It was about one in the afternoon, and the all-purpose apartment—kitchen and bathroom adjacent to the cushy couch—belonged to a hospice patient whom I had, by that time, been visiting for several months. The woman, whom I’ll call Joan (her real name and all identifying details have been altered for privacy), was a troublemaker, one who retained her youthful snicker and mischief far past retirement age. She was a selfless woman with industrial resolve, her fortitude matched only by her warmth and openness. Kindness radiated from her face; the corners of her mouth were bounded with radiating lines of joy.
But Joan’s face knew sorrow as well as kindness; those arched lines often formed rivulets for tears. And while glancing at that strange contradiction—the pairing of kindness and sorrow; laughter and tears—I came to notice a strange tension in myself. I had just exited a busy street, filled with cars and pedestrians, bathed in the early afternoon sun. Older men and women sat relaxed in the lobby of the assisted living facility, reading their weekend papers and talking about younger men and women. Parts and people were always interchanging—whether in the stop-and-go motion of city streets, or the lengthy discussions about whose grandson was going where, and doing what. There was a sense of connection, dynamism.
That sense dissolved when I entered Joan’s room. Outside, the sun warmed the world, brought life to a scene. Inside, the blinds of this small apartment were closed, light struggling through an old bulb attached to a tall light-stand. Joan sat in a recliner underneath the bulb, illuminated, and contrasted with her dark room. Her television sat a few feet forward, and to the left, buzzing its own soft light. Everything seemed frozen, insoluble.
The appearance was strange, but only at first. Soon, almost in a moment, everything would make sense. And the real tension would arise.
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We have all, every one of us, felt lonely. We have felt that scratching, aching reminder, that recursive and gnawing feeling—a voice telling you that you are not recognized, not understood, no longer valued. For some fortunate people, these feelings and voices are few and far between. But such people are, themselves, a minority. More common are those who have troubles they cannot voice; tensions they cannot relieve; deep desires, inherent yearnings to be known and loved, which they seemingly cannot fulfill. The experience is real; it is powerfully oppressive. And it is all around us.
But the witness of loneliness? That is harder to come by. I was compelled, then, by what I saw in Joan’s dark room. Here was a woman with a rich, beautifully simple life history: she had travelled all across the country; become the matriarch of a large and loving family; and spent her golden years in an easy and contented joy which asked little and received much. Her world was intuitive: she knew grief, had felt its earth-shaking seasickness, but came out stronger, somehow larger, with each trial and sorrow. It was as if, after decades of rambling across the country, seeing friends and family fall ill, recover, or die, she knew the world too well to be angry with it. But loneliness was a different story.
In many ways, Joan’s was a common situation. She had spent much of her life as an independent, active woman, raising children and supporting her family. The death of her husband, though tragic and wearying, did not break her. She remained active in her community and relationships, sending letters and phone calls to friends and family. Joan lived on her own for many years after her husband’s death; yet she rarely questioned what she was doing, or why she was doing it. Whether running errands for a friend, or chatting with a neighbor, what or why never mattered to Joan. More important was whom.
And then, slowly but surely, the steady movement of human life carried Joan on the path that we all—if fortunate enough—must walk. The calm and contented woman began to lose mobility; harmless but frightening falls became a regular concern. Having struggled with a complicated swath of illnesses since middle age, she battled pain and suffering with increasing effort. Noticing the signs, Joan’s children rented an apartment for her in an assisted living facility—the same one I would come to visit—hoping it would bring a sense of security and independence.
And indeed, Joan adored her new environment. Meals were covered, new friends were down the hall, and a host of conveniences helped ease her into this new normal. She took fast interest in her staff and co-residents. Joan’s life, at least for now, was quiet, connected—and good.
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Our routine had been well-established by the time I entered Joan’s room on that sunny afternoon. I walked through the doorway and announced myself; Joan responded, in an oddly diffident tone, “Come in!”
I sat down on the cushy couch, set my backpack to the side, and asked how Joan’s week had been. I always started with this question, even though the answer was, by now, without a doubt: “Terrible.”
I cocked my head to the side and looked into her soft eyes, which bore the sympathy and weariness of love and suffering. We began one of our long and winding chats. In my early visits, I could spend up to six hours a week talking with Joan, each time exiting her facility with surprise at the moving vehicles, the laughing couples, which now seemed so strange and foreign and dynamic. Our conversations could roam across spectrums of thought—her childhood adventures, her political stances, her constant concern for one family member or another—but they were always tinged with those opening syllables, enunciated slowly with a cocked-back head: “terr-i-ble.”
Why terrible? One answer came to mind: Joan had just been placed on hospice care. This meant her doctors felt she had six months or less to live, and would benefit from non-curative medical support. As an active man in his early-twenties, I could only imagine what would feel, to me, like a literal death sentence.
I pondered this explanation, recalling a different patient whom I had served (I’ll call her K). K was a fascinating individual, an avant-garde fashionista with a well-traveled worldliness. The first time I met her—one of only a few meetings—she took my hands with instant charm and compassion. She noted that mine were cold (I’ve always had that problem), but hers quickly warmed them. In that moment pretense left us. We understood one another in a very simple way. But when I asked how K was doing, her eyes pierced mine with stoic sincerity. “I’m going to die, and that feels awful,” she said with a sobering sigh. “There’s nothing that brings me joy now. That’s all there is to it, and I don’t have anything else to say. Don’t feel sorry for me—I’ve lived a wonderful life, really—but there’s nothing for me now.”
Now, suddenly, everything was pretense. My sense of connection, of common ground upon which to shoulder another’s burdens, fell from beneath me. The universality of suffering—one guidepost with which I tried to relate to patients—now seemed like a silly philosophy in the face of raw bleakness and sorrow. I could understand the difficulty of grappling with mortality; I could empathize with someone struck by human fragility. But someone who has lost all joy—all hope—because of that mortality, that fragility? I could understand this in theory, but I could not feel it, could not know it in my bones. Even today, I still struggle to understand the humbling experiences of those who reach such depths. And I learn, slowly and imperfectly, to see through their eyes.
I considered K’s story as I looked back at Joan. Her mortality was certainly—obviously—a struggle for her. We shared tears when discussing it. Yet I could not help but wonder: was something else bothering her? After all, Joan was not suffering from the same sort of illness as K. She was not facing some aggressive malignancy; she could very well have lived for years in that dark room. My grandmother, in her first experience with hospice, was in a similar situation: she faced a complex smattering of physiological puzzles, any of which could have killed her. But she endured for months, regaining her strength to such a degree that she actually “graduated” from hospice (which typically requires an active decline in health to maintain eligibility.)
Perhaps the uncertainty bothered her? That was certainly an issue—but still, I felt there was something more. For some reason which I could not articulate, the issue at hand expanded beyond the limits of Joan. But it was also bottled up within her, like a pressurized cannister which seems so static on its face, but is really filled with a million whizzing particles, all colliding with tremendous velocity against the walls and against one another. What was I feeling? It seemed so familiar, almost innate. I felt I knew exactly what was tearing at Joan’s soul—knew it as well as I knew myself. That speechless, longing thing which was happening in the mind of the woman before me: I wondered for a moment, looked back into Joan’s eyes, and then I knew.
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Laughter. That is what I hear, what I envision, when I think back to the simpler times. Not childhood—that great bastion of longing and nostalgia—but college, a time where I was swarmed by duties and obligations, yet immersed in a community and rhythm so enveloping that even my heart-quickening schedule could only produce a strange joy and contentment. Everything was laughter. Laughter in my classes; laughter in the dining hall; laughter in my three-person dorm room senior year, finding ironic amusement in the monk-like work habits of my roommates and I. The banalities and boredoms of life were all around us, certainly, but there was a real sense of connection, of knowingness, on that tiny campus in rural Ohio.
Looking back, not even two years post-graduation, I wonder how we came to laugh so much. How, amidst our vast course-loads, our hectic schedules, our laughably disorganized lives, we had time for such joy. Yet the answer is so intuitive that you, the reader, have probably already found it: it was the very fact of our shared experiences—the common determination, purpose, and focus of our lives—which produced our joy. My friends and I were pursuing wildly different goals and vocations (one of my roommates is now in Uganda, studying African history) but we were pursuing those goals together. Our bonds could somehow grow stronger through hours of silent study, as easily as during parties, heartfelt discussions, and walks to the gym. We each had our own imposing goals, our disheartening trials—but because we knew this, and because we were together, those separate goals and difficulties brought us closer. They connected us in laughter.
I knew things would be different after graduation. There would still be exciting problems to solve, large goals to achieve. There still would be failures and struggles. But I would no longer be doing and experiencing these things in the intricate community of my liberal arts college. This, again, comes as no surprise to anyone. But there was an important nuance that I did not realize at first. Having graduated with a clear strategy for the following two years—writing, research, hospice, medical school applications—I assumed that the rhythms and priorities of college life would blend seamlessly into my postgraduate routine.
And in a sense, they did: these last 18 months have been some of the most rewarding and productive of my life. But in other ways, they have been a tremendous struggle. No longer living in a dormitory, I have found myself yearning for the proximity, the closeness, which once tied my friends and I together. Even as I invest deeply in new friendships, new communities—particularly the graduate school Christian community at Stanford—I find my schedule and lifestyle uniquely isolating. Most people my age do not wake up at five in the morning, or go to bed at nine in the evening. And regardless of circadian rhythms, we are all so busy. We are busy with our work, our research, our future, our leisure. Where is the time for others?
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Looking into Joan’s eyes as the worn-out lightbulb cast shadows around the room, I saw that we were not so different. Her illnesses were alienating. They separated her from the normal rhythms, the thoughtless joys, of a world outside. Yet those illnesses were not, in and of themselves, the terrible thing.
Joan knew the fullness of the life she had lived. There were no more goals, no unfulfilled desires, which mortality could take from her. Instead, the terrible thing—the thing that kept Joan in a dark room, kept her from spending time with friends and family as she used to—was alienation. Joan felt that her mortality made her different, made her unwanted in a society obsessed with life. And so, amidst all the pain, all the uncertainty, loneliness was the true terror of Joan’s life.
With that realization, Joan’s despair suddenly made sense to me: because I was lonely, too. Lonely in a sense so common to our Western society: lonely because I was fixated on my goals, my work, ensconced in a blend of American individualism and Silicon Valley exceptionalism. Even as love defined my ambitions—the desire to be with the suffering; to know the mind, see the heart of another—those ambitions would not bring the human connection, the love, for which I yearned. So I, too, knew the strange ache—the gnawing feeling that, even as I achieve and accomplish, I am missing something. It is a familiar feeling. The heart quickens; nerves wash through the chest in a slow, blurry tide. The pupils dilate, and a sinking feeling drops deep into the body. One tries to think, but is thinking through a fog. Sharpness and creativity drift with the tide, leaving little tidepools. One wants desperately to reach out at this moment, and tell someone, anyone, who might understand and empathize. But that is enormously difficult, because loneliness is a profoundly common, yet personal experience. And therefore, like all universal yet personal experiences, it goes unspoken. It is reduced to a label. A pity. A stigma. And something, some strange and also unspoken thing, comes between the people who want to be understood, who want to empathize. And the problem goes unspoken.
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Recent years have seen a tremendous uptick in the literature and discussion surrounding what some—including Vivek Murphy, the former U.S. Surgeon General—refer to as an American “epidemic of loneliness.” Cigna, the health insurance company, recently published a nationwide survey of 20,000 adults, trying to gauge the national prevalence of loneliness. Over half the respondents (54 percent) “always or sometimes” felt that none of their peers knew them well. A slightly larger proportion (56 percent) sometimes or always felt that those around them were not necessarily “with them.” And approximately two-fifths felt “isolated from others”—a sense that they lacked the meaningful relationships, the companionship, which color human life.
Far from fixed or unchanging, these nationwide sentiments appear to be growing. “This trend has been taking place for years,” Dr. Murphy said in an interview with Forbes magazine, “yet we are only just recognizing its magnitude and impact.”
Hoping to explain this paradoxical trend—a collective growth of loneliness—experts have pointed towards individualist lifestyles, geographic mobility, fixation with social media, and increasingly detached workplaces. Others have focused more on outcomes: recent research suggests that loneliness is associated with greater risk of cardiovascular disease, dementia, depression, and anxiety. Workplace performance and productivity also seem to suffer.
Yet for all these analytics and assessments, everything returns to the human desires, the profound struggles, which give loneliness its full context: “I sometimes worry,” Murphy said later in his interview, “that we have lost sight of the fundamental need that each of us have for human connection. In a society that tends to prize the individual over the collective, it turns out that individuals cannot be truly fulfilled or successful without each other.”
For people like Murphy, these statistics and statements are not meant to heap more burden on the isolated. Rather, they are meant to galvanize individuals, and especially communities, to reimagine the idea of a good life; reimagine what it might mean to have your fulfillment, your success, in the context of something larger than yourself. The former Surgeon General imagines workplaces where employees see their colleagues as whole people; where social connections are prioritized alongside action items. His ideas, and those of others like him, are pragmatic, scalable, and necessary.
But ultimately, ideas are not the end goal. The end goal is a recognition of—and action on—that strange, shared need which we have for one another. The end goal is that powerful, healing sense that we are known, and loved, and surrounded, by people and communities. That sense does naturally evolve from, and contribute to, a society which finds ideas to address loneliness. But, learning from my own loneliness (imposed, ironically, by a regimented desire to help others), that society must never lose sight of the actual people, the actual stories of alienation all around us. That society must never cease to bear witness to one another’s isolation—then enter, and dissolve it.
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“No one ever told me,” C.S. Lewis once wrote, “that grief felt so like fear.”
I had wondered, in the seemingly endless moment which had passed as I looked into Joan’s eyes, why loneliness was so common, yet so unspoken. Words like “stigma” and “isolation” were simply not large enough to explain. They were important pieces to the puzzle—metaphorical bricks in the barriers between us—but they were not enough. There was some other feeling, perhaps an emotion, which better characterized loneliness and its complexity.
Some months before, I had skimmed through Lewis’ book, A Grief Observed, written after the death of his wife, the poet and writer Joy Davidman. The book, first published under the pseudonym “N.W. Clerk,” is at once a raw exploration of sorrow, and a piercing analysis of human suffering. And in this collection of unfiltered reflection, there comes a moment when Lewis describes, in his classic self-awareness, the strange similarities between grief and fear: “I am not afraid, but the sensation is like being afraid. The same fluttering in the stomach, the same restlessness, the yawning. I keep on swallowing.”
And there it was. Thinking of Lewis’ words while sitting on Joan’s couch, the whole wrapped and complicated tension seemed to unravel. I knew in so many ways, could paint in so many colors, why this woman was suffering so powerfully. I knew, because I was suffering in the same way. Both of us felt isolated; felt like no one could know our minds and hearts. We felt that way for very different reasons, but we knew the same fluttering, the same nervous tide. We knew that all of a sudden, when we needed connection most, this strange barrier had been erected between us and the world. That barrier was fear.
Lewis, too, knows this barrier: “There is a sort of invisible blanket between the world and me. I find it so hard to take in what anyone says. Or perhaps, hard to want to take it in. It is so uninteresting. Yet … I dread the moments when the house is empty.”
Why do we find it so difficult to reach through our loneliness, or the loneliness of others? The question is broad, complex, unanswerable in a single coherent piece. But I want to put forth the idea—drawn from Murphy, Lewis, myself, and most of all Joan—that of all the barriers, all the invisible blankets, fear itself reinforces our loneliness. Indeed, fear is responsible for so many estrangements and separations. Just examine the rhetoric of those who ostracize certain immigrants to the United States: even they must talk of barriers. But unlike the scare tactics which color that political realm, fear derived from loneliness separates the very people who desperately wish not to be separate.
I think of it like this. Two people are lonely. But they are lonely in very different ways. They have different histories, backgrounds, loves. Still, they are both walking through the foggy haze, that invisible tension which cannot be resolved through their own individual efforts. What they want is another human being to whom they can pour out the overflowing reservoir of thoughts and feelings which have built up in their minds without release. What they want is to confide their loneliness in one another, and in doing so, dissolve their loneliness. But they are afraid. Afraid because of the very physical and psychological experience of their isolation; afraid that they will not be accepted and loved because of it. At best, they feel, others may sit with them out of politeness and pity. And so they do not confide in one another. They remain in their darkened rooms, or they type away at their essays and research papers, not at all despairing of what they are doing, but speechlessly loathing the fact that they have done it for so long on their own. Fear builds the barriers, draws the blanket, and multiplies itself.
How do we break that cycle? How do we address the real and pernicious cycle of fear and isolation?
Just as the reader of Lewis must realize that every grief is different, we begin by knowing that people are lonely for different reasons. We then appreciate the complex mix of factors—physical, social, psychological, geographical—which contribute to their loneliness. That appreciation will help point towards specific concrete actions. (For instance, structured social time at the workplace.) But at its core, loneliness is something felt inside a human being. It is a physical and physiological experience—as students of the James-Lange Theory of Emotion will note, while reading Lewis’ reflections—but a very internal one. The deconstruction of our barriers therefore necessitates something a bit more intuitive. It requires the great connector of human beings: vulnerability. No characteristic has such capacity for transmitting ourselves, and our whole selves, as vulnerability. To reach out to another human being and communicate your own suffering is deeply frightful. But unlike prolonged loneliness, that fear quickly gives way to healing—a healing far greater than the fear could ever let on.
This is all a roundabout way of saying what Dr. Murphy communicated in a few short sentences: “I want people to know that if you are lonely, you are not the only one. And if you aren’t lonely, there is a strong chance that you know someone who is lonely.” And, moving forward from that knowledge, that it is up to us to heal people and communities broken by isolation, alienated by their disconnection. As Murphy implies, that healing begins with knowledge. Knowledge of the person, knowledge of loneliness, knowledge of the barriers which come between us.
Only when we love one another deeply enough to reveal our hurts, our loneliness, will we be truly, and powerfully, together.
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Enough time had passed to make the silence audible. Joan was still looking at me, wrapped in her struggles, aware enough to be confused with my spotty attention. I returned to the moment, endeavoring to make good on all that had transpired over those drawn-out seconds. Joan’s loneliness, I saw, was not so different from my loneliness. That is why it had felt so odd. It was like looking at a complete stranger, only to find a reflection of yourself.
I had felt lonely and isolated because of my monastic focus, because my work and life rhythms took place in the context of the self. Joan, on the other hand, was alienated and alone because she felt that, by entering hospice, she had entered some new and hopeless world. She felt that this made her different, superfluous, to a busy culture teeming with life—obsessed with life. I could tell because I had listened to her cries, her complaints, for so long. I had held her hand when I lacked the words to respond (which was more often than not). And now, aware of her alienation and my self-imposed restlessness, I had a chance to do something about both. I had the chance to rip off the cheap, silly armor which I wore to convince others that I had my life together; to show Joan that I, too, struggled, just as she struggled. That she was not alone.
But words—like that armor—are cheap. So I laid my cold hand on her warm ones, and leaned in to the silence. After enough time had passed—after the silence had grown awkward, tremendously awkward, then oddly therapeutic—I asked her to tell me more. We talked upwards of two hours, dropping the pretense and barriers which had, at one point, draped our isolations. And in revealing those isolations to one another, they were suddenly gone. A smile, a soft serene smile and laughter, returned to Joan’s face, drawing out her cheekbones and sending ripples from the corners of her mouth. There was joy in her eyes.
As I exited Joan’s room to the hallway, the hallway to the stairs, the stairs to the lobby, and the lobby to the street, I grew slowly aware of a change within me. It happened subtly and imperceptibly, but the resulting difference was unmistakable. I could not feel the beating of my heart against the chest wall; my chest was calm, relaxed. I felt light. Looking out at the street before me, still bathed in a rich and warming sunlight, I found this transition soothing, intuitive. I inhaled deeply, taking unconscious note of the people and cars moving past me. And I knew I was not alone.
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Author's Note: All individuals described in this piece have had their names, and all identifying features, altered for privacy.
