Column
Change
Loneliness
6 min read

The curse of loneliness and the hope of kindness

The tend-and-befriend response is present in many species, but it reaches a particular level of genius in ours, explains Roger Bretherton.
A person stands in a road under misty street lights.
Atharva Tulsi on Unsplash

Loneliness kills. I’ve known that for a while. It dawned on me when, as an undergraduate, I first read the anthropological studies of the so-called ‘voodoo death curse’. An admittedly politically incorrect name for a horrifying phenomenon that has haunted me ever since. The studies, reported in the early twentieth century, attempted to account for the highly effective way in which shaman in tribal cultures were able to pronounce death on aberrant members of their community. Often within days of coming under the curse, the hexed individual was dead. It looked like magic. 

Psychologists studying anxiety became interested in this phenomenon as an illustration of the connection between social stress and physical health. On closer examination, they noted that those on the receiving end of a death curse, not only came under the opprobrium of a powerful spiritual authority but were consequently entirely isolated from the community that gave them their identity. The moment the curse was decreed they became a non-person. They ceased to exist in the eyes of the collective. They became a ghoul, a wraith, an abomination to their people. They experienced a social exclusion so absolute and catastrophic that the stress of it killed them. Physical death swiftly followed social death. 

When we fall foul of the charismatic leader of a workplace... we may for a moment shiver in the chill breeze of the death curse.

But the death curse is not confined to stone age tribes and agrarian collectives. It is a ubiquitous artefact of human social life. In subtly disguised form it continues to stalk the industrialised societies of the West. We see it in any social situation that terminally frustrates our hardwired biological need to belong. When we are cast out of employment through redundancy, retirement, or sickness. When a social faux pas leaves us persona non grata. When our social media presence is more of a toenail than a footprint. When we fall foul of the charismatic leader of a workplace, a neighbourhood, a family, a church. We may for a moment shiver in the chill breeze of the death curse. We wonder briefly if the silence and the cold shoulders will kill us. 

We don’t often think about the all-too evident connection between belonging, stress and health- but we should, because social connectedness is the primary way we as a species have made it this far. Most of us are familiar with the physiological responses to acute stress. There are only a few of them. It’s like a multiple choice test, take your pick: a) fight, b) flight, c) freeze, d) faint, or e) some bespoke combo of all of the above. We probably also have some recognition that those of us living in information economies tend to spend too much time in these stressed states of mind. They are designed for short-term threats (like predators), not long-term projects and serial deadlines. The cortisol coursing through our veins designed to deliver us from danger now stops us sleeping at night, and lurks behind all the major killers of our culture: cancer, heart disease, and depression. 

But before we get to all that stressed-out running and punching and standing still like startled rabbits, there is a more common everyday way that human beings deal with stress. Our primary way of navigating a challenging and threatening world is our equally hardwired ability to reach out to others- the social engagement system. This tend-and-befriend response is present in many species, but it reaches a particular level of genius in ours. Our capacity to form groups that can coordinate action through a sense of unified purpose is what allowed our ancestors to take down woolly mammoths and survive ice ages. Our principal strength comes not from our ability to make fists, but to join hands. 

 

To fall out of connection with others is an existential threat. 

No wonder then, given our history as an eminently social species, that loneliness- the perceived shortfall between desired and actual social contact- is experienced as a menace to our survival. It once was, and still is. To fall out of connection with others is an existential threat. Clinical research has been reporting for decades that social support, or rather the lack of it, predicts and maintains pretty much every form of psychological distress we can bring to mind. In a small-scale way I repeat that finding with my own students every year. We annually distribute a 19-item well-being survey to several hundred university students. Most of it asks about the good stuff, happiness, quality of relationships, sense of purpose and so on. But one question asks them to rate, simply on a 1-10 scale, how lonely they are. Every time we run it on campus, this single lonely question predicts levels of depression, anxiety and stress, better than any other demographic. 

So, it is good that loneliness is back in the news. Only last month the US Surgeon General, Vivek Murthy, issued a report on the devastating health impact of loneliness. It affects a large proportion of the population- he cites 50% in the US, but UK estimates tend to be more conservative. It is apparently as damaging to our health as smoking 15 cigarettes a day, and twice as risky as downing six alcoholic drinks daily. Public health officials are partial to measuring mortality in fags and booze. But Vivek Murthy did something very un-like a public health official: he spoke about his own loneliness. How his very success in office had severed ties with friends and family, leaving him isolated, lonely and having to learn to re-connect. He proposes six pillars for addressing the societal scourge of loneliness, but as yet no government funding has been allocated to the initiative. 

It is when we give to others that we know we are known- we matter. 

When the experts are asked what we can do about loneliness they tend to advocate a multi-level approach. As individuals, we should Get Out. If we are lonely there are things we can do about it. Volunteering, exercise, singing, therapy, reconnecting with old friends, Counter-intuitively, we are more likely to benefit from activities in which we give something, in which we care or contribute. It is when we give to others that we know we are known- we matter. 

As groups we should Look Out. Not everybody is able to overcome the barriers to social contact. Some people through physical or mental disability need others to look out for them. I witnessed a heart-warming example of this recently. There is a notorious character who lives locally. He dresses in black, has wild hair, walks with a limp, and speaks in grunts. He’s harmless, but he scares children. I don’t know what trauma or substance reduced him to this state, but he staggers past us twice a day on the way to his allotment. A few weeks ago thieves broke into his shed and stole all his gardening tools. He was pitifully distressed. But within hours the entire neighbourhood had mobilised through social media, and equipped him with every trowel, fork and hoe, that could be spared. I can’t help feeling that there is something in us as people that wants to act kindly like this, and cultivating this instinct gives me hope that we as a society can beat back the spectre of loneliness.

Loneliness it seems may not be just a bug in our software, it may be encoded in our cultural firmware- part of its operating system. 

Which leads us to the third level of action, we need to Sort Out the dehumanising trends of our culture that inevitably generate and enable the pandemic of loneliness. As Mother Teresa famously observed, loneliness is the price we pay for wealth in the West, it is our true poverty. There may be something inspiring about the ruggedly individualistic, materialistically motivated, hyper-competitive, ideal of success that presides over our culture. But the studies of psychological wellbeing unanimously conclude that every one of those motivating values leads to misery, distrust and isolation. Loneliness it seems may not be just a bug in our software, it may be encoded in our cultural firmware- part of its operating system. Perhaps that is why most government-led attempts to alleviate the problem (in the UK and US at least) smack of tokenism. As the old organisational mantra goes: our social system is perfectly designed to bring about the outcomes it produces. So, what do we need? Nothing much. Just a completely transformed society. If only there was one of those knocking around, somewhere. 

Interview
Change
Gaza
Israel
Middle East
S&U interviews
Suffering
War & peace
11 min read

Eye witness: life and death in Gaza’s European Hospital

Returning plastic surgeon Tim Goodacre reports on the struggles, the despair and the dignity of the people and the medics of Gaza during their long nightmare.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Medical staff stand beside a bed in which a man lies with an amputated leg.
Medics confer about a patient in Gaza's European Hospital.
Tim Goodacre

Tim Goodacre is a vastly experienced plastic surgeon who recently spent two weeks in a hospital in Khan Younis treating the extensive injuries of the people of Gaza. I caught up with him to ask about his experience there.  

Graham: Let me start by asking what was it like getting into Gaza? What was the process and how difficult was it to actually get in in the first place? 

Tim: We went in as an emergency medical team under the under the auspices of the World Health Organisation, which is coordinated with UN OCHR. It was easy obviously to get to Cairo. Then we joined a convoy, a group of cars convening in the small hours of the morning in Cairo and then being escorted across the Sinai desert. We got to the border in time for dusk. What was staggering at that stage was seeing the number of lorries lined up, waiting on the Egyptian side to get in. They were two deep on one side, one deep on the other with a thin passageway through which we could drive through for mile after mile after mile of these lorries. 

Was this humanitarian aid sent from other nations? 

Absolutely. It was aid labelled from different countries or agencies. Crossing Rafah the next morning was all pretty haphazard and chaotic, but we met our driver on the other side. We then had to travel to Khan Yunis on the coast road because it was the safest part of the south Gaza strip. We went through a route called the Philadelphia Road, which is a gap between the two borders. As we drove along, we immediately were jumped on by some young lads who had put razor wire across the road. We picked up two of them who hung onto the car each side, with our window s firmly shut. As we sped along, they were our ‘protectors’, taking a pitiful sum to ensure that we would not be stopped at further razor wire and our vehicle plundered. It was our first experience of the lawlessness that's inherent at the moment in Gaza. 

All along that side of the road there were people putting up new tents after a recent further mass displacement, as far as the eye could see. It made a huge impact on me - the devastating plight of the people who were there. It looked like those pictures of Glastonbury or Woodstock, where as far as you could see, the rolling fields or sand dunes or whatever were totally covered in makeshift dwellings. It was pretty cold and windy. And subsequently, while we were there, it rained an awful lot and your heart just went out to these people.  

So these were people living in tents and temporary shelters? 

 Well, not really. They're barely tents. They're just finding flimsy bits of wood, putting them up and nailing them together. And these are not just the very poorest of the poor. This is everybody. Many of them were people from very well-to-do houses whose families have been displaced. I've worked in many parts of the world where there's poverty, but I’ve never seen so many people displaced.  

One of the things that's remarkable however is the relative cleanliness, the desire to maintain dignity in the most appalling circumstances. But a young lad who’s now a young doctor (who I have worked with for a decade now) came to see me and he was the most dejected person I've ever met. He said to me ‘they've taken away my dignity’. The abject pain in his face was something that I won't forget.  

You’ve been to Gaza many times before. What was different about this time? And you've seen it in the aftermath of previous wars and conflicts. What was what was particularly different this time? 

 It's utterly different – it’s the displaced population with nowhere to go and seeking shelter. When I first went in 2014 after Operation Protective Edge, I was taken to a huge neighbourhood of northeast Gaza, which had been flattened and at the time the impact on me was extraordinary. When I’ve visited subsequently over the last decade, they will show you this bombed out building and that flattened area, but I've never seen such vast numbers of displaced people. On the second day we moved into the European Gaza Hospital (EGH), which is where we were going to stay for the two weeks we were there. Inching slowly along amidst endless hordes of people walking around, seeing the dejection, despair, the hopelessness with nowhere to go - this for me is what defines this whole episode and makes it very different from others. This is in no way a diminution of other conflicts and human tragedies, but when there was bombing in Baghdad or in Kiev and Ukraine, people might go into underground shelters - there are places they can perhaps go to escape. Even in massacres such as in Darfur or Congo, there are places to run to. There is nothing like that in Gaza. 

Was there a pattern to the kind of medical emergencies and wounds that you were having to deal with? 

 The vast majority of injuries were the impact of high explosives, so we naturally saw quite a lot of burns, although the majority of severe burns alone were being managed by the Red Cross team also at EGH. Some of them were people who had been crushed and pulled out of buildings which had collapsed. But that was that was the minority. The majority of our cases were direct results of bomb blasts. Every time you hear a bomb, somebody is being killed, yet many others are caught on the fringe of that. Shrapnel travels at astronomical speeds and hits people in in a completely random way. These injuries are devastating. There were scores of people coming in with limbs missing. Seeing somebody with a leg off at the thigh, a leg off below the knee, an arm ripped off was all too common. It was hard to take in - you have to become somewhat immune to the backstory behind each dreadful injury, and concentrate on the carnage in front of you, to be able to deal with the constant onslaught of cases. 

How were the medics coping with it? You were there for two weeks. They are there for months, presumably on end? 

 I think it's incredibly important that we don't focus on the visiting medics. I usually peeled off at about 9pm or so in the evening - I had to go to bed and had to have a rest, but there were people trying to work through the night. What I want to focus on is the local people, particularly a young colleague, Ahmed, who was 36 years-old. He was statesmanlike in his ability to pull things together. His family are actually mostly in Dublin as they've got Irish passports. I cannot tell you how much admiration I have for that young Gazan man who shared his room with me.  

He has been managing to create a team who work alongside him, since many of the staff who had worked at the hospital before (some of whom we had trained over several years in limb reconstruction) were not there. That is because they might not be alive, or having to support their displaced families, or simply are afraid to travel in daily to the hospital, or whatever. It is a huge demand on individual doctors to leave a family group (who invariably try to stay together, so that if they are bombed, they all die together and do not have to be a sole survivor.) to then work away from such possible loss of all their family members. It's an incredible sacrifice to be working in medical care when your family are all huddled together in a place where they may all lose their life, and that gets to them in the end.  

The orthopaedic side is almost on its knees. Most of the system in the hospital is utterly on its knees. There were early years medical students who had been taught quickly how to manage wounds and to skin graft. They haven't got any pay, but some people have given a little money to my colleague’s account to try and give them some support. There were IT students and all sorts of others pulling together. How people can work in in such adversity and make things happen is quite a testament to the to the strength of humanity.  

It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed. 

What was it like living under the bombardment, which was presumably pretty constant during your time there? 

There may have been the odd period of four or five hours when there was no sound of close bombardment at all, although during that time there was probably small arms fire going on somewhere. But otherwise, it was relentless. One became somewhat used to the bombs in the distance, but when they're close by… Every time one of these bombs goes off, there are people dying. And that really that played on your mind. So huge numbers were seeking shelter anywhere in the vicinity of the hospital. If you can imagine a hospital corridor where every route is full of makeshift shelters, and you just go up around a stairwell and on the corner of each stair, there will be a family which will be hanging drapes up, trying to find some sort of privacy and dignity among the utter destitution.  

I found it very difficult to sleep during those times. The hospital is in a quadrant, a square. On one corner there was a supermarket which latterly was hit by an F16 delivered weapon. You could hear the sound of the rocket go off alongside the scream of the low flying fighter jet, and the whole building shook. There's also the incessant sound of drones. It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed.  

It made me realise what soldiers undergo when they get what used to be called shell shock. There, even if you're not injured yourself, this constant shocking damage gets to you. I knew we had the knowledge that after a short time, we would be getting out - but it made me realise how tough Ahmed and others working there have to be. It will be having a devastating impact on the population, and for a nation.  

I imagine the psychological effects of that are going to last for a long time in the lives of these people. You don't get over that quickly. If you live with that level of tension, thinking any moment now, I could die, that must stay with you and the marks of that stay for a long time. 

I'm sure that's true. I'm not an expert in PTSD and things like that. Ahmed is a Muslim and said to me more than once that when you believe in an afterlife, you believe that your time will come at some point, and you accept that. We don't know when it is or where it is, but it will come. I have frequently wondered whether any of the fighter jet pilots have ever experienced themselves what it’s like to be underneath the impact of one of their weapons? Having felt somewhat what it is like to be on the other side of such an onslaught, I do wonder whether very many of those involved in ordering conflict really have any kind of understanding of what devastation feels like, when there is nowhere to run? I fear for what this conflict does to the humanity of both sides. 

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing, 

Did you see any sign of hope or anything that gave you a sense of the way out of this? 

 The sense of hope is within the people who are there. There are many people who say they still really don't want to leave. They feel this passionately. It's their land. They do want to see a new Gaza. I tried to be somebody who lifted spirits. Communities can be rebuilt and there may be a new future which will come from the dust. I've been in touch with people in my University Medical school in Oxford to see whether we can do something about getting these young people's education continued.  

You can imagine there wasn’t a lot of laughter in the whole environment, but on the few occasions when I did gather together with my colleague’s small group of young students and volunteers, usually late into the night, we would eat whatever food goodies they had to hand, and their sense of fun would burst out. Together there was a very strong sense of community amongst them. 

How did your Christian faith inform the way you interacted with the situation? How did your Christian faith help you process what you were seeing and experiencing there? 

 I must say it was a deeply spiritual time for me. It was absolutely powerful to me to know that God cares and loves each and every one of these people. I longed to organise a football game with the kids. I was told that they had tried to do that, and it had become too dangerous. So there seemed to be no organisation around looking after the well-being of the children, their education, or the deeper impact on them of this war. People were jammed into the hospital, obviously because it was seen as a safe space, and it was humbling to think that us (as foreign workers) being there made them feel somewhat safer. It humbled me immensely.  

I felt nothing but a sense of privilege in being a witness to all this. I was reading the Psalms regularly in daily prayer. There's also something about that land being the place where God himself suffered in Christ and went through his own agony, and that the Holy Family escaped through Gaza to Egypt.  

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing, a privilege and an honour to have such access which comes with having my particular background of skills and past history with Gaza. God is over all these matters, and we are compelled to respond. 

 

Tim Goodacre is a Reconstructive Plastic Surgeon based in Oxford, with extensive experience of working in diverse environments outside the UK. He is immediate past Vice President of the Royal College of Surgeons of England.