The elephant in the room is loneliness, even if the room is a psychiatrist’s office. As psychiatrists, we deal with depression every day; it is the bread and butter of our professional lives. But depression has become a catchall complaint for everyone from the stay-at-home mother who talks only to toddlers all day to the angry unemployed man who feels the world has handed him a raw deal; the diagnosis may be accurate, but the stories people tell to explain how they arrived at their unhappy conditions are often wrong. At this moment in history, it is fashionable to talk about a “chemical imbalance,” but that label is not as illuminating as many people assume. Every thought and every emotion involves changes in electrochemical signals in the brain; therefore, all states of feeling can be regarded as chemical imbalances. What gets lost in this perspective is the complicated relationship between depression and social isolation. What gets lost is the story of a mother who grows depressed simply because she has no adults to talk to, and the story of an unemployed man who feels completely left out because his entire social world had consisted of daily contact with his coworkers.
We argue that a great many people who think of themselves as depressed have in fact a sense of isolation at the core of their feelings. Unfortunately, talking about loneliness in America is deeply stigmatized; we see ourselves as a self-reliant people who do not whine about neediness. If a person is going to complain, far better to complain about what someone has done to him (abuse, coercion, rejection) or what diagnoses and addictions he was saddled with; to wistfully describe how lonely he feels is simply not socially acceptable. Because of this persistent stigma, we as psychiatrists often learn about our patients’ isolation almost by accident, long after they’ve received the diagnoses they wanted, such as depression, anxiety, and posttraumatic stress disorder. Their stories can help us understand the stark facts of sociologists’ surveys and bridge the gap between individual choice and nationwide change. The embarrassment that our patients feel about their loneliness, an embarrassment that leads them to hide their loneliness until we ask the right questions (and ask them tactfully), also helps us make sense of seemingly contradictory sociological data.
Excerpted from The Lonely American by Jacqueline Olds, M.D., and Richard Schwartz, M.D. Copyright © 2008 by Jacqueline Olds, M.D., and Richard Schwartz, M.D. Reprinted by permission of Beacon Press, Boston.