December being a difficult month for many people who feel under pressure to socialise and be merry whilst feeling lonely, was an apt time to launch UK Research and Innovation (UKRI) cross-disciplinary Loneliness and Social Isolation Mental Health Network, of which the University of Birmingham is a part. Dr Sarah Carr explores the theme of loneliness and living with mental health problems in a re-posted blog originally hosted on the Institute for Mental Health website.
We know that loneliness and social isolation affect both mental and physical health, and we also know that many well-evaluated interventions have focused on enhancing social networks and numbers of social contacts. However, little is known about how people living with mental health problems conceptualise and experience loneliness. The Network aims to enhance and expand knowledge about loneliness, with the important inclusion of the experiential knowledge of people with mental health problems. Partners will investigate the topic in a multidisciplinary way, with historians, architects, musicians, community organisations, service users and carers, psychiatrists, psychologists, charities, neuroscientists, social scientists and others working together.
Recent research has shown that emotional loneliness is a factor in the social isolation of people with mental health problems, with the researchers noting that ‘emotional loneliness can only be described – subjectively – by a person him/herself’ (1). In a Twitter poll on loneliness I recently carried out, to which 311 people with mental health problems responded, ‘emotional isolation’ was most resonant for 40% of respondents. A piece of user-led research concluded that ‘…the stigma and discrimination experienced in relation to mental illness made the acceptance of others a vital element of many people’s survival strategy’ (2). This evidence strongly suggests that investigations into the subjective experiences of loneliness by and with people with mental health problems are important for gaining a fuller understanding of what is essentially part of the human condition.
In conventional mental health and social care research loneliness is too often conceptualised by that which we can immediately measure for service goals. We know much less about the existential and emotional experiences of people living with mental health problems and our preferences for socialization, so based on anecdotal evidence, here are some ideas for investigation by the Network partners with mental health service users and carers:
Solitude, autonomy and choice – some people want to be on their own, or are happier in their own company, satisfied with solitude; or they might be happier with a pet.
Navigating the world with psychosocial disabilities – for people who experience mental distress and/or conditions like autism, social situations can be difficult or distressing at times; conventional rules of friendship and kinship may not apply; trust may be difficult to establish. A person may choose to have few friends and the external pressure to have many social connections may be stressful and make them feel inadequate.
Internal experiences of distress and alienation – the ineffable experiences mental distress can lead to feelings of difference that may alienate a person from their family and friends. They can feel lonely and withdrawn because they feel ‘set apart’ from ‘normality’.
‘Spoiled identity’ – Erving Goffman’s idea of the ‘spoiled identity’ may be appropriate to consider (3). The sociologist argued that stigma is a process where an individual is discredited and rejected because of a particular attribute. For mental health this can mean dividing ‘those who are normal’ and ‘those who are not’. How does living with stigma and shame because of psychiatric label or status affect social isolation and feelings of loneliness?
Social exclusion and shunning – a person may be shunned by others because of their mental health problem or unusual beliefs or behaviour, even though they want friends and relationships. Poverty, bad housing, neighbourhoods with high crime rates and targeted harassment and abuse can cause social isolation and loneliness among people with mental health problems, who are unable or afraid to leave their homes.
Such questions or investigations necessarily can’t be addressed by clinical research alone. Loneliness from the perspective of people who live with mental health problems is more complex than measuring social networking and measuring quantity or even quality of relationships in instrumental terms.
A cross-disciplinary Network, investing in service user and survivor research, will be better placed to answer the complex questions about social isolation and loneliness in mental health.
(1) Wang J, Lloyd-Evans B, Giacco D et al (2017) Social isolation and mental health: a conceptual and methodological review. NIHR SSCR, London.
(2) Faulkner A, Layzell S (2000) Strategies for living: a report of user-led
research into people’s strategies for living with mental distress—summary. Mental Health Foundation, London.
(3) Goffman, E. (1986) Stigma: Notes on the management of a spoiled identity Simon & Schuster Inc, New York.