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By Heather Campbell

There is in this land an army of strong, quiet men whose names never reach the newspapers, who fill the construction camps, operate the heavy machinery, grease the wheels of communication, and weld the steely sinews of industry. They are lonely men, unmarried or separated, living unpretentiously in small hotels or single rooms….”
– Walter Bromberg, M.D., 1965

On May 3, 2017, the Jo Cox Commission on Loneliness launched its month-long campaign spotlighting male loneliness. According to the initiative, 35 percent of men in the United Kingdom feel lonely at least once a week, and for 11 percent, it’s a daily occurrence. The survey also found that more than one in 10 men say they are lonely, but would not admit it to anyone.

Ms. Cox, 41, was the British MP who was heinously killed last year outside a local library prior to a constituency meeting. Before her death, she developed a plan to bring together organizations who were working to combat loneliness. She envisioned the launch of a major commission to “turbo-charge” the issue as one of national urgency. In her memory, the cross-party Commission on Loneliness was launched in January 2017. Under the slogan “Start a Conversation,” the initiative aims to get people talking—from chatting with a neighbour to looking at what local businesses and governments can do to tackle loneliness in their communities.

Loneliness versus isolation

Loneliness is not the same as isolation. Loneliness is a distressing personal experience related to the quality of relationships. It’s an unwanted situation. You do not choose to be lonely. Isolation, on the other hand, refers to the number (the quantity) of social contacts. Having only a few close connections can be by choice, or it can involuntary.

Isolated people are not necessarily lonely. You can be alone or in solitude without experiencing loneliness. On the flip side, you can feel lonely even if you’re surrounded by others. Notably, research has found high levels of loneliness among care home residents (C Victor, 2012).

Why loneliness matters

Loneliness can affect anyone—at any age. Indeed, it’s an emotional pain that few of us have escaped. Fortunately, for most, the experience is fleeting. We may feel a pang of loneliness after moving to a new city or when travelling alone. Loneliness may also surge after losing a spouse, outliving close friends or moving far from family.

Thankfully, feelings of loneliness usually subside. Sometimes, however, the emotional pain is chronic. Such loneliness can have devastating consequences. In its unrelenting form, loneliness has been compared to smoking 15 cigarettes a day (J Holt-Lunstad et al, 2010). It has also been linked to early institutionalization and more frequent trips to the emergency department. Lonely people also tend to visit their doctor more often than the non-lonely. There is also anecdotal evidence suggesting that loneliness is a risk factor for elder abuse.

The vicious cycle of loneliness

From a legal perspective, one of the most significant and understudied aspects of chronic loneliness is its impact on social cognition. Research out of the University of Chicago suggests that loneliness is associated with paradoxically self-defeating behaviour, in which social contact is simultaneously desired and rejected (J Cacioppo et al, 2014). In other words, despite craving social contact, lonely people unwittingly push people away.

This behaviour tends to elicit negative responses from others. Family members may retreat. Friends may stop calling. Service providers may give up offering support. This reaction, while understandable, confirms the lonely person’s pessimistic expectations of others. It fuels the vicious cycle of loneliness.  

In my research, I was concerned with situations in which a chronically lonely older man—who was stuck in the vicious cycle of loneliness—was declining aging-in-place services, such as home care, and was experiencing or at risk of self-neglect. To be sure, I was not arguing that loneliness is self-neglect, but rather, I proposed that we think about loneliness as a constraint on a self-neglecting lonely person’s decision-making process.

Why lonely older men?

I wrote about lonely older men for several reasons. First and foremost, older men have largely been forgotten. This can be attributed, at least in part, to the feminization of elder advocacy:

“Whereas older women have taken advantage of the successful advocacy efforts of feminists, older men have not benefited from efforts of those in the men’s movement and there are few, if any, groups or organizations that advocate on behalf of their welfare. There are (faulty) assumptions regarding the superior quality of older men’s lives, compared to older women” (J Kosberg, 2005).

The point is driven home when scholars and advocacy groups refer to aging as “a women’s issue.” Dementia has also been labelled “a women’s issue.”

The consequences aren’t just symbolic. The women-centred lens of elder advocacy has failed to respond to the needs and challenges of older men. As I’ve previously argued, many elder abuse prevention initiatives miss the target. For example, among older adults, the main victims of securities fraud are financially-literate, college-educated married men with self-reliant personalities. Arguably, these men are least likely to attend an elder abuse prevention workshop at a local seniors centre.

I also wrote about men because of their general tendency to be less help-seeking than women. Combined with the cognitive effects of loneliness, a lonely older man may be especially prone to rejecting offers of support.

The autonomy versus paternalism debate

Such refusals by older adults are often seen as a win for the right to live at risk, but in my view, the victory can be hollow when it does not translate into a better quality of life.

Advanced by the well-intentioned, yet highly libertarian, elder rights movement in the U.S. and Canada, it has become fashionable to say that capable seniors are asserting their right to make unwise and risky decisions. But in the context of loneliness, this dogmatic mantra becomes hard to defend when we consider the psychological research which shows that chronically lonely people can become stuck in a cycle of rejecting behaviour.

To be sure, a lonely older man can often be persuaded to accept services. But sometimes these efforts fail. In such situations, our traditional understanding of the law leaves concerned third parties with two undesirable options: take no further action, or categorize the person as incapable to override his decision-making rights.

In my view, the libertarian approach of taking no further action is unsuitable because it leaves lonely older men to their own maladaptive cognitive devices. It is problematic to abandon to symptomatic refusers and let them “rot with their rights on” (PS Appelbaum & TG Gutheil, 1979).

Yet the paternalistic approach of labelling lonely older men as incapable is also unfitting because it is well-established in law that making decisions which others deem unwise or risky does not render someone incapable.

The way forward

Lonely older men face a dire crossroads. Writing on an analogous issue, Atul Gawande captures the sentiment in his book, Being Mortal. Seeking to improve end-of-life care, Dr. Gawande asks, “How did we wind up in a world where the only choices for the very old seem to be either going down with the volcano or yielding all control over our lives?”

To me, this dilemma is a sad consequence of overcorrecting the medically-dominated approach to elder care with a highly libertarian perspective that lets individuals needlessly suffer.

To be clear, I do not take issue with the importance of legal safeguards which are in place to protect the rights of capable seniors who resist intervention. Rather, I argue that the pendulum has swung too far. In our staunch pursuit of unfettered individualism, the law has given insufficient weight to psychological constraints such as loneliness which affect one’s decision-making process, yet keep them below the incapacity threshold.

In a future post, I will explore how the law in England and Wales is safeguarding seniors who are “vulnerable but not incapable.” The approach is controversial, but in my view, it could extend a supportive hand to the forgotten population of lonely older men.


This post is adapted from Heather Campbell’s master of laws thesis, “Parens Patriae 2.0: Invoking the Superior Courts’ Protective Jurisdiction to Help Lonely Older Men Age-in-Place.” Most references have been omitted for readability.

References

Appelbaum, P.S. & T.G. Gutheil. “‘Rotting with their rights on’: constitutional theory and clinical reality in drug refusal by psychiatric patients” (1979) 7:3 Bull Am Academy Psychiatry & L 306.

Bromberg, Walter. Crime and the Mind: A Psychiatric Analysis of Crime and Punishment (New York: The Macmillan Company, 1965).

Cacioppo, John T.; Stephanie Cacioppo & Dorret I. Boomsma. “Evolutionary mechanisms for loneliness” (2014) 28:1 Cognition & Emotion 3.

Holt-Lunstad, Julianne; Timothy B. Smith & J. Bradley Layton. “Social Relationships and Mortality Risk: A Meta-Analytic Review” (2010) 7:7 PLoS Med doi:10.1371/ journal.pmed.1000316.

Kosberg, Jordan I. “Meeting the Needs of Older Men: Challenges for those in Helping Professions” (2005) 32 J Soc & Soc Welfare 9.

Victor, Christina R. “Loneliness in care homes: a neglected area of research?” (2012) 8:6 Aging Health 637.

About the author
HeatherCampbellHeather Campbell, BA (Hons.), LLB, LLM, is a PhD Student (Law) at Queen’s University and founding director of Dementia Justice.
You can follow her on Twitter @SeniorsLaw.

 

 

 

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