Why positive thinking won’t end loneliness.

This letter was published on UCL’s Medical Anthropology blog, as part of the Advocacy Letter Series organised by Dr Carrie Ryan and can be found here: https://medanthucl.com/2023/09/13/why-positive-thinking-wont-end-loneliness/

Since 2018, the UK government has put in place a Ministry for Loneliness. Although this is a step in the right direction, I argue here that the Ministry’s choice in framing loneliness through the lens of psychology is counter-productive and I put forward revelant anthropological insights that better describe this topic.

This letter is addressed to Diana Barran, our current minister for Loneliness.

Dear Diana Barran,

Although I was happily surprised to discover the British government had decided to create a Ministry for Loneliness, I was saddened to see that your latest Campaign to End Loneliness report is titled the Psychology of Loneliness. In it, you praise the efficacy of mindfulness, cognitive behavioural therapy and positive thinking in helping people cope with loneliness. You put forward the initiatives that your Building Connections Fund has created as solutions to alleviate loneliness, which mostly consist of telling older people to volunteer.

I am reaching out to inform you that this report is widely out of touch with the reality of loneliness. Firstly because according to the national statistics the age group suffering most from loneliness is the 16-25 age group (Department for Digital, Culture, Media & Sport, 2021). Secondly because framing loneliness as an individual and psychological issue is not only unhelpful but also harmful.  Medical anthropology is a discipline interested in understanding the construction of health and ill-health across different cultures. In the last century, this discipline has demonstrated time and time again that health is a social and cultural matter, as well as a biological one. Biosocial medical anthropology in particular is working to highlight the social and political components of health that often get ignored. The question of loneliness is a perfect example of an issue that is being framed in an individual, psychological and medical way instead of from the social context in which it emerges. Indeed, I believe your ministry’s funds would be better spent investigating the specific social and cultural factors that lead to loneliness, instead of putting the sole responsibility on individuals, who often face structural challenges that have caused their loneliness in the first place. I therefore ask you to consider the following insights surfaced by medical anthropologists when shaping next year’s campaign strategy.

I have carefully chosen three stories to illustrate the type of insight anthropological research has already produced on the topic of loneliness, and will demonstrate how we can leverage them to improve the campaign’s strategy. As I will show, ethnography is possibly one of the most exhaustive research method for understanding any social phenomenon, providing a great starting point when it comes to designing effective surveys on the topic of loneliness.

I first ask you to consider the role culture plays in shaping mental health. To do so let’s consider the Japanese phenomenon of hikikomori, meaning “withdrawn”. The term describes the behaviour of young people who stay in their bedrooms for months on end, sometimes even multiple years, without jobs, without talking to anyone. What anthropologist Ramsey Ismail found is that people who became hikikomori did so as a result of the immense social and cultural pressure they felt to attain a high-performing “white collar” job (Ismail, 2020). As a response, some adolescents fall into severe depression and some receive the medical diagnosis of hikikomori (withdrawn). The term is mostly met with sympathy, as parents and doctors try to understand how to help these young people, as well as prevent the phenomenon in others. 25-year-old Yuto for instance recalls the anguish and lethargy he felt during his last years of high school, as all his classmates were applying to impressive universities and all the messaging around him emphasised the importance of being a high-performing individual. It seems that the socio-cultural pressure in Japan is such that it is actually quite common for people to withdraw in such a way for periods of up 3 months, which is why the diagnostic threshold of hikikomori has been placed at 6 months (Saito, 2013). New Start is an organisation that works to progressively re-integrate them into society through teaching them social skills such as speaking on the phone and training them for simple jobs. Despite the sympathy generally extended to hikikomori, New Start activists are still working to raise awareness about the “unforgiving high-pressure structure of society [that] made them hikikomori”, and move away from narratives of individual short-comings (Ismail, 2020).

This ethnographic example brings attention to the fact that people’s mental health can be greatly shaped by culture. What are the specific ways in which British culture contributes to loneliness? Identifying such social and cultural norms will bring value to your campaign.

I then ask you to consider structural challenges people might face, which can generate feelings of loneliness. Through her time spent in Mexico with high school students, anthropologist Janis Jenkins observed that a lot of them are living in structurally difficult environments. Violence and criminal activity in many neighbourhoods mean that teenagers are not allowed nor able to spend time outside, hanging out with their friends. Some also have to be home to watch their younger siblings, and do work around the house cooking and cleaning as the parents work multiple jobs. Effectively they have very little time to themselves and are not often left alone. Yet they feel lonely. The story of Marisol highlights the difficulties of this living situation, especially as both her parents struggle with their mental health, are distant, and often fight. “- To be honest, sometimes it makes me depressed, because its not like I have that closeness with my family. I mean its like everyone is off on their own and that makes me feel… desanimada [dispirited, sad] and it makes me have… I don’t know… the feelings of envy towards the rest of the people who I see are close with their families.” (Jenkins et al., 2020). Through this ethnographic example we uncover that loneliness does not always stem from being alone, but rather feeling disconnected. What are the structural components of British society that prevent people from connecting with their peers? Answering this question will produce tangible insights which will improve the effectiveness of the campaign.

Both of these stories highlight the importance of the context in which loneliness emerges and point to the fact that loneliness is not an individual issue. Loneliness therefore should not be understood through the lens of psychology. There is nothing inherently wrong with either Yuto or Marisol; they are reacting to the environments they are in. Examples of the sort are why medical anthropologists are critical of the way mental health is too often individualised, medicalised and globalised. In the case of loneliness, medical anthropologists Chikako Ozawa-de Silvia, Michelle Parsons and many others are calling for a de-pathologisation of loneliness as a disorder, and for it to be seen as “a public health issue, inherently social and culturally shaped” (2020). They argue that although humans are social creatures who seek connection and validation by others, the feeling of loneliness is not revealing of a personal defect, but rather highlights contextual challenges.

In light of these examples, I now ask you to consider the potential harm of self-help narratives in mental health and loneliness discourse. Olivia Sagan in her recent book Narratives of Loneliness (2017) has interviewed British people of all ages and retells their stories in compelling ways. She describes lonely individuals who were neglected or abused as children, individuals with complicated lives, who struggle with alcoholism, unemployment, in short who are living in challenging environments. Narratives of self-help and individual responsibility fail to acknowledge the reality of people’s lives and worsen their feelings of loneliness, as they feel they are failing to get better. One interviewee by the name of Gladys puts it simply: “- I know I should do this, should do that… Meet people! Volunteer! Be active! Get a job! They… they just don’t know… don’t have a clue… even in my self-help group, I feel I don’t measure up to what I should be doing to self-help! […] I walk along Westfield Avenue and you know, people are out having coffee, nice clothes, friends, money to spend… and I know these are… are “markers” of being human. And I don’t have them. I’m not a success story, I’m piss-poor, look a state, no job and alone – worse, I’m lonely.” (Sagan, 2017). Here we see that it is not through lack of trying that people remain lonely. Why do people who participate in group activities still experience loneliness? How do self-help narrative affect people who are struggling with loneliness? What is preventing people from resolving their loneliness, other than will power?

Current surveys do not capture the complexity of loneliness well enough. The yearly UK Community Life Survey asks people “How many times a week do you meet up with friends or family” and “How often do you volunteer” (2021). Yet, Marisol’s story clearly shows that being alone is not necessarily the reason people feel lonely. She complains about feeling disconnected from her family. And the reasons for this disconnection are structural: she lives in a dangerous neighbourhood, her parents are working multiple difficult jobs which results in their poor mental health, creating a tensed home environment. So the data captured misses the point; it does a poor job of understanding the reasons people feel lonely. How can we fix it? Many anthropologists, myself included, are advocating for a different research method, one that starts with in-depth ethnography. Indeed, the length and personal involvement required of the ethnographic method is what makes it so comprehensive. As a result, anthropologists are able to produce new insights and raise sensible questions, which should be used to inform the design of precise and practical surveys. This type of “mixed method” is called the exploratory approach, and has proven quite effective in creating change (see: Moreau and Garaway, 2018).

By moving away from a psychological framing of loneliness and using anthropological insights to identify relevant questions to survey at the national level, I believe we can make the Campaign to End Loneliness effective. I hope to have convinced you that loneliness exists within a complex social and cultural reality that must be accounted for. I hope you will consider the role social norms play in setting impossible standards in the case of Yuto, the adverse environment Marisol is facing and your responsibility towards the promotion of self-help narratives which can be very incriminating for people like Gladys.

I therefore ask you to change the messaging of your Campaign to End Loneliness to reflect the complexity of the situation. I ask you also to invest your funds into further investigating the structural components of loneliness and ways to tackle them.

I thank you for your time.

Yours sincerely,

Noemi Cassin

REFERENCES

Department for Digital, Culture, Media & Sport. (2021). Community Life Survey 2020/2021. https://www.gov.uk/government/statistics/community-life-survey-202021-wellbeing-and-loneliness/wellbeing-and-loneliness-community-life-survey-202021 (accessed 16/03/2023).

Ismail, Ramsey. (2020). "New starts at New Start: Recovery and the work of hikikomori." Transcultural Psychiatry 57(5): 698-709.

Jenkins, J. H., Sanchez, G., & Lidia Olivas-Hernández, O. (2020). Loneliness, adolescence, and global mental health: Soledad and structural violence in Mexico. Transcultural psychiatry, 57(5), 673-687.

Moreau, M. A., & Garaway, C. J. (2018). “Fish Rescue us from Hunger”: the contribution of aquatic resources to household food security on the rufiji river floodplain, Tanzania, East Africa. Human Ecology, 46, 831-848.

Ozawa-de Silva, Chikako, and Michelle Parsons. (2020). "Toward an anthropology of loneliness." Transcultural Psychiatry 57.5: 613-622.

Saito, T. (2013). Hikikomori: Adolescence without end (J. Angles, Trans.). Minneapolis: University of Minnesota Press. (Original work published 1998)

Sagan, O. (2017). Narratives of loneliness and mental ill health in a time of neoliberalism. In Narratives of Loneliness (pp. 88-100). Routledge.