belonging to themselves, they welcome what it feels like to be them. Otherwise, they risk projecting what they do not know or like about themselves onto others and feeling incapable or undeserving of love. Physical s­ elf-​­intimacy expresses this love differently. It begets a union for which persons long in order to overcome aloneness. Misconstrued by attachment theory,107 this union need not be interpersonal.108 It may involve parasocial relationships as when video players develop ­one-​­sided relationships with their avatars in console games. These imagined interactions can minimize discrepancies between who persons are and aspire to be or believe they should be109 to help love themselves (­more).110 To manage loneliness, persons may also develop through sensual proximity to themselves. For example, in perfumery, blue florals such as violet and iris reach out with aching beauty to feeling alone. Other scents help persons connect with nature to boost their mood. Examples include the w ­ oody-​­rose scent of pink pepper. More generally, sensescapes provide sensory experiences of the world. Persons discover they are always with nature that can saturate attention as an optimal experience.111 Mindfully s­ elf-​­aware, they appreciate sensations like the sun’s warmth or the comfort of clothes on their skin. They come down into and enjoy their bodies, awakening themselves to physical touch that stimulates feeling alive. They become the concocted selves they love. Indeed, the clothing brand Lonely label appeals to “­women who wear lingerie as a love letter to themselves.” This invitation connotes autoromance as an extension of physical ­self-​­love, such as autosexuality. I am using the term autosexuality to refer to a wide range of attitudes and behaviour associated with instinctual satisfaction through autoerotic stimulation. To achieve outcomes like reduced loneliness, this stimulation may be sexual, including the use of potentially solitary activities ranging from masturbation to cybersex.112 However, autosexuality also includes ­non-​­sexual practices, such as ­self-​­massage and sensual eating, which support and replenish persons’ love for themselves. Such behaviour can lift their mood in attending to and appreciating their bodies whilst indirectly experiencing pleasure from other

110  Moving forward benefits, including stress relief. From a poststructuralist perspective, autosexuality less restores wholeness to the self than reveals an “­internal otherness” because the self is “­constituted in and through its relationship to what is other to it.”113 Celibacy or sexual abstinence is a choice that some persons make to expand themselves whilst avoiding physical and psychological risks to their health from sexual activity with other persons. Accordingly, intimacy need not require other persons and is a gateway to social intimacy. Social relationships may hinder the development of ­self-​­intimacy or facilitate it by validating persons’ need to know and embrace who they are. According to CS Lewis,114 “­we need others… if we are to know anything, even ourselves.” The historian and political writer Alexis de Tocqueville similarly suggested that a castaway on a desert island is worse placed than others to achieve ­self-​­understanding and ­self-​­intimacy. However, loneliness often feels worst in the presence of other persons who, sometimes reduced to moral strangers, may appear to disapprove of them or lack the motivation to notice or care about how they feel. For example, Philip Glass’s experimental movie Koyaanisqatsi (­a Hopi word for an unbalanced life) foregrounds the sterility of the modern metropolis. Its imagery is redolent of F­ igure 4.1. Strangers move past each other without recognizing the paradox that only alone, as Arthur Schopenhauer noted,115 are they free to be completely themselves.

Conclusion Flooded with false messages about who is lovable, persons who feel lonely may believe they need others’ love because they are unworthy of s­ elf-​­love. However, this attitude is not conducive to love. Through ­person-​­centred health care, persons can create conditions conducive to ­self-​­love. Loneliness then suffocates from the positive meaning found in aloneness and transforms into solitude. S ­ elf-​­love develops as persons become aware of, accept and enact who they believe themselves to be (­becoming) rather than whom others want. Who they authentically are dwells in them rather in others with whom they may seek to connect. This awareness comes from being effortlessly present in each moment and self-caring based on developing ­self-​­knowledge, ­self-​­commitment, ­self-​­desire and self-intimacy.

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7

Solitude

This chapter discusses the concept of solitude as a healthy state of aloneness, an antidote to loneliness. Accordingly, it takes a positive attitude to periods of aloneness, including social, physical, and emotional isolation, to the extent that persons can choose their response to being alone as a state of mind. Some are happy to be alone, at least sometimes, while others fear separating themselves. Society teaches them to be afraid of isolation that contravenes social norms and expectations for togetherness, such as dining with others in public. They are assumed to require social connection and social relationships to meet a fundamental human need to survive, belong, and build communality.1 Yet, this all must change because aloneness is not inherently problematic, and asocial persons are not misfts. Nothing should be assumed wrong with persons for not having company or not wanting to pass the time with others. They may enjoy being alone to satisfy experiences such as a hunger for individual success. In cultures like Canada,2 many persons welcome their own company. Even the group-oriented “shame society” of Japan3 tolerates and has an affnity for solitude despite loneliness being a signifcant problem associated with hikikomori, severe social withdrawal, and kodokushi, solitary deaths. Japanese mainstream media promote ohitorisama, a party of one. Solo dining is widely accepted, with activities, ranging from karaoke to travel, catering for single customers. Rather than connect with poor companions or strangers,4 persons may exercise personal control through solitariness. They release themselves from the eyes of persons they know and social obligations to maintain harmonious relationships. This ability to fourish alone does not devalue social interaction,5 although persons may still overestimate the benefts of spending time with sociable others. Alone, persons can focus their attention on what interests them. Without distress, they can expand their awareness of and delight in being part of the environment to create healthy solitariness. This behaviour may be momentary or extended, as in religious and aesthetic retreats. Indeed, the same Japanese word kodoku describes solitude and loneliness. Perceptions of being continually alone vary because while some persons are “single at heart,” others like spending time on their own as an essential component of everyday living. They use this time to escape social pressures, including the ordinary and routine, and appreciate life. Meanwhile, even lonely persons can beneft from reframing their time alone.

DOI: 10.4324/9781003189879-9

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As the novelist and artist Douglas Coupland wrote, “the time you feel lonely is the time you most need to be by yourself.” Only by yourself can you choose your attitude to being alone and transmute loneliness into solitude.7 This transformation comes from understanding that the meaning given to aloneness arises within persons. They can value aloneness as solitude, a developmental milestone typically originating in infancy yet “closely related to emotional maturity.”8 Their appreciation of spending time in solitude grows as they demonstrate the courage to escape social pressure and crowds and wander mindfully alone through the unknown.9 However, even among others, they can fnd ways to take mental refuge. For example, they can choose to view their “car as a cocoon, a learning capsule.”10 Offsetting the costs associated with being alone, this preference to savour rather than fear time alone may refect “aloneliness,” the “mirror image” of loneliness. Aloneliness is defned as “the negative feelings that arise from not spending enough time alone.”11 Loneliness then need not require persons to cut their time alone. Without being excessive, the time they experience alone can be reframed as a positive state of solitude, not to be confused or confated with loneliness. This chapter explores the meaning and benefts of solitude. It suggests that beyond ameliorating how persons think about and experience their time alone, solitude characterizes this time in meaningful and productive ways. Expressed differently, the ability to live in solitude conquers loneliness. With growing independence and self-suffciency, it reveals that persons are as capable of “ultrasolitude” as of “ultrasociality,” mainly as “a product of social, not biological evolution.”12

Meaning of solitude The word solitude derives from the Latin solitudinem, meaning solitariness. It is sometimes misused as a synonym for loneliness and disparaged either as a form of poverty or for its hedonist self-indulgence of emotional sensibilities,13,14 as in Jean-Jacque Rousseau’s Reveries of the solitary walker.15 Consequently, some persons distrust solitude. In the Prologue to Thus spoke Zarathustra, an old Saint – Heilige – warns Zarathustra against returning from his mountain cave to the city to share his wisdom because “They are suspicious of solitaries and do not believe we have come in order to bestow.”16 There is also “a certain prejudice against solitude in the West.”17 It arises from the misnomer that solitude is unhealthy. The reclusive person is miscast as an outsider whose solitariness warrants pity. However, this distortion misjudges solitude. Solitude is not associated with negative personality traits, such as neuroticism,18 and is not pathological, eccentric, or a personal failing. I favour the Romantic view that solitude is a positive state. Solitude is always healthy, even in states of personal dependency like advanced age. Yet, some professional caregivers misunderstand that older adults enjoy solitude5 that does not warrant unsympathetic responses, such as disapproval and ostracism.19 For such persons who welcome solitude, choosing to continue spending time alone is less antisocial than motivated by deep needs, including spiritual

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Figure 7.1 Adriaen van der Werff. Saint Madeleine meditating in solitude, 1675–1725. Source: Wikimedia Commons.

discipline and contemplation. Figure 7.1 portrays solitude as a meaningful state of meditation consistent with self-love. The Figure symbolically resurrects health in aloneness through Mary Magdalene, the woman to whom, according to the Gospel of John (20:11–18), Jesus appeared after his resurrection. Conscious of her mortality, as represented by the skull beside her, Mary reads in “heavenly contemplation” that nourishes her alleged penitence.20 Hence, those who feel uncomfortable may beneft from spending more rather than less time alone. Nevertheless, different perspectives continue to defne solitude inconsistently. Solitude has been most often understood as a site of positive or negative aloneness.21,22 In contrast, just as I distinguish the sadness of loneliness from solitude as, always, a rewarding state of mind, Kevin Lewis23 uses the term lonesomeness to denote a similarly pleasurable but momentary mental condition. In North America, it has acquired a religious or spiritual character facilitated by solitude that need not entail disappearance from the world. Persons who leave society behind still carry its mental trappings. Retaining a sense of connection to their source society, they attend to concerns with a rejuvenated clarity of mind.24 This attention lets them contemplate their place in the

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world with wonder and humility. For example, the Trappist monk Thomas Merton favoured solitude without requiring obscurity or contradicting a love for people who welcomed his insights. Contrary to Nietzsche, Merton found that persons living “outside society have always been eagerly sought out for advice on how to live in it.”25 They rise alone to new ground from which to view life and create a healthy space of limited sociality.26 The concepts of “eco-ambiguity” and “engaged pastoral” embody this relational mindset of communing alone with nature. Arthur Schopenhauer’s27 advice was “to form the habit of taking some of your solitude into society, to learn to be alone to some extent even though you are in company.” Whether in company or not, persons can experience solitude as a satisfying state of looking inward. As in communal worship, persons can stand side-by-side. Alone together, they can be mindfully contemplative while taking comfort from nearby others who do not control them. Unafraid to be with themselves, persons savour and strengthen isolation as a sanctuary. This differentiation of solitude from loneliness is evident in everyday modern discourse. Language in daily use tends to refer to solitude “in more positive and less emotionally activated (lower arousal) contexts compared to lonely.”28 By early adolescence, many persons can perceive differences between aloneness, loneliness, and solitude.29 As a consequence, concepts such as “positive solitude”5,30 become redundant, while “anxious solitude”31,32 is a contradiction in terms since solitude is more than an absence of loneliness. It is a mental state that some persons feel intrinsically motivated to embrace with or without others.33 Spiritual retreats exemplify communal solitude in which persons live together but minimize interactions with others. A quiet space is inhabited to think, experience a sense of renewal, and be close to a spiritual presence. Moreover, although persons may experience too much solitude,34 even persons in solitude are not wholly alone.

Being alone Solitude is inseparable from relatedness because “solitude and relationship are layered and dynamically interactive states.”35 In the poem Childe Harold’s pilgrimage, the Romantic poet Lord Byron36 deduced that in solitude, “we are least alone.” Solitude is less about being alone by way of a complete absence of sociality than about valuing an inner state of being in which persons embrace themselves among non-human others and things. It includes profound and ecstatic awareness that everything is connected within and beyond the extended minds of whole persons. They cannot be separated from their lived environment, even in inner dialogue wherein “you and I” can become divided parts of nature. Hannah Arendt37 described this internal conversation as a conscious “two-in-one” dialogue. In this relational state of oneness with the world, persons welcome solitude as a friend. For example, living by himself for two years by Walden Pond in Concord, Massachusetts, the naturalist Henry David Thoreau38 remarked that he loved to be alone, without human contact, because “I have never found a companion that was so companionable as solitude.”

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Nature Nevertheless, Thoreau also recognized the concept of the solitary community in which he could enjoy being close to nature as the source of life and “live deliberately.” In this productive space, he thought deeply about society. Nature freed him from the stresses he faced in society and conditioned him to examine in solitude its critical issues in the process of reconnecting with himself as a whole person. Drawing on his memories and creating a meaningful vision of the future, Thoreau continued to revise his self-identity. He coupled with himself and distributed “others” through a kind of “self-doubling.” A resulting state of co-presence transcended his sense of self and society, adding depth to his everyday life.39,40 This experience may help to explain why contact with nature reduces loneliness, even in cities.41 In nature, persons can commune with sacred spaces. Imposing no immediate social demands, but having a positive meaning, nature may introject something with which persons have (had) or want a meaningful relationship.8,42 For example, in New Zealand, indigenous Māori are tangata whenua, the people of the land, whose spiritual and ancestral connection to nature links generations as an essential source of their identity. More generally, persons may attach unselfconsciously to places like a tranquil forest or an island landscape43 amid rejuvenating forces like beauty and uniformity.44 In the poem “Daffodils,” the speaker describes an image, penned by the poet’s wife,45 of nature’s oneness: “I wandered lonely as a cloud … [until] “I saw a crowd, A host, of golden daffodils; … [whose recollection] is the bliss of solitude”46 Other connections may form with abstract entities, such as a nation-state or divine presence, to restore spiritual life to the soul or express faith in an afterlife.47,48 This divine nature is not separate from them. Christians believe they are part of the body of Christ, who is always with them. As the Christian Neoplatonist Nicholas of Cusa put it, “God is the not-other.”49 Persons exist through this divine “not-other” that comes before everything since God lacks nothing. Nothing can be outside God. Therefore, persons differ from God in ways distinctly different from other fnite, limited things. Ultimately, because God is not-other than anything God has created, the Old Testament explains that persons need not fear feeling alone and needy, for “The Lord is my shepherd: I have all that I need” (Psalm 23:1). Indeed, persons can overcome loneliness because they are never alone (Joshua 1:9). The Lord is with them (Isaiah 41:10) and will always hold them close (Psalm 27:10) wherever they go (Joshua 1:9), without abandoning them (Psalm 94:14). Human realm Persons may similarly imagine that human others are spiritually in reach. Diogenes Laërtius paraphrased Aristotle’s observation that “a friend is another self”50

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just as, when others are nearby, lovers may experience aloneness – and solitude – as if they were “a single soul inhabiting two bodies.”51 At the same time, persons confront the impulse to maintain their integrity and the inescapable reality of their separateness. As the Japanese Tale of the Heike says, even couples “who had slept on adjoining pillows were as remote from one another as the sky.”52 Nevertheless, persons continuously strive to achieve at least temporarily a binding unity from being singularly alive in real space or even virtual space. The latter space includes the digital world and other deceased ancestors who offer a sense of continuity with the past. Clear in the last example is the projected possibility that as Rudolph Steiner,53 the philosopher, suggested in 1918, the dead are always with us in our midst, answering in our soul what we ask of it, especially on waking and falling asleep. In the same way, persons may experience “indirect or substitutive engagement”54 with various creatures, such as companion animals, that reduce loneliness.55 This beneft of pet-ownership characterizes groups, such as older women,56 for whom pets provide an unconditional source of close and embodied contact.57,58 Emotional support animals may also relieve loneliness in persons like adults with serious mental illness,59 and particular dog breeds are exceptionally affectionate. For example, think Golden retrievers, Labrador retrievers, and pugs. Meanwhile, persons may draw comfort from connecting to consequential objects or entities, such as the home that is a sanctuary, a signifcant other. As Thoreau wrote, “I have a great deal of company in the house, especially in the morning when nobody calls.”38 Nietzsche16 went further in conversing with solitude, which he called his “house” and “home.” Persons there may relish other “little solitudes” like sipping coffee, enjoying other consumer products,60 and immersing themselves in valued activities like work.61 Figure 7.2 speaks to their capacity to escape the mental prison of loneliness. Solitude can be found at home in a room without walls, a relational unity of meaning.62,63 Within places, everyday physical objects become part of their self-narrative. Persons are not alone because they form emotional bonds with these objects, including photographs, books, and transitional objects ranging from blankets to teddy bears. Edvard Munch saw his paintings as his children from which he could not stand to be separated. Through their symbolic power, such things may vicariously trigger images and profound connections to unrelated phenomena. More than substitutes for lost times or missing others, the associations imagined, for example, through creative visualization, can quieten the mind. Persons gain meaning from a sense of comforting order in exercising their minds. They entertain happy memories and fctions to envision their higher self and what they really want. Boundaries between the real and unreal, nevertheless, are blurring. For example, virtual reality is creating increasingly credible computerized facsimiles. People can come to personify and identify with pet-centred online activities,64 animatronic pets,65,66 and social robots onto which they project feelings of companionship and reduce loneliness. In transforming the nature of intimacy, technological advances in artifcial agents may even source loneliness-relieving erotic

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Figure 7.2 Antonello da Messina, Jerome in his study, circa 1474. Source: Wikimedia Commons.

sensuality.67 When fantasy crosses into auto-eroticism, persons may self-satisfy sexual desire through tools like adult toys. Open marketing on the Internet stimulates their mainstream use.68 New options to develop relationships with machines include human-like, full-body sex dolls and sex robots with artifcial intelligence. Within cyborg anthropology,69 critics70 warn that human simulacra risk posthuman objectifcation. Any fantasy can degenerate into “fantasy loneliness” from not being in touch with reality.71 However, positive affect in imagining object relations can facilitate solitude. For example, as sexuality becomes increasingly open to interpretation, humanoid “allodolls” introduce the possibility of intimacy via nonsexual roles. Companionship and parasocial relationships can form with humanized

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devices as if they were persons. With no fxed ties, emotional closeness (confuent love74) redefnes intimacy beyond duties associated with romantic love. In this context, scholarship explores whether animated, customizable robots exacerbate social withdrawal or have therapeutic value.75 For example, they could enable experimentation with new plastic forms of relationality.76 There is scope for robots to facilitate solitude in particular groups, such as persons who are disabled, old, or both.77 Imagination here is at play in conditioning relationships, whether with nonhumans or other human beings, such as media characters.78 Although this fctional emotional engagement can lead mental simulations to override reason, the relationships imagined with themselves and others (who are not in a relationship with them) avert risks, such as rejection. The illusory relationships with social surrogates can defuse feelings of loneliness when productive, real interactions are unavailable.79 One reason is that, as Donald Kaufman explains to his brother Charlie in the movie, Adaptation, “you are what you love, not what loves you.” Persons reframe their time alone as a one-sided state of independence freeing and flling their minds with creative possibilities. Their imagination becomes an inward eye with which, alone, they envision themselves in a state of connectedness. They may even lose time to become what they see and do through a daydreaming state of psychological fow.80 The same state emerges when artists, for example, become one with their work. Communing with characters, writers experience solitude on their own but not alone, since they create a “locale wherein the artist seeks objects, engages with them, and sometimes even reenacts reunion with them.”81 This art can take various forms, which Carl Jung called active imagining, through creative processes like painting and writing. As Franz Kafka35 concluded, “one can never be alone enough when one writes.” When writers write, their language is skin. Its words are like fngers that rub against the desired other.82 They may fasten or push apart, as when self-love requires this writing to lay others to rest. Recall Sylvia Plath’s Daddy, in which the poet metaphorically kills her deceased father to break symbolically free from his oppressive shadow. “Daddy,” she writes, “I have had to kill you.” He dies inside of her so she may live … even though four months later, living meant joining him in death, exorcizing his death as a sacrifcial victim at her own hands.

Benefts of solitude I now wish to discuss the benefts of solitude as a goal-directed, adaptive experience that persons can choose and control to resolve loneliness. These benefts attach value to time spent outside social contexts. I shall focus, in turn, on six overlapping benefts: Freedom, inner peace, empowerment, self-attunement, creativity, and communion. Freedom Solitude is liberating. Emily Dickinson is often identifed as someone who found it so. There is an anecdote that on taking her young niece to the second-foor, corner

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bedroom of her Amherst home – where she wrote most of her 1,775 poems – she mimed locking the door from the inside with an imaginary key before explaining, “Matty, here’s freedom.”83 Virginia Woolf84 would have understood. Her extended essay, A room of one’s own, explains women’s need for their own private space, with lock and key, to liberate their intellectual potential from stifing, gendered expectations. The same need intersects with other social conditions such as childhood,85 a developmental period when social disadvantage can stop solitude from supporting two forms of freedom that fow through life. The frst freedom is from the gaze and demands of powerful others. Beyond this negative freedom, solitude facilitates the second, positive freedom to be whom one is and do what one wants. Schopenhauer27 remarked that persons could be completely themselves only when alone. The reason, Leonardo da Vinci86 had explained, is that “If you are alone, you belong entirely to yourself.” You are at liberty to continue to explore, discover, connect to, and appreciate who you are (becoming) and can accomplish on your own (see Chapter 6).87 Like Wordsworth’s lonely cloud, solitude then is a state of natural freedom whose positive possibilities give cause to restore the heart to contentment and pleasure. Persons are free to value the time they spend alone, and choose solitude. For example, the Buddhist nun Tenzin Palmo opted in 1976 to live alone in a remote mountain cave in the Himalayas for 12 years, including three in complete isolation. She reports, “I wasn’t lonely in the cave. I was lonely when I lived in the community” because “if one is relating with others, then one is relating within a role.”88 In solitude, away from contact with other persons, she escaped the expectations associated with social roles and identities. Palmo thrived in her spiritual practice, valuing freedom from external interference. Nietzsche89 similarly explained, “That is why I go into solitude, so as not to drink out of everybody’s cistern. When I am among the many, I live as the many do, and I do not think as I really think.” Solitude helps persons act on intrinsic motivation. For example, they can pursue education and leisure, snatching the time to read alone for themselves. What they read becomes their companion in expanding their apprehension of the world through inner dialogue. However, while some writers, such as Stephen King, write to discover what they think, the persons who read a lot may risk losing the ability to think for themselves.90 Readers need to think about what they read. They may use this thinking, for example, to learn a craft whose development over time can be expected to increase their enjoyment of it. For example, they may write or indulge in activities like listening to or playing music.91 As a social surrogate, music may provide a sense of empathic companionship.92 In freeing persons as moral agents, solitude enables them to be happy and fourish. They act in good faith to avoid social conformity and create and be themselves in ways that respect their self-esteem.54 Inner peace In Ode on solitude, Alexander Pope93 explained that the bliss of solitude is a blessing for persons in “peace of mind.” The preference of the young poet

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for a quiet, simple life, disconnected from social demands, seems ever more understandable today. Modern life is fast-paced and stressful. Work pressures and family responsibilities easily overstimulate and overwhelm persons in timetabling effortful thinking.94 Solitude offers respite and solace. It is a restful space, typically of silence and stillness, in which persons can be with themselves, clear the mind and fnd within what the Stoics – most notably Marcus Aurelius – called their “inner citadel” or soul.95 This stronghold frees them of the interruptions taking place outside its walls so that, as the Victorian poem Invictus explains,96 “I am the master of my fate/I am the captain of my soul.” Courageously responding to the amputation of his lower leg, the poet affrms that persons can stand back from life’s storms and stop struggling against them in a sanctuary where high arousal emotions, such as stress, drift away. Affective self-regulation frees them to open their mind to recharge97 and follow one of two paths. The frst involves spending time in quiet meditation or undistracted contemplation. Caspar David Friedrich’s later allegorical landscape paintings exemplify such introspection. They depict often-solitary fgures thinking deeply about something. Persons immerse themselves in nature to discipline internal chatter, free their spirit, and befriend silent awareness. They connect with and come to their senses, literally and fguratively. The Aboriginal concept of dadirri, deep listening, illustrates this refective practice. Listening to the spirit of the land, persons tap into “that deep spring inside” them to bring together every part of their being.98 More than being in nature (Figure  7.1), they become one with nature. Figure  7.3 depicts how post-Second World War photographer and “peace correspondent”99 Édouard Boubat gave composed presence to this experience. He depicts young Rémi listening, with closed eyes, to what sounds like the sea in a shell almost too large for him to hold. One recognizes the boy’s enchanted fnding of “Mysterious union with his native sea/Even in such a shell the Universe itself/Is to the ear of Faith.”100 Dadirri allows persons to attend to the now or some other time, bridging time.101 In that sense, it differs from mindfulness, appropriately so, according to Sadhguru, the Indian yogi, because mindful presence neglects memories (the past) and imagination (the future). Therefore, Titian’s Allegory of prudence looks to conserve the past, know the present and foresee the future. It recognizes persons as historically situated beings.102 Their experiences, revealed Marcel Proust,103 are not tied to time. Their potentiality obligates them to project themselves and seize possibilities to act in the future. Hence, one reason for contemplation is understanding and preparing for these projective possibilities. The second path requires persons to clear their minds and free themselves from interest in thoughts. Contrary to the misnomer of mindfulness, the mind is emptied. When thoughts arise, persons do not follow them. Instead, they choose to allow their thinking to subside, if not disappear entirely. Letting go of their thinking frees them to be inwardly conscious so that fully present they notice sense perceptions and attend in peace to the voice of their body, its feelings and sensations. Consequently, they stop confusing these inputs with distracting signs

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Figure 7.3 Édouard Boubat. Rémi listening to the sea, 1995. Source: Wikimedia Commons.

and return to reality. For example, a choice to reconnect with nature takes priority over photographs that Susan Sontag104 suggested can lie and imprison reality. This recoupling helps persons feel alive from a sense of belonging that provides emotional release from loneliness. The emptiness of their time alone ceases to be a space to fll. It becomes something that gifts them an awareness of their place in life. As discussed in Chapter 6, the concepts of vā and ma embody this constitutional sense of space whose mukayu (richness in emptiness) denotes its natural value. Thus, persons can appreciate solitude’s power to relieve negative affect even in confictual social networks.105 They accept their aloneness without needing to understand it or feeling lonely because, as Franz Kafka, the novelist, reputedly stated, “…become quiet, and still, and solitary. The world will freely offer itself to you to be unmasked. It has no choice; it will roll in ecstasy at your feet.” With a focus of attention and heightened awareness and mental clarity, persons notice (perhaps for the frst time) what others may overlook beneath the surface of everyday life, including the fact everything is connected. Another Japanese concept, yugen, describes this sense of unseen beauty. From subtle awareness of the unseen, persons expand their possibilities and deepen appreciation of the taken-for-granted. The Navajo word hozh’d expresses this feeling of wholehearted

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appreciation. It speaks to a relaxed state where each person appreciates the world’s beauty to feel more like themselves. Empowerment Solitude distances persons from social norms that sap the spirit. Empowered to disengage from unhealthy attitudes toward isolation, the weight-bearing camel (as Nietzsche put it) becomes a lion.16 The lion becomes inner-directed and acquires the strength to reshape its cognition and, with personal integrity, its sense of identity. Solitude energizes rather than drains the lion. Free from external pressures and constraints, it “gains strength,” explained Laurence Sterne, the Anglo-Irish novelist and cleric, “and learns to lean upon itself.” In this condition, leonine persons become robust enough to accept what they are – alone106 – and, in that heroic acceptance, appreciate themselves being alive on their own. Realizing what they have missed in themselves and others, they see the bigger picture and boldly choose to face the world by cultivating independence. As Schopenhauer explained, “To be self-suffcient, to be all in all to oneself … to be able to say omnia mea mecum porto [everything I have, I carry with me’] … is assuredly the chief qualifcation for happiness.” Consequently, persons need consciously to accept responsibility to be selfmaking moral agents.37 With inner resourcefulness and self-reliance, they do not let life control them. They manage it on their terms, pursuing their passions. Engaging in challenging life projects, they uncover hidden aspects of self-identity and redesign their lives. They may take innovative and creative approaches to solve problems, increase productivity and add value every day. Paradoxically, through self-development and respecting the freedom of others to manage without them, they even become capable of developing rich social lives.107 Self-attunement Solitude, therefore, is a sublime condition in which persons are unafraid to spend time on their own. Rather than resist this time, they use it to ponder and recentre themselves. Mindfully taking time out,97 they shed outside distractions. They disengage from other persons and focus on reconnecting to aspects of their lives they usually disregard. In this process of self-resuscitation, they regulate their attention and emotions.108 Reducing negative and positive high arousal affects, they deactivate affective experiences108 to refect on taken-for-granted beliefs and explore dimensions of themselves, including their shadow side. Confronting “dark aspects of the personality as present and real”109 can be self-transforming. Yet, in making immorality conscious and familiarizing oneself with it, “one always has a chance to correct it.”110 In learning to accept and know the parts of themselves they don’t want to admit, persons achieve the maturation and healing to integrate their shadow with the rest of themselves. In this state of wholeness and solidity, they become content in their own company even under dismal circumstances. Thus, according to Albert Camus,111 Sisyphus happily

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accepted the absurdity of his unending struggle to roll a rock up a mountain only to have it fall back of its weight. He strengthened his character and reshaped his identity in creative rebellion against life’s vicissitudes.112 Creativity According to Edward Gibbon, the 18th-century English historian, “conversation enriches understanding, but solitude is the school of genius.” Solitude fertilizes creativity and productivity by creating space for the mind to reach out for meaning. Persons become free to practise self-artistry and generate outputs for others as much as themselves. For example, Gustave Courbet drew inspiration to paint what he could see when walking alone in the forest of his birthplace Ornans. In this landscape, he withdrew into himself. He used pensive solitude as an innerdirected experience113 to create art that reproduced the qualities of introversion and absorption while celebrating the Franche-Comté. Yet, there is scope to highlight further the porosity of the boundary between solitude and creativity. Solitude is creativity. Just as the recent (Muon g2) particle physics experiments indicate that space is not truly empty, so too does the time that persons spend alone contain sparks of potentiality. Lack of social stimulation frees the mind to energize the natural fow of these virtual excitations into surges of inspiration. Similarly, sexual transmutation allegedly rechannels sexual energy into creative energy.114 Under such conditions, the mental downtime of solitude is a creative state in which effortless action is naturally energetic. The Taoist concept of wu wei expresses this principle. It emphasizes how effortless action in solitude generates original ideas, respectful of instinct. The Vedic principle of economy of effort resonates with this notion of accomplishing more by doing less in situations of acceptance and defencelessness.115 Resulting undeliberate ideas “are like goddesses who appear only to the solitary mortal.”116 Solitude breeds them by forging the space and stillness needed to stimulate the brain’s default mode network in memory, self-knowledge, and self-refection. Via leisure and from a state of wakeful rest, increased activity in this large-scale network increases activity in the neural circuits associated with imagination.117 Without being aware of thinking, the mind drifts. Automatic (system 1) thought processes unconsciously take place. They include intuition as a direct form of knowledge that, suggested the philosopher Henri Bergson,118 is absolute. Contra Immanuel Kant, 119 it goes in the same direction of life by enabling persons to know the world as it essentially is. From system 1 thinking, the most salient ideas pass simultaneously to the brain’s executive control network to evaluate.120 Solitude facilitates this increased functional connectivity between brain networks. Under these conditions across the lifespan, persons grow their self-concept without really trying. They achieve self-transformation, for example, by learning or practising a musical instrument or immersing themselves in novel work projects to solve challenging problems effciently. Creativity may also facilitate reminiscence, internalize the presence of supportive others, or access an outer-directed higher level of consciousness of the world’s sacredness.121

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Fundamental to the imagination and creative activity is daydreaming, a private state of fantasy where people lose or lighten control and experiment with the unknown. They temporarily shift their attention from the external environment toward internal mentation and the soul. Thoughts wander spontaneously in short vacations and incubate in an ongoing, playful stream of artful consciousness. Although this inner monologue can distract persons from essential tasks at hand, its energy can facilitate adaptive coping. It frees persons to grapple with concerns and unfnished goals by reimagining things, such as how to spend time alone. Approximately threequarters of respondents to a survey on the New York Times TiernyLab science blog reported that others “frequently” or “always” form part of their daydreams when alone with their thoughts.122 The fantasies about signifcant others make persons feel less alone. It transforms their loneliness into solitude by replenishing social connectedness in the mind122,123 and stimulating a sense of life satisfaction.31 Communion While loneliness is a spiritual condition, solitude can help persons become spiritually aware. Like the Khaggavisana Sutta’s lone Rhino in the forest, they can use solitude to escape unhealthy attachments and fnd enlightenment wandering alone, literally and metaphysically. Their solitude may even be considered part of a cosmic plan that fulfls the need of each person to engage closely with and become something larger than themselves. As a peak experience, this transcendence ministers to “the radical inadequacy of their personal existence.”124 It expands them or occurs in them to make room for the world.125 According to Hermann Hesse’s126 Refections, persons discover in solitude that their “innermost self is the spirit, that it is God, the indivisible.” Neville Goddard127 similarly suggested God is not Other since “I and my father are one” (John 10:30). Solitude facilitates this quasi-mystical, spiritual discovery as part of, or independent from, organized religion. Time alone becomes awe-full rather than awful in transporting persons deep into and beyond their conscious selves.128 This self-transcendence may come through practices ranging from meditation and prayer to enjoying music, art and food. As Daniel Defoe’s castaway novel Robinson Crusoe illustrates, persons free themselves to use resources, like religious faith and gratitude for what is at hand, to make it abundant, survive, improve themselves and fourish against the odds. Purged of his sinful nature, Crusoe was “more happy in this solitary condition than I should have been in the liberty of society.”129 Nietzsche130 similarly observed that solitude “is a sublime inclination and impulse to cleanliness which shows that contact between people (“society”) inevitably makes things unclean.” And spiritual communion can facilitate this cathartic state through solitude that helps persons appreciate and give direction to the time they choose or not to spend alone. They awaken themselves to create meaning and purpose in their aloneness. They attend fully to this meaning to fnd and care for themselves as part of the vastness of abstract entities like humanity, nature and an immaterial, spiritual essence, such as a soul.

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The soul is “the source and coordinating principle of the individual life.”131 Solitude, a word that derives from “soul-mood,” uplifts the soul. It is an ecstatic respite for a person’s soul, whose communion132 – as part of the soul of the world, anima mundi – heals the separation of the body from the soul. Persons become less lonely in constructing a world that reanimates things since a world that lives with a soul admits respect and care in every aspect of life.133 Solitude, then, signifes an intimate connection with the cosmos or spirit-world. It opens and quietens the mind by temporarily closing it to sensual activity. As described in the Zhuangzi, an ancient Taoist text, this “fasting of the heart” (the centre of human cognition for the ancient Chinese) removes self-awareness. It lets go of a desire and expectation to fll the void of aloneness. Celebrating what is present, it stops yearning for what is absent or missing and releases the need to exercise control until, explains the Tao te ching, the “mud settles, and the water is clear.”134 Nothing then disturbs the connection with the all-encompassing force of the Tao. This state of true self-transcendence reduces persons to a satisfying and complete sense of oneness. Losing consciousness of themselves, persons fnd that loneliness dissolves in a solution of love. This loss of self-consciousness expands them, or it contracts them to make room for and overcome time alone in a state of inner unity, a sense of otherness.125 Alternatively, persons may experience a state of pseudo-transcendence that, without restoring wholeness, allows them to channel-switch. Through experiences such as fow,80 aesthetic transcendence and dissociation,135 they shift their focus from the immediate experience of being alone and lose themselves in the intimacy of their inner world, as if in an Edward Hopper painting. These psychological states of transcendence and pseudo-transcendence facilitate a harmonious condition of artful and spiritual peace that surrenders rational control. In taking the time to engage the subliminal mind, experience equanimity, and become conscious of the infnite, persons replace loneliness with solitude. Proverbs (18:1) states that “Whomever isolates himself (sic) seeks his own desire; he breaks out against all sound judgment.” Yet, solitude is an unselfsh commitment to serving the world in groups such as cloistered nuns and monks.136 Rewarding in itself rather than compensating for a loss or lack of relationships with others, it elevates life. Persons need to develop an emotional capacity for solitude since loneliness may be less problematic than having too little solitude.137

Conclusion Spending some time alone need not be a problem for persons. Indeed, it is an opportunity for them to move from loneliness to solitude. This chapter has discussed the meaning of solitude and it potential to treat loneliness. It has distinguished solitude as always a healthy state of being in which persons are not wholly isolated. Scope for relatedness to themselves and non-human others and things infuses their time alone. The many benefts of solitude in nature and the human realm

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were suggested to include freedom, inner peace, empowerment, self-attunement, creativity, and communion. The next chapter expands on how solitude depends on and facilitates privacy as a component of personal freedom.

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41 Hammoud R, Tognin S, Bakolis I, et al. Lonely in a crowd: Investigating the association between overcrowding and loneliness using smartphone technologies. Scientifc Reports. 2021;11(1):1–11. 42 Bowlby J. Attachment and loss: Vol. 1 Attachment. New York: Basic Books; 1982. 43 Brinklow L. The island mystic/que: Seeking spiritual connection in a postmodern world. In: The changing world religion map: Sacred places, identities, practices and politics. Dordrecht: Springer; 2015. Pp. 97–113. 44 Macho T, Rashof S. Alone with oneself: Solitude as cultural technique. Angelaki – Journal of the Theoretical Humanities. 2021;26(1):9–21. 45 Woodmansee M. The cultural work of copyright: Legislating authorship in Britain, 1837–1842. In: Kearns T, Sarat A, eds. Law in the domains of culture. Baltimore, MD: University of Michigan; 2000. Pp. 65–96. 46 Wordsworth W. Daffodils. In: Curtis J, ed. Poems, in two volumes, and other poems, 1800–1807. Ithaca, NY: Cornell University; 1983. 47 Epley N, Akalis S, Waytz A, Cacioppo JT. Creating social connection through inferential reproduction: Loneliness and perceived agency in gadgets, gods and greyhounds. Psychological Science. 2008;19:114–120. 48 Lamb C, Evans M, Babenko-Mould Y, Wong C, Kirkwood K. Conscience, conscientious objection, and nursing: A concept analysis. Nursing Ethics. 2019;26(1):37–49. 49 Hopkins J. Nicholas of Cusa on God as not-other: A translation and appraisal of De Li Non Aliud. Minneapolis, MN: Arthur J Banning Press; 1987. 50 Aristotle. The Nicomachean ethics. London: Kegan Paul; 1893. 51 Laërtius D. The lives and opinions of eminent philosophers. London: G Bell and sons; 1901. 52 McCullough HC. The tale of the Heike. Stanford, CA: Stanford University Press; 1990. 53 Steiner R. The dead are with us. Forest Row, Sussex: Rudolf Steiner Press; 2006. 54 Koch P. Solitude: A philosophical encounter. Chicago, IL: Open Court; 1994. 55 Powell L, Edwards KM, McGreevy P, et  al. Companion dog acquisition and mental well-being: A community-based three-arm controlled study. BMC Public Health. 2019;19(1):1428. doi: 10.1186/s12889-019-7770-5. 56 Pikhartova J, Bowling A, Victor C. Does owning a pet protect older people against loneliness? BMC Geriatrics. 2014;14:106. doi: 10.1186/1471-2318-14-106. 57 Gilbey A, Mcnicholas J, Collis GM. A longitudinal test of the belief that companion animal ownership can help reduce loneliness. Anthrozoos. 2007;20(4):345–353. 58 Petersen E, Fiske AP, Schubert TW. The role of social relational emotions for humannature connectedness. Frontiers in Psychology. 2019;10. doi: 10.3389/fpsyg.2019.02759. 59 Hoy-Gerlach J, Vincent A, Scheuermann B, Ojha M. Exploring benefts of emotional support animals (ESAs): A longitudinal pilot study with adults with serious mental illness (SMI). Human Animal Interaction Bulletin 2021;10(2):1–19. 60 Wang X, Sun Y, Kramer T. Ritualistic consumption decreases loneliness by increasing meaning. Journal of Market Research. 2021;58(2):282–298. 61 Diaz I, Chiaburu DS, Zimmerman RD, Boswell WR. Communication technology: Pros and cons of constant connection to work. Journal of Vocational Behavior. 2012;80(2):500–508. 62 Cutchin MP. The complex process of being at-home in assisted living. In: Rowles GD, Bernard MA, eds. Environmental gerontology: Making meaningful places in old age. New York: Springer; 2013. Pp. 3–18.

134 Moving forward 63 Tuan Y-F. Topophilia: A study of environmental perception, attitudes, and values. New York: Columbia University Press. 64 Zhou Z, Yin D, Gao Q. Sense of presence and subjective well-being in online pet watching: The moderation role of loneliness and perceived stress. International Journal of Environmental Research and Public Health. 2020;17(23). doi: 10.3390/ijerph17239093. 65 Tkatch R, Wu L, MacLeod S, et  al. Reducing loneliness and improving wellbeing among older adults with animatronic pets. Aging and Mental Health. 2021;25(7):1239–1245. 66 Hudson J, Ungar R, Albright L, Tkatch R, Schaeffer J, Wicker ER. Robotic pet use among community-dwelling older adults. Journals of Gerontology Series B-Psychological Sciences and Social Sciences. 2020;75(9):2018–2028. 67 Tutter A. The erotics of knowing: A neglected contribution to analytic eroticism. Journal of the American Psychoanalytic Association. 2018;66:407–441. 68 Döring N, Pöschl S. Sex toys, sex dolls, sex robots: Our under-researched bed-fellows. Sexologies. 2018;27(3):e51-e55. 69 Haraway D. A cyborg manifesto: Science, technology, and socialist-feminism in the late 20th century. In: Weiss J, Nolan J, Hunsinger J, Trifonas P. eds. The international handbook of virtual learning environments. Dordrecht: Springer; 2006. Pp. 117–158. 70 Richardson K. Sex robot matters: Slavery, the prostituted, and the rights of machines. IEEE Technology and Society Magazine. 2016;35(2):46–53. 71 Rolheiser R. The restless heart. London: Hodder and Stroughton; 1979. 72 Langcaster-James M, Bentley GR. Beyond the sex doll: Post-human companionship and the rise of the ‘allodoll.’ Robotics. 2018;7(4):62. 73 Giddens A. The transformation of intimacy. Sexuality, love and eroticism in modern societies. Cambridge: Polity Press; 1992. 74 Bauman Z. Liquid times: Living in an age of uncertainty. New York: Wiley; 2007. 75 Eichenberg C, Khamis M, Hübner L. The attitudes of therapists and physicians on the use of sex robots in sexual therapy: Online survey and interview study. Journal of Medical Internet Research. 2019;21(8). doi: 10.2196/13853. 76 Viik T. Falling in love with robots: A phenomenological study of experiencing technological alterities. Paladyn. 2020;11(1):52–65. 77 Cox-George C, Bewley S. I, sex robot: The health implications of the sex robot industry. BMJ Sexual and Reproductive Health. 2018;44(3):161–164. 78 Horton D, Richard Wohl R. Mass communication and para-social interaction: Observations on intimacy at a distance. Psychiatry. 1956;19(3):215–229. 79 Derrick JL, Gabriel S, Hugenberg K. Social surrogacy: How favored television programs provide the experience of belonging. Journal of Experimental Social Psychology. 2009;45(2):352–362. 80 Csíkszentmihályi M. Creativity: Flow and the psychology of discovery and invention. New York: Harper Collins; 1996. 81 Heller E, Born J, eds. Letters to Felice. F. Kafka. New York: Shocken; 1973. 82 Barthes R. A lover’s discourse. New York: Hill and Wang; 1978. 83 Rich A. Vesuvius at home. Parnassus Poetry in Review. 1976;5:49–74. 84 Woolf V. A room of one’s own. London: Hogarth Press; 1946. 85 Palludan C, Winther IW. ‘Having my own room would be really cool’: Children’s rooms as the social and material organizing of siblings. Journal of Material Culture. 2017;22(1): 34–50. 86 Da Vinci L. The notebooks of Leonardo da Vinci. Vol 1. New York: Dover; 2012.

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87 Buchholz ES, Catton R. Adolescents’ perceptions of aloneness and loneliness. Adolescence. 1999;34(133):203–204. 88 Cave in the snow – Buddhism documentary; 2018. Available at: https://www.youtube. com/watch?v=sQMLYJEX4wM. Accessed 20 January 2022. 89 Nietzsche F. Daybreak: Thoughts on the prejudices of morality. Clark M, Leiter B, eds. Hollingdale RJ, trans. Cambridge: Cambridge University Press; 1997. 90 Schopenhauer A. On reading and books. Parerga and Paralipomena. 1851:554–564. 91 Berlin I. Two concepts of liberty. In: Hardy H, ed. Isaiah Berlin. Liberty. Four essays on liberty. Oxford: Oxford University Press; 1969. Pp. 118–172. 92 Schäfer K, Saarikallio S, Eerola T. Music may reduce loneliness and act as social surrogate for a friend: Evidence from an experimental listening study. Music and Science. 2020;3. doi. 10.1177/2059204320935709. 93 Rawson C, ed. Pope: Poems. New York: Alfred A Knopf; 2018. 94 Storr A. Solitude: A return to the self. New York: Simon and Schuster; 2005. 95 Aurelius M, Gill G. Meditations. Oxford: Oxford University Press; 2011. 96 Henley WE. Poems. Glasgow: Good Press; 2019. 97 Nguyen TT, Ryan RM, Deci EL. Solitude as an approach to affective self-regulation. Personality and Social Psychology Bulletin 2018;44(1):92–106. 98 Atkinson J. Trauma trails: Recreating song lines. North Melbourne: Spinifex Press; 2002. 99 Chalifour B. Edouard Boubat for press freedom. Afterimage. 2003;30(5):12. 100 Bushell S, Butler J, Jaye M, eds. The excursion, by William Wordsworth. Ithaca, NY: Cornell University Press; 2007. 101 Moustakas C. Loneliness and love. Englewood Cliff, NJ: Prentice-Hall; 1961. 102 Vanlaere L, Gastmans C. A personalist approach to care ethics. Nursing Ethics. 2011;18(2):161–173. 103 Proust M. In search of lost time. London: Chatto and Windus; 1992. 104 Sontag S. On photography. Vol 48. New York: Picador; 1973. 105 Birditt KS, Manalel JA, Sommers H, Luong G, Fingerman KL. Better off alone: Daily solitude is associated with lower negative affect in more confictual social networks. Gerontologist. 2019;59(6):1152–1161. 106 Tillich P, Tillich P. The eternal now. New York: Scribner; 1963. 107 Klinenberg E. Going solo: The extraordinary rise and surprising appeal of living alone. New York: Penguin; 2013. 108 Liu X, Xu W, Wang Y, et al. Can inner peace be improved by mindfulness training: A randomized controlled trial. Stress Health. 2015;31(3):245–254. 109 Jung CG. Aion: Researches into the phenomenology of the self. London: Routledge; 2014. 110 Jung CG. Psychology and religion. New Haven, CT: Yale University Press; 1960. 111 Camus A. The myth of Sisyphus. London: Penguin UK; 2013. 112 Simon E. The myth of Sisyphus: Renaissance theories of human perfectability. Madison, WN: Fairleigh Dickinson University Press; 2007. 113 Bowker JC, Stotsky MT, Etkin RG. How BIS/BAS and psycho-behavioral variables distinguish between social withdrawal subtypes during emerging adulthood. Personality and Individual Differences. 2017;119:283–288. 114 Roustang F. Sublimation: Necessity and impossibility. In Dufresne F, ed. Returns of the French Freud: Freud, Lacan, and Beyond. New York: Routledge; 2013. Pp. 25–34. 115 Chopra D. The seven spiritual laws of success – One hour of wisdom: A pocketbook guide to fulflling your dreams. San Raphael, CA: Amber-Allen Publishing; 2010.

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116 Proust M, Scott-Moncrieff CK, Enright DJ. Time regained. Vol 6. New York: Random House; 1996. 117 Spreng RN, Dimas E, Mwilambwe-Tshilobo L, et  al. The default network of the human brain is associated with perceived social isolation. Nature Communications. 2020;11(1): 1–11. 118 Bergson H. Creative evolution. London: Electric Book Company; 2001. 119 Kant I. Critique of pure reason. New York: Willey Book Co.; 1899. 120 Beaty RE, Kenett YN, Christensen AP, et al. Robust prediction of individual creative ability from brain functional connectivity. Proceedings of the National Academy of Sciences of the United States of America. 2018;115(5):1087–1092. 121 Long CR, Seburn M, Averill JR, More TA. Solitude experiences: Varieties, settings, and individual differences. Personality and Social Psychology Bulletin. 2003;29(5):578–583. 122 Poerio GL, Totterdell P, Emerson L, Miles E. Helping the heart grow fonder during absence: Daydreaming about signifcant others replenishes connectedness after induced loneliness. Cognition and Emotion. 2016;30(6):1197–1207. 123 Poerio GL, Smallwood J. Daydreaming to navigate the social world: What we know, what we don’t know, and why it matters. Social and Personality Psychology Compass. 2016;10(11):605–618. 124 Evans J. The art of losing control. Edinburgh: Canongate; 2017. 125 Rotenberg M. The psychology of Tzimtzum. Jerusalem: Maggid Books; 2016. 126 Hesse H. Refections. New York: Farrar, Straus and Giroux; 1974. 127 Goddard N. Feeling is the secret 1944. Hawthorne, CA: BN Publishing; 2005. 128 Andrews SE. From awful to awe-full: Easing the discomfort of uncertain waiting periods. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2017;78(5-B(E):Sefe. 129 Defoe D. Robinson Crusoe. New York: Open Road Integrated Media; 2014. 130 Nietzsche FW. The complete works of Friedrich Nietzsche: The frst complete and authorized English translation. Vol 15. Edinburgh: TN Foulis; 1924. 131 Willard D. Spiritual disciplines, spiritual formation, and the restoration of the soul. Personality and Social Psychology Bulletin. 1998;26(1):101–109. 132 Metcalfe AW. Solitude as a community of difference. Journal of Spirituality in Mental Health. 2013;15(1):3–18. 133 Moore T, Thomas P. Care of the soul. New York: Harper Collins Publishers; 2005. 134 Hinton Dt. The four Chinese classics: Tao Te Ching, Chuang Tzu, Analects, Mencius. Berkeley, California: Counterpoint; 2013. 135 Buetow S. Rethinking pain in person-centred health care: Around recovery. Oxford: Routledge; 2021. 136 Durà-Vilà G, Leavey G. Solitude among contemplative cloistered nuns and monks: Conceptualisation, coping and benefts of spiritually motivated solitude. Mental Health, Religion and Culture. 2017;20(1):45–60. 137 Svendsen L. Philosophy of loneliness. London: Reaktion Books; 2017.

8

Privacy

Solitude and privacy overlap and exhibit similar features. Both concepts refer to being-apart-from-others1 in spaces that persons value and deliberately aim to maintain.2 However, solitude and privacy also differ in signifcant ways. Solitude is a condition of healthy aloneness in or without others’ felt presence. In contrast, privacy temporarily frees persons from unwanted observation and public disclosure of certain aspects of their lives.3 Solitude typically trusts in privacy, yet persons can experience solitude without privacy when content to be alone in public places. For example, persons may enjoy dining alone in public or buying a single movie ticket. Meanwhile, some persons value personal privacy as a relatively recent concept. They fear others’ negatively judging them if they lose privacy. This chapter discusses personal privacy as an increasingly vulnerable form of solitude to protect in the battle against loneliness. However, the debate between privacy and openness is not a zero-sum game.4 Social restrictions on privacy can beneft individuals and society. Individuals beneft, for example, through convenient access to personalized recommendations for services and commodities.5 Meanwhile, limits on privacy may protect other moral interests, such as national security, corporate effciency, and the public health. For example, government authorities may give out sex offender registry information directly to the public (as in the United States) or only to authorized personnel (as in New Zealand) to safeguard the offender and community from the risk of anti-social behaviour.6 Public trust in criminal justice systems commonly mediates individuals’ evaluation and acceptance of some loss of personal privacy for the public good.7 The protection of privacy can also undermine a social order rooting self-defnition in social relationships.1 However, this book has grounded self-identity in persons’ relationships with themselves as much as others. It now suggests that privacy helps to turn time alone into healthy solitude as a state8 or mode of privacy.9 This chapter will speak to privacy’s benefts and to concerns arising from threats to privacy. These dangers grow salient as expanding public spaces continue to weaken, for example, through gathering, processing, and sharing big data online. The chapter will suggest that some of the privacy loss is critical to recover if persons who want to be alone are to avoid loneliness or move from loneliness into solitude.

DOI: 10.4324/9781003189879-10

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Privacy benefts Privacy is widely desired. Persons want some privacy beyond the sanctuary of the mind, even in public spaces. For example, they may favour limits on public surveillance and expect to blend in with the anonymity of similar persons. Privacy in public is also a reasonable expectation of persons having an intimate or traumatic experience.10 However, more than an expectation or privilege, privacy is widely acknowledged as something all persons are entitled to. Based on respect for persons, it is a fundamental human right in international law. All the major international and regional human rights agreements recognize the right11,12 even though some scholars regard privacy as a cluster of derivative rights across many contexts.13 Every person has a basic right to and interest in privacy that limits the unsolicited observation and reporting of their behaviour in an increasingly interconnected world. Most countries’ constitutions also recognize their population’s right to privacy.14 By limiting others’ access to their lives, privacy enables persons to safeguard their values, such as liberal, democratic participation,8 including freedom of association and speech.15 Privacy assures each person of their liberty and autonomy to select and manage a performative space off-stage until they are ready to open it in public. They need this exclusive space in order to be themselves, maintain social boundaries, be true to who they are when no one else is looking, and avoid continually explaining themselves to others.16 Privacy protects their negative liberty to live without undue access by17 and interference from others, including governments, other public entities, and private actions. It also relieves social pressure on persons to conform to group norms and rules. Persons no longer need to follow the crowd for the sake of social approval, group identity and well-being, and social harmony at the interpersonal and societal levels.18 Without needing authorization, they can behave more authentically and less discreetly than in public. They can grow and regulate their emotions, identity, and reputation by keeping information about themselves as their confdential property to avoid unwanted confict and social disapproval. Therefore, personal privacy functions as a safety valve.8,19 The “nothing to hide” argument contends that persons need not fear relinquishing their privacy if they have nothing to conceal.4 However, all persons have aspects of their life they would prefer not to put in the public eye, examples including their fnancial situation and a mental health diagnosis. They also do things privately they would not do in public. Thus, persons aim to restrict access by others to their information. They protect their reputation against risks to their functioning, status, and dignity, such as embarrassment or shame.20 Privacy also helps them process and release feelings like loneliness. It aids emotional regulation to support a healthy self-identity and intimate communication in stable relationships21,22 even when secrecy is required. Secrecy The most innermost self is as much a secret to oneself as others. Persons can strive to hide as little as possible from themselves, yet they sometimes fnd their

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own and others’ secrets are necessary to protect. Whereas privacy shares personal information selectively, secrecy is a deliberate choice by persons not to reveal information to anyone else. Therefore, secrecy conceals more than what is private.23 It can be associated with negative emotions, such as shame and loneliness, but not necessarily so. Alexander Pope wrote in his Ode on solitude, “Thus let me live, unseen, unknown.” It is not diffcult to imagine why. Secrecy facilitates solitude when it helps persons live authentically without revealing or discrediting themselves in others’ eyes.24 Therefore, secrecy can avoid harming others or even yield a pleasant surprise. Moreover, not having secrets is to lack a self. All of that said, privacy does not depend on secrecy. For example, consider the life and work of the English artist LS Lowry, who played “the uncultured amateur for the London newspapers as a form of self-protection.”25 Lowry typically kept from the press his work during the day as a rent collector, while his compositions of tortured sexual fantasies mostly came to light after his death. Nonetheless, Lowry’s peopled landscapes depict his intimacy with the secret lives of his subjects. And his life as an artist was more private than secret. Once his disapproving mother had fallen asleep at night, Lowry joyfully escaped  – with her knowledge  – to the cramped attic of their Salford house. There, he painted into the early morning hours, using this private time to transform his loneliness into solitude. Unsentimentally identifying with his poor, matchstick fgures, Lowry felt less alone. “Were it not for my painting,” he admitted, “I couldn’t live. It helps me forget that I am alone.”26 He lost himself in his paintings that froze time and returned him to his childhood. They answered loneliness as “a private problem, a public issue,”27 defying barriers including the unappreciation of his work by his demanding mother and almost everyone else of his time. Nevertheless, secrecy and privacy overlapped for Lowry, as in other situations where they resist the loneliness that can come from feeling unfashionably different. An example is the practice of Muslim women physically veiling part of the head. Some women wear a veil in secret. Others openly wear it to display their need for privacy. They use it to escape the erosion of their traditional cultural identity28 and express solidarity with the women forced to veil.28 The covering can weaken the gendered loneliness29 produced by the male gaze,30 yet also protect and enhance femininity and beauty while indicating religious commitment.31

Loss of privacy Such benefts of privacy can help liberate persons through solitude. Threats to these benefts warrant concern. The greatest danger is that human lives and personal content sharing are becoming more public (the privacy dilemma). Paradoxically, the more visible and liberated persons become in public, the more indeterminate they become. Things like their personal identity disappear. As everything claims value, nothing retains value.32 Privacy then risks becoming an empty right. As noted in Chapter 5, even the concept of personhood falls prey to

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a dizzying proliferation and confusion of types. Four forces continue to reproduce these conditions through interpenetrating private and public spaces. Deindividuation When persons lose somewhere to be free from observation, they become part of the crowd. According to the 19th-century social psychologist Gustave le Bon,33 the crowd swallows each member’s identity and conscious personality. Through this anonymizing experience of deindividuation,34 individuals transition into socially normative expressions of themselves. They wear social masks to be accepted by groups and generate empathy and community, including a sense of collective effervescence.35 However, this effortful behaviour is often unhealthy. It weakens members’ ability to know and enact private and personal aspects of themselves. COVID-19 lockdowns have exemplifed this moral challenge. Putting everyone into extended confnement has destabilized freedom of movement and decisionmaking outside and inside the home. Having others always nearby has made it diffcult to spend private time in solitude. This erosion of physical privacy disproportionately has affected the poorest households where persons might not have their own bedroom, and crowding is a chronic stressor.36 A similar absence of physical privacy from enforced proximity characterizes modern, open workspaces. An absence of defned zones promotes a fat hierarchy and dilutes differences between colleagues. However, to manage workloads and avoid distractions from a lack of auditory privacy,37 workers withdraw into themselves. Taking care not to interrupt others, they use electronic communication to replace meaningful face-to-face interaction,38 and commonly report being too busy to take a break. They are disinclined to interrupt their work, talk to colleagues they may barely know, and yield to social pressure to drink a beverage that will still be available later. Since meaningful time alone can be challenging to create in a small, personal space,24 workers also resort to other isolating behaviour, like wearing noise-cancelling headphones in quiet, modern offces. Hot-desking exacerbates the silo-borne risk of social alienation and adds to the attractiveness of remote working from places like home. Mass surveillance Mass surveillance, including physical and data surveillance, expands public knowledge of private lives, intruding on opportunities for solitude. Just as Shakespeare’s Hamlet opens thematically with the question “Who’s there?”, persons today wonder who is watching them. While Hamlet could not escape the prying eyes and ears of the Danish court of Elsinore, many persons have become concerned about losing control of their information. They worry about it becoming accessible to others without their consent. Despite their right to the protection of personal data, users are potentially visible online yet cut off from anonymous agents who could be recording and judging their behaviour at any moment.39 These information gatekeepers could also mishandle this personal information,40

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for example, by inappropriately sharing it with third parties. Digital users can quickly and understandably feel isolated and lonely in a virtual panopticon, a computer-generated prison. Key reasons include uncertainty and fear around the extent, nature and implications of their privacy loss. Some users are hypervigilant to these and other threats, such as political censorship and advertising as marketers fragment exposure to online content. This epistemic fragmentation41 sorts persons into social categories42 to predict which products and services will interest them and then target, stimulate and reproduce their involvement in certain forms of commercial activity and social media.43,44 These developments expand as technological advances create a new, mass surveillance society. Satellites, cameras, computer and network surveillance, and social network analysis exemplify the pervasive and growing use of technologies to monitor and regulate individuals’ location and behaviour.45 The need to control the COVID-19 outbreak has expanded this use of artifcial intelligence and surveillance technologies. While Hamlet’s panopticon society drove him insane, persons today feel vulnerable to privacy violations.46 How they live their lives is mostly of little interest to those around them, yet their anxiety can cause them to repress their behaviour. They may practise self-censorship47 in forms including “distortion, anticipatory deletion, softenings, even revision to hide suppression.”48 Internet users may browse privately to stop others, including users of the same device, from knowing about their activities, including gift shopping, gaming, or digital sex activities. They may also take other precautions. For example, practitioners of sexting may turn to trustworthy social network sites to exchange sensitive messages with persons they believe they can count on to protect their privacy.49 However, there is no full-proof way to guarantee the privacy of the material shared. Movies such as Sexting in suburbia speak to the enormous harm that betrayal of such trust can produce. At the same time, the science fction television series Person of interest foreshadows where social trust in the government might lead. The series envisions an all-seeing artifcial intelligence called “The machine” that tracks everyone’s movements and communications without their knowledge and consent. Its purpose, akin to Immanuel Kant’s categorical imperative, is dutifully to save lives and foresee and prevent serious crime. This image of the price of public security is not wholly unrealistic in depicting what could one day follow privacy infringements, including the emergence of Samaritan, a rival machine embodying “radical evil.” Yet, at all levels of society, determining liabilities for privacy breaches can be diffcult. Even ordinary citizens, such as parents, are becoming involved in tracking and surveillance activities through using legitimate devices, such as smartphones.50 Thus, rather than avoid harm, publicly exposing persons’ whole digital footprint without their consent could sacrifce their well-being in forms ranging from spoiling a surprise to triggering embarrassment or punishment without a fair trial. Harassment, including face-to-face bullying and cyberbullying, could also occur,51 augmenting the loneliness contributing perhaps to persons risking their privacy in the frst place. Whether persons have anything to hide or not, exposing their

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efforts to conceal their behaviour can inhibit healthy solitude and pluralization.52 As many Edward Hopper paintings depict, loneliness can be worst when, surrounded by others, persons feel pressure to bare their private lives. Public intimacy The third force eroding privacy is constant social pressure on persons to make their private information communal and public. Online, this pressure comes from FOMO, fear of missing out, or, worse, cyberbullying. Social sharing of web content comes to be widely expected as a form of social reciprocity.53 One consequence has been the development of public intimacy as a social state that exteriorizes personal intimacy into what the psychiatrist Jacques Lacan54 playfully called extimité or extimacy. This new form of intimacy can cause loneliness by displacing the centre of persons outside themselves.55 Expected to be always publicly accessible online and attuned to others,56 they rely on technological affordances. These design properties enable them to generate and easily share information online to bond with others by using social media, smartphones, tracking systems,57 and telepresence robots.58 Social media platforms have become digital billboards on which, at any time, persons can post and view all manner of content, including text, images, and videos. This content-sharing has many benefts, such as increasing online visibility, exchanging information, building relationships,59 and achieving social support, including material and psychological resources. However, in distinguishing themselves from others, users lose control over privacy. They can quickly feel lonely in being constantly reminded online of how they fall short of others, for example, in what they don’t have and other’s do. Pressure to shift their identity toward social norms then acts against needs for agency and authenticity. Oversharing While some persons respond to a loss of privacy control through self-censorship, others display online disinhibition and oversharing.60 This loss of reserve augments the loss of privacy and solitude through information sharing by governments, corporations, and criminals. Users are complicit in publicly revealing information about themselves with too much detail or more widely than intended.61 Sensitive information about other persons may also be distributed without their prior knowledge or consent. Such oversharing increases with age.62 It can occur offine and online but characterizes social media use where digital affordances stimulate oversharing63 and amplify exhibitionist impulses.64 Sharing intimate text messages, images, and videos has almost become normalized among groups like Asian, older adolescents.65 This behaviour goes beyond healthy disclosure when it masks vulnerability and discomforts others.66 And it breeds voyeurism and repeated scrutiny and judging of stored material.67 Lonely persons are prone to overshare on social media to improve their visibility and connect with others. Today’s confessional culture exploits their fragility by

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68

promoting self-disclosure to relieve anxiety or guilt and feel fully and authentically alive. Persons may feel negative emotions like shame and embarrassment when they worry their behaviour has crossed boundaries.69,70 Oversharing exacerbates these concerns when it appears attention-seeking. For example, success stories may be misconstrued as boastful rather than celebratory. Lamentations of failure can seem disingenuous and designed to elicit sympathy rather than intimacy. Therefore, even if not generating overt disapproval, persons may regret certain revelations. They may still feel socially alienated and lonely if others do not affrm them, for example, by “liking” the content they share on Facebook or Twitter accounts or remembering their birthday or anniversary. Online users are doubly harmed because they know others can see their posts are not receiving much recognition or validation. In summary, a perceived loss of personal privacy exacerbates feelings of loneliness that persons seek to escape through public activity. Online users let their digital footprint swell in size despite many of them claiming to care about threats to the privacy of their personal information.71

Privacy restoration Persons risk losing themselves and feeling lonely as the private becomes public. They need to become aware of these dangers and not cynically resign themselves to the privacy threats in their lives.72 This resistance is vital because, as Napoleon Bonaparte reputedly pointed out, persons fght harder for their interests than their rights. Recognizing privacy as a moral interest prepares persons to minimize the costs and risks of privacy loss while maximizing privacy restoration benefts to themselves and society.73 From the perspective that privacy is sick but alive and worth saving, two sets of changes are needed. The frst need is systematically to re-establish personal privacy as a valued social norm. This societal development will routinize the implementation of structures to enhance trustworthiness in using personal data and avoid the Trojan priestess Cassandra’s misfortune of not being trusted when trust is warranted. The structures needed will repair public trust in social and organizational privacy behaviour, for example, by simplifying and consistently following online privacy policies and terms and conditions agreements. A concomitant need exists for states and organizations to reform privacy-related laws and policies, with which all parties should become familiar, and appropriately penalize breaches. Second, individual persons need to increase their control over the conditions under which public and private entities manage their data without compromising the public good. For example, by upgrading their digital literacy and performance, digital users can recover much of the personal data taken away by social media, such as Facebook and Twitter. They can increase their Internet knowledge, tighten social privacy and account settings, avoid third-party storage of private information, and embrace privacy-enhancing technologies, such as anti-spyware. Since online users may still overshare information, they also

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need to become more risk avoidant to control social contact with others in ways that include limiting both information misuse and self-disclosure of sensitive biographical details.74,75 Although self-disclosure can contribute to emotional closeness,76 and lack of self-disclosure can increase loneliness,77 persons may then beneft from reframing their social identity. To avoid excessive self-exposure, they can be educated to self-regulate78 through internalizing surveillance – a process described by Michel Foucault as panopticism. User-orienting online sites could facilitate this empowerment of persons to manage effectively what information they share, with whom, how, and under which conditions.79 For example, a recent, systematic review80 of 17 studies found that active or instructive strategies for parental mediation reduced youth’s online information disclosure. In response to tracking and mass surveillance, online users can also use digital platforms, such as YouTube, to focus on relatively anonymous discovery and entertainment. This online behaviour minimizes the use of social media accounts and interactions. Additional opportunities exist to adopt secure strategies, like onion-routing, to protect private access to Internet sites. Users can legally send and encrypt traffc across a decentralized network through multiple servers. Resultant anonymous and safe information communication could decrease self-consciousness, facilitate more authentic content-sharing, and reduce loneliness.81,82 However, these two sets of solutions assume a public-private divide, as does all of this chapter, even though this assumption can be questioned. Public-private boundaries both destabilize and move in response to behaviour like oversharing. And publicity need not come at the expense of privacy, or vice versa. As evident in the concept of extimacy, each state implicates the other, not as oppositional polarities but as relational forms in conversational tension. In this dialectical reconceptualization, publicity can protect some privacy by revealing a semblance of reality that enchants and conceals as much as it discloses.83 Digital social steganography exemplifes this paradoxical occurrence. Within groups like teenagers, it controls and communicates information in plain sight via encoded messages that different audiences simultaneously interpret in different ways. These messages appear innocuous unless the reader is privy to the information needed to decode them. Thus, there are limits on the need to control privacy to manage loneliness from and as a predictor of public activity.

Conclusion Solitude depends on and facilitates privacy as a component of personal freedom. Without compromising social priorities, such as public security, persons have a legitimate and legally recognized interest in keeping their behaviour private. Serving this moral interest helps them protect their autonomy and happiness and facilitate solitude.84 This chapter has discussed how modern human lives are becoming increasingly public. The erosion of privacy is conducive to loneliness. Safeguarding privacy requires both re-establishing personal privacy as a social norm manifest in the law and organizational behaviour, and upgrading

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online users’ digital literacy and performance. Society could expect these privacyenhancing changes to help transform loneliness into solitude without compromising the public interest.

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146 Moving forward 26 Dolce J. ‘Mr Turner’ and ‘Mrs Lowry and son’: The art of Timothy Spall. Quadrant. 2021;65(5):84–89. 27 Williams SE, Braun B. Loneliness and social isolation – A private problem, a public issue. Journal of Family and Consumer Sciences. 2019;111(1):7–14. 28 El Guindi F. Veil: Modesty, privacy and resistance. New York: Berg; 1999. 29 Ng SV. Social media and the sexualization of adolescent girls. American Journal of Psychiatry Residents’ Journal. 2016;11(12):14. 30 Mulvey L. Visual pleasure and narrative cinema. In: Mulvey L, ed. Visual and other pleasures. Dordrecht: Springer; 1989. Pp. 14–26. 31 Khondkar M. Hijab as a Muslim attire and a fashion trend in Bangladesh. European Journal of Business and Management. 2021;13(3):57–70. 32 Baudrillard J. The transparency of evil. London: Verso; 2009. 33 Le Bon G. The crowd: A study of the popular mind. Mineola, NY: Dover Publications; 2002. 34 Kelman HC. Violence without restraint: Refections on the dehumanization of victims and victimizers. In: Kren GM, Rappoport LH, eds. Varieties of psychohistory. New York: Springer; 1976. Pp. 282–314. 35 Gabriel S, Naidu E, Paravati E, Morrison C, Gainey K. Creating the sacred from the profane: Collective effervescence and everyday activities. Journal of Positive Psychology. 2020;15(1):129–154. 36 Fuller TD, Edwards JN, Vorakitphokatorn S, Sermsri S. Chronic stress and psychological well-being: Evidence from Thailand on household crowding. Social Science and Medicine. 1996;42(2):265–280. 37 Peterson TO, Beard JW. Workspace technology’s impact on individual privacy and team interaction. Team Performance Management. 2004;10(7/8):163–172. 38 Bernstein ES, Turban S. The impact of the ‘open’ workspace on human collaboration. Philosophical Transactions of the Royal Society B: Biological Sciences. 2018;373(1753). doi: 10.1098/rstb.2017.0239. 39 Rose N. Governing the soul: The shaping of the private self. London: Free Association Books; 1998. 40 Izuma K. The social neuroscience of reputation. Neuroscience Research. 2012;72(4):283–288. 41 Milano S, Mittelstadt B, Wachter S, Russell C. Epistemic fragmentation poses a threat to the governance of online targeting. Nature Machine Intelligence. 2021;3(6):466–472. 42 Lyon D. Surveillance as social sorting. Privacy, risk and automated discrimination. New York: Routledge; 2005. 43 Matz SC, Appel RE, Kosinski M. Privacy in the age of psychological targeting. Current Opinion in Psychology. 2020;31:116–121. 44 Lee K, Noh M, Koo D. Lonely people are no longer lonely on social networking sites: The mediating role of self-disclosure and social support. Cyberpsychology, Behavior, and Social Networking. 2013;16(6):413–418. 45 Park S, Choi GJ, Ko H. Information technology-based tracing strategy in response to COVID-19 in South Korea – Privacy controversies. JAMA. 2020;323(21):2129–2130. 46 Macnish K. Government surveillance and why defning privacy matters in a postSnowden world. Journal of Applied Philosophy. 2018;35(2):417–432. 47 Warner M, Wang V. Self-censorship in social networking sites (SNSs)–privacy concerns, privacy awareness, perceived vulnerability and information management. Journal of Information, Communication and Ethics in Society. 2019. doi: 10.1108/JICES-07-2018-0060.

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48 Galison P. Blacked-out spaces: Freud, censorship and the re-territorialization of mind. British Journal for the History of Science. 2012;45(2):235–266. 49 Zemmels DR, Khey DN. Sharing of digital visual media: Privacy concerns and trust among young people. American Journal of Criminal Justice. 2015;40(2):285–302. 50 Ghosh AK, Badillo-Urquiola K, Guha S, LaViola Jr JJ, Wisniewski PJ. Safety vs. surveillance: What children have to say about mobile apps for parental control. Proceedings of the 2018 CHI conference on human factors in computing systems. Paper no. 124. April 2018:1–14. 51 Kowalski RM, Giumetti GW, Schroeder AN, Lattanner MR. Bullying in the digital age: A critical review and meta-analysis of cyberbullying research among youth. Psychological Bulletin. 2014;140(4):1073–1137. 52 Mordini E. Nothing to hide biometrics, privacy and private sphere. In: Schouten B. Juul NC, Drygajlo A, Tistarelli M. Biometrics and identity management. First European Workshop 7-9 May 2008. Roskilde: BioID:247–257. 53 Barak A, Gluck-Ofri O. Degree and reciprocity of self-disclosure in online forums. CyberPsychology and Behavior. 2007;10(3):407–417. 54 Lacan J. The seminar. Book VII. Vol 60. London: Routledge; 1959. 55 Miller JA. Extimite. In: Bracher M, Alcorn, M W Jr, Corthell RJ, Massardier-Kenney F, eds. Lacanian theory of discourse. Subject, structure, and society. New York: New York University Press; 1994. Pp. 74–87. 56 Kirschner PA. Can we support CCSL? Educational, social and technological affordances. Heerlen: Open Universiteit Nederland; 2002. 57 Błachnio A, Przepiorka A, Bałakier E, Boruch W. Who discloses the most on Facebook? Computers in Human Behavior. 2016;55:664–667. 58 Niemelä M, van Aerschot L, Tammela A, Aaltonen I, Lammi H. Towards ethical guidelines of using telepresence robots in residential care. International Journal of Social Robotics. 2021;13(3):431–439. 59 Chaudoir SR, Fisher JD. The disclosure processes model: Understanding disclosure decision making and postdisclosure outcomes among people living with a concealable stigmatized identity. Psychological Bulletin. 2010;136(2):236–256. 60 Suler J. The online disinhibition effect. Cyberpsychology and Behavior. 2004;7(3): 321–326. 61 Marwick AE, Boyd D. Networked privacy: How teenagers negotiate context in social media. New Media and Society. 2014;16(7):1051–1067. 62 Long MR, Horton WS, Rohde H, Sorace A. Individual differences in switching and inhibition predict perspective-taking across the lifespan. Cognition. 2018;170:25–30. 63 Frijns T, Finkenauer C, Keijsers L. Shared secrets versus secrets kept private are linked to better adolescent adjustment. Journal of Adolescence. 2013;36(1):55–64. 64 Gentina E, Chen R. Digital natives’ coping with loneliness: Facebook or face-to-face? Information and Management. 2019;56(6):103138. doi: 10.1016/j.im.2018.12.006. 65 Laohabutr P, Subchartanan J, Suteerojntrakool O, Tempark T, Bongsebandhuphubhakdi C. Thai teens’ privacy-related practices on Facebook. Journal of Children and Media. 2021(October). doi: 10.1080/17482798.2021.1993288. 66 Al-Saggaf Y, Nielsen S. Self-disclosure on Facebook among female users and its relationship to feelings of loneliness. Computers in Human Behavior. 2014;36:460–468. 67 Mäntymäki M, Islam, A K M N. Voyeurism and exhibitionism as gratifcations from prosuming Facebook. ECIS 2014 Proceedings – 22nd European Conference on Information Systems. Tel Aviv: ECIS; 2014.

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68 Levontin L, Yom-Tov E. Negative self-disclosure on the web: The role of guilt relief. Frontiers in Psychology. 2017;8. doi: 10.3389/fpsyg.2017.01068. 69 Munar AM. Digital exhibitionism: The age of exposure. Culture Unbound. 2010;2(3):401–422. 70 Mäntymäki M, Islam AN. The Janus face of Facebook: Positive and negative sides of social networking site use. Computers in Human Behavior. 2016;61:14–26. 71 Kokolakis S. Privacy attitudes and privacy behaviour: A review of current research on the privacy paradox phenomenon. Computers and Security. 2017;64:122–134. 72 Hoffmann CP, Lutz C, Ranzini G. Privacy cynicism: A new approach to the privacy paradox. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. 2016;10(4). doi: 10.5817/CP2016-4-7. 73 Lee H, Park H, Kim J. Why do people share their context information on Social Network Services? A qualitative study and an experimental study on users’ behavior of balancing perceived beneft and risk. International Journal of Human-Computer Studies. 2013;71(9):862–877. 74 Rokach A. Private lives in public places: Loneliness of the homeless. Social Indicators Research. 2005;72(1):99–114. 75 Basak R, Sural S, Ganguly N, Ghosh SK. Online public shaming on Twitter: Detection, analysis, and mitigation. IEEE Transactions on Computational Social Systems. 2019;6(2):208–220. 76 Collins NL, Miller LC. Self-disclosure and liking: A meta-analytic review. Psychological Bulletin. 1994;116(3):457–475. 77 Solano CH, Batten PG, Parish EA. Loneliness and patterns of self-disclosure. Journal of Personality and Social Psychology. 1982;43(3):524–531. 78 Van Dijk J. The network society. London: Sage; 2020. 79 Derlega VJ, Chaikin AL. Privacy and self-disclosure in social relationships. Journal of Social Issues. 1977;33(3):102–115. 80 Lo Cricchio MG, Palladino BE, Eleftheriou A, Nocentini A, Menesini E. Parental mediation strategies and their role on youths’ online privacy disclosure and protection: A systematic review. European Psychologist. 2021. doi: 10.1027/1016-9040/a000450. 81 Morahan-Martin J. The relationship between loneliness and Internet use and abuse. CyberPsychology and Behavior. 1999;2(5):431–439. 82 Morahan-Martin J, Schumacher P. Loneliness and social uses of the Internet. Computers in Human Behavior. 2003;19(6):659–671. 83 Jurgenson N, Rey P. The fan dance: How privacy thrives in an age of hyper-publicity. In: Lovink G, Rasch M, eds. Unlike us reader. Amsterdam: Institute of Network Cultures; 2013. Pp. 61–75. 84 Gaukroger C. Privacy and the importance of ‘getting away with it.’ Journal of Moral Philosophy. 2020;17:416–439.

9

Closing words

The recent focus of loneliness research on meeting unmet social needs pays too little attention to each person’s relationship with themselves. Negating the complexity and uniqueness of experience of being alone or lonely, it devalues their capability to self-manage being alone. They can realize this capability by developing virtues, such as self-love. This book has suggested how person-centred health care can help persons learn to cultivate and enact such vritues to enjoy being alone. Constructing aloneness as a resource, it promotes their adoption of a positive attitude toward themselves and their isolation. As a subjective state, loneliness thus becomes conducive to cognitive remodelling as healthy solitude. Persons become as content alone as with others and may even choose to spend more time on their own. This prescription refects my conceptual review of relevant literature, a critical appraisal that calls for revision of thinking about loneliness. I view this review as the frst step in reconceptualizing the “excessive focus on the nature of humans as social beings and loneliness as social disruption.”1 I hope that others will suggest ways to refne my ideas within an open and inclusive dialogue. An expanded conversation is needed until empirical testing, through observation and experiment, becomes useful. Until then, such testing (and advocacy to implement my ideas) is premature. These steps would repeat the mistake of trying to measure and treat loneliness without adequately understanding it. Hence, gathering empirical evidence has been beyond the scope of this book and its staged commitment to contribute theoretical insights from existing knowledge. Following my Introduction, Part I of the book addressed myths and misinformation in loneliness research. Part II suggested a path forward based on persons’ capabilities to manage feeling alone in ways that include spending more time in solitude. It highlighted a need to customize care for all persons as whole beings in whom loneliness is one aspect of their life. Putting their personhood rather than their loneliness frst supports them as moral agents to develop their inner world so they can choose how to care about themselves alone and with others. Rather than squint to psychology with social eyes, the book has looked to the mental processes through which persons can give positive meaning to aloneness. In emphasizing relational intimacy within as much as between persons, this perspective acknowledges that social connectedness is essential for health and quality of life. However, it also observes that social life contributes to loneliness,

DOI: 10.4324/9781003189879-11

150 Moving forward for example, through pressure for social conformity. Therefore, rather than simply look to building connections with others, the answer to loneliness lies inside persons. By cultivating virtues, such as loving themselves as much as others, they can give productive meaning to aloneness and its value. They can choose to experience isolation as healthy rather than pathological, especially when solicited rather than unwanted. From this perspective, solitude transforms loneliness as a prize of psychology. It is a stimulating revolutionary shift that persons can embrace bottom-up.2 COVID-19 might have been a catalyst for this change. While government restrictions have imposed physical isolation that feeds talk of worsening loneliness, most persons have adapted. They have begun to notice, for example, that they can keep working from home. Independently, they can connect with all their senses and focus without distraction. As more persons develop this awareness, fundamental social change could help persons value themselves enough to push into new, self-protective frontiers. The paradox would emerge then of an external impetus to fourish by looking inward to welcome time alone. I call on others now to help develop my ideas so that they and I can conduct research to test them empirically. Loneliness will continue to be challenging to manipulate experimentally for prevention and treatment. However, an exciting opportunity exists to implement longitudinal, multiple methodologies. Remedying the design limitations of existing studies in at-risk populations, this approach could operationalize, check, and advance the use of person-centred health care to move loneliness into solitude.

References 1. Motta V. Key Concept: Loneliness. Philosophy, Psychiatry, and Psychology. 2021;28(1):71–81. 2. Moghaddam FM. The shark and the octopus. In: Wagoner B, Moghaddam FM, Valsiner J, eds. The psychology of radical social change. From rage to revolution. Cambridge: Cambridge University Press; 2018. Pp. 275–290.

Index

agency 6, 10, 13, 48, 59, 62, 73, 75, 80–83, 86–87, 91, 98, 100, 121, 124, 127, 130, 140, 142, 149 alief 90 aloneliness 117 aloneness 1–6, 8, 10–11, 14, 23, 33, 57–58, 73–74, 81, 84–91, 101, 104, 109–110, 116–121, 126, 129–130, 137, 149–150 anxiety 4, 42, 46, 48, 143; social anxiety 43, 45, 63, 141 Anne Frank 90 Arendt, H. 12–13, 119 Aristotle 1, 88, 104, 120 Arnold, M. 78 Atlas 9, 87 attitudes 2–3, 6, 10–11, 14, 21–22, 30–31, 47, 87, 89, 99, 101, 105–110, 116–117, 127 Augustine, St. 101 authenticity 8, 22, 43, 58, 62, 64, 74–77, 85, 90, 97, 106–110, 138–139, 141–144 Avicenna 28 baka shoujiki 75 Bioethius 31 biopsychosocial 80, 82, 86 Bonaparte, N. 143 Bryon, G.G. 119 Buddha 105; Buddhism 99, 104, 124 Calvin, J. 100, 103 Camus, A. 13, 30, 127–128 Chaplin, C. 62 character building 3, 14, 43–44, 49, 81–82, 89–90, 96, 118, 128 Cioran, E. 43 Coleridge, S.T. 27 companion animals 121 Courbet, G. 128

COVID-19 1–3, 7, 27–32, 41–42, 45–47, 57, 60, 63–64, 79, 85, 140–141, 150 creativity 11, 14, 31, 43–44, 73, 85, 88–89, 121, 123, 127–131 crowds 6, 8–9, 28, 76–77, 90, 117, 120, 138, 140; crowding 28, 31, 140 Cummings, E.E. 85 dadirri 125 Dali, S. 33 defnitions 2–3, 10, 62, 75, 77–78, 80, 82, 101, 107, 116–118, 123, 137 deindividuation 140 Deleuze, G. and Guattari, F. 100 dialectics 44, 144 Dickinson, E. 123 Dostoevsky, F. 31, 42, 105 Ecclesiastes 46 eco-ambiguity 119 Einstein, A. 58 Eliot, G. 97 Eliot, T.S. 10, 74, 96–97 emergence 78, 81–83, 86 Emerson, R.W. 98 emotion 1–2, 4, 7, 10–11, 23, 30, 32, 41, 44, 48–49, 58, 63, 73, 77, 79, 85–88, 99, 106, 109, 116–127, 130, 138–139, 143–144 emotion regulation 10, 48, 87, 99, 127, 138 enactivism 82, 86 Epictetus 10 Erikson, E. 88 evidence-based medicine 12, 80 fear management 90, 117, 120; of harming others 9; of loneliness 26, 46, 58, 96, 116; of missing out 142; of privacy loss

152

Index

138, 141; of social threats 12, 48, 64, 97; of scrutiny 24, 63, 137; of the future 43 fourishing 2, 24, 85–91, 96, 116, 124, 129, 150 Forster, E.M. 25 Foucault, M. 106, 144 Frankl, V. 10–11, 42, 89 free will 10–11, 80 freedom 10, 24, 27, 30, 33, 42–43, 45, 58, 62, 65, 73, 75, 78, 87, 90, 107–108, 123–124, 127, 131, 138, 140, 144; see moral agency Freud, S. 104 Friedrich, D.C. 85, 125 Frost, R. 85 goal-setting 11, 44, 60, 64, 82, 85, 89, 107–108, 123, 129 Goethe, J.W. von 105–106 Guglielmi, L. 29 Hafz 42 Hegel, F. 44 Hemingway, E. 9, 84 Hesse, H. 129 hikikomori 7, 116 Hillel the Elder 103 Hobbes, T. 62, 79 holism 2–3, 5, 13, 24, 44, 77, 81–84, 88, 90–91, 99, 103–108, 119–120, 126–130, 141, 149 honne 75 Hopper, E. 29, 130, 142 Hugo, V. 13 Hume, D. 100 incarceration 7, 27, 30–31, 45, 121, 126, 141 independence 4, 6, 8–9, 13–14, 26–28, 58, 60–66, 65–66, 73, 77–79, 83, 87, 97, 104, 117, 123, 127, 150 individuals 75–77 individualism 6, 27, 65–66, 73, 84, 98 individuation 47 inertia 24 information and communication technologies 1, 25–27, 31–33, 48, 60–62, 79–80, 86, 141–143 inner peace 98, 123–127, 130–131 interbeing 103; see Thich Nhat Hanh intimacy 25, 49, 63–66, 79, 99, 103–105, 121–123, 130, 139; intimacy-focused care 81–82, 88; public intimacy 142; see self-intimacy

intraindividual 75 introversion 4, 13, 32, 60–61, 63, 128 invisible hand 61–63 isolation: social 7, 10, 12, 23–27, 33, 42, 47, 58, 60–61, 66, 77, 97; physical 27–33, 47, 150; emotional 23, 33, 73, 116 Jacobi, C.G.J. 44 James, W. 10 Joyce, J. 10 Jung, C. 10, 12, 60, 97, 99, 106, 123 Kafka, F. 96, 123, 126 Kahlo, F. 28, 102, 104 Kant, I. 44, 62–63, 101, 103, 128, 141 Karamustafa, G. 31 kineticism 82–87 Kipling, R. 75 kodoku 116; kodokushi 7, 116 Koyaanisqatsi 110 Lacan, J. 142, 144 Laërtius, D. 120 “law of least effort” 44 Lewis, C.S. 4, 43, 60, 110 living alone 3, 6, 26–28, 30, 47, 65–66, 116, 119; arrangements 24, 28, 31, 65, 119; in the moment 43; worthwhile 14, 74, 105 loneliness as ally 43; attitude to 2–3, 6, 11, 14, 22, 31, 47, 80, 89, 101, 107, 116–117, 127; defnition 2–3, 24, 45, 47, 49, 57; duration 1, 31, 41–43, 47, 49; epidemic 1, 41, 45–46, 49; etymology 23; frequency 27, 32, 41, 47–49; gender 7, 9, 30, 41, 47–49, 63, 65, 73, 76, 79–80, 124, 139; health outcomes 1, 24, 30, 42–49; middle-aged 3, 46–47, 49, 66; old age 24–27, 30, 41, 46–49, 65–66, 79, 103, 105, 117, 121, 123; severity 7, 41; silver lining 41–45; social prescribing 1–2, 6–7, 57, 83; social problem 1–3, 6, 13, 22, 24, 57–58, 61, 73, 80, 85; vulnerable social groups 1, 26, 29–30, 49; youth 3, 7, 24–26, 42, 46–48, 60, 90, 97, 119, 142 lonesomeness 118 love 43, 47, 77, 89–91, 96, 98–110, 119, 123, 130; see self-love Lowry, LS 139 Magdalene, Mary 118 Magritte, R. 9

Index maitri 104 Malcolm, X. 31 Mandela, N. 45, 103 Mandeville, B. 62 marital status 4, 12, 27, 47, 49, 65–66, 104, 116 mass surveillance 26, 140–144 Mead, H. 99 meaning: of aloneness 3–6, 9–14, 23, 33, 41, 48, 64, 81, 85–89, 96, 106–107, 110, 117–118, 121, 129–130, 140, 149; of home 30; in life 7, 11, 31, 42, 45, 47, 61, 63, 73, 86, 89, 91, 101, 103–104, 108, 120–121; of personhood 79–80; of social connection 25, 33, 74, 81, 99, 140; of stories 21; of touch 32 meaning-oriented care 82, 88–89 Merton, T. 119 Mill, J.S. 108 Milton, J. 42 mindfulness 106 modern technology 25–27, 31–33, 48, 60–62, 79–80, 86, 106, 121–123, 141–143 Montaigne, M. de 28 Munch, E. 28, 76, 121 Narcissus 105 narcissism 100 nature 60–61, 120 negative capability 43 Newton, I. 28 Nicholas of Cusa 120 Nietzsche F. 6, 8, 11, 90, 97, 99, 103, 107, 117, 119, 121, 124, 127, 129 ohitorisama 116 old testament 120 oneliness 61 Ortega y Gasset, J. 13 Orwell, G. 76 oversharing 142–144 parasocial relationships 66, 109, 122–123 Parmenides 88 particularism 81–82, 84 patient-centred health care 80, 83 Penelope 33 person-centred health care 2, 4–5, 11, 78, 80–91 person-enabling care 82, 88–91; see empowerment person-frst care 81–83

153

personal identity 6, 9, 21, 24, 44, 47, 49, 58, 64, 76–77, 96, 108, 127, 137–140, 144 personhood 5, 10, 77–80, 86; legal 78–79, 86; artifcial intelligence 79–80, 86 philautia 104 Philoctetes 43 Pico della Mirandola, G. 10 Plath, S. 9, 123 Plato 105 Poe, E.A. 47–48 Pope, A. 139 preferences 7, 24, 60, 87, 108, 124 privacy benefts 138–139; loss of 139–143; restoration 143–144 Promethean 46 Proust, M. 125 psychological fow 123, 139 public intimacy 142 public policy 6–7, 25 quarantine 1, 27–31, 47, 63–64, 140 relationality 83, 87–88 relocation 24, 42, 46, 48 responsibilities 6, 11, 25, 43, 75, 77, 79–80, 87, 89, 96, 98, 101, 105, 107, 125, 127, 141 rights 5, 30, 32, 61–62, 77–80, 96, 138–140, 143 Rilke, R.M. 4 Robinson Crusoe 129 Rogers, C. 102 Rousseau, J-.J. 30, 101, 117 Russell, B. 8 Sadhguru 125 Sarte, J.-P. 11, 65, 97 Schiele, E. 31 Schopenhauer, A. 7–9, 63, 77, 89, 110, 119, 124, 127 secrecy 138–139 seijaku 85 self-acceptance 87, 90, 100–102, 106–108, 110 self-actualization 44, 81–82, 87, 90–91, 106, 108, 149 self-care 6, 11, 99, 103–105 self-commitment 99, 105–108, 110 self-compassion 13, 43, 88, 90, 96, 99, 104, 106 Self-desire 105, 108–110

154

Index

self-esteem 4, 10, 33, 48, 58, 96–99, 104–105, 108–110, 124 self-improvement 4–5, 21, 26, 43, 58, 63, 74, 80–91, 101, 106–108, 127, 129, 142 self-interest 59–66 self-intimacy 99, 105, 109–110 self-knowledge 3, 99, 104–106, 109–110, 128 self-love 2, 4–5, 12–14, 57–58, 73, 77, 80–81, 83–85, 88–91, 96–110, 118, 123, 149 selfhood 99–100 sensory experience 25, 31, 80, 109, 150; see touch deprivation sexuality 28, 32–33, 64, 66, 80, 109–110, 122, 128, 137, 139, 141 Shakespeare, W. 28, 107, 140–141 shame 44–45, 66, 97, 106, 108, 116, 138–139, 143 Sheldon, WL 89 single parents 66 single-person households 27, 65 social alienation 23, 25–26, 30, 77, 83, 97, 105, 140, 143; and bad faith 7, 12, 26, 43 social animals 58–66 social capital 21, 57, 64 social conformity 8, 11, 26, 43, 45, 60, 62, 64, 74–77, 124, 138–142, 150 social connectedness: limitations 3, 7–10, 63–65 social cooperation 57, 59–66, 73 social distancing 29, 32–33, 57, 63–64 social exclusion 24, 48, 64, 78, 83, 117 social media 4, 9, 26, 142–144 social needs 3–7, 24, 32–34, 43, 49, 57–59, 62–64, 66, 73–75, 78, 88, 91, 97, 104, 110, 116, 130, 138 social networks 1, 3, 7, 10, 21–28, 33, 44–47, 49, 62, 65, 126, 128, 141 Socrates 105 solitude 2–6, 11, 13–14, 16–18, 22, 33–34, 40, 47, 54, 66, 71, 73, 77, 80–81, 83–93, 96–98, 110, 116–145, 149–150; and communion 124, 129–130; creativity 14, 43–44, 73, 85, 88, 121, 123, 127–129, 131; empowerment 2–3, 6, 123, 127, 131; freedom 123–124; inner

peace 98, 123–127, 130; selfattunement 123, 127–128, 131 spirituality 8, 33, 43, 48, 60, 74–75, 79, 87–88, 90, 108, 117–120, 124–125, 129–130 Steiner, R. 121 stimulation 26–28, 43, 61, 80, 89–90, 105, 109, 122, 125, 128, 141–142 strength in weakness 44–45, 83 Stroud, R. 31 studio apartments 27 suffering 9, 41–42, 75, 80, 85, 91 tatemae 75 Thich Nhat Hanh 103 Thoreau, H.D. 121 Thucydides 90 Tocqueville, A. de 110 Tolle, E. 74 touch deprivation 25, 27, 32–33 transcendence 13, 99, 129–130 ubuntu 87 ultrasolitude 117 unity of opposites 44 urban life 27–28, 63, 65, 77, 117 vā 74, 90, 127 Van Gogh, V. 27 veiling 139 Virgil 99 virtues 2, 4–6, 10, 13, 30, 33, 42–44, 49, 74–75, 78, 81, 85, 89–91, 96, 100–101, 105–108, 117, 125, 129, 149–150 wabi-sabi 107 waifu 80 Wells, H.G. 25 Wilde, O. 74 Woolf, V. 9, 124 Wordsworth, W. 120, 124 work 1, 30–32, 42, 48, 64–65, 80, 140, 150 wu-wei 44 yin-Yang 44 Zipf, G.K. 44