India, June 15 -- It looks different to every person who fights it. In Japan and South Korea, people are so lonely, they may die and not be discovered for days. (In Japan, a country of 124 million, over 58,000 such deaths occurred in 2024 alone.) In the US and parts of Europe, so isolated are some people's lives that this has happened in the workplace. In India, amid the teeming millions, there is the loneliness in a crowd that Edward Hopper captured so evocatively, in his paintings of modern American life. There is also the loneliness of being. the only Dalit, a differently abled person, mentally challenged, or simply the head of a household in a system where such a man is expected to have all the answers and show none of the strain. Typically, loneliness is understood as the sentiment of: "If I disappeared tomorrow, would anyone really care that I was gone?" In our overcrowded, overworked, insular cities, there are also the questions: "If I disappeared tomorrow, would they miss me or what I bring to the table?" and "Do they even see me? Do they know I'm here?" Many of us have asked these questions, in anger or anxiety. When such questions go from the occasional rant to the ideas by which one defines one's place in the world, it is considered chronic loneliness. More ironclad definitions are hard to come by. The World Health Organization (WHO) describes loneliness as a "subjective distressing experience" that stems from perceived isolation or the lack of meaningful connections. It has been ringing the alarm bells about this condition for years. In 2023, WHO declared loneliness a "global public health concern". Also that year, it invited 11 key policymakers, researchers and advocates to join a Commission on Social Connection, to help frame a strategy for solutions. "Given the profound health and societal consequences... we have an obligation to make the same investments in rebuilding the social fabric of society that we have made in addressing other global health concerns, such as tobacco use, obesity, and the addiction crisis," Dr Vivek Murthy, then US Surgeon General and co-chair of the commission, said in a statement. What do the health and societal consequences look like? In a 2023 report that became controversial for its title (Our Epidemic of Loneliness and Isolation) but not for its findings, Dr Murthy laid out the ways in which isolation could have an impact similar to smoking 15 cigarettes a day. The condition is associated with a 25% increase in the risk of early death, a 30% rise in the risk of stroke and cardiovascular disease, and an increase of as much as 50% in the risk of developing dementia. The reasons are as simple as you think. Everyone needs someone to help care for them, and encourage them to care for themselves. We all lean on others to alleviate stress, stay active. But we also lean on others to confirm that we matter and belong. The simple truth is, we need other people, as Dr Murthy puts it, in an illuminating conversation with Simon Sinek on the podcast A Bit of Optimism in January. Can one be lonely in a country of 1.4 billion? About 13% of India's seniors report loneliness, researchers from Banaras Hindu University (BHU) found, when they analysed data from the Longitudinal Ageing Study in India (LASI) Wave-1, a survey of over 72,000 individuals conducted in 2017-18. Around the world, and now in India, a shift in family structure - from joint to nuclear to a rise in single-person households - has contributed to loneliness. But the problem goes much deeper. There is, of course, the growing reliance on digital platforms, which has resulted in a worrying trend of social isolation even among the youth, says Dr Manoj Sharma, head of the SHUT (Service for Healthy Use of Technology) clinic at the National Institute of Mental Health and Neuro Sciences . But then he hits on perhaps the most dominant factor in the rise of loneliness. "In an increasingly competitive world, we are, from a young age, constantly hustling and chasing one goal after another. This leads to stress, anxiety and a sense of isolation that stems from the structure of one's day and life, as well as from feelings such as 'Am I doing enough?' 'Am I falling behind?'" Sharma's view is echoed by doctors, psychiatrists, researchers in health, urban planning and social affairs, mayors, governors and prime ministers around the world. One reason loneliness hurts so much is that it creates a sense of invalidation and insecurity. The opposite, the sense of inclusion and acknowledgement, is easy enough to achieve. A passing interaction with a stranger, a visit from a volunteer or a chat with the local grocer can help. Both sides in such interactions walk away feeling ebullient. Studies have traced this to a rush of endorphins that researchers say evolved as a way to encourage humans to bond, as a way to increase our chances of survival. And yet, as Murthy points out on the podcast, rather than promote such interaction and connection today, we tell people that their best chance of finding joy is to focus on themselves. "We are taught to prize success over relationships and that is part of the problem," he says. How did we end up with this idea? The shift was cultural. And we can even, in a sense, date it. Until the 1800s, loneliness just meant oneliness, a kind of solitude, says cultural historian Fay Bound Alberti, author of A Biography of Loneliness (2019). The term evolved to capture a kind of emotional lack, Alberti says, in a "period of industrialisation, urbanisation and the breakdown of traditional communities. (amid) a movement. towards individualism and consumer capitalism." Over the next century, this new culture began to spread. Then came the wars, the Great Depression, and the horrors of the holocaust. By the end of World War 2, the Greatest Generation (born 1901 to 1924), had reached and breached their limits on enforced hardship and sacrifice. They had lost family, friends and some of the best years of their lives to what were arguably the worst three decades in modern history. Exhausted and ready to move on, they stepped into an economic boomtime. In the US, this resulted in a decade, the 1950s, defined by a drive for individual success and an almost-unprecedented growth in personal wealth. Modesty was shrugged off; status symbols abounded. Our current world, as Sinek puts it in his podcast, could be seen as the extreme end of this pendulum swing. By the time the internet and social media arrived, we were already living in an age that prized busyness, minimised the importance of personal connection, and equated success with material wealth alone. Where once we built stronger bonds than most animals, through community living, music, storytelling, laughter, the same endorphin system was now activated by meaningless nuggets on a glowing screen. Where do we go from here? It helps that governments around the world are acknowledging the problem, says Hans Rocha IJzerman, a behavioural scientist, founder and director of the Annecy Behavioral Science Lab (ABSL) in France, and an associate researcher at the Oxford Internet Institute. Part of the reason countries are doing this is that loneliness is expensive. Studies in the UK, Australia and Japan have thrown up alarming statistics on the degrees to which it can raise healthcare expenses and lower productivity. It affects fertility and mortality rates too. Meanwhile, the issue does need a lot more research, IJzerman says. We have varying definitions, a lack of country- specific data, and no body of research yet on the kinds of context-specific changes and interventions that might help. It will be important to address this gap as part of general health surveillance, IJzerman says. Or, as the former Surgeon General puts it: "We need to widen the lens through which we look at health."...