The New York Times has recently reported that United Kingdom has appointed a ‘minister’ for loneliness (UK Appoints Minister for Loneliness by Celan Yeginsu, Jan 17, 2018). Many recent studies suggest that loneliness is a serious problem with considerable medical consequences. The most important medical consequence is of course depression that in itself increases the risk for all sort of physical ailments.

The article mentioned above quotes Prime Minister May of UK: "For far too many people loneliness is the sad reality of modern life….I want to confront this challenge for our society and for all of us to take action to address loneliness endured by the elderly, by carers, by those who have lost loved ones --- people who have no one to talk to or share their thoughts and experiences with."

Loneliness is most common among the very elderly and the adolescent. The teenage ‘angst’ is a well-known subject for literature and the movies. ‘Nobody understands me’ being a common refrain that many of us have voiced as young people but survived. It is, however, the elderly that are most often confronted with true loneliness. The commonest reason is the loss of a lifelong partner after decades of being together.

I have the example of my own parents to illustrate this problem. My parents met when they were still in their late teens. They got married in their early twenties soon after they finished medical school. My mother passed away at the age of eighty. My father who was left behind was apparently in good medical condition in spite of also being eighty years old.

In two years my father became sick and almost died. Fortunately, I was able to bring him to the United States where he underwent lifesaving major surgery. A couple of years later after he had recovered completely from his medical problems I came to see him in Lahore. What I saw shocked me.

The person who I had always known as a ‘natty’ dresser extremely particular about his looks was sitting on a chair wearing a ragged undershirt and a ‘lacha’ and I could tell that he hadn’t had a bath in days. He has not been living alone. He had a houseful of servants; and a bunch of younger siblings, nephews and nieces that literally lived down the street from him and dropped by to see him almost every day but he was still utterly lonely.

One look at him and I realised that if left like he was, he would not last for more than a year or so. It is then I decided that the old man needed his only son at his side. The rest as they say is history. But within a year the man I had known was back to his previous self. Only half in jest I would say that he had a more active social life than I did! And yes he outlived my mother by more than a decade.

My father’s example illustrates two points. First that even though my father was healthy when my mother passed away but he almost died in couple of years. His problem had been present though undiagnosed even before my mother died, I cannot but accept the possibility that depression as a result of loneliness exacerbated the problem. The second point is that even after a full medical recovery he was clearly depressed and as a physician was overmedicating himself with many different antidepressant medicines with horrific side effects.

The reason why I have described my father’s case is because it is quite typical of what happens and how people can become lonely even when not alone. And that the intervention needed to bring them out of that condition is often not very complicated. And once that basic intervention takes place, the person can and often does improve rapidly.

In Pakistan, many of us still live in a joint family system and the parents of the people from my generation have mostly been lucky to have children around them to take care of them and more importantly just to be with them. But it is my generation that I worry about. Today we live in a world that is much more connected and most, if not all, of us have children that study abroad and many now live and work abroad. As we get older loneliness will become a problem for many of us.

In the article I quoted above, it is said that up to nine million people in UK were suffering from this problem (roughly one out of seven people) and that 200,000 people had not spoken to anybody over the previous month. These are alarming numbers. Another aspect of loneliness is that it might also afflict people in the workplace. This latter situation is obviously exacerbated by changes that are taking place in where and how people work.

When I started my medical training in the New York metropolitan area almost forty six years ago, we had a weekly tradition. Every Friday at the end of the work week, many of the doctors, nurses and other staff that were not on duty on that night would aggregate at the local bar and as they say ‘raise’ a glass or two. This meeting was referred to as the ‘liver rounds’.

Why liver rounds, that I leave for my readers to figure out. Today that would be difficult considering the opprobrium attached to the mingling of the sexes and the simultaneous consumption of alcoholic beverages.

Over the rest of my professional years, I kept up a similar tradition though modified. Every Friday in my medical office in the hospital I worked in, the medical partners had lunch served at our expense for all the people that worked for us and with us.

In Pakistan during my years working in Mayo Hospital and KE, I would at least once every two weeks share a lunch or a ‘heavy tea’ with my staff at my expense. Working in a place smack in between Gawalmandi and Neela Gumbad in Lahore was conducive to the consumption of much good food. And of course this improved the work environment and ‘injected’ an extra dose of camaraderie into the junior staff.

Unfortunately, in today’s world, too many young people are hooked on their smart phones and communicate with friends and family through that device rather than directly. This is making many people who depend on these devices much less adept at the social skill known as ‘schmoozing’.

Once you stop talking directly, you are just a step away from not talking at all. Loneliness however is not the same thing as solitude. Many of us need ‘down time’ to think about things and to put our thoughts together.

President John F Kennedy during a dinner for a number of Nobel laureates (April 1962) said to them: "I think this is the most extraordinary collection of talent, of human knowledge, that has ever been gathered at the White House, with the possible exception of when Thomas Jefferson dined alone." Even though the statement was made partly in jest, it perfectly describes the difference between being alone and being lonely.