Patralekha Chatterjee | Loneliness is the hidden pandemic in Covid times

Britain has a minister for loneliness. So does Japan. But loneliness is not just a First World problem. Nor confined to the elderly. It is now a stark reality even in a country like India with a predominantly young population. The Covid-19 pandemic has just made things worse.

What Covid-19 did was to freeze our lives. A year and a half later, it is becoming glaringly obvious that the gradual reopening of society and the economy is not going to make things easier automatically. Enforced social isolation has aggravated the problem of loneliness, across all age groups. What is truly worrying is that despite the high decibel talk about mental health, loneliness, per se, and its impact on health and well-being, still don’t get much public or policy attention.

Loneliness was on the rise even before the pandemic. Social isolation and loneliness are widespread, with some countries reporting that up to one in three older people feel lonely, the World Health Organisation says. There is a lot of research showing the serious impact of social isolation and loneliness on older people’s physical and mental health, quality of life as well as longevity.

“While most studies reporting the burden of loneliness were conducted in industrialised nations where aging and many socioeconomic stressors are affecting social networks, similar problems are emerging in low- and middle- income countries (LMICs) like India,” notes a 2020 study titled “Prevalence and correlates of loneliness in India: A systematic review” by Mahbub Hossain, Neetu Purohit, Nusrat Khan, E. Lisako J. McKyer, Ping Ma, Sudip Bhattacharya and Priyanka Pawar.

The researchers note that despite a high burden of loneliness across the nation, there is a lack of empirical evidence on the prevalence or other quantitative measures of the severity of loneliness in India. They stress that it’s critical to understand how different sociodemographic factors, socio-cultural norms and co-morbidities are associated with loneliness to inform further research and interventions to address the same.

Why is loneliness not on the policy table in India?

One key reason is that loneliness is a subjective experience. This makes it hard to identify.

“Loneliness is a state of the mind. It can exist even if one lives in crowded spaces. It is a marker of a lack of social connect. Even before the onset of the pandemic, many elderly people in the country experienced loneliness. What is new is that more young people have experienced it, because of the restrictions on mobility...” says Dr Soumitra Pathare, director of the Centre for Mental Health Law & Policy in Pune.

The other reason is stigma.

Sonali Vaid, a Harvard-educated public health expert, says many young people are reluctant to admit to loneliness. “They would much rather say they are bored.” Many also don’t wish to acknowledge that virtual social networks don’t necessarily make for emotional connections.

Many elderly people have withdrawn into a bubble after long stretches of complete social isolation, says Ms Vaid. Some have lost their appetites; others find it difficult to communicate, she points out.

Because loneliness is not a disease, it is not a priority for the policy folks.
For example, what really affected a lot of people was the closure of public spaces, like parks, during the second wave when there was a sharp spike in infections and deaths in many parts of India, Ms Vaid notes. “If you are closing parks, where will ordinary elderly people go for a walk?”

What happened as a result in many instances was counterproductive. Younger people climbed gates and hit playgrounds and parks. The elderly met in drawing rooms, and the infection spread.

Even now, hardly anyone talks about the importance of ventilation, of being outdoors, says Ms Vaid.

Vicky, a South Delhi hairdresser and an anguished parent, constantly worries about his moody and often listless four-year-old. The child has not been to any pre-school or had play time with other children. He stays indoors the entire day “Once, a cousin dropped in, with his child. My son was thrilled. All through last year and till recently, he did not go to a park. Nowadays, I take him for a walk in the neighbourhood park, before leaving for work. He enjoys it, but most of his time is spent with adults.”

Vicky did not think his son was enjoying online classes. “He probably feels lonely. He stands in the balcony looking longingly at puppies down below.”
Who are the worst-hit by the loneliness crisis?

“What is worrying,” says Dr Pathare, is that in a country like ours which suffers from an acute shortage of mental health professionals, “those who are more vocal about their needs get attended”. In the process, the real needy get pushed to the back of the queue, because the number of people who need counselling or mental healthcare have risen sharply. “This is what I would call diversion of resources from those in real need to those who are less needy in a scarcity situation.”

A medical doctor working in a government hospital in West Bengal’s North 24 Parganas district flags the severity of the social isolation and loneliness crisis for those living in abject poverty. Most elderly people who are coming to the hospital are in a serious condition because of the extreme delay in accessing treatment. This happened, he says, because their primary caregivers died of Covid-19. There was simply no one to bring them to the hospital. Many who visit government hospitals are also unable to articulate their feelings of extreme social isolation, loneliness and the sense of being abandoned.

How does one battle the hidden pandemic of loneliness?

Clearly, the starting point is to talk about it. Only then can it get on to the policy table. Loneliness can’t be cured by medicines. Neither can there be top-down solutions. What will go a long way are social interventions. Dr Pathare talks about one community-led intervention his organisation is involved in. “We are training young people - college students to become peer counsellors, support other young people by active listening, behavioural action, etc. This is mental health first aid. In Gujarat, we are training community volunteers in 500 villages as part of a programme called ‘atmiyata’. This is about teaching how to practice empathy. It involves four to five sessions.”

India still largely depends on the family to take care of its elderly and its young. But there are new realities in the pandemic-battered world. What is needed is social care. And it has to be low-intensity, low-cost, scalable and sustainable, as Dr Pathare puts it.