Loneliness has been called a “silent plague.” While reports point out the irony of the increasing prevalence of loneliness in a world where technology offers more opportunities for connection than ever before, a number of people caught in the grips of a crisis which leaves them feeling untethered have documented their distress on social media. Whole subreddits are devoted to the lonely. On Instagram and X, posts lamenting the lack of support and the stigma around chronic loneliness sit neatly beside those looking to reframe loneliness by philosophizing it while many others turn to sharing the solitary figures in Edward Hopper’s paintings as capturing the essence of urban loneliness and longing. As one Redditor sums it up: “Loneliness is truly one of the most devastating things to experience.”

Loneliness has long existed as part of the human condition, but its damaging effects were ushered into the spotlight more prominently due to the isolation brought on by the Covid19 pandemic. It is now receiving considerable attention, primarily as a health concern. While it is hard to estimate the number of people experiencing the distress that comes with a disconnection from society, perceived or otherwise, a Meta-Gallup survey across 142 countries found that one in four people reported feeling very or fairly lonely. This comes up to well over a billion people across the globe. And officials have now sounded the alarm.

Towards the end of 2023, the World Health Organization (WHO) declared loneliness a global public health concern. The WHO also announced an international commission on fostering social connection – considered to be the first global initiative of its kind – that will be led by the US Surgeon General, Dr. Vivek H. Murthy and African Union youth envoy, Chido Mpemba. The commission will run for three years, exploring the role social connection plays in improving people’s health, raising awareness and focusing on devising solutions to “build social connections at scale.”

Loneliness is more than just a “bad feeling,” says a report released by the office of the US Surgeon General last year. It is a “profound threat,” harmful to both individual and societal health. In his letter prefacing the report, Dr. Murthy (who previously dubbed loneliness an “epidemic”), said that the health risks of social disconnection and loneliness is equivalent to that of smoking 15 cigarettes a day, and is greater than the risks associated with obesity and physical inactivity. Such dire impacts are seconded by studies, such as a review published in Nature Human Behaviour in June 2023 that linked both loneliness and social isolation with a greater risk of premature death. “We now know that loneliness is a common feeling that many people experience. It’s like hunger or thirst. It’s a feeling the body sends us when something we need for survival is missing,” Murthy said.

Loneliness has been associated with an increased risk of cardiovascular disease, stroke, dementia, as well as mental health conditions such as depression and anxiety disorders. Loneliness itself is not a diagnosable clinical condition. But recent research into its risks and health impacts have led some to liken it to a “disease.” In this way, some critics argue that loneliness, a part of the human condition, is being medicalized. But can loneliness be solved through medicine’s pharmaceutical approach? The answer might lie in understanding the complexities of loneliness and the factors that shape it.

Look back in time and loneliness turns out to be a “relatively new concept,” Amelia S. Worley wrote in The Conversation. The words “lonely” or “loneliness” didn’t appear in writing until the 17th century. Its predecessor, “oneliness” was devoid of any emotional or negative connotations. Although rarely used, the term "loneliness" back then referred to people and places “far from neighbours,” Worley noted. Though loneliness is mostly considered a negative experience today, no consensus has been reached on how to define it. Why? As an editorial in The Lancet notes, loneliness is a highly subjective experience that is shaped by cultural norms and resists standardization.

But for the sake of clarity, the American Psychological Association defines it as the “affective and cognitive discomfort or uneasiness from being or perceiving oneself to be alone or otherwise solitary.” It is the distress that emerges from a perceived gap in the quantity or quality of one’s relationships, distinct from the state of being alone.

Even though loneliness, at different levels, is experienced by everyone, Fay Bound Alberti argued that “[L]oneliness is not a universal condition; nor is it a purely visceral, internal experience. It is less a single emotion and more a complex cluster of feelings, composed of anger, grief, fear, anxiety, sadness and shame.”

Some of the proposed solutions for chronic loneliness, however, may attempt to paint it as a universal experience, all the while pointing to the sheer scale of the problem that is worrying officials across countries. The UK and Japan each have appointed a Minister for Loneliness. Researchers in the US took a different approach, directing their efforts towards creating a loneliness pill. Dr. Stephanie Caccioppo found that pregnenolone, a neurosteroid can help reduce the stress-response that often accompanies loneliness and makes social interactions feel threatening. It seems counterintuitive that a pill – a product of the individualization of medicine – can address what is at its roots an issue of social disconnection. But Cacciopo told Smithsonian Magazine that the intent of the pill is not to eradicate the feeling of loneliness but only reduce the fear that prevents someone who is lonely from interacting with others.

Medicalizing loneliness may have its advantages – it pushes the suffering of countless people who have been forced to keep their distress hidden for fear of further isolation into the limelight. It makes sense that as our society evolves and changes, what constitutes a health concern does too. A public health approach to loneliness can draw attention to the crisis at hand and invigorate efforts to address it.

But critiques have emerged over time warning of how pathologizing loneliness, which is hard to define to begin with, risks glossing over the complexities of the human condition, the cultural and environmental factors responsible in shaping its experience, as well as the breakdown of community that underlies its rising prevalence. Arguing that loneliness is not only a concern of individual psychology but is “inherently social, cultural, and relational,” a group of cultural anthropologists, ethnographers, and mental health researchers wrote: “Our need to connect with others is the very thing that creates the potential for loneliness. For this reason, loneliness should not be pathologized as a disorder, but rather seen as a natural expression of what it means to be a social being, born into and existing within society.”

Further, in a 2018 correspondence published in The Lancet, the authors noted, “The medicalisation of social issues has not worked in the past. From obesity to HIV/AIDS, health researchers and practitioners are fighting—with limited success—to convince society that public health problems require integrated and holistic approaches. Medicalisation of loneliness will discourage the collaboration needed, and medicine probably has no effective instruments with which to single-handedly address the absence of human connection.”

When the language of medicine is applied to loneliness, it ends up framing the problem as one to be “cured.” In doing so, it may end up simplifying an issue that at its crux is much more nuanced. “The medicalisation of loneliness mystifies a condition for which there is no cure,” Frank Furedi wrote in The Guardian.

Another form of simplification emerges in the assumptions that have long been associated with loneliness – namely, that it is a problem predominantly affecting industrialized, high-income, Western countries, and more specifically, the elderly. The WHO estimates that while 1 in 4 older adults experience loneliness and social isolation, between 5 and 15% of adolescents experience loneliness – though this is considered to be an underestimation. The association of loneliness with individualistic cultures in popular opinion also leads to the false assumption that people in collectivist societies – such as India – don’t experience it to the same degree. But a 2022 paper that studied data from 113 countries found loneliness at problematic levels to be a common experience worldwide. It also flagged critical data gaps; while large amounts of research on loneliness is available in developed regions, especially in Europe, low and middle-income countries lack such data. “Such data gaps might be a result of limited resources and competing priorities from issues deemed more urgent, such as food security, housing, and basic provision of medical services,” the researchers noted, pointing to equity issues.

A 2022 report by The Aspen Institute further highlighted how loneliness in India may look different to that in the West. “A translation for the term ‘loneliness’ does not exist across the many languages and dialects spoken in India, including Hindi, the official government language,” it noted. This may not only prevent an “accurate articulation” of the emotion for some, but also ends up limiting the development of appropriate interventions.

The authors of the report ask a pertinent question – “whose loneliness matters?” In doing so, they underscore the problem of equity and access that invisiblizes the distress of loneliness and social disconnection in marginalized and underprivileged communities, who may also be the ones experiencing it the most.

It then becomes relevant to think of loneliness not only as an individual state but also as a product of several environmental, cultural and systemic factors that may increase social disconnection. For instance, Mpemba told The Guardian that across Africa, issues around peace, security, unemployment and uncertainties and vulnerabilities to the climate crisis increase social isolation. Meanwhile, The Lancet editorial states that several factors – from how our cities are planned to promote or deter social connection, the growing popularity of remote work, social media use and its researched impacts on feelings of disconnection – shape loneliness. “Austerity, poverty, racism, and xenophobia cause inequity and feelings of exclusion. Societal trends towards individualism, at the expense of collectivism and feeling of belonging, risk increasing feelings of loneliness,” it added.

As Mpemba noted, loneliness transcends borders and may affect every facet of health, wellbeing and development. The WHO’s commission seems to be focusing on a more community-oriented approach that prioritizes social connection and focuses on a range of interventions – from social prescribing to policies that address exclusionary and discriminatory practices. But as the critiques of medicalization point out, addressing loneliness goes beyond health and would require not only developing a deeper, cross-cultural understanding of it, but also integrated efforts from several different factions of society.