My clients who are living with chronic conditions and pain often talk to me about feeling lonely and isolated. Here are some examples:
A client I will call Javier talked to me about feeling alone in the world. “I’ve never had that many friends. I am kind of a loner. And none of my family members all live in another time zone. I know I need to push myself to get out more and be around people, but after I work all day, I usually don’t feel like going out. Especially if my pain is acting up on me. I sign up for things like classes or groups that might help me meet people, I commit to a time, and then I have to cancel. So I am by myself a lot.”
Another client, who I will call Jenny, talked about her feelings of loneliness. “I am a mother of teens and I have a husband. I am pretty much never alone. But I’m so lonely. My kids are always needing something. Everything is about them. My husband can’t listen when I talk about my pain, he tells me not to think about it and it will go away. But of course pain doesn’t work that way. I give to my family because that’s the way I am wired. But I don’t get much support in return. When they ask me how I feel I have given up on answering the question beyond two words: ‘I’m okay.’ But I’m not okay most of the time.”
And a client I’ll call Anita described her feelings of being cut off from other people due to her chronic pain. “I especially feel isolated at work. I have good days and bad days. On a bad day, I may have to hunker down at my desk and focus on getting my work done. On a real bad day, I may have to work at home. My co-workers kind of tiptoe around me, like I’m fragile and might break. They don’t come to me for help or advice, they don’t ask me to get lunch with them, they don’t invite me to after work get-togethers. I feel like they see me as someone they can’t count on. They don’t treat me like I’m part of the team.”
As you may have summarized from the examples I provided, loneliness and isolation comes in more than one form. Some have a long history of not having much of a social support system, and feel even more alone as a result of their health and the limitations it places on them. Others have people in their life, but don’t feel they have anyone who really understands them or even wants to try.
Risks to Your Mental and Physical Wellness
Let me clarify the definitions of loneliness and isolation. Isolation is a state of being in which you have little or no contact with other people, with very little social interaction and potentially long periods of not being around other humans. Keep in mind that it is possible to be surrounded by other people and still have a sense of being isolated if you don’t feel understood or supported.
Loneliness is an emotional state in which you feeling alone, feeling separate from other people, feeling empty. Being isolated from other people can lead to feelings of loneliness. But also keep in mind that people who have been feeling lonely for a long time may have trouble getting connected with people again, leaving them in isolation.
I think it’s fair to say that loneliness and isolation often go hand in hand. But what is important is that loneliness and isolation can have a negative impact on your mental health which can, in turn, affect your physical health.
While loneliness is not a mental health diagnosis, it can contribute to depression and anxiety. Loneliness can be a factor in mental decline. Research has shown that loneliness can worsen fatigue and chronic pain. Research has also shown that the health risks of loneliness and isolation are similar to smoking and obesity.
Be aware that mental health diagnoses like depression and anxiety may occur concurrently with chronic conditions and chronic pain. The word co-morbidity would apply here. And I can say from my own personal experience as a psychotherapist that many of my clients living with chronic conditions and chronic pain do indeed have a dual diagnosis of their chronic condition and a mental illness diagnosis, especially depression.
At this point you might be tempted to ask: Are you trying to scare me, Dr. Gary? The answer is no, not at all. But I do want to emphasize the importance of identifying any isolation and loneliness you may be experiencing and, most important, doing something about it.
And I have some ideas to help.
First, Perspective: Address Isolation and Loneliness in Your Mind
Cognitive-behavior therapy (CBT) is an approach used by mental health providers – including myself – to treat their clients. CBT is based on the idea that if you change the way you think, you can change the way you feel. So when a client comes to me to talk about their feelings of loneliness and isolation, I am going to talk to them about their thoughts, their beliefs about themselves and other people, and how that might be impacting the way they feel. CBT has a lot to offer someone who is not feeling connected with other people.
Keep in mind that you are not the only person in the world who feels this way. Sure, you’re feeling lonely. Even if you are isolated and feeling very alone, you are not alone. You are sharing the experience of isolation and loneliness with many people who are also isolated and lonely. It’s a universal human experience. You are not alone, not really. And like the multitudes of other people who are feeling the same way, you’re doing the best you can during a difficult time in your life.
Avoid all-or-nothing/black-and-white thinking. You might have a very specific image in your mind about what your life would look like if you weren’t lonely. But is that the only way? Keep in mind that you may meet people who are fun to do things with, but aren’t so good at conversation. Or others who can sit and talk for hours but don’t share other interests with you. Appreciate people for who they are. Focus on the many shades of gray that exist between being isolated and your image of an active social life. Keep your mind open to people who can can bring something to your life, even if it isn’t everything you want, while you also bring something to their lives.
Watch your self-talk. It has been my experience that my clients who are experiencing loneliness and isolation can fall into self-criticism, blaming themselves for their current experience of loneliness. What are you telling yourself? Are you looking around at seemingly happy people and calling yourself a loser? Labeling yourself as unlovable? Telling yourself that you have nothing to offer? We live up to our own expectations for ourselves, and negative expectations begin in our own minds when we indulge the inner voice of self-criticism. Talk back to that self-critical voice. Dismiss negative thoughts about yourself. Give yourself encouragement: “I am a kind, friendly person. In my own time, at my own pace, I am working on bringing more supportive people into my life.”
Remember: Having a chronic condition doesn’t mean you are “damaged goods.” When I talk to clients about the impact of their chronic condition on their life, the word that often comes up is the word “normal.” They worry that they aren’t like other people. And their biggest fear about not being normal is being socially disconnected, not included in social events, not fun, not datable. All because of their chronic condition that feels like a stamp on their forehead. Your chronic condition is a part of your life, sure. And yes, it presents responsibilities and challenges. But your chronic condition is a slice out of a very multi-faceted pie. It is not all of who you are. Shift your perspective by embracing the kind, caring, engaging person that you are inside, and then commit to showing that to the outside world!
Next Step: Take Action to Get Connected with People
I use CBT techniques with my own clients. One important CBT technique is homework. My clients and I brainstorm, for example, on how to get more connected with people so they can feel less lonely. As we brainstorm ideas, my clients choose the ones they want to try out. That becomes their homework. Here are some CBT homework ideas for coping with isolation and loneliness.
Be a friend to yourself. Take actions to make yourself feel better. When you are feeling especially lonely, do something you enjoy. Listen to some music. Watch a show you enjoy. Read something entertaining or intellectually engaging. This is also referred to as self-soothing. In other words, be your own compassionate best friend.
Get out by yourself. Getting out of the house on your own can help with isolation. Don’t use not having someone to do things with as an excuse to stay home alone. Walk around at a shopping mall. Take a book and sit in a coffee shop. Go to a movie. Being around people can help you to feel less lonely. And who knows, you might strike up a conversation with someone.
Be a joiner. Consider where the likely candidates are hanging out. A spiritual or religious meeting place? Classes? A support group? Volunteering? You might want to do some Internet searching on the things that interest you and the name of your town. Find a meeting and then give yourself a push to take the first step to make a connection. Don’t overlook the online world as a way of connecting with people, including online support groups related to your chronic condition.
Reach out to someone who also needs a friend. Is it possible that you may be overlooking someone who might enjoy spending some time with you, and would appreciate having you in their life? Consider doing an inventory of your social contacts with an eye toward people you might consider reaching out to. Anybody you know who could use a friend? Identify people you know who could use some support, and give them a call.
Be an engaged listener. When you meet people, be careful about not making the conversation all about getting your own needs met. Be a listener. Ask questions. Offer support. And stay positive! As the saying goes, the way to make a friend is to be a friend. Being an engaged listener is one of the best ways to honor another person.
Don’t get discouraged. Some people are going to be more open to getting to know you than others are. It’s about chemistry, and that’s hard to predict. When someone doesn’t seem all that open to connecting with you, try not to take it personally and get discouraged. So try not to assume that someone can’t be a good friend if you don’t feel a connection right away. Bringing people into your life is a process. Keep at it. Give it time.
Be willing to take the first step. I have had clients admit to me that what they really want is for their doorbell to ring, as much as they also realize how unlikely this is. As much as you may not feel up to doing the work to connect with people, the first step is up to you. There are a lot of great people who are looking for friends, too. But they’re probably not going to knock on your door if they don’t know you’re interested in getting to know them. Yes, it’s a project. But you can do it!
Be patient. It may take some time, and some trial and error, to figure out the best way for you to build connections. You’re a work in progress, two steps forward, one step back. Everybody has their own unique tool box for building a support network, and over time you will figure out yours.
And stay on top of your wellness routine. Be on guard for feelings of helplessness and hopelessness that can lead to you give up on taking the best possible care of yourself. Even if you aren’t feeling it, do what you need to do each and every day to manage your chronic condition and maintain your wellness. Here’s an additional incentive: When you are at your best, you are also more likely to send out the optimistic and confident vibes that attract other people. Don’t give in, don’t give up. You’re worth it!
Isolation. Loneliness. They don’t have to be your destiny. Do the mental work and then take action to get more support. One step at a time, one connection at a time. I know you’ve got it in you!
Gary McClain, MS, PhD, LMHC, is a therapist, patient advocate, blogger, and author, specializing in helping clients deal with the emotional impact of chronic and life-threatening illnesses, as well as their families and professional caregivers. He works with them to understand and cope with their emotions, to learn about their lifestyle and treatment options, to maintain compliance with medical regimens, to communicate effectively with the medical establishment, and to listen to their own inner voice as they make decisions about the future. His email is: gary@JustGotDiagnosed.com. He welcomes your questions and comments.