We are now six months into the COVID-19 pandemic, with no clear end in sight. An obvious question for researchers is how pandemic protective measures—eg, sheltering in place and physical distancing—have affected our mental well-being. The protracted nature of the pandemic has afforded researchers time to study its impact. Many study participants have reported feeling more lonely during the COVID-19 pandemic. Individuals particularly hard hit by personal crisis, for example, life-threatening illness, death of a loved one, or financial ruin have described a type of loneliness that philosophers and some psychologists have termed existential loneliness (Ettema et al., 2010).
In this article, I examine existential loneliness within the broader context of the loneliness literature. I begin with the distinction between social isolation and loneliness, the impact of social isolation and loneliness on mental and physical health—particularly on seniors, followed by some surprising findings from a recent study comparing loneliness before and after the current pandemic.
Social Isolation and Loneliness: An Important Distinction
Examining the impacts of loneliness requires that we first distinguish it from social isolation. Ong et al. (2016) distinguished between loneliness (the subjective experience or perception of being isolated) and social isolation (the actual size of one’s social network and the frequency of social interactions). Importantly, some may be socially isolated but not bothered by minimal social contact while others may have frequent social contact but still experience loneliness.
Why Social Isolation and Loneliness Matter
Even prior to the current pandemic, researchers were claiming that industrialized societies were in the midst of an “epidemic of loneliness.” In 2018, the UK government appointed a Minister for Loneliness after a 2017 report found that nine million Brits reported having frequent or chronic feelings of loneliness. A 2018 University of Michigan study reported similar prevalence rates of loneliness in the United States. A 2019 Angus Reid Institute study found that one-third of Canadians reported feeling lonely or very lonely.
Cacioppo and Cacioppo (2014) found that socially isolated individuals are at increased risk for depression, cognitive decline, and dementia. Holt-Lunstad and colleagues (2010) found that loneliness and social isolation are major risk factors for illness and premature death. For example, loneliness and social isolation increase the risk of having a stroke or developing coronary heart disease by 30 percent (Holt-Lunstad & Smith, 2016), which is comparable to other risk factors such as smoking 15 cigarettes a day (Holt-Lunstad et al., 2010). Finally, Holt-Lunstad’s research found loneliness to be a significant health risk factor, regardless of nationality, age, or gender (Holt-Lunstad et al., 2017; see also Alcarez et al., 2019).
Seniors are Particularly Vulnerable to Loneliness
Much of the loneliness literature concerns seniors. My colleague, Dr. Paul Wong (2015), published a paper describing the loneliness of being an older man in the grips of a medical emergency. Age-related illness as experienced by Dr. Wong, however, is just one of several risk factors that make seniors vulnerable to loneliness. As we age, our social networks become smaller due to retirement, widowhood, and children leaving home (the “empty nest” phenomenon; Holt-Lunstad, 2017). Research by Steffens et al. (2016) found that retirees had a 12 percent higher risk of death if they withdrew their membership in two social groups in the first six years of retirement. An Association of American Retired People (AARP)-funded website dedicated to the problem of socially-isolated seniors also identified rural living, lack of accessible/affordable transportation options, untreated hearing loss, mobility impairment, ageism (age discrimination), poverty, and lack of opportunities to engage with or contribute to society as factors contributing to loneliness and social isolation. With seniors being a growing demographic in industrialized nations (World Health Organization, 2011), the problem of loneliness will likely continue for the foreseeable future.
What the COVID-19 Pandemic Has Taught Us About Loneliness
As mentioned above, the extended nature of the COVID-19 pandemic has made it possible to examine its impact, if any, on the prevalence of loneliness and social isolation in society. Luchetti and colleagues (2020) found that, paradoxically, study participants asked about social distancing and shelter-in-place orders reported feeling less lonely. The study concluded that “the feeling of increased social support and of being in [the pandemic] together may increase resilience to loneliness, even among at risk groups . . . Individuals, families and communities can still come together and feel emotionally close despite the physical distancing” (p. 8, 9). In response to the pandemic, study participants reached out to friends and family via phone calls, video chats and other physically distant means as a buffer against loneliness. Other studies conducted since the onset of the COVID-19 pandemic have found similar results (Folk et al., 2020; Jacobson et al., 2020; Tull et al., 2020; cited in Luchetti et al., 2020). These findings reinforce previous research that suggests social isolation and loneliness may be overlapping yet distinct phenomena; in other words, one can be physically alone without necessarily feeling lonely.
Three Types of Loneliness
Here I focus on the literature concerning loneliness and dying. Although contracting the COVID-19 virus is not necessarily fatal, I agree with Dr. William Berry’s characterization of the pandemic as an existential crisis in a recent Psychology Today article. An exhaustive review of the existential loneliness and dying literature is not possible here but a meta-analytic review conducted by Ettema et al. (2010) is useful for its identification of three types of loneliness in the literature: social, emotional, and existential. Social loneliness is the sadness and longing associated with being physically isolated and having a lack of meaningful social connection, ie, being lonely and alone. Emotional loneliness, on the other hand, is the feeling of sadness and longing even in the presence of others, ie, being lonely in a crowd.
Existential loneliness is a more fundamental experience of loneliness based on the awareness of being separate when confronted in death. Existential loneliness cannot be resolved “by the presence of others nor by an adequate dealing with feelings—the isolation of having to die alone remains” (Ettema et al., 2010, p. 142). Instead, coming to terms with existential loneliness requires that we also come to terms with the loneliness of dying.
Existential Loneliness as an Opportunity for Transformation
Those who have written about existential loneliness have emphasized that a personal crisis can be an opportunity for personal transformation—a chance to transform a negative experience into a positive one. As Ettema and colleagues (2010) concluded, “to the extent that awareness and acceptance of existential loneliness may lead to inner growth, existential loneliness is considered to be a positive force . . . It is by giving meaning to our life and death that we use our potentialities and develop our capacities as human beings” (p. 152). In this way, existential loneliness is akin to other phenomena described in the psychology literature, including death-rebirth experiences (James, 1909), spiritual awakenings (Alcoholics Anonymous, 2001), tragic optimism (Frankl, 1946/1985), positive disintegration (Dabrowski, 1964/2016), shattered assumptions (Janoff-Bulman, 1989), posttraumatic growth (Tedeschi & Calhoun, 1995), and redemptive sequences (McAdams, 2006; cited in Jordan, 2020).
Treating Existential Loneliness
Treating existential loneliness requires a different approach, one that operates at the level of identity, values, and purpose. Research by Steffens et al. (2016) recommended that “practical interventions should focus on helping retirees to maintain their sense of purpose and belonging by assisting them to connect to groups and communities that are meaningful to who they are” (p. 7). A further examination of treating existential loneliness is beyond the scope of this article but quality existential psychotherapy content is available at existential-therapy.com, drpaulwong.com, emmyvandeurzen.com, kirkjschneider.com, and, of course, meaning.ca.
Alcaraz, K. I., Eddens, K. S., Blase, J. L., Diver, W. R., Patel, A. V., Teras, L. R., . . . & Gapstur, S. M. (2019). Social isolation and mortality in US black and white men and women. American Journal of Epidemiology, 188(1), 102–109.
Cacioppo, J. T., & Cacioppo, S. (2014). Older adults reporting social isolation or loneliness show poorer cognitive function 4 years later. Evidence-Based Nursing, 17(2 ), 59–60.
Ettema, E. J., Derksen, L. D., & van Leeuwen, E. (2010). Existential loneliness and end-of-life care: a systematic review. Theoretical medicine and bioethics, 31(2), 141–169.
Holt-Lunstad, J., & Smith, T. B. (2016). Loneliness and social isolation as risk factors for CVD: Implications for evidence-based patient care and scientific inquiry. Heart, 102(13), 987–989.
Holt-Lunstad, J., Robles, T. F., & Sbarra, D. A. (2017). Advancing social connection as a public health priority in the United States. The American Psychologist, 72(6), 517–530.
Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316.
Jordan, D. J. (2020). “Like an awakening: Transformative learning as identity transformation for men in recovery from addictions” [Master’s thesis].
Luchetti, M., Lee, J. H., Aschwanden, D., Sesker, A., Strickhouser, J. E., Terracciano, A., & Sutin, A. R. (2020). The trajectory of loneliness in response to COVID-19. American Psychologist. Advance online publication.
Masi, C. M., Chen, H. Y., Hawkley, L. C., & Cacioppo, J. T. (2011). A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review, 15(3), 219–266.
Ong A. D., Uchino B. N., & Wethington E. (2016). Loneliness and health in older adults: A mini-review and synthesis. Gerontology, 62(4), 443–449.
Steffens, N. K., Cruwys, T., Haslam, C., Jetten, J., & Haslam, S. A. (2016). Social group memberships in retirement are associated with reduced risk of premature death: Evidence from a longitudinal cohort study. BMJ Open, 6(2), e010164.
Wong, P. T. P. (2015). A meaning-centered approach to overcoming loneliness during hospitalization, old age, and dying. In A. Sha’ked & A. Rokach (Eds.), Addressing loneliness: Coping, prevention and clinical interventions (pp. 171–181). Routledge/Taylor & Francis Group.
World Health Organization. (2011). Global health and aging.
Preventing Social Isolation and Loneliness Among Older People—A World Health Organization (WHO) publication from 2019.
This Pandemic Is Lonely. But Don’t Call Loneliness an ‘Epidemic’—A May 2020 article that offers a different perspective on loneliness. Linking isolation with infectious disease isn’t helpful, says historian Fay Bound Alberti. However, Covid-19 offers a unique opportunity to reframe the issue.
How to be Alone: An Antidote to One of the Central Anxieties and Greatest Paradoxes of our Time—Maria Popova provides an excellent review of fiction and autobiographical writings that have examined the benefits of solitude (voluntary aloneness) and Western culture’s morbid fear of being alone.