“Feeling Not Seen, Not Heard, Not Understood”

Note: This long read essay is a result of a survey and study undertaken by the writers on unpacking loneliness in Indian cities and the kinds of responses it might require. It also contains a podcast on the connections between loneliness and mental health.  

I think there is something about being surrounded by people, and still feeling lonely, that makes the feeling harder. Being in a city means being constantly surrounded by groups of friends, couples, communities and that sometimes makes me feel more acutely, obviously alone.”
~ Survey respondent, Mumbai

I remember being 20 and sitting in a family counselling centre in Mumbai where I had been placed as a social worker in the making. I watched woman after woman come in, listened to stories of domestic violence, cheating, heartache, and under it, the dark hollow of longing to be seen. At 27, I found myself sitting in Hanging Gardens reading Nausea, Jean-Paul Sartre’s ‘seminal work of contemporary philosophy’ as the jacket claimed. It hadn’t been a good year and I had spent most of my time inhaling books to stay alive and make sense of the senselessness that had gripped me. Nausea was, ironically, my anchor for a while. ‘I want to leave, to go somewhere where I should be really in my place, where I would fit in … but my place is nowhere; I am unwanted.’, I read, as a butterfly hovered over my shoulder like a silent messiah.

I am now 36 and as I sit at my desk mulling over loneliness, I am reminded of the past ‘me’s’ who have folded their way here and they whisper: Loneliness is personal.

At The Curio-city Collective (TCC), we asked city dwellers in a qualitative survey: ‘How would you describe the feeling of loneliness?’ “It is like a dead weight you carry around. One knows that there is no point of carrying it, yet you can’t seem to drop it”, said one. And others, “Like there is nobody to witness my life or share myself with.”; “Loneliness is feeling not seen, not heard, not understood.”; “Wanting to be held sometimes, sometimes missing home.”; “My chest feels hollow and there’s an inexplicable sadness (which may also be depression) to go with it.” At the end of the week we had 56 kaleidoscopic responses across age and gender from seven cities, each different yet each a personal truth to the person writing it.

The definition of loneliness spans the objective and the subjective. People who live alone are at a greater risk of feeling lonely but the key ingredient to understanding loneliness is the subjective evaluation of one’s state. If one perceives oneself as isolated (and this can be ironically midst a crowd as it is in cities or within a family or relationship), then one is lonely.

Loneliness is personal also because not only does it leave its fingerprint deep in our feelings, it also leaves its mark within our tissues. Loneliness is recognised as an important indicator of both physical and psychological well-being of an individual. Broad-based epidemiological studies have over the years provided clear and compelling evidence that the status and nature of social relationships can predict important health outcomes (ranging from risk of depression, suicidal ideation, anxiety, BP, coronary artery diseases, strokes, etc) and risk for premature death. In fact, as multiple newspaper articles on health quote, weak social connection is as harmful to health as smoking 15 cigarettes a day! Loneliness isn’t within the ambit of diagnosable illness but it is the fomenting ground for illnesses and reduced quality of life.

Loneliness and the Human Condition
Emily Dickinson, poet and known recluse once wrote: ‘It might be lonelier/ Without the loneliness/ I’m so accustomed to my fate’. It is certain that in some ways loneliness is as integral to the human experience as feeling joy or sadness. When we asked our survey respondents, ‘Are there periods in life when you feel/felt particularly lonely?’, responses spoke to themes of migrating to new cities; breakups/ separations/ conflict with/ loss of spouse, family or friends; staying or doing things alone, especially around festivals and holidays; moments of vulnerability, sickness or disability; of being misfits in teenage years or through isolation in old age; while considering the future; during pregnancy or through raising children alone – amongst many others.

These are all themes that have occurred or might occur in some shape or form for many of us through the period of our lives. Yet this most universal experience is not easy to admit, to ourselves and to others around us. On being asked if they had friends and family they were able to connect with on low days, many respondents admitted that even though they did have people around, they hesitated in reaching out to them. “[…] I often hesitate because everyone is going through difficulties of their own and I don’t always reach out for the fear of adding more heaviness to their lives.” Another said: “Are they accessible and available, yes this is home city. But does that mean one feels secure in doing so, no.” Johann Hari in his book, Lost Connections, speaks to the danger of succumbing to this hesitation one too many times: ‘Protracted loneliness causes you to shut down socially, and to be more suspicious of any social contact […]. You become hypervigilant. You start to be more likely to take offense where none was intended, and to be afraid of strangers. You start to be afraid of the very thing you need most’. This is referred to as ‘the “snowball” effect, as disconnection spirals into more disconnection’.

There are multiple reasons that ascertain who might have a greater predisposition to feeling lonely. Cacioppo & Patrick in their book Loneliness: Human Nature and the Need for Social Connection explain that these include: our genetically inherited disposition for social inclusion; our ability to cope with challenges emotionally; and, how we frame our experience, perceive and create our idea of our social world. This might explain how, merely, the number of social bonds doesn’t help reduce or alleviate loneliness, other aspects complicate what might help a person feel better. In recent years, there have been various attempts at working on breaking through the shadowy barriers of loneliness, some are through exercises that build individual social resilience (‘Introspection, connection and interaction’, S.Cacioppo suggests in an interview) and just a few months back it was even reported that a pill, that might counter the snow-ball effect and help people reengage, might be in the offing!

Yet as humans, we are also creatures embedded within communities and the world around us. While engaging with individual response and coping mechanisms are an important element of unravelling the puzzle, there are dangers to seeing a pill or therapy as the sole response to addressing loneliness. The brewing concern around loneliness currently isn’t just about its existence but the systemic large-scale occurrence and the chronic nature of it that is now being observed. Countries like the US and UK are seeing disturbing trends of increasing loneliness and reducing social ties in recent years. Similarly, rising trends of Kokodushi in Japan and Godoska in South Korea, both terms for lonely deaths, are raising urgent and important questions on the challenges of a massively changing demography and modern globalised life.

That Particular Flavour of Loneliness
“You can be lonely anywhere, but there is a particular flavour to the loneliness that comes from living in a city, surrounded by millions of people,” says Olivia Laing in her book, The Lonely City: Adventures in the Art of Being Alone. Turns out this might be true.

While no large-scale research currently exists in supporting the claim of widespread loneliness in Indian cities, there are signs that it may be a serious growing concern. In the last few years, newspapers have reported a barrage of stories that carry anecdotal and experiential accounts from psychologists and counsellors who say that they are seeing an increase in the number of cases where loneliness plays an important part in the psychological distress being experienced by individuals. Of the few studies available on the subject, a study conducted by Agewell Foundation on Loneliness in the 60+ age group across 300 districts of India reported that an astounding 47.49% respondents reported experiencing loneliness. The data showed that prevalence of loneliness in elders was much higher in urban areas (64.1%) than in rural (39.19%). This is backed with alarming mental health stats such as the fact that India has 17·8% of the global population in 2016 but accounts for 36·6% of global suicide deaths among women and 24·3% among men.

The 2015-16 National Mental Health Survey of India (NMHS), mirroring similar international findings, brought home the fact that there exists a greater prevalence of psycho-social disorders in large cities in India. This was specifically true of conditions related to mood, stress, schizophrenia and other psychoses – the prevalence of which was nearly 2-3 times more in urban metros. The NMHS Report noted that ‘One can speculate and consider the contribution of several factors (…) for this higher prevalence’ suggesting that breakdown of social systems, amongst other factors like fast paced lifestyle, stress, complexities of living, challenges of economic instability etc, could be responsible and that ‘(…) there is a need for an urban specific mental health programme’.

While studies like the ones mentioned above only speculate on the connection between social environments and mental health conditions, a now famous study published in Nature in 2011 took such findings one step further. Based on fMRI scans of the brains of volunteers living in different settings (rural to urban), it found that ‘a key brain structure for negative emotion (the amygdala) was found to be more active during stress in city dwellers, and a regulatory brain area (the cingulate cortex) more active in people born in cities’. Both the amygdala and the cingulate cortex play key roles in emotion regulation and management. The study was able to pinpoint the distinct neural mechanisms that link urban environments for the first time to our social stress processing. It indicated that modern city life is potentially putting us at risk for greater illness.

Recognising these multiple connections and combining this with the grim picture of access to mental health support in India, gives us serious cause for concern. In a conversation with TCC, Aparna Joshi, Assistant Professor, Centre for Human Ecology (TISS), explained how mental health was often referred to as the ‘Cinderella of Health Sciences’ due to the neglect it has seen. Where an estimated 150 million people in India are in need of active interventions for mental illnesses, only about 30 million are able to access services. NMHS also showed how most states covered under the survey had a ratio of less than 1 psychiatrist per a lakh population. This lack of mental health human resources extends even to psychologists and psychiatric social workers.

If cities currently are grounds for growing loneliness and distress, there is an urgent need to open conversations on de-stigmatising these issues and explore ways in which understanding, access and support can be improved.

to a podcast on loneliness in cities with Sonia Thomas and Sandhya Menon.

Layering Understanding and Response
In a 2016 paper, Stephanie Cacioppo et al give a framework for loneliness that helps us move from the arena of the internal to take a more systemic view of how loneliness can be understood and responded to. They point to three dimensions of our social and attentional space: intimate space (the closest space surrounding a person usually in reference to a partner), social space (the space in which people feel comfortable interacting with family and acquaintances), and the public space (a more anonymous space). Our experience of loneliness can occur within a specific arena or span them. This tells us not only how complicated loneliness is but also how understanding and tackling it must involve research and response at multiple levels.

This is also the place in this story of mental health where it’s important to acknowldege that famous feminist adage: the personal is political. If loneliness is personal, it cannot escape being political. Our three arenas of space are embedded within a socio-cultural, economic and environmental context that informs and shapes them. An international survey on loneliness and social isolation in US, UK and Japan found: ‘Loneliness appears to occur in parallel with reports of real life problems and circumstances. Across the three countries, people reporting loneliness are more likely to report being down and out physically, mentally, and financially’.

A psychosocial approach ‘describes the connection between an individual and their environment, interpersonal relationships, community and cultural practices. It suggests that social context influences and interacts with the psychological (emotions, thoughts, feelings, reactions)’.

Embracing the psychosocial approach in understanding and responding to loneliness hence becomes an important starting point in untangling the current trend of growing loneliness. This approach is increasingly being promoted by mental health practitioners to speak on and create holistic healthcare models that can be rigorous in their responsiveness. A psychosocial approach ‘describes the connection between an individual and their environment, interpersonal relationships, community and cultural practices. It suggests that social context influences and interacts with the psychological (emotions, thoughts, feelings, reactions)’. As an example, a paper on loneliness in the elderly in India points out the complex number of elements which could contribute to loneliness in old age: increasing age, changing living situations, financial solvency, widowhood, increasing dependency ratio, type of family, social networks, gender etc.

Our contexts and social realities play a role in how we end up feeling. Social locations defined by our gender, age, disability, income, class, caste and a host of other sociological categories present in diverse combinations for an individual are relevant. This is very important for a country like India to acknowledge, where poverty has a huge presence in the city and marginalisation exists in complex forms. Hence, in order to reduce systemic experiences of loneliness and build flourishing and meaningfully connected communities, we need to understand and address both the biological and sociological roots of the issue. This implies inter-sectoral responses that not only address the medical and therapeutic requirements of individuals but also work towards mitigating and addressing issues that might be tied to their sociological location.

This second layer of addressing a concern at the social level is being termed as ‘social prescribing’ where health professionals can refer patients to multiple support systems ranging from allied health professionals, police, job centres, social care services, housing associations, skill building workshops etc. This could even include schemes that can involve a variety of activities directed at recreation, social reintegration and community building provided by a host of voluntary and community sector organisations. Some examples could include activities relating to gardening, cooking, sports, group learning, etc. In the UK where growing loneliness has led to the appointment of a Minister for Loneliness, the National Health Service (NHS) has pledged ‘1,000 new social prescribing link workers by 2020/21’. These link workers ‘will become an integral part of the multi-disciplinary teams which are part of primary care networks’. Similar social experiments are on in other countries and in cities like Copenhagen, Milan and Seoul to mention a few—led by governments and non-profit organisations.

In fact when we asked our respondents, ‘What do you think can be done to decrease loneliness in cities?’, it turned out that these kinds of interventions were much in demand! A young respondent asked, “Can someone please invent parties for introverts? Support groups that allow you to consistently hang out with people regularly.” An older respondent suggested, “There should be organizations which will bring people together. Helplines also.” A female respondent from Chennai pointed rather poignantly for the need of communities built around shared ideas and interests, “Like minded people getting together and being lonely together. So beautiful.

Can someone please invent parties for introverts? Support groups that allow you to consistently hang out with people regularly.”

The poignant responses to our survey also suggested how elements of modern city life intertwined with city design and planning, play a role in our emotional experience. Post the 90s, Indian cities experienced massive changes. I grew up in Bangalore and saw it transform from a sleepy green ‘pensioner’s paradise’ to a traffic filled ‘IT City’. Globalisation was as much a socio-cultural phenomenon as an economic one and alongside the entry of networked technology in our lives, it re-organised how we experience work and living in cities.

In a question regarding the ‘role of the city in making people more lonely’ one of the most common points emphasised was one we all recognise: busyness. “When you live a fast paced life it is difficult to establish trusting and meaningful relationships. People are quick to ghost you and cut you from their life. Most of the friendships lack trust and are shallow.”, said one respondent from Hyderabad. Another from Secunderabad mirrored this sentiment: “Everybody in the city is perpetually busy. Nobody cares what is happening in other people’s lives.” Some were more specific of the elements that kept them busy: “There is also the contemporary problem of commutes to and from work being long and exhausting, leaving little time for anything other than work and commuting. This could add to the feeling of loneliness among people who have long commute times.” Respondents also highlighted exhausting work cultures; distances and traffic; lack of accessible, inexpensive, public, safe green and cultural spaces – as issues that influenced their states of mind and could contribute to loneliness in cities.

Again, research backs these experiences and intuitive guesses. To take the example of commuting – Robert Putnam, a Harvard political scientist who has written extensively on social capital, in an interview said, “There’s a simple rule of thumb: Every ten minutes of commuting results in ten per cent fewer social connections. Commuting is connected to social isolation, which causes unhappiness.” Similarly, where public spaces are concerned, in a study in Australia, Public Open Space (POS), community centres, schools and shops were shown to foster a sense of community, an important oppositional force to the feeling of loneliness. In the UK, public libraries are even actively creating programmes to reach out to the lonely and isolated! Around the world urban planners and designers are exploring ways to bring back elements of cities that could make them friendlier – community grown gardens or veggie patches, community parks, public squares – all are being experimented with.

The imagination of Indian cities, in the past decade or two, has been motivated by the glamour of becoming global capital destinations. Large infrastructure projects have been created around the idea of evoking Indian versions of Shanghai or Singapore. This, over the years, has led to the current scenario where cities like Mumbai are simultaneously one of the richest cities in the world in terms of billionaires who reside there but are also, unfortunately, some of the least inclusive and livable cities in the world. This disparity alongside growing health concerns in Indian cities are increasingly indicating the need to change our current approach and consider how to build cities from the perspective of individual and collective well-being.

A New Imagination
Cacioppo and Patrick (2008) in their book on loneliness explain the evolutionary roots of the feeling of loneliness: ‘Our forebears depended on social bonds for safety and for the successful replication of their genes in the form of offspring who themselves survived long enough to reproduce.’ Social bonds were required condition for the survival of the species and hence loneliness or social pain evolved to warn them when their social bonds were in danger. The idea being that as the hand learns to withdraw from the act of touching a flame because of the feedback of physical pain, loneliness or social pain would prompt people to work on breaking their possible state of isolation and return to the work of building social bonds.

But what if you don’t return to the task? What if you continue to hover your hand over the flame? An issue like loneliness, that has such deleterious effects on our individual well-being and the holistic well-being of society, indicates to us most deeply the need for individual and collective introspection. It asks of us to take a quiet moment, breathe, and set ourselves the question: If I am lonely and if we are lonely – what needs to change?

Arpita Joshi and Srinidhi Raghavan are co-founders of The Curio-city Collective (TCC), an NGO working on the issue of wellbeing in Indian cities. Arpita’s interests lie in inter-generational equality and justice, climate justice, child rights and gender. Srinidhi works on women’s rights, sexuality, and disability rights. Join the TCC Community and follow the TCC Podcast to learn more. Episode 1 and 2 of the podcast address the topic of mental wellbeing in Indian cities.

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