by Angela Eagle
This is precisely the sort of loneliness that modern society imposes on more and more of our citizens.
A study by the Mental Health Foundation found that in the UK, one in ten of us feels lonely often and 48 per cent of people think we are getting lonelier in general. There are two groups that appear to have a particular vulnerability to loneliness: the elderly – which may come as no surprise given the adult social care crisis facing Britain – and also young adults – a phenomenon that has only recently started drawing attention from policy-makers. It isn’t just the elderly and young adults. Many adults, even those who co-habit or are in a relationship, feel alone. Loneliness is subjective and can be self-reinforcing. If we are lonely, we can start to change our behaviour in response to that sense of social alienation.
What makes loneliness really worrying is that it seriously harms our overall mental and physical health. There is a growing body of academic and scientific research quantifying how, why and to what extent loneliness affects us. What we now know is that loneliness is more than just a malady of the mind; it’s fundamentally antithetical to human nature. We are simply not built to operate as atomised individuals.
Truth be told, humans are a relatively physically weak, slow and vulnerable species. Our bipedal posture limits our speed; we don’t have offensive adaptations like claws; our teeth evolved for an omnivorous diet in which most of our calories come from non-meat sources; we lack fur or camouflage; and our skin is so fragile papercuts are a health hazard in our offices. What has made humans so extraordinarily successful and dominant as a species is our ability to co-operate. We evolved the capacity to create a far broader range of vocalisations than any other species to help us communicate with one another in languages of our own creation. We have evolved abstract reasoning, an innate desire for reciprocity, an aversion to cheating; a whole range of evolutionary modifications underpinned by complex neurological and other physical adaptations that further shape our cognition and behaviour. In short, we are adapted to be highly social animals that experience and enjoy a range of meaningful co-operative social interactions. Mrs Thatcher presented her folksy aphorisms about self-reliance and individualism as though they were based on common sense: in fact, she was just wrong. They were quite the opposite.
George Monbiot, the Guardian journalist who has done sterling work both highlighting and seeking to personally address loneliness through his Breaking the Spell of Loneliness album and tour with Ewan McLennan, has collated the latest findings on loneliness and our health:
Social isolation is as potent a cause of early death as smoking fifteen cigarettes a day; loneliness, research suggests, is twice as deadly as obesity. Dementia, high blood pressure, alcoholism and accidents – all these, like depression, paranoia, anxiety and suicide, become more prevalent when connections are cut. We cannot cope alone.
Professor John Cacioppo at the University of Chicago, a social neuroscientist, has been at the forefront of producing scientific evidence of the physiological effects of loneliness: a rise in stress hormones as well as corollary decreases in immune function and cardiovascular function.
Loneliness in modern Britain is felt in every age group, social class and type of household. But we do know that there are certain risk factors: living alone, not working or a significant life event that disrupts our social circles, such as a death, moving to a new community, or leaving the parental home.
Loneliness in older people has had some attention thanks to charities such as Age UK, the Campaign to End Loneliness and more. They have reported:
Seventeen per cent of older people are in contact with family, friends and neighbours less than once a week and 11 per cent are in contact less than once a month;
Over half (51 per cent) of all people aged seventy-five and over live alone;
Two fifths of all older people (about 3.9 million) say the television is their main company;
Sixty-three per cent of adults aged fifty-two or over who have been widowed, and 51 per cent of the same group who are separated or divorced, report feeling lonely some of the time or often;
Fifty-nine per cent of adults aged over fifty-two who report poor health say they feel lonely some of the time or often, compared to 21 per cent who say they are in excellent health;
A higher percentage of women than men report feeling lonely some of the time or often.
For the main part, central government has washed its hands of the need to intervene to help stave off loneliness. The Care Act 2014 actually increased the requirements on councils, specifically to avoid for as long as possible the point at which older residents need to enter residential care by providing support in homes. However, as a result of cuts to councils, we will be spending £6 billion less on adult social care in England this year than in 2010. Defunded councils, barely able to provide those duties that are mandated by law, have lost so much capacity that no sensible person could lay the blame at their feet. With the squeeze on council resources, direct provision is disappearing. Day centres and sites for social initiatives such as lunch clubs are being sold off by local authorities to protect core services. Labour and Conservative councils alike are trying to expand their capacity by taking a co-ordinating role with the NHS, the police and a network of voluntary services that has emerged to try to reach into the crevices in which we have warehoused thousands of lonely older citizens and provide a loving, helping hand.
Cutting funding is especially damaging when you consider the demographic pressures in Britain. The ONS, in a report on loneliness, states:
The average age of the UK population is expected to increase over the coming decades. We have projected … that the number of people aged eighty and above is expected to more than double by 2037 and the number of people aged over ninety is expected to triple. The number of centenarians show an expected increase of sevenfold … from 14,450 in mid-2014 to 111,000 in mid-2037.
There are always glimmers of hope. Social entrepreneurs such as Alex Smith, of North London Cares, South London Cares and Manchester Cares, try to bring together older and younger residents so they might form meaningful relationships and a sense of community. As they say on their website:
We do this because London is a place of extremes. While our capital is one of the most dynamic places in the world, full of cultural and economic opportunities and a hotbed of innovation and change, it can also be anonymous, lonely and isolating.
For our older neighbours in particular, many of whom have spent a lifetime in their home neighbourhoods in Camden and Islington, the rush and pace of the city can often now feel too much. Getting around can be frightening, and trends including globalisation, gentrification, migration, digitisation and the housing bubble are transforming our communities faster than ever.
The multiplying effect of those pressures is that many older people have deep roots – from Kilburn to Kentish Town – but few connections. Meanwhile, young professionals – often graduates from across the country and around the world – can have hundreds of connections in the social media age, but no roots in their communities.
However, no matter how much the voluntary sector does, they will never have the capacity – at scale – to generate sufficient funding to match growing demand. And there is another problem: quite often, misconceived regulation can throttle the voluntary sector’s capacity to initiate change. A Joseph Rowntree Foundation article by Tracey Robbins stated in 2013:
Regulations around insurance, safeguarding and health and safety frustrated other ideas such as a pop-up café for a neighbourhood with no community centre, and reduced it to a coffee morning in a church – although 100 people each week still came. Restoring a village cinema for all ages became a film club mainly attended by adults. Intergenerational drama never happened as youth providers could not work outside their remit. The examples go on and on. Practical, simple interventions were seen as too risky, too hard and were therefore diluted or deferred.
Members of the Campaign to End Loneliness have discovered that
even living in a care facility is not, in itself, a cure for loneliness, and again found stifling regulations to be part of the problem. They reported in 2015:
There is a growing understanding that communal living is not an effective antidote to loneliness, and that, in fact, older people in residential care demonstrate worrying levels of loneliness and isolation.
Experts acknowledged this issue and recognised that the vast majority of current initiatives were aimed at older people living in the community.
Some experts argued that the limitations on opportunities for social interaction among those in care settings were primarily a product of the barriers created by the high levels of physical disability and cognitive impairment that exist among most residents of residential care. However, others perceived additional barriers created by a culture of risk aversity among care home owners and a failure by practitioners and commissioners to recognise the need for individuals in care homes to maintain social connections beyond their interactions with other residents.
What galls most is that whereas this government has prioritised its obsession with eliminating ‘red tape’ for businesses (quite often so they can continue sharp practices), they have singularly failed over seven years to think more creatively about eliminating bottlenecks for looking after vulnerable members of our community.
At every level, whether in terms of matching funding to demand; sorting out the regulatory framework; providing meaningful co-ordination as only the state can do at a national level; or even showing that they grasp the scale of the problem, the Tory government has completely failed.
Moreover, while the ongoing crisis of how we care for our elderly has been botched by David Cameron and now Theresa May, a new crisis is starting to emerge: loneliness among young people.
A spate of studies in recent years has shown that young people are increasingly feeling more lonely and anxious than any other age group. Body dysmorphia is driven by ‘perfect body’ images which grace the covers of magazines and today proliferate on ‘curated spaces’ like Instagram, in which young children are encouraged to study poses, lighting and makeup to ensure they take the perfect photo to display to the world.
In 2010, the Mental Health Foundation found loneliness to be a greater concern among young people than among the elderly. Those aged 18–34 were more likely to feel lonely often, to worry about feeling alone and to feel depressed because of loneliness than those over fifty-five.
In 2014, the insurer Aviva released its latest Health Check UK Report. In it, they confirmed that 18–24-year-olds are now more likely than older people to state they feel lonely. They found:
Over a quarter of 18–24-year-olds suffered anxiety last year.
An astonishing 48 per cent of 18–24-year-olds say they often feel lonely.
Constant social network connection is doing little to alleviate loneliness.
Panic attacks are now common for one in seven 18–24-year-olds.
It is an utterly modern paradox: we have never been more connected and yet felt more alone.
As reported in The Guardian, Professor Maureen Baker, chair of the Royal College of General Practitioners, said in 2016:
[Loneliness] figures highlight worrying trends, particularly regarding the growing number of young women accessing mental health treatment. Society is changing – even in the last seven years, social media, for example, has increased in popularity and the number of platforms people might be present on has multiplied.
As a result, young people are facing unprecedented pressures, not just over the emergence of cyberbullying and revenge porn, but constant exposure to unattainable aspirations of what they should look like, and be like.
A series of studies has shown that the modern focus on individuals in economic and social life rather than communities has had an impact on social connection by driving a bigger wedge between those at the top and those left behind. A 2009 study by the World Health Organization found that unequal societies have higher levels of mental health problems and that injustice and inequality are ‘deeply toxic’.
Those under forty have grown up under Thatcherism but those under twenty-five are our first truly digital generation. A study by researchers at the University of Pittsburgh has found that ‘the more time young adults spend on platforms such as Facebook, Twitter, and Pinterest, the more likely they are to feel cut off from the rest of society’ and that ‘more than two hours of social media use a day doubled the chances of a person experiencing social isolation’.
The researchers posited three explanations. One is that social media displaces time for real-life experiences. Second, that social media may encourage feelings of exclusion, such as seeing others enjoying themselves while the viewer is isolated. And finally, that exposure to deliberately idealised and exaggerated representations of other people’s lives may provoke envy and feelings of insufficiency. Every generation has this phenomenon, of course, whether it be the rich kid at school with the brand-new Nike trainers while a poorer child can feel the holes under their big toe in their no-brand shoes, or the one whose parents own the big house down the road, while a poorer child lives in a small flat with their parents on a deprived estate. Nowadays, though, technology has hyper-powered our awareness of how others live and the inequalities that birth confers upon us, while our economic system has both narrowed our children’s opportunities to get on in life and extended the sheer scale of those inequalities. When we couple that with the degradation of our social infrastructure for young people – youth clubs, parks, after-school clubs and so much more – can it be surprising at all that young people are so angry and frustrated with politics here and in countries that have gone down a similar route?
Loneliness, then, we would argue, is a direct result of the injection of market fundamentalism into the public sphere in a number of areas. We have outsourced the state’s role in helping to support meaningful and satisfying social interaction among elderly citizens to the voluntary sector, while the private sector – Facebook, Twitter and Instagram – plays the same role for our youngest citizens. Unfortunately, the voluntary sector simply does not have the scale to fund and deliver services to the growing number of people in need of a helping hand and a little bit of love in their lives. And while social media, the private sector’s solution to a lack of social interaction, can be great at times – especially for those people that already feel engaged in society – it has played some part in increasing the loneliness and anxiety for those who are less engaged. Together, this has driven an increase in the prevalence of loneliness, which is making us sicker and less happy as a nation.
And that, surely, is the point. It makes no sense that we are spending less as a state on the maladies that drive people to mental and physical ill-health – and therefore reliance on our overburdened NHS – to say nothing of the personal misery of an unfulfilled life. It is empirically self-defeating to cut £6 billion from adult social care and hundreds of millions from our social infrastructure when the effect is a major increase in demand to the £140 billion health system. If you wanted to think of it in terms of a business, what do we think the effect is to the productivity of our workers if they are anxious, lonely, stressed and unhappy?
This is yet another frustrating example of the stultifying didacticism of Hayekian ideology triumphing over both common sense and the corroboratory scientific evidence. As we have shown, it is based on a fundamental misreading of human history and human nature. The results of the short-termism, solipsism and greed of Hayek’s political project will require patience, compassion, pragmatism and intelligence to turn back the tide and build a cohesive, mutualist, happy and strong society.
CHAPTER NINE
MENTAL HEALTH AND ILLNESS
It seems remarkable today but, seventy years ago, in 1948, when the National Health Service was founded, we hadn’t yet found a vaccine for polio or diphtheria; thousands of children died or were left severely disabled. The first antibiotic, penicillin, had only been on sale for two years,
and streptomycin, which cures tuberculosis, was still years from being discovered. Even so, our understanding of and ability to treat mental health effectively was simply medieval by comparison.
Psychiatric care in England dates back to 1247, when a priory on the site of what is now Liverpool Street station started to provide shelter for the sick and infirm. It came to be known as Bedlam. It was only in the Victorian Age, after the passage of Wynn’s Act of 1808 and the Shaftesbury Acts of 1845, that the state started to build a network of ‘asylums’ on the outskirts of major cities ‘for the regulation of the care and treatment of lunatics’ in rural environments. Even then, people suffering from mental illness were crammed into these asylums by magistrates without any real psychiatric evaluation. The administrators had no drugs with which to manage mental illness; the ‘treatment protocols’ were less about treatment and more about observation, supervised activity and restraint when symptoms worsened.
The situation was worse still for women. Those with postnatal depression, stress or anxiety would find themselves detained and labelled hysteric. Many women in the 1920s were admitted as social punishment for being ‘immoral’, i.e. sexually active or difficult. It was seen as a means of controlling them, although many would then become institutionalised and go on to spend the rest of their lives incarcerated. When Angela first worked for the Confederation of Health Service Employees, COHSE (now part of UNISON), some of the victims of this awful policy were still alive and being cared for in the remaining mental institutions. The system was coercive, conservative and in some cases actively abusive, with drugs sometimes used simply as a chemical cosh rather than having any therapeutic use.