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On Health and Loneliness

Learning Objectives
1. Explain a new or unfamiliar viewpoint on a topic of ethical or professional conduct
2. Evaluate the usefulness of this information for health care practice, teaching, or conduct
3. Decide whether and when to apply the new information to health care practice, teaching, or conduct
1 Credit CME

This essay connects loneliness with health problems and argues that both are comorbid with authoritarian politics. Although an old idea from Plato and Aristotle, this problem takes an acute shape in the contemporary world, as argued by Hegel, Hannah Arendt, and Kate Manne, and has a gendered dimension, as men are lonelier than women. This article also attends, briefly, to empirical material about loneliness in the contemporary world.

Witness as Social Capital

In despair, my best friend called me.

He is a married gay man. I had been present at a dinner at his home 6 weeks before when a faculty member from his 8-year-old daughter's school called to warn him about an impending set of virulently homophobic policies. Now he described the institutional discrimination that the young child was facing because of his sexual orientation—discrimination so frightening that her pediatrician had sent her to the emergency room with acute appendicitis, only to discover that she suffered from terrible anxiety. He began to weep as he described how, because of her age, they had hoped she would be insulated from adults' bigotry. However, teachers talk and so do parents, and bad news travels fast on the playground. He asked me, among other questions, whether his own child would eventually become a bigot, under this and similar pressures. I reassured him that she would not.

I was left with many questions, and among them are topics of this essay: What if, for reasons of gender socialization or social capital, he had been unable to call me? What if I had not been at his house to bear telephonic witness to his trauma? What if, busy or simply distracted, I had not picked up the phone on the day of despair? What if, a week later as the policy emerged, I had not sat with him as we read the policy together, just so he would not have to be alone in a room full of hate? What if, many weeks later, for whatever reason, I had been unable to give his daughter a small gift as she started her new school, to take her for the weekend to give him and his husband time to recuperate, and to attend her new activities as a loving and trusted adult? In short, what if the conditions that make friendship and solidarity possible had not been present? My friend and I had dined nearly weekly for 20 years, a connection made possible by multi-generation intellectual capital, good jobs, and the moral luck of having landed those good jobs in physical proximity to one another. But many people in advanced capitalist societies suffer loneliness in their times of trauma. This loneliness is not only bad for our health; it is also comorbid with authoritarian politics, currently rife with the very homophobia that my friend was suffering from.

Loneliness Observed

Quiz Ref IDAdults in the contemporary United States are remarkably isolated. According to Daniel Cox, summarizing the May 2021 American Perspectives Survey, “nearly one in five Americans reported having no close social connections, a double-digit increase from 2013.”1 The survey's methodology defines “close social contact” as the kind of contact my friend had sought from me: having someone to speak to about an important personal matter, and within the last 6 months.1

Although discrimination is especially painful, particularly when it targets and affects a child, you could substitute any of the routine indignities of adult life for my friend's: the slow decline of a parent or spouse; the generalized fear that comes with living in the giant medical experiment constituted by a novel coronavirus; and, of course, actual pediatric cancer or appendicitis or the loss of a child to death. To these we might add the particular pains of economic life: loss of a job or the denial of a promotion; the pain of inflation and wondering if one's resources will be enough to protect one's family; worry about medical costs; and acculturation into an environment that associates happiness exclusively with material gain.

At the distance of several months, my friend has stopped the smoking he began. He again sleeps through the night. In fits and starts, he has regained his lifelong exercise program, helped along by me as we meet for a session on the elliptical. He is a person of great personal strength. But it did not hurt that I and some others were able to stand by him in friendship and counsel.

Insight From Philosophy

Arendt. Rich is the theory that connects isolation and loneliness to authoritarian politics, especially in Hannah Arendt's writings. Quiz Ref IDNear the end of The Origins of Totalitarianism, Arendt explains what she calls “organized loneliness”: “[w]hat prepares men [people] for totalitarian domination … is the fact that loneliness, once a borderline experience usually suffered in certain marginal conditions like old age, has become an everyday experience of the ever-growing masses of our century.”2 Such loneliness—which can be experienced in a crowd, too—happens when friendships are unlikely, impossible, or threatened.

Arendt's main philosophical influences are Plato, Aristotle, Hegel, and Marx. All are thinkers who refute the premises of the social contract theory that informs modern political life—and especially the idea of an isolated individual as a premise or starting point, which severs our most basic connections with other humans. For Arendt, once human nature as a concept is filled in with ideological individualism, we are cut off from other humans so dramatically that the 2 basic functions of human community are abrogated. First, we no longer are able to verify truths of the physical world by asking for confirmation from a fellow person. Common sense erodes as there is nothing common or sensical,2 a point highlighted beautifully by the erosion of truth in the many alternative realities now available, as mediated by our tiny screens. Second, in this extreme loneliness, we are no longer able to organize or be a self, because, as Arendt writes: “for the confirmation of my identity I depend entirely on other people.”2 Arendt draws the 2 functions from Hegel, whose critique of ideological individualism also caused him to reject the contract tradition. Hegel derives these 2 functions from Aristotle's notion of zoon politikon (political animal), which Hegel has not only understood better than most other commentators, but also applied to the modern world.

Marx. Hegel's student, Marx, in his 1844 manuscripts, gives an account of how everyone suffers in modernity: though we do not often focus on loneliness, according to Marx, the suffering it causes cannot be escaped entirely even by the very rich.3 The word Marx uses for loneliness, alienation, has 4 dimensions. Our loneliness is so extreme that we are alienated from the physical world, from our own activity, from the practices through which we might actively construct—in community—a human nature apart from that prescribed by contractarian individualism, and from other humans in our day-to-day lives. Marx worries, in particular, about the way modernity forces everyone to view everyone else as a competitor for scarce resources, even in the most intimate friendships. It is difficult to imagine a more organized loneliness, indeed. The critique is so comprehensive that it leaves readers wondering how anyone, even my friend and I, could have formed a friendship at all.

Plato and Aristotle. We find connections between organized loneliness and authoritarian politics already and explicitly in both Plato and Aristotle. In the Symposium, Plato argues that (non-Greek) political regimes have deliberately hobbled friendships “on account of their tyrannies … for I suspect that it is not to the advantage of the rulers that great and proud thoughts be engendered among their subjects, any more than friendships and associations.”4Quiz Ref IDAristotle echoes the idea in the Nicomachean Ethics, after explaining the kind of virtuous friendship that allows one to seek counsel from a friend as the highest form of friendship—and after arguing that such virtuous friendships are necessary for happiness, the highest good. But, as Aristotle warns, “while in tyrannies friendship and justice hardly exist, in democracies they exist more fully; for where citizens are equal they have much in common.”5 For Plato and Aristotle, true friendship thus was moral, had functions of counsel and correction as well as accompaniment—as applied in the global health work of Paul Farmer6—that made better political bodies possible, and made life worth living.

Manne. Yet we cannot neglect the gendered dimensions of isolation, loneliness, and the collapse of friendship. Quiz Ref IDAs the 2021 American Perspectives Survey also reveals, men suffer from a decline in close friendships at a more precipitous rate than women, with 15% of men reporting no close friendships at all, a 5-fold increase since 1990.1 When we parse these empirical data by age, we find that young men are the most vulnerable to loneliness.

As Kate Manne points out, the incel phenomenon—a category overwhelmingly populated by young heterosexual males who are either White or idealize whiteness—is characteristic of persons who blame loneliness, whatever its causes, on women.7,8Quiz Ref IDThe social structure of forced competition highlighted in Arendt and Marx also causes members of incel communities to compete for status and blame women for their resulting loneliness. The violent consequences of this blame of and competition for individual women structure the misogyny Manne analyzes.7 And they are, indeed, violent public health problems: among other incidents, Manne highlights the 2014 Isla Vista sorority shooting as well as domestic violence.7

Theweleit. And these men, as Klaus Theweleit puts it, could be “the tip of the patriarchal iceberg, but it's what lies beneath the surface that really makes the water cold.”9 Men might be lonelier in part because of misogyny: they are both isolated from women and reliant on them for social connections with friends and family. Because such connections take time and effort to cultivate but might not appear to do so, the work of forging connections is yet another kind of labor to which men might feel entitled. Unsurprisingly, then, authoritarian regimes have, historically, reoccupied the terrain of “traditional gender roles” and aggressively controlled reproductive labor, as Theweleit also documents.9 My friend's gender socialization, tempered by his sexuality, might have insulated him from the worst consequences of regressive gender role nostalgia.10

Still, we must ask how loneliness feeds the public health epidemics of our times—or even if it is itself a public health epidemic—and how we might combat or remedy such loneliness in our moral practices, including our principled stands against misogyny.

By asking for a friend.

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The AMA Journal of Ethics exists to help medical students, physicians and all health care professionals navigate ethical decisions in service to patients and society. The journal publishes cases and expert commentary, medical education articles, policy discussions, peer-reviewed articles for journal-based, video CME, audio CME, visuals, and more. Learn more

Article Information

AMA Journal of Ethics

AMA J Ethics. 2023;25(11):E850-854

AMA CME Accreditation Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

Conflict of Interest Disclosure: Author disclosed no conflicts of interest.

The viewpoints expressed in this article are those of the author and do not necessarily reflect the views and policies of the AMA.

Author Information:

  • Amy E. Wendling, PhD is a professor of philosophy at Creighton University in Omaha, Nebraska. A former Fulbright Fellow, she has authored numerous articles on property, time, alienation, and screen technology and is the author of The Ruling Ideas: Bourgeois Political Concepts (Lexington Books, 2012).

Cox  DA.  Men's social circles are shrinking.  Survey Center on American Life. June 29 , 2021. Accessed March 31, 2023. https://www.americansurveycenter.org/why-mens-social-circles-are-shrinking/
Arendt  H.  The Origins of Totalitarianism. Harvest; 1973.
Marx  K.  Economic and philosophic manuscripts of 1844.  In: Engels  F, Marx  K; Tucker  RC, ed.  The Marx-Engels Reader. WW Norton; 1972:66–125.Google Scholar
Plato.  Plato's Symposium. Benardete  S, trans. University of Chicago Press; 1993.
 Aristotle.  The Complete Works of Aristotle: The Revised Oxford Translation. Vol 2. Barnes  J, ed. Princeton; 1984.Google Scholar
 Paul Farmer: “accompaniment” as policy.  Harv Mag. May 25 , 2011. Accessed June 26, 2023. https://www.harvardmagazine.com/2011/05/paul-farmer-accompaniment-as-policyGoogle Scholar
Manne  K.  Down Girl: The Logic of Misogyny. Oxford University Press; 2018.
Manne  K.  Entitled: How Male Privilege Hurts Women. Crown/Random House; 2020.
Theweleit  K.  Male Fantasies Volume 1: Women, Floods, Bodies, History. University of Minnesota Press; 1987. Godzich  W, Schulte-Sasse  J, eds.  Theory and History of Literature; vol 22.
Applebaum  A.  Twilight of Democracy: The Seductive Lure of Authoritarianism. Doubleday; 2020.
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
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  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.


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