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Waiting to die

Manish Nandy |

“My world has already died, I am just waiting for my body to die,” said Nagendra Patil. Patil, an impressive presence at 82, had been a professor in a well-known university, written two books, attended conferences overseas and served on key government committees. Despite hooded eyelids and a sagging jowl, Patil, a tall, elegant man, was fine-looking and his words took me by surprise.

Patil, a widower, had a son in New York, another in Pune, and a daughter, now married, in town. They were all professionally accomplished, all busy, and, though dutiful, had scant time to spare for an aging man who had always been very independent. Most of his friends, he explained, had died or turned too decrepit to drive the long distance in gruelling traffic to his home. He felt a little out of touch with Economics, the subject on which he had once expatiated with confidence, and he no longer attended lectures or seminars.

“I have nobody to talk to. I have no friends, no relations, and no hope of acquiring one now,” he said with finality. Patil is not alone. There is a vast number of people, in their sixties, seventies and now eighties, who are lonely and socially isolated. They have nobody to share their joys and sorrows with, to speak and unburden themselves. There are several who are not socially isolated; they live with their children, even with their spouses, without a meaningful nexus that could ease their loneliness. Others are, dismally, both lonely and socially separated. They feel they live like zombies.

This is not just a social or psychological issue. It is a huge healthcare issue. These zombies have bodies, and we know of clear links between such loneliness and a host of maladies ~ arthritis, diabetes, cardiac problems and dementia ~ not to mention a slide to risky behaviours like smoking and a proclivity for suicide. Dr. Dhruv Khullar of Weill Cornell Medicine calls loneliness a “growing epidemic” and Professor John Cacioppo of University of Chicago says it kills as ruthlessly as poverty. The lonely sleep poorly, have lower immunity to deadly diseases, lose their judgment faster and die distinctly earlier.

Cacioppo explains that this happens because loneliness affects white cell production, which impairs immunity from infections, and triggers the body’s stress response, which raises cortisol level and vascular resistance, in turn raising blood pressure and lowering blood flow to organs. The University of California tracked 1600 persons in their seventies and found the lonely ones developed problems in daily living and died roughly ten years earlier. Just as disturbing is MIT’s finding that the brain region that generates feelings of loneliness, Dorsal Raphe Nucleus, is precisely the region that is also the seat of depression. Thirty-four per cent of Americans over 65 live alone, the percentage rising to 50 for those above 85. Britain, which too has a high proportion of older people living alone, seems to find women feel lonelier than men, or at least seek support more readily. India, which has a large cohort of older people but a smaller relative percentage, will find little comfort in the fact that young adults, before they reach middle age, are just as vulnerable to loneliness.

Social isolation is sometimes the result of physical factors. Poor vision or blindness may inhibit some links; hearing problems, aggravated by the unremitting noisiness of Indian cities, are a bigger barrier to connecting with others; the cost and hassle of traffic in larger cities stop people from seeing friends and relations. There are ways to go around these blocks. Loneliness, however, is a subjective feeling that springs from many sources and is even harder to tackle. One may not lose friends to death or distance, but find they have grown so far apart that no real exchange is possible any more. One may get tired of meaningless palaver and banal gossip, and stop conversing with people around them, including their spouses.

What do we do with this threat to health and happiness? What have others done, with any degree of success? Conventional wisdom has tended to place the responsibility for action on the victim himself. Do something, it exhorts, to save yourself. The two most popular prescriptions have been to learn a new language and to acquire a pet. No doubt, acquiring an unknown language is a bracing and wholesome exercise and it can open the door to a new world view, helping one to understand the Germans or the Chinese better. Getting a Labrador in the house has been known to do wonders for the home-bound, forcing one to be out walking morning and evening and developing a fond attachment which is invariably reciprocated in full measure.

The problem is that the lonely and dejected don’t easily take the big step of enrolling for a course or exploring breeders to find a charming dog whose long ears or short tail would capture one’s heart ~ unless a thoughtful friend escorts you to the language school and pays the subscription or escorts a delightful pup right to your doorstep. One must think of alternatives.

One low-key alternative is to encourage older people to join groups. Well-meaning neighbours, relatives and acquaintances could be the go-between and induce reclusive people to come and meet new people or renew connection with earlier acquaintances. Larger communities offer the opportunity of varied groups, but even in smaller communities people can get together for tea and talk.

Larger cities in many countries have started forming ‘senior centres’ where the elderly can meet regularly and do things of common interest ~ play cards, activate book clubs, organize talks, plan trips, have dance and exercise classes. Often such centres take advantage of their numbers and negotiate bargain prices for their members in restaurants, theatres and cruises. Even persons of few interests are likely to encounter a person or subgroup that attracts their curiosity.

Loneliness particularly afflicts people who have worked at insular jobs of a technical nature and have scant interpersonal skills. Some experts have recommended training in such skills to help older folk acquire new friends. The US Department of Defense, for instance, offers special training of that kind to combat troops who are likely to see duty at difficult and lonely outposts, and may be compelled to build relations with unusual people under difficult circumstances.

Since the absence of interaction is at the heart of loneliness, programmes have been developed to achieve planned interaction of the lonely. The British programme called “Befriending” arranges periodic interaction of lonely people with a skilled volunteer who provides one-on-one companionship and helps uncover serious issues. West Virginia University has a more complex programme named “Listen”, which brings together people in multiple two-hour sessions where they mutually explore what they need in terms of help and friendship.

There are also programmes that connect older people with younger people, on the theory that such interaction would provide a spurt to the lonely and help them reappraise their world with a new and unique perspective. In addition, there are now public programmes and popular private websites that seek to attract people to specific activities, like literary discussions, light exercises, jogging and hiking, plays and concerts. The lonely person can pursue his or her own interest, in the congenial company of the likeminded.

There are key organizations, especially in countries with a large graying population, that are now undertaking major efforts to help the lonely. The United Kingdom has taken a lead with The Campaign to End Loneliness, organisations like Age UK and Open Age, and its very effective Silver Line Helpline. The United States has the large American Association of Retired Persons and Friendship Line, run by the Institute of Aging. Given the swiftly rising numbers of retired and elderly persons in India, one hopes for extensive and innovative institutions that can start making a difference in the life of the lonely.

The introspective, lonely UN Secretary-General Dag Hammarskjöld, who died in a plane crash in his unending quest for peace, once said that the prayer of the lonely must be to find something to live for, something great enough to die for. Loneliness kills, but we can help the lonely to survive and serve, maybe even achieve something great.

The writer is a Washington-based international development advisor and had worked with the World Bank. He can be reached at [email protected]