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Loneliness

Mental Health

5 March 2024

5 min read

What Bobby Brazier, Jo Marsh and Eleanor Rigby have in common

A public health campaign asks influencers if they are lonely.

Belle Tindall

Belle is the staff writer at Seen & Unseen and co-host of its Re-enchanting podcast.

a young man looks pensive as he answers a questuon while sitting in a fancy room.

Bobby Brazier at 10 Downing Street.

NHS.

‘Loneliness. It’s a part of life. Let’s talk about it’

That’s the new slogan offered by the NHS in partnership with the Department for Culture, Media and Sport. As part of their campaign, they recently invited young influencers and TV personalities to Downing Street to do just that – to talk about loneliness.

With those aged between 16 and 29 now twice as likely to report feeling lonely as those over 70, these celebrities were tasked with answering a few of the questions most asked by people within that age group. Their questions went along these heart-wrenching lines:

Why am I so lonely?

Is it normal to feel lonely?

Will I always be this lonely?

And while their answers to such questions were a little ‘meh’ (whose wouldn’t be? They were given seven seconds to answer some of humanity’s deepest questions), it doesn’t much matter, their answers weren’t really the point. Rather, viewers were presented with a handful of popular, successful, lovable (looking at you, Bobby Brazier) and happy looking people doing something notoriously difficult: admitting loneliness.

And I think that may be the point.

I am of the firm opinion that admitting to feeling lonely is one of the hardest things a person could do. I have certainly never had the bravery to do it.

I remember watching Greta Gerwig’s 2019 adaptation of the beloved 1868 novel, Little Women, for the first time; I was always going to love it, I had decided as much before even stepping foot in the cinema. But there was one scene that felt as if it literally took my breath away. I was left winded in row C.

It is toward the end of the film, and Jo Marsh, the feisty, strong and independent protagonist, is giving a feminist monologue for the ages (albeit to her mum) as she stands in the attic of her childhood home. Jo speaks of women’s minds and souls, their ambitions and talents, she explains how sick she is of being underestimated, getting more impassioned with every word. That is, until she tearily ends her speech by declaring – ‘…but I’m so lonely.’

This isn’t in the book.

This final line was written by Greta Gerwig specifically for this adaptation. And the only person who seemed to be more taken aback by Jo’s words than me (an owner of more editions of the novel than is cool to admit), was Jo herself, who instinctively clasped her hand to her mouth as if she couldn’t believe that she’d just said such words aloud.

As far as filmmaking goes, it was genius. As far as human nature is concerned, it was, well, true.

Not only do we find loneliness acutely painful, but we also tend to find it near impossible to admit to, so much so, the government currently feels the need to step in. Why is that, I wonder? Why does ‘lonely’ seem to be the hardest word?

Those who admit to their own loneliness are wading into profoundly vulnerable waters.

Part of it is certainly because there is a social stigma attached to feeling lonely. Ironic, isn’t it? How loneliness has social connotations. Nobody wants to be Eleanor Rigby, nor Father McKenzie, nor any of ‘the lonely people’ that Paul McCartney so pities, for that matter. It’s one of the only Beatles songs you wouldn’t want to have been written about you. Loneliness feels like a failure somehow, and so we struggle to admit it, even to ourselves. A failure because, we’re supposed to be self-sufficient, independent, free-thinking, emotionally-sturdy individuals (which is the operative word, of course). That’s what individualism has taught us, isn’t it? And so, how do we reconcile that with the piercing pain of isolation? How do we admit that there’s a deep crack within us that can’t be papered over by success, or wealth, or another episode of our favourite podcast? How do we go about admitting such a lack? A lack, which despite individualism’s best efforts, has us naturally wondering why it’s there in the first place; are we unpopular? Unattractive? Unlikable? Or worst of all, unlovable?

Those who admit to their own loneliness are wading into profoundly vulnerable waters. And most of us are utterly unwilling to follow them there, lest we be spotted by a budding Paul McCartney and our loneliness be immortalised.

And then, of course, there’s the other side of the coin: what does our loneliness say about the people who we are in relationship with? Nobody wants to unleash the panic and guilt tucked away in that can of worms (which, I must note, is unnecessary panic and guilt - there could be any number of reasons you’re feeling lonely, despite your very rich relationships).

And so, we just don’t say the word. And that’s what appears to be making the NHS and, rather randomly now that I think about it, the Department for Culture, Media and Sport so nervous.

We need to admit when we’re lonely. We have to pull a Jo Marsh and say it out loud. We must give language to the lack that we feel.

To be known and loved is my deepest and truest need.

One of the things that I find myself most consistently thankful for when it comes to my Christian faith (you know, apart from the most obvious aspects…) is that it gives me such language. At the risk of sounding annoyingly self-centred, it dignifies the feelings that I find hard to even acknowledge. It offers explanation, and therefore, a comfort that I could never find anywhere else; a comfort rooted in truth.

It may sound nuts, but I have come to understand the reality of loneliness, not through influencers on a sofa in Downing Street (although that’s great), and not even through Jo Marsh’s monologue (which is even greater), but through an ancient Hebrew poem. This poem tells me that to be alone is ‘not good’.

Not good. Not right. Not as it should be.

That’s God’s point of view at least – that to be alone, properly, completely and permanently alone, goes against the very fabric of the world. It is at odds with human flourishing. I’ve come to deeply value how concrete that is. I’ve also learnt to relax into the knowledge that not only is loneliness ‘normal’ (referring to one to the questions referenced at the beginning), it’s natural, in every possible sense of the word.

To be known and loved is my deepest and truest need. I was designed for relationship, with God and with people. And therefore – with all the complex ways that life unfolds - to be lonely, is to be human.

So, with all of this in mind, I’m tempted to end where we began, to come full circle and once again borrow the government’s words:

‘Loneliness. It’s a part of life. Let’s talk about it.’

Article

Care

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21 June 2023

5 min read

The healing touch in an era of personalised medicine

As data powers a revolution in personalised medicine, surgeon David Cranston asks if we are risk of dehumanising medicine?

David Cranston

David Cranston is emeritus Professor of Surgery at Oxford University. As well as publishing academically, he has has also authored books on John Radcliffe, and mentoring.

A doctor looks thoughtful will holding a stethoscope to their ears.

Photo by Nappy on Unsplash.

In 1877 Arthur Conan Doyle was sitting in one of Dr Joseph Bell’s outpatient clinics in Edinburgh as a medical student, when a lady came in with a child, carrying a small coat. Dr Bell asked her how the crossing of the Firth of Forth had been on the ferry that morning. Looking sightly askance she replied;

“Fine thank you sir.”

He then went on to ask what she had done with her younger child who came with her.

Looking more astonished she said:

“I left him with my aunt who lives in Edinburgh.

Bell goes on to ask if she walked through the Botanic Gardens on the way to his clinic and if she still worked in the Linoleum factory and to both these questions she answered in the affirmative.

Turning to the students he explained

“I could tell from her accent that she came from across the Firth of Forth and the only way across is by the ferry. You noticed that she was carrying a coat which was obviously too small for the child she had with her, which suggested she had another younger child and had left him somewhere. The only place when you see the red mud that she has on her boots is in the Botanic Gardens and the skin rash on her hands is typical of workers in the Linoleum factory.

It was this study of the diagnostic methods of Dr Joseph Bell led Conan Doyle to create the character of Sherlock Holmes.

A hundred years later and I was young doctor. In 1977 there were no CT or MRI scanners. We were taught the importance of taking a detailed history and examination. Including the social history. We would recognise the RAF tie and the silver (silk producing) caterpillar badge on the lapel of a patient jacket. We would ask him when he joined the caterpillar club and how many times he had had to bail out of his plane when he was shot down during the war – a life saved by a silk parachute. We would notice the North Devon accent in a lady and ask when she moved to Oxford.

The patient’s history gave 70% of the diagnosis, examination another 20% and investigation the final 10%. Patients came with symptoms and the doctor made a presumptive diagnosis – often correct - which was confirmed by the investigations. Screening for disease in patients with no symptoms was in its infancy and diseases were diagnosed by talking to the patients and eliciting a clear history and doing a meticulous examination. No longer is that the case.

At the close of my career, as a renal cancer surgeon, most people came in with a diagnosis already made on the basis of a CT scan, and often small kidney cancers were picked up incidentally with no symptoms. The time spent talking to patients was reduced. On one hand it means more patients can be seen but on the other the personal contact and empathy can be lost.

Patients lying in in bed have sometimes been ignored. The consultant and the team standing around the foot of the patient’s bed discussing their cases amongst themselves. Or, once off the ward, speaking of the thyroid cancer in bed three or the colon cancer in bed two. Yet patients are people too with histories behind them and woe betide the medic, or indeed the government, who forgets that.

With computer aided diagnosis, electronic patient records and more sophisticated investigation the patient can easily become even more remote. An object rather than a person.

We speak today of more personalised medicine with every person having tailored treatment of the basis of whole genome sequencing and knowing each individual’s make up. But we need to be sure that this does not lead to less personalised medicine by forgetting the whole person, body mind and spirit.

Post Covid, more consultations are done online or over the telephone -often with a doctor you do not know and have never met. Technology has tended to increase the distance between the doctor and patient. The mechanisation of scientific medicine is here to stay, but the patient may well feel that the doctor is more interested in her disease than in herself as a person. History taking and examination is less important in terms of diagnosis and remote medicine means that personal contact including examination and touch are removed.

Touching has always been an important part of healing. Sir Peter Medawar, who won the Nobel prize for medicine sums it up well. He asks:

‘What did doctors do with those many infections whose progress was rapid and whose outcome was usually lethal?

He replies:

'For one thing, they practised a little magic, dancing around the bedside, making smoke, chanting incomprehensibilities and touching the patient everywhere.? This touching was the real professional secret, never acknowledged as the central essential skill.'

Touch has been rated as the oldest and most effective act of healing.

Touch can reduce pain, anxiety, and depression, and there are occasions when one can communicate far more through touch than in words, for there are times when no words are good enough or holy enough to minister to someone’s pain.

Yet today touching any patient without clear permission can make people ill at ease and mistrustful and risk justified accusation. It is a tightrope many have to walk very carefully. In an age of whole-person care it is imperative that the right balance be struck. There’s an ancient story that illustrates the power of that human connection in the healing process.

When a leper approached Jesus in desperation, Jesus did not simply offer a healing word from safe distance. he stretched out his hand and touched him. He felt deeply for lepers cut off from all human contact. He touched the untouchables.

William Osler a Canadian physician who was one of the founding fathers of the Johns Hopkins Hospital in Baltimore, and ended up as Regius Professor of Medicine in Oxford, said: