Psychiatry

Interpersonal and Biological Processes

ISSN: 0033-2747 (Print) 1943-281X (Online) Journal homepage: https://www.tandfonline.com/loi/upsy20

Loneliness

Frieda Fromm Reichmann

To cite this article: Frieda Fromm Reichmann (1959) Loneliness, Psychiatry, 22:1, 1-15, DOI:
10.1080/00332747.1959.11023153

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Loneliness t
Frieda Fromm-Reichmann *

I AM NOT SURE what inner forces have made me, during the last years, ponder
about and struggle with the psychiatric problems of loneliness. I have found a
strange fascination in thinking about it-and subsequently in attempting to break
through the aloneness of thinking about loneliness by trying to communicate what I
believe I have learned.
Perhaps my interest began with the young catatonic woman who broke through
a period of completely blocked communication and obvious anxiety by responding
when I asked her a question about her feeling miserable: She raised her hand with
her thumb lifted, the other four fingers bent toward her palm, so that I could see
only the thumb, isolated from the four hidden fingers. I interpreted the signal with,
"That lonely?," in a sympathetic tone of voice. At this, her facial expression loosened
up as though in great relief and gratitude, and her fingers opened. Then she began
to tell me about herself by means of her fingers, and she asked me by gestures to
respond in kind. We continued with this finger conversation for one or two weeks,
and as we did so, her anxious tension began to decrease and she began to break
through her noncommunicative isolation; and subsequently she emerged altogether
from her loneliness.

I have had somewhat similar experi- seek scientific clarification of the subject.
ences with other patients; and so I have Thus it comes about that loneliness is one
finally been prompted to write down what of the least satisfactorily conceptualized
I have learned about loneliness from my psychological phenomena, not even men-
work with these patients and from other tioned in most psychiatric textbooks. Very
experiences of my own. little is known among scientists about its
The writer who wishes to elaborate on genetics and psychodynamics, and various
the problems of loneliness is faced with a different experiences which are descrip-
serious terminological handicap. Loneli- tively and dynamically as different from
ness seems to be such a painful, fright- one another as culturally determined lone-
ening experience that people will do prac- liness, self-imposed aloneness, compulsory
tically everything to avoid it. This solitude, isolation, and real loneliness are
avoidance seems to include a strange re- all thrown into the one terminological
luctance on the part of psychiatrists to basket of "loneliness."
* M.D. Koenigsberg, Germany 13; Intern, Psychiatric Hosp., Univ. Koenigsberg 13; Municip. Hosp.
Moabit, Berlin, Asst. Neurol. Clin. 14; Asst. Instr., Psychiatric Hosp., Univ. Koenigsberg 14-16; in charge,
Hosp. and Dispens. Brain-Injured Soldiers, Koenigsberg 16·18; Rsc. Asst., Inst. Brain-Injured Soldiers,
Frankfurt 18-20; Asst. Psychotherapy Dept. SanItarium Weisser Hirsch, Dresden 20-24; Psychoanalytic
Training, Munich, Berlin 23-26; Visit. Phys., Psychiatric Hosp., Univ. Munich 23; in charge, prIvate psycho·
analytic sanitarium and private practice psychoanalysis, Heidelberg 24-33; cofounder, teacher, Psychoan-
alytic Inst. S.W. Germany, FrankfurL 29-33; psychoanalytic practice, Strasbourg, Alsace 33-34; Asst. Phys.
35-57, Dir. Psychotherapy 42-49, Supervisor Psychotherapy 49-57, Chestnut Lodge Sanitarium; Fellow,
Center for Advanced Study in the Behavioral Sciences, Stanford, Calif_ 55-56. Board of Managers, Wash.
Inst. Mental Hygiene 42-57; Chairman, Council of Fellows, Washington School of Psychiatry. Member:
German Med. Soc., German Soc. Neurology, German Soc. Psychiatry, German Psychoanalytic Soc., Amer.
Psychoanalytic Assn., Amer. Med. Assn., Washington-Baltimore Psychoanalytic Soc. (Pres. 39-41); Fellow.
Amer. Psychiatric Assn., Adolph Meyer Award, 1953; Academic Address, Amer. Psychiatric Assn., St. Louis,
1954.
t Editor's note: This paper was left in draft form by Dr. Fromm-Reichmann. Preliminary work on it
was done by Mrs. Virginia Gunst, and further editing and bibliographical work was done by the staff of
PSYCHIATRY.
[1]
2 FRIEDA FROMM-REICHMANN

Before entering into a discussion of the command over his creativity. Some of
psychiatric aspects of what I call real lone- these people, SChizoid, artistic personali-
liness, I will briefly mention the types of ties in Karl Menninger's nomenclature,
loneliness which are not the subject of submit to the world, as a product of their
this paper. The writings of modern soci- detachment from normal life, "fragments
ologists and social psychologists are of their own world-bits of dreams and
widely concerned with culturally deter- visions and songs that we-out hcrc-
mined loneliness, the "cut-offness and soli- don't hear except as they translate
tariness of civilized men"-the "shut-up- them." 4 It should be added that an origi-
ness," in Kierkegaard's phrase 1 which nal, creative person may not only be
they describe as characteristic of this cul- lonely for the time of his involvement in
ture. While this is a very distressing and creative processes, but subsequently be-
painful experience, it is by definition the cause of them, since the appearance of
common fate of many people of this cul- new creations of genuine originality often
ture. Unverbalized as it may remain, it is antedates the ability of the creator's con-
nevertheless potentially a communicable temporaries to understand or to accept
experience, one which can be shared. them.
Hence it does not carry the deep threat of I am not talking here about the tem-
the uncommunicable, private emotional
experience of severe loneliness, with which porary aloneness of, for instance, a person
this paper will be concerned. who has to stay in bed with a cold on a
I am not here concerned with the sense pleasant Sunday afternoon while the rest
of solitude which some people have, when, of the family are enjoying the outdoors.
all by themselves, they experience the in- He may complain about loneliness and feel
finity of nature as presented by the moun- sorry for himself, for to the "other-di-
tains, the desert, or the ocean-the experi- rected" types of the culture, "loneliness is
ence which has been described with the such an omnipotent and painful threat
expression, "oceanic feelings." 2 These . . . that they have little conception of
oceanic feelings may well be an expression the positive values of solitude, and even
of a creative loneliness, if one defines crea- at times are very frightened at the pros-
tivity, with Paul Tillich, in the wider sense pect of being alone." 5 But however much
of the term, as "living spontaneously, in this man with a cold may complain about
action and reaction, with the contents of loneliness, he is, needless to say, not lonely
one's cultural life." 3 in the sense I am talking about; he is just
I am also not concerned in this paper temporarily alone.
with the seclusion which yields creative Here I should also like to mention the
artistic or scientific products. In contrast sense of isolation or temporary loneliness
to the disintegrative loneliness of the which a person may feel who is in a situa-
mental patient, these are states of con- tion of pseudo-companionship with others,
structive loneliness, and they are often with whom an experience cannot be
temporary and self-induced, and may be shared, or who actively interfere with his
voluntarily and alternately sought out and enjoyment of an experience. To convey
rejected. Nearly all works of creative more clearly what I have in mind, I quote
originality are conceived in such states of Rupert Brooke's poem, "The Voice":
constructive aloneness; and, in fact, only
the creative person who is not afraid of Safe in the magic of my woods
I lay, and watched the dying light.
this constructive aloneness will have free Faint in the pale high solitudes,
1 Sj1iren Kierkegaard, The Concept of Dread, trans-
And washed with rain and veiled by
lated by Walter Lowrie; Princeton, N. J., Princeton night,
Univ. Press, 1944; p. 110. See also Erich Fromm,
Escape from Freedom; New York, Rinehart, 1941. • Karl Menninger, The Human Mind; New York,
• Sigmund Freud, Civilization and its Discontents; Knopf, 1930; p. 79.
London, Hogarth, 1939; see, for instancc, p. 8. 5 Rollo May, Man's Search for Him,,~elf; New York,
8Paul Tillich, The Courage to Be; New Haven, Norton, 1953; p. 26. See also David Riesman, The
Yale Univ. Press, 1952; p. 46. Lonely Crowd; New Haven, Yale Univ. Press, 1950.
LONELINESS 3

Silver and blue and green were showing. ties to the lost beloved one. 7 By such in-
And the dark woods grew darker still; corporation and identification the human
And birds were hushed; and peace was
growing; mind has the power of fighting the alone-
And quietness crept up the hill; ness after the loss of a beloved person.
Somewhat similar is the sense of lone-
And no wind was blowing
someness which lovers may suffer after a
And I knew broken-off love affair. Daydreams, fanta-
That this was the hour of knowing, sies, and the love songs of others-or
And the night and the woods and you
Were one together, and I should find sometimes original compositions-help
Soon in the silence the hidden key the unhappy lover to overcome his tem-
Of all that had hurt and puzzled me- porary solitude: "Out of my great worry
Why you were you, and the night was I emerge with my little songs," as the
kind,
And the woods were part of the heart German poet Adelbert von Chamisso put
ofme.- it.
And there I waited breathlessly,
Alone; and slowly the holy three, The kind of loneliness I am discussing
The three that I loved, together grew is nonconstructive if not disintegrative,
One, in the hour of knowing, and it shows in, or leads ultimately to,
Night, and the woods, and you-- the development of psychotic states. It
And suddenly
There was an uproar in my woods, renders people who suffer it emotionally
paralyzed and helpless. In Sullivan's
The noise of a fool in mock distress, words, it is "the exceedingly unpleasant
Crashing and laughing and blindly going,
Of ignorant feet and a swishing dress, and driving experience connected with an
And a Voice profaning the solitudes. inadequate discharge of the need for hu-
man intimacy, for interpersonal inti-
The spell was broken, the key denied me
And at length your flat clear voice beside macy." 8 The longing for interpersonal
me intimacy stays with every human being
Mouthed cheerful clear flat platitudes. from infancy throughout life; and there is
You came and quacked beside me in the no human being who is not threatened by
wood. its loss.
You said, "The view from here is very I have implied, in what I have just said,
good!" that the human being is born with the
You said, "It's nice to be alone a bit!"
And, "How the days are drawing out!" need for contact and tenderness. I should
you said. now like to review briefly how this need
You said, "The sunset's pretty, isn't it?" is fulfilled in the various phases of child-
hood development-if things go right-in
* * * * * * *
By God! I wish-I wish that you were order to provide a basis for asking and
dead! 6 answering the question, What has gone
wrong in the history of the lonely ones?
While the loneliness of the person who That is, what has gone wrong in the his-
suffers the sense of loss and of being alone tory of those people who suffer from their
following the death of someone close to failure to obtain satisfaction of the uni-
him is on another level, it too does not con- versal human need for intimacy?
cern me here. Freud and Abraham have The infant thrives in a relationship of
described the dynamics by which the intimate and tender closeness with the
mourner counteracts this aloneness by in- person who tends him and mothers him.
corporation and identification; this can
often be descriptively verified by the way Hogarth,• Sigmund Freud, The Ego and the Id; London,
1935; pp. 36-37. Freud, "Mourning and
in which the mourner comes to develop a Melancholia," in Collected Papers 4:152-170; London,
Hogarth, 1934; see especially p. 160. Karl Abraham,
likeness in looks, personality, and activi- "Notes on the Psycho-Analytical Investigation and
Treatment of Manic-Depressive Insanity and Allied
• Reprinted by permission of Dodd, Mead & Co. Conditions," Ch. 6; in Selected Papers on Psycho-
from The Collected Poems of Rupert Brooke, copy- Analysis, London, Hogarth, 1927.
right 1915 by Dodd, Mead & Co., Inc. Copyright 1943 8 Harry Stack Sullivan, The Interpersonal Theory
by Edward Marsh. of Psychiatry; New York, Norton, 1953; p. 290.
4 FRIEDA FROMM-REICHMANN

In childhood, the healthy youngster's long- with others. Thus his primary sense of
ing for intimacy is, according to Sullivan, isolation may subsequently be reinforced
fulfilled by his participation in activities if, despite the pressures of socialization
with adults, in the juvenile era by finding and acculturation, he does not sufficiently
compeers and acceptance, and in preado- learn to discriminate between realistic
lescence by finding a "chum." In adoles- phenomena and the products of his own
cence and in the years of growth and de- lively fantasy. In order to escape being
velopment which should follow it, man laughed at or being punished for replac-
feels the need for friendship and intimacy ing reports of real events by fictitious
jointly with or independently of his sexual narratives, he may further withdraw, and
drive. 9 may continue, in his social isolation, to
A number of writers have investigated hold on to the uncorrected substitutive
what may happen, at various stages of de- preoccupation. An impressive example of
velopment, if the need for intimacy goes the results of such a faulty development
unsatisfied. For example, Rene Spitz dem- has been presented by Robert Lindner, in
onstrated the fatal influence of lack of love his treatment history of Kirk Allen, the
and of loneliness on infants, in what he hero of the "true psychoanalytic tale,"
called their "anaclytic depression." 10 An "The Jet-Propelled Couch." 18
interesting sidelight on this is provided by Incidentally, I think that the substitu-
experiments in isolation with very young tive enjoyment which the neglected child
animals, in which the effect of isolation may find for himself in his fantasy life
can be an almost completely irreversible makes him especially lonely in the present
lack of development of whole systems, age of overemphasis on the conceptual dif-
such as those necessary for the use of ferentiation between subjective and ob-
vision in accomplishing tasks put to the jective reality. One of the outcomes of this
animal. l l Sullivan and Suttie have noted scientific attitude is that all too frequently
the unfortunate effects on future develop- even healthy children are trained to give
ment if a person's early need for tender- up prematurely the subjective inner re-
ness remains unsatisfied, and Anna Freud, ality of their normal fantasy life and, in-
in her lecture at the 1953 International stead, to accept the objective reality of the
Psychoanalytic meetings in London, de- outward world.
scribed sensations of essential loneliness The process by which the child with-
in children under the heading of "Losing draws into social isolation and into his
and Being Lost." 12 substitutive fantasies may occur if the
Both Sullivan and Suttie have particu- mothering one weans him from her caress-
larly called attention to the fact that the ing tenderness before he is ready to try
lonely child may resort to substitute satis- for the satisfactions of the modified needs
for intimacy· characteristic of his ensuing
factions in fantasy, which he cannot share
developmental phase. As Suttie has put
• See footnote 8; especially pp. 261-262. it, separation from the direct tenderness
10 Rene Spitz and Katherine M. Wolf, "Anaclytic
Depression," pp. 313-342; in Psychoanalytic Study of and nurtural love relationship with the
the Child, Vol. 2; New York, International Univ. mother may outrun the child's ability for
Press, 1946.
11 John C. Lilly has referred to these experiments making substitutions.14 This is a rather
in "Mental Effects of Reduction of Ordinary Levels serious threat to an infant and child in a
of Physical Stimuli on Intact, Healthy Persons,"
Psychiatric Research Reports, No.5; American Psy- world where a taboo exists on tenderness
chiatric Association, June, 1956. among adults. When such a premature
1lI Sullivan, footnote 8. Ian D. Suttie, The Origins
of Love and Hate; New York, Julian Press, 1952. weaning from mothering tenderness oc-
Anna Freud, Internat. J. Psycho-Anal. (1953) 34:288;
(1954) 35:283. curs, the roots for permanent aloneness
An interesting description by a layman of the im- and isolation, for "love-shyness," as Suttie
pact of loneliness in childhood is given by Lucy
Sprague Mitchell in her Two Lives: The Story of has called it, for fear of intimacy and ten-
Wesley Clair Mitchell and My,~elf (New York, !:limon
and Schuster, 1953). In this book she vividly con- 18 Robert Lindner, The FiftY-Minute Hour: A Col-
trasts her own childhood loneliness with the affec- lection of True Psychoanalytic Tales; New York,
tion, approval, and security her husband had as a Rinehart, 1955; pp. 221-293.
child. ... Suttie, footnote 12; pp. 87-88.
LONELINESS 5

derness, are planted in the child's mind; life is out of the realm of expectation or
and the defensive counterreactions against imagination. This loneliness, in its quin-
this eventuality may lead to psychopatho- tessential form, is of such a nature that it
logical developments. is incommunicable by one who suffers it.
Zilboorg, on the other hand, has warned Unlike other noncommunicable emotional
against psychological dangers which may experiences, it cannot even be shared em-
arise from other types of failure in han- pathically, perhaps because the other per-
dling children-failures in adequate guid- son's empathic abilities are obstructed by
ance in reality testing. If the omnipotent the anxiety-arousing quality of the mere
baby learns the joy of being admired and emanations of this profound 10neliness,17
loved but learns nothing about the outside I wonder whether this explains the fact
world, he may develop a conviction of his that this real loneliness defies description,
greatness and all-importance which will even by the pen of a master of conceptuali-
lead to a narcissistic orientation to life- zation such as Sullivan. As a matter of
a conviction that life is nothing but being fact, the extremely uncanny experience of
loved and admired. This narcissistic- real loneliness has much in common with
megalomanic attitude will not be accepta- some other quite serious mental states,
ble to the environment, which will re- such as panic. People cannot endure such
spond with hostility and isolation of the states for any length of time without be-
narcissistic person. The deeply seated coming psychotic-although the sequence
triad of narcissism, megalomania, and hos- of events is often reversed, and the lone-
tility will be established, which is, accord- liness or panic is concomitant with or the
ing to Zilboorg, at the root of the affliction outcome of a psychotic disturbance. Sub-
of loneliness. 15 ject to further dynamic investigation, I
The concepts of Sullivan, Suttie, and offer the suggestion that the experiences
Zilboorg are all based on the insight that in adults usually described as a loss of
the person who is isolated and lonely in reality or as a sense of world catastrophe
his present environment has anachronis- can also be understood as expressions of
tically held on to early narcissistic need profound loneliness.
fulfillments or fantasied substitutive satis- On the other hand, while some psychia-
factions. According to Sullivan and Suttie, trists seem to think of severe psychotic
it may be the fulfillment of his early needs loneliness as part of, or as identical with,
which has been critical; or, according to other emotional phenomena, such as psy-
Zilboorg, the failure may have been in chotic withdrawal, depression, and anx-
meeting his needs later on for adequate iety, I do not agree with this viewpoint,
guidance in reality testing, in general. I shall elaborate on the inter-
Karl Menninger has described the relationship between loneliness and anx-
milder states of loneliness which result iety later. So far as psychotic withdrawal
from these failures in handling infants and is concerned, it constitutes only seemingly
children in his "isolation types of person- a factual isolation from others; the rela-
ality"-that is, lonely and schizoid person- tionship of the withdrawn person to his
alities. 16 The more severe developments interpersonal environment, and even his
of loneliness appear in the unconstructive, interest in it, is by no means extinguished
desolate phases of isolation and real lone- in the way that is true of the lonely per-
liness which are beyond the state of feel- son. So far as depressed patients are con-
ing sorry for oneself-the states of mind cerned, every psychiatrist knows that they
in which the fact that there were people
17 Some attention has been given to this interfer-
in one's past life is more or less forgotten, ence of anxiety with the freedom of utilizing intui-
and the possibility that there may be in- tive abilities by a seminar in which I participated,
dealing specifically with intuitive processes in the
terpersonal relationships in one's future psychiatrist who works with schizophrenics. See
"'r'he 'Intuitive Process' and its Relation to Work
l6 Gregory Zllboorg, "Loneliness," The Atlantic with Schizophrenics," introduced by Frieda l<'romm-
Monthly, January, 1938. Reichmann and reported by Alberta Szalita-Pemow;
16 See footnote 4. J. Amer. Psychoanal. Assn. (1955) 3:7-18.
6 FRIEDA FROMM·REICHMANN

complain about loneliness; but let me sug- tion of some lonely psychotics may be the
gest that the preoccupation with their re- fact that, perhaps because of their inter-
lationships with others, and the pleas for personal detachment, some of them are
fulfillment of their interpersonal depend- more keen, sensitive, and fearless observ-
ency-needs-which even withdrawn de- ers of the people in their environment
pressives show-are proof that their lone- than the average nonlonely, mentally
liness is not of the same order as the state healthy person is. They may observe and
of real detachment I am trying to depict. feel free to express themselves about
The characteristic feature of loneliness, many painful truths which go unobserved
on which I shall elaborate later, is this: or are suppressed by their healthy and
It can arouse anxiety and fear of contami- gregarious fellowmen. But unlike the
nation which may induce people-among court jester, who was granted a fool's
them the psychiatrists who deal with it in paradise where he could voice his unwel-
their patients-to refer to it euphemisti- come truths with impunity, the lonely
cally as "depression." One can understand person may be displeasing if not frighten-
the emotional motivation for this defini- ing to his hearers, who may erect a psy-
tion, but that does not make it conceptu- chological wall of ostracism and isolation
ally correct. about him as a means of protecting them-
People who are in the grip of severe de- selves. Cervantes, in his story, "Man of
grees of loneliness cannot talk about it; Glass," has depicted a psychotic man who
and people who have at some time in the observes his fellowmen keenly and offers
past had such an experience can seldom them uncensored truths about themselves.
do so either, for it is so frightening and As long as they look upon him as suffi-
uncanny in character that they try to dis- ciently isolated by his "craziness," they
sociate the memory of what it was like, are able to laugh off the narcissistic hurts
and even the fear of it. This frightened to which he exposes them.ls
secretiveness and lack of communication I would now like to digress for a mo-
about loneliness seems to increase its ment from the subject of real, psychoto--
threat for the lonely ones, even in retro- genic loneliness to consider for a moment
spect; it produces the sad conviction that the fact that while all adults seem to be
nobody else has experienced or ever will afraid of real loneliness, they vary a great
sense what they are experiencing or have deal in their tolerance of aloneness. I have,
experienced. for example, seen some people who felt
Even mild borderline states of loneli- deeply frightened at facing the infinity of
ness do not seem to be easy to talk about. the desert, with its connotations of loneli-
Most people who are alone try to keep the ness, and others who felt singularly peace-
mere fact of their aloneness a secret from ful, serene, and pregnant with creative
others, and even try to keep its conscious ideas. Why are some people able to meet
realization hidden from themselves. I aloneness with fearless enjoyment, while
think that this may be in part determined others are made anxious even by tempo-
by the fact that loneliness is a most un- rary aloneness-or even by silence, which
popular phenomenon in this grou p-con- mayor may not connote potential alone-
scious culture. Perhaps only children have ness? The fear of these latter people is
the independence and courage to identify such that they make every possible effort
their own loneliness as such-or perhaps to avoid it-by playing bridge, by looking
they do it simply out of a lack of imagina- for hours at television, by listening to the
tion or an inability to conceal it. One radio, by going compulsively to dances,
youngster asked another, in the comic parties, the movies. As Kierkegaard has
strip "Peanuts," "Do you know what put it, "... one does everything possible
you're going to be when you grow up?" by way of diversions and the Janizary
"Lonesome," was the unequivocal reply of
18 r.p.fVAntp.R RRIlVPr'lfll, "Mlln of Glllss," pp. 760.
the other. 796; in The Portable Ce1'vantes, translated and edited
Incidentally. one element in the isola- by Samtwl Ftltnam; New YOl'k, Viking Press, 1951.
LONELINESS 7

music of loud-voiced enterprises to keep group as the avoidance of loneliness. As

lonely thoughts away. . . ." 19 Sullivan points out, people will even resort
Perhaps the explanation for the fear of to anxiety-arousing experiences in an ef-
aloneness lies in the fact that, in this cul- fort to escape from loneliness, even
ture, people can come to a valid self-orien- though anxiety itself is an emotional ex-
tation, or even awareness of themselves, perience against which people fight, as a
only in terms of their actual overt rela- rule, with every defense at their dis-
tionships with others. "Every human be- posaJ.21 Needless to say, however, the per-
ing gets much of his sense of his own re- son who is able to do this is not fully in
ality out of what others say to him and the grip of true, severe loneliness, with its
think about him," as Rollo May puts it.20 specific character of paralyzing hopeless-
While alone and isolated from others, ness and unutterable futility. This "naked
people feel threatened by the potential horror" is beyond anxiety and tension; de-
loss of their boundaries, of the ability to fense and remedy seem out of reach. Only
discriminate between the subjective self as its all-engulfing intensity decreases can
and the objective world around them. But the person utilize anxiety-provoking de-
valid as this general explanation for the fenses against it. One of my patients, after
fear of loneliness may be, it leaves un- she emerged from the depths of loneliness,
answered the question of why this fear is tried unconsciously to prevent its recur-
not ubiquitous. rence, by pushing herself, as it were, into
Generally speaking, I believe that the a pseudo-manic state of talkativeness,
answer lies in the degree of a person's de- which was colored by all signs of anxiety.
pendence on others for his self-orientation, Another drastic defensive maneuver
and that this depends in turn on the par- which should be mentioned is compulsive
ticular vicissitudes of the developmental eating. As Hilde Bruch's research on
history. Here, you may recall, I am talk- obesity has shown, the attempt to counter-
ing about aloneness, and not what I term act loneliness by overeating serves at the
real loneliness; and whether the same same time as a means of getting even with
holds true for loneliness, I do not know. the significant people in the environment,
Only an intensive scrutiny of the devel- whom the threatened person holds re-
opmental history of the really lonely ones sponsible for his loneliness. z2 The patient
might give the answer; and the nature of I have just mentioned, who resorted to
real loneliness is such that one cannot pseudo-manic talkativeness as a defense
communicate with people who are in the against loneliness, told me that her hap-
grip of it. Once they emerge from it, they piest childhood memory was of sitting in
do not wish-or they are unable-to talk the darkened living room of her home, se-
about their loneliness or about any topiC cretly eating stolen sweets. In her first
which is psychologically connected with therapeutic interview, she said to me,
it, as I suggested earlier. "You will take away my gut pains [from
Descriptively speaking, however, one overeating], my trance states [her delu-
can understand why people are terrified sional states of retreat], and my food; and
of the "naked horror"-in Binswanger's where will I be then?" That is, if she gave
term-of real loneliness. Anyone who has up her defenses against her loneliness,
encountered persons who were under the where would she be then?
influence of real loneliness understands Sullivan, it should be added, thought
why people are more frightened of being that loneliness-beyond his description of
lonely than of being hungry, or being de- it in terms of the driving force to satisfy
prived of sleep, or of having their sexual the universal human need for intimacy-
needs unfulfilled-the three other basic is such an intense and incommunicable
needs which Sullivan assigns to the same
21 See footnote 8; p. 262 .
19Kierkegaard, footnote 1; p. 107. .. Hilde Bruch, The Importance of Overweight;
so Rollo May, Man's Search for Himself; New York, New York, Norton, 1957; "Developmental Obesity
Norton, 1953; p. 32. and Schizophrenia," PSYCHIATRY (1958) 21:65·70.
8 FRIEDA FROMM-REICHMANN

experience that psychiatrists must resign loneliness must be understood in this

themselves to describing it in terms of spirit:
people's defenses against it. Freud's Now, Loneliness forever and the earth again!
thinking about it seems to point in the Dark brother and stern friend, immortal face
same direction, in his references to lone- of darkness and of night, with whom the
liness and defenses against it in Civiliza- half part of my life was spent, and with whom
I shall abide now till my death forever, what
tion and its Discontents. 23 is there for me to fear as long as you are with
me? Heroic friend, blood-brother of Proud
SOME DESCRIPTIONS OF LONELINESS BY Death, dark face, have we not gone together
POETS AND PHILOSOPHERS
down a million streets, have we not coursed
together the great and furious avenues of
I think that many poets and philoso- night, have we not crossed the stormy seas
alone, and known strange lands, and come
phers have come closer to putting into again to walk the continent of night and listen
words what loneliness is than we psychia- to the silence of the earth? Have we not been
trists have. Loneliness is a theme on brave and glorious when we were together,
which many poets have written-for in- friend, have we not known triumph, joy and
glory on this earth-and will it not be again
stance, Friedrich HOlderlin, Nikolaus Le- with me as it was then, if you come back to
nau, and Joseph von Eichendorf among me? Come to me, brother, in the watches of
the German romanticists, T. S. Eliot in the night, come to me in the secret and most
England, and Walt Whitman and Thomas silent heart of darkness, come to me as you
Wolfe in this country. Let me remind you, always came, bringing to me once more the
old invincible strength, the deathless hope, the
for instance, of Walt Whitman's poem, "I triumphant joy and confidence that will storm
Saw in Louisiana a Live-Oak Growing," the ramparts of the earth again.25
which, although it is not a song of real Incidentally, Wolfe's polar concept of
loneliness, depicts beautifully the experi- loneliness as such and yet also as an ex-
ence of the alone person: pression of great potentiality for love is
I saw in Louisiana a live-oak growing, reflected in the psychiatric hypothesis
All alone stood it, and the moss hung about the childhood experience of the
down from the branches;
Without any companion it grew there, ut- lonely schizophrenic. Many psychiatrists
tering joyous leaves of dark green, now believe that the lack of real attention
And its look, rude, unbending, lusty, made and acceptance by the significant adults
me think of myself; of his infancy and early childhood hits
But I wonder'd how it could utter joyous
leaves, standing alone there, without its him especially hard because of his innate,
friend, its lover near-for I knew I specific potentialities for sensitive respon-
could not.... 24 siveness to love and intimacy. This situa-
More recently, Thomas Wolfe has writ- tion forms the cradle of his later loneliness
ten of the development from Judaism to and simultaneous yearning for, yet fear of,
Christianity as the development from interpersonal closeness. The lonely schizo-
loneliness to love. To him, the books of phrenic's capacity for love is the reason
the Old Testament-particularly the Book why he is able sometimes to develop
of Job and the sermon of Ecclesiastes- intense experiences of transference in
provide the most final and profound litera- his relationship with the psychotherapist
ture of human loneliness that the world -something with which psychiatrists
has known. Wolfe, in contrast to all of are now familiar, although they used
the dramatists and most of the poets, sees to be misled by his simultaneous fear of
the essence of human tragedy in loneli- closeness into doubting the possibility of
ness, not in conflict. But he senses a solu- establishing workable therapeutic rela-
tion of the tragedy of loneliness in the tionships. I think that Thomas Wolfe's
fact that the lonely man is invariably the concept of loneliness is useful to the psy-
man who loves life dearly. His hymn to 2. Reprinted from "Death the Proud Brother," by
Thomas Wolfe (copyright 1933, Charles Scribner's
28 See footnote 2. Sons) with the permission of the publishers. See
2' Walt Whitman, Leaves of Grass; New York, Thomas Wolfe, The Face of a Nation; New York;
Harper, 1950; pp. 273-274. Scribners, 1957; pp. 179-180.
LONELINESS 9

chiatrist in attempting to understand this with the intention of talking, she was just
bipolarity of schizophrenic dynamics. as little able to tell me about her loneli-
Among philosophers, I think that Bin- ness in so many words as are most people
swanger has come nearest to a philosophi- who are engulfed in or have gone through
cal and psychiatric definition of loneliness a period of real psychotic loneliness. After
when he speaks of it as "naked existence," several futile attempts, she finally burst
"mere existence," and "naked horror," out, "I don't know why people think of
and when he characterizes lonely people hell as a place where there is heat and
as being "devoid of any interest in any where fires are burning. That is not hell.·
goal." 26 Tillich describes, by implication, Hell is if you are frozen in isolation into
the people whom I would call lonely as a block of ice. That is where I have been."
those in whom the essentially united ex- I don't know whether this patient was
periences of the courage to be as oneself familiar with Dante's description of the
and the courage to be as a part are split, ninth and last, or frozen circle of the In-
so that both "disintegrate in their isola- ferno. It is in essence quite similar to the
tion." 27 Kierkegaard,28 Nietzsche, Buber, patient's conception of hell-the "lowest
and others are also able to say more about part of the Universe, and farthest remote
loneliness than we psychiatrists have said from the Source of all light and heat," re-
so far. Buber, in particular, has presented served for the gravest sinners, namely
psychiatrists with the understanding of those "who have done violence to their
an important link between loneliness, own kindred (like Cain who slew Abel),
schizophrenic states, and psychotherapy.29 and those who committed treachery
He states that isolated and lonely people against their native land." Among others,
can communicate and be communicated Dante met there "two sinners that are
with only in the most concrete terms; one frozen close together in the same hole." 80
cannot break through their isolation with Despite the difficulty of communicating
abstractions. Buber's remarks add an about loneliness, every now and then a
emotional basis for understanding the creative patient succeeds in conveying his
concreteness of schizophrenic communica- experience of essential loneliness artisti-
tion and thinking, which psychiatrists and cally after having emerged from it. Mary
psychologists have so far primarily Jane Ward succeeded in doing so in her
studied from the viewpoint of the theory novel, The Snake Pit.n
of thought processes. The most impressive poetic document
of loneliness from a mental patient of
PATIENTS' DESCRIPTIONS OF LONELINESS which I know has been written by Eithne
Tabor, a schizophrenic patient at St. Eliza-
One of our patients at Chestnut Lodge, beths Hospital:
as she emerged from a severe state of
schl:t.ophl'enic devressiun, a::;ked Lo see me PANIC
because she wished to tell me about the
deep state of hopeless loneliness and sub- And is lhere anyone at all?
And is
jective isolation which she had undergone There anyone at all?
during her psychotic episodes. But even I am knocking at the oaken door
though she was now in fine command of And will it open
the language, and even though she came Never now no more?
I am calling, calling to you-
2. Ludwig Binswanger, Grundformen und Erkennt- Don't you hear?
nis Menschlichen Daseins; Zurich, Niehans, 1942; And is there anyone
pp. 130, 177-178. Near?
27 See footnote 3; p. 90.
28 Spren Kierkegaard, Fear and Trembling; New
And does this empty silence have to be?
York, Doubleday, 1954. The Sickness Unto Death;
Princeton, Princeton Univ. Press, 1945; see especially 80 The Divine Comedy of Dante Alighieri: The
pp. 102-103. Carlyle Wiksteed Translation; New York, Modern
2. Martin Buber, Dialogisches Leben: Gesammelte Library, 1932; p. 169.
philosophische und padagogische Schrifte; Zurich, 81 Mary Jane Ward, The Snake Pit; New York,
Gregor Muller Verlag, 1947; pp. 135, 397. Random House, 1946.
10 FRIEDA FROMM-REICHMANN

And is there no-one there at all porarily without leading to psychotic de-
To answer me? velopments-if it does not, in fact, occur
T do not know the road- as an inherent part of mental illness. One
I fear to falL source of verification is found in the psy-
And is there anyone choses which develop in people undergo-
At all? S2
ing an experience of enforced isolation,
Another patient, after her recovery, the other in the psychosis-like states en-
wrote the following poem, "The Disen- suing from experimentally induced states
chanted," which she dedicated to me: of loneliness.
The demented hold love Three types of non experimental isola-
In the palm of the hand, tion may be differentiated. The first is the
And let it fall voluntary isolation which comes about in
And grind it in the sand_ the course of polar expeditions, or in the
They return by darkest night
To bury it again, lives of rangers at solitary outposts. Such
And hide it forever isolation may be tolerated without serious
From the sight of men. SS emotional disturbances. Courtauld's "Liv-
In another poem, "Empty Lot," also ing Alone Under Polar Conditions" may
written after her recovery, she depicted be mentioned as representative to some
symbolically what loneliness feels like: degree. 35 Courtauld, who was isolated on
the Greenland icecap in a weather station,
No one comes near here writes that there is no objection, in his
Morning or night.
The desolate grasses judgment, to a solitary voluntary mission
Grow out of sight. if one is certain of adequate measures for
Only a wild hare one's safety and of ultimate relief. He
Strays, then is gone. recommends, however, that only persons
The landlord is silence.
The tenant is dawn.S4 with active, imaginative minds, who do
not suffer from a nervous disposition and
All these poems have-only seemingly are not given to brooding, and who can
coincidentally-a common feature: They occupy themselves by such means as read-
are not entitled "Loneliness," but "Panic," ing, should go on polar expeditions.
"The Disenchanted," and "Empty Lot." Is The second type of isolation is repre-
this because of the general inclination of sented by solitary seafarers, who seem to
the word-conscious and word-suspicious be in a considerably more complex situa-
schizophrenic to replace direct communi- tion than the polar isolates or solitary
cations and definitions by allusions, sym- rangers. Most of the solitary sailors seem
bols, circumlocutions, and so on? Or is it to suffer from symptoms of mental illness.
an unconscious expression of the fear of Slocum, for instance, developed hallucina-
loneliness-a fear so great that even nam- tions of a savior who appeared in times of
ing it is frightening? If one remembers particular stress-a reflection, probably,
that fear of loneliness is the common fate of his inner conviction that he would
of the people of this Western culture, be survive. s6
they mentally healthy or disturbed, it The third group consists of those who
seems that the choice of the titles of these are subjected to solitary confinement in
poems is determined by this fear. prisons and concentration camps. They
are, of course, seriously threatened by psy-
ENFORCED AND EXPERIMENTAl, ISOLATION
chotic developments, and they do fre-
There are two sources of verification for quently become victims of mental illness.
the al:Jl:Jumption that severe loneliness can- Christopher Burney has written a re-
not ordinarily be endured more than tem- port about his survival, without mental
82 Eithne Tabor, The Cliff's Edge: Songs of a Psy- .5 A. Courtauld, "Living Alone Under Polar Condi-
chotic; New York, Sheed and Ward, 1950; p. 36. Re- tions," The Polar Record, No.4, July, 1932; Cam-
printed by permission of the author. bridge, The University Press.
•• By permission of the author. •• Joshua Slocum, Sailing Alone Around the World:
S< By permission of the author. London, Rupert-Hart-Davis, 1948.
LONELINESS 11

illness, of eighteen months of solitary con~ small changes, such as a change in the se-
finement by the Germans during World quence of receiving first soup and then
War 11.37 His isolation was made worse bread, to receiving first bread and then
by cold, physical and emotional humilia- soup. He also felt being moved from one
tion, and a near-starvation diet. On the cell to another as a threat to his equi-
few occasions when he had an opportunity librium, even though the new cell, as such,
for communication, " ... I found that the was obviously preferable to the old one.
muscles of my mouth had become stiff and While Burney survived his ordeal with-
unwilling and that the thoughts and ques- out mental illness, he was aware, toward
tions I had wanted to express became ri- the end of the eighteen months of solitary
diculous when I turned them into confinement, that isolation was threaten-
words." 38 "Solitude," he says, "had so far ing his mental health. "As long as my
weaned me from the habit of intercourse, brain worked," he says, "solitude served a
even the thin intercourse of speculation, purpose, but I could see that it was slowly
that I could no longer see any relationship exhausting the fuel with which it had
with another person unless it were intro- started, and if it stopped from inanition I
duced gradually by a long overture of would have nothing left but cold and
common trivialities."39 hunger, which would make short work of
Burney describes the systematic de- me. Metaphysics were not enough: they
vices he developed to counteract the dan- are an exercise, weakening rather than
ger of becoming mad; he forced himself nourishing; and the brain requires food
to divide his lonely days into fixed peri- of real substance." 41 The intensity of
ods, with a daily routine made up of such the effort it had taken to stay adjusted
items as manicuring his fingernails with to his solitary life may be measured by
a splinter of wood he had managed to peel the fact that, at the first opportunity to
from his stool, doing physical exercises, communicate, he did not dare to talk, "be-
pacing up and down his cell, counting the cause I thought it quite probable that if
rounds he made, and whistling a musical I opened my mouth I should show myself
program made up of every tune he could to be mad." 42 "I tried to talk . . . and
remember. He forced himself to divide the succeeded a little, but constantly had to
eating of his one meager meal per day be- check my tongue for fear of uttering some
tween noon and evening, despite the crav- impossibility." 43
ing of his hungry stomach. On one of the The reports of Ellam and Mudie, and
rare occasions when he was allowed to go Bernicot include statements similar to
outside for exercise, he brought back with these last remarks of Burney's.44 As Lilly
him to his cell a snail; "It was company of says, in discussing these accounts, "The
a sort, and as it were an emissary from inner life becomes so vivid and intense
the world of real life. . . ." 40 He disci- that it takes time to readjust to the life
plined his mind to work on intellectual among other persons and to reestablish
and spiritual problems, whose starting one's inner criteria of sanity." 45
point had frequently to come from the One more remark about Burney's ex-
torn and ancient sheets of newspaper, or perience: I believe that his unquestion-
sometimes pages of books, given him for ing, matter-of-fact belief in the spiritual
toilet paper.
validity of the political convictions which
Secretly routinizing his life proved to be were the cause of his imprisonment may
an important safeguard for his mental have been an additional factor which
equilibrium. The illlportallce of this de-
vice can be measured by the degree to helpec'J him to survive 'his ordeal without
which Burney felt threatened by even .. See footnote 37; p. 150.
.. See footnote 37; p. 151.
.., Christopher Burney, Solitary Confinement: New .. See footnote 37; p. 152 .
York, Clerke and Cockeran, 1952. .. Patrick Ellam and Colin Mudie, Sopranino; New
.. See footnote 37; p. 86. York, Norton, 1953. Louis Bernicot, The Voyage of
.. See footnote 37; p. 105. the Anahita; London, Rupert-Hart-Davis, 1953•
to See footnote 37; p. 109. .. See footnote 11; p~ 4.
12 FRIEDA FROMM-REICHMANN

becoming mentally ill. In this sense, his tion and decreased variation in their sen-
confinement was more of a piece with the sory environment. In the Canadian
voluntary isolation of the polar explorers experiments the aim has been to reduce
than, for example, with the imprisonment the patterning of stimuli to the lowest
of a delinquent. The delinquent prisoner level; while the National Institute of Men-
is not likely to have the determination and tal Health experiments have endeavored
devotion to a cause which helped Burney to reduce the absolute intensity of all
to stay mentally sound, even though he physical stimuli to the lowest possible
was deprived of the opportunity to work level.
or to receive stimulation through reading The subjects of the McGill experiments
-which for many others seem to have spent twenty-four hours a day, with time
been the two most effective antidotes or out for eating and elimination, on a com-
remedies for the humiliation of confine- fortable bed with a foam rubber pillow.
ment and the rise of disintegrating Although communication was kept to a
loneliness. minimum, an amplifier connected with
My suggestion that Burney's conviction earphones was provided, through which
and determination were factors in his re- an observer could test the subject ver-
maining mentally healthy raises a ques- bally. Other noises were masked by fans
tion about the inner emotional factors and the humming of air-conditioners. The
which determine whether a person can subjects wore translucent goggles which
tolerate isolation or will be particularly transmitted diffused light but prevented
vulnerable to its dangers. So far, I have patterned vision, and gloves and card-
not succeeded in finding specific psycho- board cuffs reaching from below the el-
dynamic or descriptive data which could bow to beyond the fingertips. The most
be helpful in differentiating between striking result of these experiments was
people who react to solitude with or with- the occurrence of primarily visual, but
out succumbing to psychotic loneliness. also auditory, kinesthetic, and somesthetic
However, it should be possible to learn hallucinatory experiences. The subjects,
more by interrogating persons who have even though they had insight into the ob-
exposed themselves voluntarily to a life jective unreality of these experiences,
of solitude and isolation. found them extremely vivid.
The last important source of insight into In Lilly's experiments at the National
the psychodynamics of loneliness is the Institute of Mental Health, the subject
Significant experimental work of Donald was immersed, except for his head, in a
Hebb and his group at McGill Univer- tank of water at such temperature that he
sity 46 and of John C. Lilly at the National felt neither hot nor cold. In fact, he tactu-
Institute of Mental Health,47 who have ex- ally could feel the supports which held
posed their subjects to experimentally him, and a blacked-out mask over his
created states of physical and emotional whole head, but not much else. The sound
isolation. Both investigators have brought level was also low, and the total environ-
about marked temporary impairments of ment was an even and monotonous one.
people's emotional reactions, mental ac- Lilly has reported the various stages of ex-
tivities, and mental health by cutting perience through which subjects go, with,
down lhe scope of their physical contad eventually, the projection of visual
with the outside world through experi- imagery.
mental limitations:: of their sensory percep-
.6 W. H. Bexton, Woodburn Heron, and '1'. H. Scott, LONELINESS AND ANXIETY
"Effects of Decreased Variation in the Sensory En-
vironment," Canadian J. Psychol. (1954) 8:70-76; My impression is that loneliness and the
Woodburn Heron, "The Pathology of Boredom." Sci-
entific American (1957) 196:52-56. Woodburn Heron, fear of loneliness, on the one hand, and
W. H. Bexton, and Donald o. Hebb, "Cognitive Ef- anxiety, on the other, are sometimes used
fects of a Decreased Variation in the Sensory En-
vironment," Amer. Psychologist (1953) 8:366 (ab- interchangeably in our psychiatric think-
stract). ing and in our clinical terminology. For
.7 See footnote 11.
LONELINESS 13

instance, it is probably true that what psy- this universal emotional experience that
chiatrists describe as separation-anxiety it has limited our ability to study other
can also be described as fear of loneliness. ubiquitous emotional experiences ade-
Furthermore, most authors agree, explic- quately. For instance, the neglect ac-
itly or implicitly, with the definition of corded loneliness has also existed, to a
anxiety as a response to the anticipated lesser degree, for grief, which has, by and
loss of love and approval by significant large, been mentioned only as a part of
people in one's environment. Tillich ex- mourning, depression, and melancholia;
presses a similar idea when he postulates as far as I know, nowhere, except in Sul-
the ability to accept acceptance in spite of livan's writings, has its significance as an
the anxiety of guilt as the basis for the independent emotional experience in its
courage of confidence. 48 Does that not im- own right been recognized. 50 Hope, as an
ply that man with his imperfections is outcome of memories of previous satisfac-
threatened by loneliness if his anxiety tion, as a stimulus for efforts focused upon
prevents him from accepting acceptance? positive goals, and as a means of relieving
And does this in turn not mean that anxi- tension, has only recently been introduced
ety is closely related to the fear of isola- as an important concept by Thomas
tion or loneliness? Or, when Tillich says French. 51 The psychodynamics of realis-
that "the anxiety of meaninglessness is tic worry in its own right have been re.;.
anxiety about the loss of an ultimate con- cently investigated for the first time by
cern," is that not synonymous with Bins- Judd Marmor. 52 Very little is known
wanger's depiction of loneliness as a state about the psychodynamics of pain. Envy
of need in which people are bare of any is a universal human experience whose
interest in any goal? 49 significance as an independent emotional
Yet I suspect that if we psychiatrists experience has again been noted only by
can learn to separate the two dynamisms Sullivan, as far as I know. 53 And above
more sharply from one another, we will all, real loneliness has only quite rarely
come to see that loneliness in its own right been mentioned, in so many words, in the
plays a much more significant role in the psychiatric literature. Thus I believe that
dynamics of mental disturbance than we the suggestion is justified that the inter-
have so far been ready to acknowledge. I relation of loneliness and anxiety be
find good reason for this hypothesis in my thoroughly scrutinized, with the goal of
own experience with my patients and on accomplishing a new and more precise
the basis of the many reports about other differentiation between the two dyna-
patients which I have heard from my isms.
colleagues.
This, in turn, makes me wonder about PHYSICAL LONELINESS
the origin of this conceptual merger be-
tween anxiety and loneliness. I have al- I would like to add to this discussion of
ready suggested that this may have been emotional loneliness a word about physi-
brought about originally by the fear of cal loneliness. The need, or at least the
loneliness, which the psychiatrist, of wish, to have, at times, physical contact
course, shares with his nonprofessional with another is a universal human phe-
fellowmen. But perhaps this is an over- nomenon, innate and constant, from the
simplification. Perhaps a contributing time when the human infant leaves the
factor i~ thu uvurlncreu~ing iU!:lighL of womb al1d is physically separated fr0111 his
psychiatrists into the enormous psycho- 150 Harry Stack Sullivan, Clinical Studies in Psy-
dynamic significance of anxiety for the chiatry; New York, Norton, 1956; pp. 105-112.
•, Thomas French, The Integration of Behavior.
understanding of human psychology and Vol. I: Basic Postulates; Chicago, Univ. of Chicago
psychopathology, which has brought Press, 1952.
50 Judd Marmor, "The Psychodynamics of Realistic
about such a degree of preoccupation with Worry," pp. 155-263; in Psychoanalysis and the So-
cial Sciences, Vol. 5; New York, International Univ.
.. See footnote 3; p. 164. Press, 1958.
•• See footnote 3; p. 47. See also footnote 26. 53 See footnote 50; pp. 128-138 .
14 FRIEDA FROMM-REICHMANN

mother. Physical and emotional disturb- lonely, and their even greater difficulty in
ances in infants due to consistent lack of admitting it to the therapist in so many
physical contact have been repeatedly de- words, explains the relief with which
scribed, and such a wise and experienced some lonely mental patients respond if the
psychotherapist as Georg Groddeck has psychiatrist takes the initiative and opens
repeatedly elaborated on the topic of lone- the discussion about it-for example, by
liness for nonsexual physical contact in offering a sober statement to the effect
adults. that he knows about the patient's loneli-
In the middle and upper social strata of ness. Of course, I do not mean to say that
Western culture, physical loneliness has such a statement can be offered to patients
become a specific problem, since this cul- before they have overcome at least some
ture is characterized by so many obses- fraction of their isolation. This can be ac-
sional taboos with regard to people's complished by the doctor's mere presence,
touching each other, or having their without therapeutic pressure; that is, the
physical privacy threatened in other ways. doctor should offer his presence to the
I agree with Gorer's suggestion that lonely patient first in the spirit of expect-
American drinking habits can be under- ing nothing but to be tolerated, then to be
stood as a means of counteracting the accepted simply as a person who is there.
threats of physical loneliness. 54 The possibility that psychotherapy may be
People who give massages or osteo- able to do something about the patient's
pathic treatment are quite aware of the loneliness should, of course, not be verbal-
fact that their treatment, irrespective of ized at this point. To offer any such sug-
the specific physical ailment for which it gestion in the beginning of one's contact
is primarily applied, often helps their pa- with an essentially lonely patient could
tients emotionally by relieving their lend itself only to one of two interpreta-
physical loneliness. Pointing in the same tions in the patient's mind: Either the
direction is the pacifying influence which psychotherapist does not know anything
an alcohol back rub often has on mental about the inexplicable, uncanny quality of
patients, and the eagerness with which the patient's loneliness, or the psycho-
many of them ask for it. therapist himself is afraid of it. The mere
statements, however, that "I know," and
PSYCHOTHERAPY WITH THE LONELY "I am here," put in at the right time, by
implication or in so many words, may be
Now I would like to make some obser- accepted and may replace the patient's
vations drawn from my experience in psy- desolate experience of "nobody knows ex-
chotherapy with lonely patients. I have cept me." I have tried this device with
said that most patients keep their loneli- several patients and have been gratified
ness hidden as a secret from others, often by its results. It has helped patients to
even from themselves. In Otto A. Will's make an initial dent in their inner loneli-
recorded interview in psychotherapy, the ness and isolation, and has thus become a
doctor and Miss A, the patient, talk about beneficial turning point in the course of
an internist whose patients go to see him their treatment.
allegedly for physical treatment, but actu- The psychiatrist's specific personal
ally because they are lonely. And while problem in treating lonely patients seems
Miss A herself "may talk of many things to be that he has to be alert for and recog-
. . . one of her most essential problem.s 1s n1ze traces of his own lonelinells or fear
that of loneliness." 55 of loneliness, lest it interfere with his fear-
I think that this great difficulty of pa- less acceptance of manifestations of the
tients in accepting the awareness of being patient's loneliness. This holds true, for
example, when the psychiatrist, hard as
.. Geoffrey Gorer, The American People; New
York, Norton, 1948; p. 130. he may try! cannot understand the mean-
.. Otto A. Will and Robert A. Cohen, "A Report ing of a psychotic communication. He
of a Recorded Interview in the Course of Psycho-
therapy," PSYCHIATRY (1953) 16:263-282; p. 278. may then feel excluded from a 'we-experi-
LONELINESS 15

ence' with his patient; and this exclusion I have postulated a significant interre-
may evoke a sense of loneliness or fear of latedness between loneliness and anxiety,
loneliness in the doctor, which makes him and suggested the need for further con-
anxious. ceptual and clinical examination of lone-
liness in its own right and in its relation
I have made an attempt in this paper to to anxiety. I expect that, as a result of
invite the interest of psychiatrists to the such scrutiny, it will be found that real
investigation of the psychodynamics of loneliness plays an essential role in the
loneliness, as a significant, universal emo- genesis of mental disorder. Thus I sug-
tional experience with far-reaching psy- gest that an understanding of loneliness
chopathological ramifications. Such inves- is important for the understanding of men-
tigation may identify certain trends in tal disorder.
the developmental history as specific for CHESTNUT LODGE
persons suffering from real loneliness. ROCKVILLE, MARYLAND