More than a Feeling

When Dr Zohar Lederman was an emergency medicine doctor in Israel, he was struck by how many patients did not want to go home because they had no one to go home to. They often ended up in the hospital longer than their condition warranted, but medical staff were not trained nor evaluated on how to help such people. “It was heartbreaking. These patients were really out of the realm of emergency medicine,” he said.

The situation inspired him to delve deeper into the problem of loneliness. The results, in both philosophical and scientific terms, were stark: loneliness puts people at higher risk of stroke, anxiety, dementia, depression, suicide and other diseases, and it is common. “Loneliness makes you sicker and increases your risk of premature death. Basically, it’s a kind of social determinant of health,” he said.

Dr Lederman, now Clinical Practitioner in HKU’s Department of Emergency Medicine in the School of Clinical Medicine and Research Fellow in the Centre for Medical Ethics and Law, has been investigating how to mitigate the problem and better understand the implications for society from medical and bioethics perspectives – particularly as surveys show that loneliness affects one-third of people in Hong Kong and Mainland China, about 40 per cent in Japan and one in two in the US.

“I believe there is an ethical case to engage more systematically with loneliness, first of all as a public health issue and secondly, as a deeply fundamental issue for human beings that goes beyond human health. I think we have largely failed so far in dealing with loneliness because our definition is too narrow,” he said.

Lots of kinds of loneliness

Traditionally, loneliness has been considered a distressful mismatch between expected and perceived social relations. But social scientists have proposed that it can come in many forms, he said.

Political theorists such as Hannah Arendt talk of political loneliness in which people are deprived of political participation and feel alienated from the process, such as Palestinians in the West Bank and Gaza.

There is also ethical loneliness, where someone suffers a great injustice such as the Holocaust but does not feel heard or understood when they talk about the experience. And there are things like a lonely death, sexual loneliness or the loneliness of people with disabilities that hinder their communication with others. Caretakers can also feel lonely.

Dr Lederman said these are not simply alienating experiences. Since people have evolved to be social and interdependent, loneliness should be seen within that context. “If one recognises that not being lonely is important to human life and human flourishing, and that people have an entitlement or right not to feel lonely in much the same way they have a right to health, then there are ethical implications for governments and society,” he said.