While the COVID pandemic initiated a lockdown, beginning mid-March of 2020, allowing only essential workers to leave their homes, the problems of an enforced isolation exposed us to many stresses and losses. This was true of all ages with a variety of consequences. Under the surface of everyday life individuals could keep hidden from themselves, if not others, the anxieties of their lives. This is hard to maintain in a time of crisis.
As a practicing psychotherapist and trained psychoanalyst, I now worked with my patients via Telehealth. Most adapted well to the change from in-person to audio/video platform or the telephone. The latter preferred by those who did not like their appearance viewed through the screen. I mostly see adults ranging in age from their early 30s to late 80s. Most were in long term treatment on a weekly basis although some wanted to see me more frequently. I was ‘on call’, and compassion fatigue was extending to my profession. I also had many referrals from December 2020 through 2021. My colleagues were all swamped and a new phenomena emerged: the Waiting List (WL). This was totally foreign to me as a helping professional. People asked to be put on my WL when I couldn’t see them. People thanked me for returning their calls. I was mortified to learn colleagues were not returning calls. I did all I could to make referrals to those I couldn’t see. It is a big step when someone calls for help. He/she/they need to have their call returned. Even with less stigma about seeking mental health treatment, it is a big step to pick up the phone to ask for help. It is unacceptable to me that a mental health professional did not return the call.
The ideas I will be discussing are drawn from my over 50 years of private practice and in particular the acute time of the COVID pandemic 2020-2022.
Loneliness means different things. We can all feel lonely sometimes, though some sense of shame seems to be attached to acknowledging this, as if it were some defect on our part that we are in this state. Emotional loneliness, the absence of a meaningful emotional relationship where we don't have an intimacy with someone is a very painful state of loneliness. A lack of friends to hang out with, share activities together is a social loneliness. Working remotely made people realize we have work relationships we miss. Many homebound persons heard the clarion call of the American Society for the Prevention of Cruelty to Animals (ASPCA) to take animals from the shelter. An unexpectedly large number of dogs and cats were adopted or fostered. It was a mutually beneficial arrangement for animals and humans as an antidote to loneliness.
Then of course there is the concept of existential loneliness. This is a fundamental sense of separateness from others and the wider world. While the pandemic took a toll on all of us in one or more ways, to experience any of these types of loneliness would not be unlikely. The problem is if you suffered pre-pandemic with these difficulties more chronically and were helpless and hopeless about making your life better. If you are isolated, and unable to reach out to others in the best of times, you are avoidant of social interaction. The very thing that could be a lubricant to your loneliness and isolation you are incapable of doing. Several of my patients fell into deeper depressions. One woman in her late 70s was conveying, without saying it, she did not want to keep on living. I said the words for her. This is very important to do. The therapist must not be afraid to acknowledge and talk to people about why they may not want to live. I felt she needed to go into the hospital.Very often we see high anxiety along with depression. The hospital helps people feel safe. I also had been concerned about her medications, cognitive functioning, and any unknown health problems. All this could be taken care of during a psychiatric hospitalization. I know her adult children were concerned about her. What is most revealing occurred when I asked her how she felt about going into the hospital as I thought it could be helpful. She said: ‘But, I won’t know anyone.’
While we have medicines to treat biochemical processes in the brain that cause not only depression and anxiety, we need talking therapy. Psychosocial factors are often the determiner for those who live with an emotional aloneness that invisibly surrounds their internal world.
It is a ‘fixed state’ rather ethereal in nature. It is determined early in life as it relates to the development of the kind of attachment bond possible or impossible to have. The dyad of mother and infant set the stage assuming mother is the primary caregiver. In our early development it is critical for the mother to be attuned to her infant: to be able to respond to the ‘signals’ and needs of the infant not the other way around. As development proceeds the relationship to one’s father becomes important. More opportunities for positive or negative attachment that will effect future life. Then the impact of life events within the family. Those who have suffered loss and disruption of primary attachment figures because of separations, divorce and death of a parent will be more vulnerable to emotional aloneness. There are other situations that can affect the individual and predispose him/her/they to feeling emotionally alone: having a physically or mentally disabled sibling, having a brother or sister die growing up. The impact particularly on the children growing up of these tragic events can leave an underlying feeling of being emotionally alone. This permeates the fabric of one’s life. Often the less recognized feeling of sadness is entwined with loss of the attachment figure leading to the feeling of abandonment responsible for the state of emotional aloneness. Other defenses and symptoms are more visible.
The benefits and value of psychoanalysis as an understanding and theory of human behavior and pathology, as well as a form of treatment, speak to the deeper problems and symptoms that can be present for those who suffer from emotional aloneness. And that is not to say they can’t feel lonely as well!
It is important to recognize our early experiences within our families of origin will provide good fortune or bad when it comes to our own coping with life. That mental health is recognized as important as physical health is an achievement of the times we live in. Life throws things our way for better and worse. That we have the strength, and resilience, to seek out whatever will help us on our life’s journey is something we can and should do.