Is Loneliness a Psychological Dysfunction_ a Literary Study of the Phenomenon of Loneliness

Is loneliness a psychological dysfunction? A literary studyof the phenomenon of loneliness

Brita Nilsson1PhD, RN, Unni A. Lindstrom2

PhD, RN and Dagfinn Naden1PhD, RN

1Faculty of Nursing, Oslo University College, Oslo, Norway and 2Department of Caring Science, Abo Akademi, Vasa, Finland

Scand J Caring Sci; 2006; 20; 93–101

Is loneliness a psychological dysfunction? A literary

study of the phenomenon of loneliness

The purpose of this investigation was to explore how

loneliness is described in literature and research. The study

employed a hermeneutic approach rooted in the ideology

of humanistic science in a caritative nursing tradition. Data

sampling for the study was completed over two different

periods of time (1998 and 2004). The main findings are

that loneliness is understood as a complex dimension in

our lives and it can be experienced at many levels.

Through the survey of the theoretical material, loneliness

may be understood as a structural dimension of existence

and not as an illness. The deep dimension of loneliness,

however, can entail suffering that is possibly so intolerable

that it may turn towards becoming an illness. Loneliness is

assumed as something we are, an ontological structure in

our existence. Loneliness can therefore be turned into

suffering as well as into health. It is perhaps in the silent

reflective loneliness that we paradoxically develop a

greater understanding of the benefits of togetherness. Our

conclusion is therefore, that the phenomenon of loneliness

is not a psychological dysfunction.

Keywords: loneliness, solitude, philosophy, psychology,

caring, nursing.

Submitted 27 January 2005, Accepted 19 December 2005

Introduction

This article is the first of several on the phenomenon of

loneliness drawn from a larger subject in which the purpose

was to develop a deeper understanding of the significance of

loneliness in human existence in a nursing-scientific

psychiatric context. Prior understanding of loneliness is

perceived not only as a common phenomenon but also a

mysterious one. It was the mysterious and multifaceted

aspects of the phenomenon that disturbed andmotivated to

undertake the study of loneliness (1). The study is donewith

a caring-scientific perspective and a general hermeneutic

approach based on Gadamer’s thinking (2).

The paradigm of the study

The first author’s personal paradigm was earlier based on

Heidegger’s philosophy (3), viz. his ontological concept of

caring. This fundament has gradually directed itself towards

caring sciences’ paradigm within the concept of caritas’

ethical and metaphysical understanding of the human

being. The study is based on the human science ideograph-

ical school, and seeks a boundary breaking and creative

approach to the comprehension of loneliness in a herme-

neutic understanding, where Gadamer (2) is the source of

inspiration. The research field is of an existential character

and the pre-understanding is specially emphasized in the

ontological, epistemological and methodical deliberations.

Loneliness and modern society

Loneliness as a theme and specific area of interest was

not developed as an area of research in Western history

before the advent of the modern age around the 1700s

(1, 4). However, loneliness as a theme was described

early on in fictional works (5, 6), as well as in poetry

and painting (Munch; Hertervig), in patient literature

and autobiographies (7, 8). Loneliness as a theme for

research does not have a long history. In the Nordic

countries and the USA, research groups and individual

researchers emerged in the late 1970s and studied

loneliness first as subthemes and subsequently as the

subject for independent studies.

It appears that the influence of modern research had

asserted itself. In a contextual meta perspective, Western

industrialized society is termed a ‘Narcissistic Age’ (9), but

it is also referred to as ‘The Age of Loneliness’, in which the

phenomenon of loneliness, regardless of victims’ age, has

become almost epidemic (10, 11). Loneliness as a dys-

function in modern times is revealed partially in surveys

concerning society’s technological advancement (11), in

Correspondence to:

Brita Nilsson, Faculty of Nursing, Oslo University College, Oslo,

Norway.

E-mail: [email protected]

� 2006 The Authors. Journal compilation � 2006 Nordic College of Caring Science. 93

the use of Internet and its relation to loneliness (12).

Cultural background plays a significant role in studies of

loneliness. As an example, one might mention the diffi-

culties ethnic groups’ have in readjusting, their loneliness

in a new country, new schools, new social relationships, as

well as their homesickness (13).

Loneliness is further regarded as an important factor in the

development of medical dysfunctions, such as psychoso-

matic disorders, breast cancer, cardiovascular dysfunctions,

etc. (14). In the great majority of cases, an in-depth des-

cription of loneliness per se was lacking, in that loneliness

was related only to various types of dysfunctions.

Purpose

The purpose of this article is to provide an overview for

how loneliness is described by different disciplines as a

phenomenon, as well as to show how loneliness has been

represented in a nursing-scientific psychiatric context

during the period extending from 1980 to the present day.

The research topic of this study is: (i) How is loneliness

described in literature and research? (ii) How is loneliness

understood in relation to psychological dysfunction in a

clinical, nursing science context?

Method

The focus of this study is twofold, comprising on the one

hand studies of literature that treats loneliness as a

phenomenon, and on the other hand, studies of loneli-

ness in research articles on nursing and caring science in

a psychiatric context, as well as how loneliness is des-

cribed in newer psychology and psychiatry literature.

Data sampling for studies on loneliness was completed

over two different periods of time, in 1998 and in 2004.

The data sampling periods may be seen as an expression

of the hermeneutical process, since access to classical

literature on loneliness was gained through articles that

in turn yielded new search terms. Therefore, several of

the references will be older than from 1980. The texts

that are used were reviewed a number of times through

a hermeneutical process, from the whole to the part and

back again to the whole, etc. to get a deeper under-

standing of loneliness as a phenomenon described in

literature. An examination of texts is not performed

using a determined technique or method, but rather

relies on the examiner’s degree of instinctive under-

standing of loneliness as suffering. At the same time, this

instinct entails the necessity of being placed at risk (2),

open-mindedly towards a new emerging understanding.

Criteria for inclusion and exclusion of literature

In 1998, a data search was completed on Medline, Cinahl

and Bibsys; subsequently, another data search was done in

2004. Search terms used earlier, as well as expanded and

modified search terms, were used in the area of ’solitude’.

This resulted in the emergence of new articles that had

escaped our notice during the first sampling, as well as the

reappearance of many of the earlier searched articles. The

results from the last search period were startling, since in

2001 there was a veritable ‘explosion’ of articles. For the

search term ‘loneliness’, there were 2890 hits. In this

‘jungle’ of research articles the following inclusion and

exclusion criteria were made.

Inclusion criteria

1 Research articles and books that specifically examined

loneliness as a phenomenon.

2 Research articles and books which specifically examined

the meaning of solitude (the positive dimension of lone-

liness).

3 Empirical articles which directly examines loneliness in a

psychiatric clinical context.

4 Articles which included loneliness as a phenomenon

related to different types of disease.

Exclusion criteria

1 Articles which were beside research questions.

2 Articles which merely mentioned loneliness indirectly in

relation to different somatic diseases.

3 Nonscientific articles.

In the great majority of cases, an in-depth description of

loneliness per se was lacking, in that loneliness was related

only to various types of dysfunctions. This present article

will distinguish between philosophical and empirical arti-

cles and books.

Loneliness as a phenomenon in a philosophical,psychiatric and psychological context

Definitions of loneliness

There are a number of definitions of loneliness that more or

less derive from forms of expression and causal relation-

ships. Well-known researchers on loneliness such as Peplau

and Perlman (15) have sought to look behind the intuitive

understanding of loneliness by, among other means,

reviewing 12 definitions of loneliness from which they

synthesize three common elements such as: loneliness is a

subjective and distressing negative experience and occurs in

a person’s social relations out of a withdrawal from human

contact based on a need for psychological security. Loneli-

ness, therefore, is not synonymous with objective social

isolation. People are able to be alone without feeling lonely,

both in a crowd and in ‘twosome ness’.

The definitions, in our understanding, did not provide a

deeper description of the phenomenon of loneliness,

beyond the fact that the experience of loneliness was

related to distress and that it is a personal experience in the

� 2006 The Authors. Journal compilation � 2006 Nordic College of Caring Science.

94 B. Nilsson et al.

individual’s life. But what was the make-up of this

distress? And what social relations precipitate the need for

psychological security? These questions led me to further

studies on loneliness in the fields of philosophy and psy-

chiatry. However, access was gained via the articles’ ref-

erences to classics in the field of loneliness research, to

more in-depth descriptions of loneliness as a phenomenon.

Loneliness in a philosophical context

Authors of books such as Gotesky (16), Weiss (17),

Mijuskovic (4), Hartog et al. (18) and Peplau and Perlman

(15) are examples of important researchers on loneliness.

A common denominator is the individual’s experience of

loneliness in various types of isolation. Loneliness is thus

shown to be both a subjective and a shared common

phenomenon among humans.

Weiss (17), Yalom (19) and Gotesky (16) all expound on

various forms of loneliness. Weiss makes a distinction

between two forms of loneliness: emotional isolation, as a

result of the loss of intimately close persons (parents, loved

one or children), and social isolation, as a consequence of a

loss of, for example, friends, neighbours, colleagues, etc.

(17).

Yalom asserts, based on his own clinical practice as a

psychiatrist, to have identified three types of isolation as

related to the experience of loneliness: (i) interpersonal

isolation normally experienced as loneliness resulting from

a number of factors, such as geographic isolation, lack of

social experience and personality type; (ii) intrapersonal

isolation, emphasized as a central dimension in all psycho-

pathology, and is not only linked to psychological defence

mechanisms, but also construed to have an even deeper

form such as a fragmenting of the self; and (iii) existential

isolation which Yalom perceives as a ‘separation from the

world’, where the person is confronted with an anxiety in

the face of nothingness, but also his own freedom. Loneli-

ness is regardedas thedeepest sourceofnormal anxiety (19).

Gotesky differentiates between four forms of loneliness,

listing them as: (i) physical solitude, i.e. a physical cutting-

off from others; (ii) the feeling of loneliness that occurs

when one is excluded by others – an estrangement; (iii) a

feeling of isolation resulting from the person’s experience

of himself as an outsider; and (iv) ‘solitude’, linked to a

person’s own desire for loneliness. Solitude is positive and

not linked with pain, since the person actively seeks this

type of loneliness for various reasons, such as contempla-

tion, artistic endeavours, etc. (16).

We note, then, that all three researchers divide loneli-

ness into different categories, which in turn have common

traits and discrepancies among them. The common

denominator is the individual’s experience of loneliness in

various types of isolation, an isolation of both inner and

outer nature. Differences become apparent in Gotesky’s

model, which introduces two relationships. The first is that

the individual is physically cut-off from other people and

is, in other words, wrapped up in his own ‘bodily envel-

ope’. The other is that the individual seeks solitude, and

this is corroborated by Gadamer (20) whereby loneliness

may be experienced as essentially good. It is at this junc-

ture that we are in the presence of a term that is self-

contradictory, since loneliness on the one hand is experi-

enced as deeply painful and bad, while on the other it is

something good – something we actively seek.

Is loneliness a meaningful dimension in the existence?

Through this study, we gradually became aware of the pos-

itive dimension of loneliness, an aspect that does not appear in

the aforementioned synthesized 12 definitions (15).

The question is whether ‘lonely’ is a description of what

one is or rather what one becomes? Put another way: Is

loneliness an inherent dimension in humans or is loneli-

ness something that one experiences sporadically? The

question led to the philosopher B. Mijuskovic, who

maintains that there is a tendency to consider loneliness as

a modern phenomenon. Mijuskovic thinks this as a mis-

conception, since people have suffered from acutely per-

vasive feelings of loneliness since time immemorial. The

human being is a thoroughly lonely creature that seeks

desperately to find an escape from its loneliness. But what

is it about the phenomenon itself that entails the impulse

to flee one’s loneliness? And why do humans feel cut-off

from other people’s consciousness – and their existence?

People have this experience of loneliness because of their

own consciousness. Loneliness, according to Mijuskovic (4,

21) is a construct of the consciousness, both as a concept

and as an emotion. In our understanding of Mijuskovic, he

seems to think that the human being is metaphysically and

psychologically alone in the world, and that loneliness is

one basic structure in the human consciousness (4).

Here we approach a central point, since loneliness thus

far is considered by Mijuskovic as a basic structure in the

human consciousness. This is reinforced by Yalom’s thesis

that the source of existential anxiety is loneliness. But

what is it about humans that precipitate this keen

experience of loneliness? Mijuskovic leads us to look at

human consciousness and development of consciousness

in the Western culture and asks to what extent a person is

consciously aware of his loneliness? Authors Moustakas

(22), Mijuskovic (4, 21, 23), Yalom (19) and Rouner (24)

indicate both common and different forms of loneliness.

They conceptualize loneliness from an existentialist per-

spective, whereby one may regard loneliness on the one

hand as a life quality, by thinking through ones own val-

ues, and on the other hand, as a source of inner pain.

What was baffling for us was the duality of loneliness, in

that loneliness as a dysfunction and loneliness as a

meaningful dimension in existence crossed over and

intersected one another. In other words, there was an


A literary study of the phenomenon of loneliness 95

inadequate distinction between loneliness as a dysfunction

and loneliness as a beneficial quality.

This led us to do a data sampling using the search term

’solitude’, to locate books and articles treating the more

meaningful connotations of loneliness. Important authors

found both in books and articles were Tillich (25), Rouner

(24), Thorsen (26), Griffin (27), Younger (28) and Rocach

(29, 30). Rocach (29) describes, among other things, the

subjective dimension of loneliness as related to life cycles,

noting that it is ineffective to distance oneself from one’s

loneliness, which can thereby be alleviated only tempor-

arily. Her interesting articles illustrated well the tension

between the meaningfulness of loneliness and loneliness

as a dysfunction. Classics in the field of research on lone-

liness drew attention to philosophers who seemingly were

able to provide a deeper answer to the question ‘What is

loneliness?’, i.e. the ontological dimension of loneliness. In

other words, what might provide an in-depth under-

standing of loneliness? Mijuskovic was important for his

texts from 1977 to 1988 on the phenomenon of loneliness.

His book and articles from that period have been read and

studied for this investigation. Likewise, Heidegger (3) was

an important source, particularly for his interpretation of

the human ‘solus ipse’. The interest that was awakened

concerning loneliness’ beneficial nature led to an exam-

ination of the texts of philosopher Powys (31), in which he

provides insight towards an understanding of the mean-

ingful encounter with beneficial loneliness in oneself

through an opening of the senses and towards the meta-

physical mystery of life.

Summary and conclusion

Our pre-understanding of loneliness as suffering was

changed through the examination in philosophical litera-

ture. This change in our pre-understanding made us open

for the possibilities in which loneliness could have health

potential. In other words, we regarded that loneliness was

a subjective experience and that it could be expressed in

suffering as well as in health. But what was it about the

modern Western society which emerged loneliness as

suffering? The question seemed important.

Loneliness in psychological and psychiatricarticles and books

Within the field of developmental psychology and psychi-

atric professional literature related to persons with severe

psychological dysfunctions, there is a surprising lack of

specific theme-focused discussion of loneliness, per se. The

lack of specific studies on loneliness within the fields of

professional psychology and psychiatry had already been

noted in 1959 by Fromm-Reichman (32), who maintained

that loneliness was one of the least satisfactorily described

phenomena in psychology, and that it was indeed not even

mentioned in professional psychiatric literature; the latter

was later confirmed by Leidermann (33), Cohen (34) and le

Roux (13). Studies in ‘loneliness and psychiatry’ in articles

showed even less ‘loneliness’ as a theme. Most of them

were concerning loneliness among the elderly, young

people and alcoholics. ‘Loneliness and schizophrenia’ yiel-

ded 17 findings, of which only one article specifically ad-

dressed loneliness in schizophrenic patients, and then only

in conjunction with social isolation (35). Thus the

remaining articles touched on the phenomenon in its

relationship to: treatment, general needs, group therapy,

pathological suspicion, etc. However, still they were inter-

esting because of their diffusion between loneliness as a

psychological dysfunction as well as a common feeling (36–

38). Other studies found were associated to primary

empirical themes, such as alcohol abuse, the elderly, sex-

uality, depression, suicide and serious illnesses (39–42). At

the same time, the need for more research was emphasized

by Cohen (42). There are, however, authors in psychiatry’s

human science field who indirectly treat the theme of

loneliness in persons with serious psychological dysfunc-

tions, where loneliness emerges as a result of psychological

and psychiatric problems (19, 43–47). In the Nordic coun-

tries we have Sandin (48) and Brudal (49) who also touch

loneliness indirectly in their understanding of people with

serious mental illness. In other words, despite the above

authors’ psychodynamic view they seem to understand

loneliness as something which occurs because of psycho-

logical problems and not as a phenomenon in it self.

Summary and conclusion

Literature in books and research articles from 1980 to 2004

on the phenomenon of loneliness has been examined for a

philosophical, psychiatric and psychological context.

Loneliness as a phenomenon appears diametrical, since it is

seen on the one hand as a dysfunction and on the other as

meaningful for existence. The dominant general impres-

sion in philosophical books is that loneliness is regarded as

a category of existence and not as an illness. Allowances

must be made, however, for the fact that loneliness is seen

mainly as a dysfunction. The problem is that there appears

to be a lack of distinction between loneliness as a dys-

function and loneliness as a beneficial factor. A number of

different definitions of loneliness are presented, and this is

interesting in itself, since multiple interpretations may

confirm the fact that loneliness as a phenomenon, its

meaning, its emotive content and form of expression are

neither easy to understand nor to define. Beginning in

2001, there is a proliferation of articles on loneliness linked

partially to various traits resulting from modern develop-

ment and partially to different somatic dysfunctions.

In psychological and psychiatric literature, there is a

curious lack of specific research on loneliness related to

psychological dysfunction. To the extent that loneliness is



described, it is related to other primary psychiatric diag-

noses; in only a minor degree do descriptions of loneliness

appear, and then it is understood as a tendency in psy-

chiatric illness or as a factor in a causal relationship (19, 44,

45, 47). One can therefore conclude that loneliness in

philosophy is assumed as a category of existence, while

there in psychology and psychiatric literature is a domin-

ant understanding of loneliness which emerges from a

psychological dysfunction, and at the same time the phe-

nomenon loneliness is very poorly described.

Nursing and caring science studies on lonelinessrelated to serious psychological dysfunctions

How is loneliness described in nursing and caring scientific

research articles related to serious psychological dysfunc-

tion? The theme of loneliness, which is treated by a

number of nursing and caring scholars both inside and

outside of the Nordic countries (50–52) are related to:

general health, illness, the relationship of loneliness and

well-being, stress and age. Hagerty and Williams (53)

demonstrate, among other things, that a low degree of

belonging is associated to a higher level of depression and

loneliness. Peplau’s article is also interesting, since she

focuses on an understanding of the development of lone-

liness from a social perspective (54). These two perspec-

tives, the individual and the social aspect, are the basis for

the nurse’s approach to the patient.

In Norway, Bondevik (55) has in her PhD made a study

of loneliness related to the oldest old, where among other

things, their relationships between loneliness and social

contacts were investigated. The results show that the

elderly are not as lonely as we think they are. In Thorsen’s

study (26), the primary theme is loneliness among the

elderly, in conjunction with contact and health conditions.

In Finland, Lindstrom’s (56) qualitative study of loneliness

and the patient’s perception of the caritative environment,

as well as the latter’s relation with patients, is important

and interesting. Different descriptions of psychiatric

patients’ loneliness are expounded here, as well as descrip-

tions in particular of schizophrenic patients’ loneliness.

Likewise, loneliness appears as a partial implication in

Eriksson (57), in connection with perception of suffering.

Loneliness also emerges as a theme in Lindholm (58). In

Lindholm et al.’s study (59), the heuristic value is found in

the discovery of the fact that loneliness in young people is

related to both suffering and desire. The sample groups for

the study comprised two groups of young people, and the

study itself has a nursing science application in its her-

meneutical approach. Likewise, Lindstrom and Lindholm’s

(60) study shows that loneliness is one category of exist-

ence. Furthermore, the same authors demonstrate the

existential meaningfulness of loneliness and write:

It belongs to the mystery of love that one attempts to

uphold another’s loneliness and create a free space in

which existential loneliness can be transformed into a

mutually shared loneliness (60, p. 41).

Erdner et al. (61) describe in their article the disadvantages

that long-term psychiatric patients experience in the

Swedish community where they live. The study is ethno-

graphic and the sample group comprises four patients. In

the content analysis of 12 interviews, loneliness emerges as

one of three primary themes. Moreover, Nystrom’s (62)

study of the daily existence of persons with serious psy-

chological dysfunctions shows that loneliness is one of the

categories of experience.

Within psychiatric nursing, serious psychological dys-

functions and loneliness there were the two findings that

concerned in part the psychiatric patients’ experience of

loneliness in hospital (63), and in part, poetry as an

approach (64). De Niro’s (65) article discusses the alien-

ation of schizophrenic patients, where loneliness is one

implied aspect. Three articles were of interest indirectly,

through an examination of the first authors study’s

empirical focus: ‘loneliness in persons living alone with

serious psychological dysfunctions’ (1). One of the articles

concludes that it is positive for the psychiatric patient to

live in his own home (66). The second article may be seen

contextually in relation with the first and concerned what

may be predicted about the welfare of elderly long-term

psychiatric patients in their home community and how

patients’ welfare is improved if varied types of assistance

are provided (67). The third article concerned a 3-year

comparative study on the treatment of schizophrenic

patients living alone as opposed to living with the family;

the study concludes that treatment is most effective in

cases where the patient resides with a family (66). In

Thesen’s study (68), psychiatric patients in local commu-

nity healthcare facilities and their professional caregivers

were surveyed to determine the presence of stigmatization,

seen from both the caregivers’ and the patients’ point of

view. In the studies as a conclusion, the lack of and need

for an examination of the term stigmatization was

emphasized. For patients in local community healthcare

facilities, a self-stigmatizing tendency arises through the

use of medical psychiatric terms, and anxiety and loneli-

ness follows in the wake of stigmatization.

Borge et al. (69) in their study of quality of life, inves-

tigated persons with serious psychological dysfunctions

who were released to live on their own in the care of their

local community psychiatric facility after having been

institutionalized for a period of 6 years. The result showed

that health personnel became the single most important

network for the patients, corroborating Kristoffersen’s (70)

findings. Patients outside the institution were the most

socially active and had the most satisfactory contact with

their own families. Loneliness was one of the variables in

the survey and 63% of the patients expressed a feeling of

well-being in the neighbourhood, and in the use of their

time. Loneliness was not perceived as a persistent problem.



In nursing studies, there are few studies concerning the

specific significance of loneliness in terms of psychological

dysfunction. On the other hand, the following articles are

indirectly applicable. Killeen (10) asserts, as do several

other authors, that loneliness is a little-discussed theme,

and that it is therefore difficult to define. She touches on

the taboo of loneliness (the shamefulness in expressing

one’s loneliness). Killeen illustrates two conditions. The

one is that loneliness in different patient types and differ-

ent illness types can be alleviated practically using various

means, from bringing objects from home to the institution,

to pets, to different groups, etc. But as Killeen states, we

have not come closer to an understanding of the phe-

nomenon of loneliness itself. She concludes her article by

stating that loneliness requires a sensitive presence to the

patient, rather than practical measures. Like Thesen and

Killeen, Vuokila-Oikkonen et al. (71) discuss the rela-

tionship between loneliness and shame, wherein shame

over one’s psychological dysfunction engenders feelings of

differentness and loneliness. The patients’ feelings of

shame, however, are ignored by the caregivers.

Data sampling using the search term ’solitude’ yielded a

very modest number of articles. Wilkins (72) views ’sol-

itude’ as a creative force. Larsson (73) sees a positive

developmental potential in children who seek solitude and

who are not over stimulated. Polcino (74) sees ’solitude’ as

a possibility for contemplation and meaningful friendship.

Articles examined institutionalized patients’ experiences

with loneliness and the effect of loneliness on psycholo-

gical illness is Vuokila-Oikonen et al. (71), Parkkila (75)

and Old (76). They reveal that loneliness is a continual,

painful companion, and causes the patient to regard his

affliction as a personal defect or deficiency. In this respect,

the experience of loneliness exacerbates the psychological

dysfunction.

In the classification of nursing diagnoses from 1982, one

finds the term ’social isolation’. Isolation is defined here as:

‘Aloneness experienced by the individual and perceived as

imposed by others and as a negative or threatened state’. In

1994, the term ‘risk for loneliness’ is applied, and is defined

as a ‘subjective state in which an individual is at risk of

experiencing vague dysphoria.’ The latter appears in

NANDA Nursing Diagnoses (77). NANDA seems vague in

its reference to loneliness.

Conclusion

In nursing and caring literature from the Nordic and

European countries there is a dominant general impres-

sion that loneliness is regarded as a category of existence

and not as a psychological dysfunction. But here as well,

loneliness is poorly and indirectly described in a psychi-

atric context. In American articles the dominant impres-

sion seems to indicate that loneliness is a psychological

dysfunction. Also NANDA (77) can be used as a classical

example in their understanding of loneliness. Here one

finds the expression ‘risk for loneliness’, which seems to

indicate that loneliness is regarded as a disease.

Discussion

The results from this study’s topic concerning how lone-

liness is described and how loneliness is understood in

relation to psychological dysfunction show that the lit-

erature contains various perceptions and, in part, contra-

dictory descriptions of loneliness. The contradiction’s line

of division appears to run, on the one hand, between the

general understanding of loneliness as an illness that can

be treated (35, 37, 39, 63, 77) and, on the other hand,

loneliness as an inherent dimension in human existence

(3, 4, 22, 25, 31, 32).

In the field of philosophy, loneliness appears to be

regarded as a category of existence, whereby loneliness in

a nursing and caring scientific perspective can be said to

belong to the domain of life suffering. The philosopher

Mijuskovic (4) is relevant in his development of the deeper

dimension of loneliness. The phenomenon of loneliness is

illustrated from a historical perspective, as well as from

subjectivity’s and consciousnesses existential perspective.

His interesting result leads to the conclusion that loneliness

is not only a category of existence, but also an ontological

dimension in the individual. He regards the ontological

dimension of loneliness, however, as essentially painful for

the human being.

Ehrlich (47) and Powys (31), on the contrary, emphasize

the meaningfulness of loneliness. We must say that we

are in agreement with Ehrlich (47), who identifies the

dilemma in trying to define loneliness. The dilemma arises

out of two conditions. The one is that loneliness is per-

ceived differently in different countries. The other is the

lack of a specific distinction between loneliness as benefi-

cial/meaningful (solitude) and loneliness as suffering.

Solitude is described, for example, both as suffering and

benefit (29, 30, 33). Loneliness as both suffering and

health quality exist as a multidimensional phenomenon.

The most surprising finding was the lack of treatment of

loneliness as a theme in recent psychological and psychi-

atric professional literature. Fromm-Reichman’s article

suggests a rationale for the lack of professional studies in

the field:

Either the psychotherapist does not know anything

about the inexplicable, uncanny quality of the

patient’s loneliness, or the psychotherapist himself is

afraid of it (32, p. 32).

One might ask why the professional field of modern

developmental psychology has dealt to such a small extent

with a specific treatment of the phenomenon of loneliness.

It is almost as if existential and metaphysical questions

have been removed, thereby reducing an understanding of

human psychology.



In nursing and caring scientific literature, loneliness is

described as both suffering, meaning illness, and as desir-

able, meaning health. The existential dimension of lone-

liness emerges to a larger extent in the caring science lit-

erature than in the nursing science literature. In caring

science loneliness is also related to suffering and health

and not to specific types of illnesses.

In nursing literature, loneliness emerges as an existential

dysfunction lined to different kinds of illness, including

psychological illnesses. In other words there seems to be a

difference between caring and nursing science literature

concerning the relationship between the existential

dimension and different types of illnesses.

Loneliness can be understood as an existential category of

life, and therefore not as an illness, even though suffering in

loneliness is exacerbated by the psychological dysfunction.

In our understanding, there is nothing which explicitly

examines the active and existentially dynamic significance

of loneliness in conjunction with serious psychological dis-

order. What occurs is that loneliness is indirectly illustrated

in connectionwith various illnesses and phenomena. To the

extent that loneliness is described and addressed, it is illus-

trated predominantly by association with different somatic

and psychiatric contexts. Is it possible that this is due to the

perception of loneliness as a general and common human

phenomenon? Can this be the reason why the inner and

outer nature of loneliness has not attracted focused atten-

tion from professional scholars in the fields of nursing,

psychology and psychiatry?

The fact that loneliness as a phenomenon in its own right

has not become the object of specific research in aWestern-

cultural perspective seems paradoxical, in light of the

explosion of articles in which loneliness is described as a

component in various modern lifestyles. In modern society,

increasingly more people live alone and loneliness results

in all its multidimensional complexity and subjective forms

of expression. The latter situation may be related, on the

one hand, to increasing individualism and independence-

mindedness, along with the demand for time efficiency. An

increased dependence from others has occurred, based on

technological advancements. Halvorsen (78) maintains

that in societies with a low degree of confidence, one sees a

tendency towards distrust combined with adversarial

scepticism, which in turn can lead to social isolation and a

subsequent feeling of painful loneliness. The possibility for

restored trust risks being further reduced. Mutual trust

between citizens, therefore, seems to be increasingly more

important. On the other hand, since a cultural liberation

has occurred, this, in an existential perspective, may offer

people positive opportunities to ponder their loneliness in

existence, an existence that loneliness is, and that does not

necessarily constitute a suffering loneliness. The present

examination of literature seems to present the view of an

individualistic position which, on the one hand, can con-

tribute to a subjective experience of consciousness about

the depth of loneliness. On the other hand, one sees the

contours of a helpless uncertainty about the type of

fellowship that might offer favourable conditions for a

meaningful loneliness.

Conclusion

The study of research entailed an unanticipated and

altered understanding of the phenomenon of loneliness.

Since preconception was dominated by an understanding

of loneliness as suffering, theoretical studies entailed

questions as to the inherent health possibilities of loneli-

ness. Loneliness is understood as a complex and mysteri-

ous dimension in peoples’ lives and it can be experienced

at many levels. Loneliness appears, in other words, to

manifest itself through different subjective expressions,

both in terms of general health as well as in the domain of

life and illness suffering.

Although there are a number of definitions of loneliness,

we choose, based on this study, neither to define nor to

concur with any of the definitions of loneliness. In our

understanding, loneliness appears multifaceted and para-

doxical. Any briefly formulated definition therefore risks

obstructing an understanding of the phenomenon, rather

than opening to comprehension of so abstract a phenom-

enon as loneliness. In the review of the theoretical field

today, what emerges is a particular lack of studies on the

specific significance of loneliness for persons with serious

psychological dysfunctions. Through the survey of theor-

etical material, loneliness may be understood as a struc-

tural dimension of existence and not as an illness. The deep

dimension of loneliness, however, can entail pain that is

possibly so intolerable that it may turn towards becoming

an illness.

In a nursing and caring scientific perspective, the fol-

lowing conclusions are drawn:

1 Loneliness of the suffering type may appear at an outer

level, as well as on an existential and ontological level.

2 At the outer level, one experiences the discomfort of

loneliness that entails one’s seeking to distance oneself

from it through fellowship with people one does not

always have something in common with.

3 At an existential level, loneliness is experienced as

emptiness and alienation, with various associated emo-

tional qualities, such as shame and guilt in the wake of

loneliness.

4 At the ontological level, loneliness may manifest itself

outwardly as a deep feeling of abandonment by something

or someone.

5 In loneliness that is healthy and therapeutic, one can

‘tolerate’ oneself and others; loneliness is experienced as

both good and bad, often through loss, grief, longing and

hope. One experiences pleasure in ’solitude’ through

reading a good book, listening to music or walking in

natural surroundings. Through our senses, we are able to



experience nature around us in all its transformations. We

experience the beauty of existence in an eternal perspec-

tive. It is perhaps in this silent loneliness that we para-

doxically develop a greater understanding of the benefits of

togetherness. Our conclusion is therefore, that the phe-

nomenon of loneliness is not a psychological dysfunction.

Author contributions

Brita Nilsson and Dagfinn Naden have conceptualized the

idea of the larger project, which this article is part of. Brita

Nilsson, Dagfinn Naden and Unni A. Lindstrom have all

given contributions in the process of constructing the

design of the total study. Brita Nilsson has drafted/written

the article. Dagfinn Naden has revised and given com-

ments included in the article.

Funding/sponsorship

We thank Faculty of Nursing, Oslo University College, for

financing this research.

References

1 Nilsson B. Savntes tone i ensomhetens melodi–Ensomhet hos

aleneboendepersoner med alvorlig psykisk lidelse (The Tune

of Want in the Loneliness Melody–Loneliness Persons with

Serious Mental Suffering Living Alone) (Doctoral Thesis).

2004, Abo Akademi, Abo, Finland.

2 Gadamer HG. Truth and Method, 2nd revised edition. 1999,

The Continuum Publishing Company, New York.

3 Heidegger M. Varat och Tiden, del I og II (Being and Time). 1981,

Doxa Press, Lund, Sweden.

4 Mijuskovic BL. Loneliness in Philosophy, Psychology and Litera-

ture. 1979, Van Gorcum, Assen, The Netherlands.

5 Wolfe T. Finn veien, engel (Find the Way, Angel). 2001, Cap-

pelen Forlag, Oslo.

6 Strindberg A. Ensam (Lonely). 1998, Forlaget Geelmuyden

Kiese, Stockholm.

7 Ahrne M. Epleblomster og ruiner (Apple Blossoms and Ruin).

1982, Aschehoug Forlag, Oslo.

8 Jaer B-J. Englehierarkiet…et personlig dokument om schizo-

fren (The Hierarchy of Angels… A Personal Document of

Schizophrenia). 1995, Galehuset Forlag, Oslo.

9 Riesman D. Det ensomme massemenneske (The Lonely Crowd),

2nd edn. 1985, Gyldendal, Kobenhavn.

10 Killeen C. Loneliness: an epidemic in modern society. J Adv

Nurs 1998; 28: 1–11.

11 Stivers R. Shades of Loneliness: Pathologies of a Technological

Society. 2004, Rowan & Littlefield Ltd, Lanham, MD,

Washington DC.

12 Moody EJ. Internet use and its relationship to loneliness.

Cyber Psychol Behav 2001; 4: 393–401.

13 le Roux A. The relationship between loneliness and the

Christian faith. S Afr J Psychol 1998; 28: 174–82.

14 Page RM, Wrye SW, Cole GE. The role of loneliness in health

and wellness. Home Healthc Nurse 1986; 4: 6–10.

15 Peplau LA, PerlmanD. Loneliness a Sourcebook of Current Theory:

Research and Therapy. 1982, John Wiley & Sons, New York.

16 Gotesky R. Aloneness, loneliness, solitude. In An Invitation to

Phenomenology (Edie JM ed.), 1965, Quadrangle Books, Chi-

cago, IL.

17 Weiss R. Loneliness: The Experience of Emotional and Social

Isolation. 1973, The Massachusetts Institute of Technology,

The MIT Press, Cambridge, England, Massachussetts.

18 Hartog J, Audy JR, Cohen YA. The Anatomy of Loneliness.

1981, International Universities Press, New York.

19 Yalom ID. Eksistentiel psykoterapi (Existential Psychotherapy).

1998, Hanz Reitzels Forlag, København.

20 Gadamer HG. Teoriens Lovprisning (The Theory of Glorification),

1st edn. 2000, Systimes Studieserie, Systime A/S, Arhus,

Denmark.

21 Mijuskovic BL. Loneliness and a theory of consciousness. Rev

Exist Psychol Psychiatry 1977; 15: 9–31.

22 Moustakas CE. Loneliness and Love. 1972. Prentice-Hall, Inc. A

Spectrum Book, Engle-wood Cliffs, NJ.

23 Mijuskovic BL. Types of loneliness. Psychology 1977; 14: 24–

29. Southern Illinois University at Carbondale, USA.

24 Rouner L (ed.). Loneliness. 1998, Notre Dame Press, Ind.

University of Notre Dame Press, Boston, MA, USA.

25 Tillich P. Loneliness and solitude. In The Anatomy of Loneliness,

2nd edn (Hartog J, Audy JR, Cohen YA eds), 1981, Inter-

national Universities Press, New York, pp. 547–53.

26 Thorsen K. Alene og Ensom, Sammen og Lykkelig? Ensomhet i

ulike Aldersgrupper (Alone and Lonely, Together and Happy?

Loneliness in Different Groups of Ages). Research report 2. 1990,

Norwegian Gerontological Institute, Oslo.

27 Griffin M. The phenomenology of the alone condition: more

evidence for the role of aloneness in social facilitation.

J Psychol 2001; 135: 125–35.

28 Younger JB. The alienation of the sufferer. Adv Nurs Sci 1995;

17: 53–72.

29 Rokach A. Loneliness and the life cycle. Psychol Rep 2000; 86:

629–42.

30 Rokach A. Surviving and coping with loneliness. J Psychol

2001; 124: 39.

31 Powys JC. A Philosophy of Solitude. 1974, Village Press, Lon-

don. Published first time in 1933.

32 Fromm-Reichmann F. Loneliness. Psychiatry 1959; 22: 1–15.

33 Leiderman PH. Pathological loneliness: a psychodynamic

interpretation. In The Anatomy of Loneliness (Hartog J, Audy JR,

Cohen YA eds), 1981, International Universities Press, New

York, USA, pp. 377–93.

34 Cohen N. On loneliness and the ageing process. Int J Psy-

choanal 1982; 63: 149–55.

35 Schein HM. Loneliness and interpersonal isolation: focus for

therapy with schizophrenic patients. Am J Psychother 1974;

28: 95–107.

36 Greben SE. The re-establishment of trust through psycho-

therapy. Can J Psychother 1984; 29: 350–54.

37 Hattori T, Ogasawary Y. Suicide and suicide attempts in

general hospital psychiatry: clinical and statistical study.

Psychiatry Clin Neurosci 1995; 49: 43–48.

38 Russel D, Peplau LA, Cutrona CE. The Revised UCLA Lone-

liness Scale: concurrent and discriminant validity evidence.

J Pers Soc Psychol 1980; 39: 472–80.



39 Medora NB, Woodvard JC. Factors associated with loneliness

among alcoholics in rehabilitation centers. J Soc Psychol 1991;

131: 769–79.

40 Roscoe B, Skomski GG. Loneliness among late adolescents.

Adolescence 1989; 24: 947–55.

41 Baretta D, Dantzler D, Kayson W. Factors related to loneli-

ness. Psychol Rep 1995; 76: 827–30.

42 Cohen GD. Loneliness in later life. Am J Geriatr Psychiatry

2000; 8: 273–5.

43 Benedetti G. Klinisk Psykoterapi (Clinical Psychotherapy). 1974,

J. W. Cappelens Forlag A/S, Oslo.

44 Sullivan HS. The Interpersonal Theory of Psychiatry. 1953, W.W.

Norton & Company Inc., New York.

45 Strauss JS. Subjectivity. J Nerv Ment Dis 1996; 184: 205–12.

46 Davidson L, Stayner D. Loss, loneliness and the desire for

love: perspectives on the social lives of people with schizo-

phrenia. Psychiatr Rehabil J 1997; 20: 3–12.

47 Ehrlich HS, Shmuel H. On loneliness, narcissism, and inti-

macy. Am J Psychoanal 1998; 58: 135–62.

48 Sandin, B. Nar varat ar at inte vara (When being is not to be).

In Lifelines – Psychiatry and Humanism (Gilbert S, Haugsgjerd

S, Hjort H eds), 1989, TANO AS, Oslo, pp. 45–53.

49 Brudal PJ. Psykoser og Psykoseterapi. En model for psykiatriens

hverdag (Psychosis and Psychotherapy: A Model in Psychiatry).

1999, Tano Aschehough, Oslo.

50 Hojat M. A psychodynamic view of loneliness and mother–

child relationships. In Loneliness (Hojat M, Crandall R eds),

1989, Sage Publications, New York, pp. 89–100.

51 Francis GM. Loneliness: being practical about an abstraction.

Va Nurse Q 1981; 49: 34–37.

52 McInnis GJ, White JH. A phenomenological exploration of

loneliness in the older adult. Arch Psychiatr Nurs 2001; 15:

128–39.

53 Hagerty BM, Williams RA. The effects of sense of belonging,

social support, conflict, and loneliness on depression. Nurs

Res 1999; 48: 215–9.

54 Peplau HE. Loneliness. Am J Nurs 1955; 55: 1476–81.

55 Bondevik M. De eldste eldre, erfaringer og refleksjoner (The

oldest of the old, their experiences and reflections), Doctoral

thesis, 2000. Department of Public Health and Primary

Health Care, Division for Nursing Science, University of

Bergen, Bergen, Norway.

56 Lindstrom UA. Ensamhetskanslan sviker inte. En kvalitativ studie

rorande patienters upplevelser av vardkultur och vardrelation pa

psykiatrisk sjukhus (The Feeling of Loneliness Don’t Betray. A

Qualitative Study Concerning the Patients Experience of the Nursing

Culture and Interpersonal Relations). Research report no. 6.

1995, Abo Akademi University, Abo, Finland.

57 Eiksson K (ed.). Moten med Lidanden (Encountering Suffering).

1993, Abo Akademi University, Abo, Finland.

58 Lindholm L. Den unga manniskans halsa och lidande

(The Health and Suffering Among Young Persons) (Doctoral

Thesis). 1998, Abo Akademi University, Vasa, Finland.

59 Lindholm L, Granstrom E, Lindstrom UA. Den unga man-

niskans ensamhet. En upplevelse av lust och lidande (Young

people’s loneliness – an experience of joy and suffering).

Hoitiede 2001; 13: 242–8.

60 Lindstrom UA, Lindholm L. Ensamhet. Kontext och

meningssamanhang (Context and the relationship of mean-

ing). In Gryning II–Klinisk Vardvetenskap (Dawning – Clinical

Caring Science) (Eriksson K, Lindstrøm UA eds), 2003, Abo

Akademi University, Abo, Finland, pp. 35–45.

61 Erdner A, Nystrom M, Severinsson E, Lutzen K. Psychosocial

disadvantages in the lives persons with long-term mental

illness living in a Swedish community. J Psychiatr Ment Health

Nurs 2002; 9: 457–63.

62 Nystrøm M. Allvarligt psykisk storda manniskors vardagliga

tillvaro (The Daily Life of People with Serious Mental Illness)

(Doctoral Thesis). 1999, Acta Universitatis Gothenburgensis,

Gøteborg, Sweden.

63 Cohen L, Heim K. Island living: the experience of loneliness

in a paychiatric hospital. Appl Nurs Res 1994; 7: 7–13.

64 Felver L. The wind and the lonely: an experience with poetry

in a therapeutic relationship. Wash Nurse 1982; 12: 4.

65 De Niro DA. Perceives alienation in individuals with residual

type schizophrenia. Issues in mental health nursing. Wash

Nurse 1995; 16: 185–200.

66 Owen C, Rutherford V, Wright JM, Tennant C, Smallman A.

Housing accommodation preferences of people with psychi-

atric disabilities. Psychiatr Serv 1996; 47: 628–32.

67 Hogarty GE. Three years trials of personal therapy among

schizophrenic patients living with or independent of family.

Am J Psychiatry 1997; 154: 1504–13.

68 Thesen J. Being a psychiatric patient in the community –

reclassified as the stigmatized ‘other’. Scand J Public Health

2001; 29: 248–55.

69 Borge L, Martinsen E, Ruud T, Friis S. Quality of life, lone-

liness and social contact among long-term psychiatric

patients. Tidsskrift for Den Norske Laegeforening (Journal of

Norwegian Medical Association) 2000; 120: 52–55.

70 Kristoffersen K. Opplevelse av a være søster eller bror til en

person med langvarig mental lidelse (Experience and

Reactions of Being the Sibling of a Person Suffering From a

Prolonged Mental Illness). Doctoral thesis, 1997, Universit-

etet i Bergen, Institutt for samfunnsmedisinske fag: Seksjon

for sykepleievitenskap, Bergen.

71 Vuokila-Oikkonen P, Janhonen S, Nikkonen M. Patient ini-

tiatives in psychiatric care concerning shame in the discus-

sion in co-operative team meetings. J Psychiatr Ment Health

Nurs 2002; 9: 23–32.

72 Wilkins LE, Burch S. Solitude: a creative power for NP suc-

cess. Kans Nurse 1999; 74: 13–14.

73 Larsson RW. The emergence of solitude as a constructive

domain of experience in early adolescence. Child Dev 1997;

68: 80–93.

74 Polcino A. Loneliness – the genesis of solitude, friendship and

contemplation. Hosp Prog 1979; 60: 61–65.

75 Parkkila M. Institutionalized long-term patient’s experiences

of loneliness. Hoitotiede 2000; 12: 26–35.

76 Olds J, Scwartz RS. What is the psychiatric significance of

loneliness? Forum Ment Health Lett 2000; 16: 8.

77 NANDA. Nursing Diagnoses Definitions and Classification. 1997–

1998, North American Nursing Diagnosis Association,

Philadelphia, PA, USA, 38–39.

78 Halvorsen K. Ensomhet og sosial isolasjon i var tid (Loneliness and

social isolation in our time) 2005, Gyldendal Norsk Forlag AS,

Oslo, Norway.



Documents

Is Loneliness a Psychological Dysfunction_ a Literary Study of the Phenomenon of Loneliness