Tales From The Therapist's Couch

A young woman comes to see me during the Christmas break of her first term at university. She tells me that she is scared. It is not what she imagined it would be at all. It's as if she is on one side of a glass wall and everyone else is on the other. She can't concentrate during lectures, and sometimes, for no apparent reason, her heart races with an awful feeling of panic. She has never been homesick before, but misses her family and friends terribly. Is she ill? Could I please explain what is happening?

A young woman comes to see me during the Christmas break of her first term at university. She tells me that she is scared. It is not what she imagined it would be at all. It's as if she is on one side of a glass wall and everyone else is on the other. She can't concentrate during lectures, and sometimes, for no apparent reason, her heart races with an awful feeling of panic. She has never been homesick before, but misses her family and friends terribly. Is she ill? Could I please explain what is happening?

A man comes to therapy in a strop because he is late. His busy timetable is a whirlwind of work obligations and social engagements. Although he lives by himself, he is rarely alone. One day he comes to a session immediately after a colleague's funeral. His mood is different. It is as if he has run out of steam. In this unusually quiet space, he breaks down and sobs. After a while, he tells me that while he was standing by the graveside he felt as if something had caught up with him that he had been running from all his life. It was a terrible and overwhelming awareness that he was lonely.

Loneliness. Most of us have feared it, many of us have felt it. Yet how little we openly talk about it with one another. People discuss their sex lives more frankly and easily than any ache of loneliness. In our busy, extrovert culture, we frequently link loneliness with physical solitude, yet there are plenty of solitaries totally happy in their own company. Loneliness is just as likely to reside within an unhappy marriage or busy social life.

Because it is something of a social taboo, many assume that their disquiet and unhappiness has another cause, and so in the consulting room loneliness is invariably hidden behind any number of disguises. Patients describe how they feel tearful, anxious or full of panic; sad, lifeless, or sometimes so busy they manage to avoid having time to feel very much at all. Sometimes loneliness is expressed in physical symptoms: headaches, heart pains and numerous other small maladies that get scrutinised and dwelt upon out of all proportion. So it can often take some time in therapy to wade through a thicket of symptoms before a clearing is reached, and the real cause emerges.

Our language has only one word to describe the experience of loneliness, yet there are different degrees and types. Broadly speaking, it's possible to talk about three kinds of loneliness: developmental, situational and internal, which may well overlap. The young woman above, stumbling a little after her first university term, was suffering from what I would call a mixture of developmental and situational loneliness. Developmentally, she was in the throes of late-adolescent/coming-of-age turbulence, a time that for many involves a massive identity crisis, and when the "I" in "Who am I?" often feels in a state of uncertainty and flux. When securely held by the familiar world of family and friends, this young woman had enjoyed the challenge and buzz of experimenting with many different selves. But in the new university setting, her confidence ebbed, and so the process of exploring her own separate identity was swamped with insecurity.

This young woman only needed short-term therapy, as she had, deep down, a sound capacity to be alone and enjoy her own separateness, as well as the ability to form relationships. What she needed was to learn how to trust herself, to avoid retreating into a shell of shyness, to reach out and start to build a new network of friendships and hobbies that would ease the loss of the familiar.

Internal loneliness is harder to heal. Here, the emotion is unrelated to any "time of life" or outer, situational change. The man described above suffered from just such internal loneliness. He continually filled his diary in order to ward off the discomfort he felt when alone for any length of time. Yet because he used the company of others to avoid being by himself, relationships never felt nourishing. Hence he was always lonely.

The writings of the psychoanalyst Winnicott explore how the roots of such profound loneliness reach far back to infancy. Winnicott explores how such an inability to feel safely alone stems from an experience of feeling abandoned or unloved. In the case of the man above, he was sent to five different boarding schools between the ages of seven and 14, which resulted in a terrible feeling of abandonment and insecurity, as well as a difficulty in making meaningful friendships.

This man's story is probably an extreme version of something familiar to many of us. In the exquisite phrase Carson McCullers used for the title of one of her novels, The Heart is a Lonely Hunter - and we probably all know the feeling of hunting with a restless busyness for something that eludes us. What the man above needed to do was to face his fear of loneliness. The challenge was then to learn how to feel more secure when alone, and therefore more content when in the company of others.

elizabeth.meakins@blueyonder.co.uk

Elizabeth Meakins is a psychoanalytic psychotherapist in private practice. None of the above clinical material refers to specific cases