David Haslam

Sir David Haslam, member of the Rethinking Medicine working group.

It is as dangerous as smoking, as risky as high blood pressure, as hazardous as obesity. It increases the likelihood of mortality by 26%, particularly through heart disease and stroke. It has clear correlations with cognitive decline, the development of dementia, depression, and suicide. People with it are more likely to visit their GP, have higher use of medication, higher incidence of falls and increased risk factors for long term care. The pharmaceutical industry is working on a medication to treat it.

It is loneliness.

Loneliness as a condition 

Where exactly are the boundaries of healthcare? For those of us who work in the medical frontline, we are faced every day by the complexity of this issue. Where does unhappiness end and depression start? At what point might shyness be considered a disease? When is the normal abnormal?

A report last year in The Guardian featured an eminent clinical psychologist who described loneliness as a “social isolation syndrome”, and then went on to describe the possibility – indeed the likelihood – of drugs being developed to address the problem. Can this possibly be appropriate?

In no way do I mean to decry the incredible importance of loneliness, the despair and heartache it can cause, and the important correlations between loneliness and ill health. But if anything demonstrates the potential overmedicalisation of society it must be the concept of prescribing medication. 
The thought of all these lonely people, perhaps sharing an apartment block or village but never having any human contact with each other, and each taking medication for their loneliness should fill us with despair.

A medical problem?

But these are not simple issues. The dividing lines between health care, social care and everyday life are almost entirely artificial constructs. If loneliness increases the risk of raised blood pressure (it does), and raised blood pressure increases the risk of stroke (it does), would it not be logical to tackle loneliness in the same way that we tackle raised blood pressure? 

Or what about obesity, which is linked with high blood pressure, and so with stroke? Much obesity is linked with societal issues such as food industry policy, poverty, education, marketing, and even political attitudes. Does this mean that the medical world should not engage with the issue of obesity? Where does a problem cease to be medical? When is it inappropriate, and even harmful, for doctors to be involved? When is it unkind for us to say “not our problem”? If these issues are not for the medical world to deal with, whose problems are they? And when one of the few readily available free sources of advice and support in the UK happens to be the NHS, is it any wonder that people bring their problems to doctors? 

The thought of all these lonely people, perhaps sharing an apartment block or village but never having any human contact with each other, and each taking medication for their loneliness should fill us with despair. 

I recall one particular morning surgery when I saw two teenage boys, both of whom had been excluded from school because of bad behaviour. Their teachers felt that they needed a mental health referral. I recall cynically thinking that the school had successfully addressed one of their performance targets (removing problems from their quality metric denominator) by passing the problem onto me. Such cynicism was unbefitting, I know. After all, they both were started on medication by the child and adolescent mental health (CAMH) team. Was this proof that this really was a medical problem? Or was there precious little else that was available to do for them? Is the availability of a treatment the way we define what is a medical problem? Am I now making you deeply uncomfortable with this line of questioning?

And if an effective pill is developed for loneliness, what then?

Is it any wonder that we need to rethink medicine?

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