Eleanor Rigby is not at all fine.

‘Eleanor Rigby

Picks up the rice in the church where a wedding has been

Lives in a dream

Waits at the window

Wearing the face that she keeps in a jar by the door

Who is it for?’

Eleanor Oliphant may be perfectly fine – but Eleanor Rigby is not. Maybe you’re not either.

It’s no fun to be lonely. It’s no fun to live by yourself and spend each evening trying to keep yourself busy in the hope that you can somehow forget how alone you really are. Sometimes though, you just can’t forget and it’s a job then to do anything at all. The weekends don’t help. Rather than being something to look forward to, they serve only to heighten the sense of isolation that you feel as the long hours drag by with you seeing nobody from the end of one working week to the beginning of another.

Hopes of ever meeting somebody and settling down seem like an unattainable dream. And so, as the loneliness continues, the unhappiness grows. The more unhappy you become, the greater the anxiety you feel at what it would take for the sadness to end until you find, in time, that the more you long for the loneliness to end, the more you long to be alone. You wonder what the point of it all might be and conclude that there is no point at all.

Alone in your room, imagining the happiness of others, it’s easy to sing silently along to The Velvet Underground,

All the people are dancing

And they’re having such fun

I wish it could happen to me

But if you close the door

I’d never have to see the day again’

Antidepressants may be offered to you but they never really help. No substitute for friends, they’re not the answer – too often they just make you feel worse. Conceivably, talking therapy could help a little but, rather than the simple steps towards a better tomorrow that it was suggested they would be, each session becomes just one more thing to survive, just one more hurdle to overcome. It’s hard to know what to do in such circumstances, not because you lack intelligence, on the contrary you have learnt well what the world has too readily taught, that isolation is good and that we all have to make it on our own.

And so, as I talk to such people, I sense them whispering, ‘I don’t know what to do’. And too often, like them, I find myself stuck, not knowing how to answer. When we eventually part, as I too abandon them to their solitude, their sadness surrounds me and increasingly it becomes my own.

‘All the lonely people – where do they all come from?’

Loneliness, and the accompanying anxiety that is so often both its’ cause and effect, is a common problem and, to those who experienced it, it is both crippling and overwhelming. And the problem is getting worse and will, I suspect, continue to do so for as long as society persists in fragmenting and we carry on being encouraged to live too much of our lives online. Because a life lived virtually is a life that isn’t quite complete – and a life that isn’t quite complete will feel, to many, like a life that is no longer worth holding on to.

Something is missing from our all too virtual lives, something has been lost.

And that something is ourselves

We all so long to be found.

‘Will you search through the loamy earth for me

Climb through the briar and bramble

I will be your treasure’

So run the opening lines of Johnny Flynn’s theme song to the TV comedy series ‘Detectorists’. If you haven’t seen it then do yourself a favour and give it a go. It’s about two friends, Andy and Lance, who spend all their spare time metal detecting. To be honest, not a lot happens. But as what doesn’t happen unfolds, a wonderful friendship between two people is portrayed, one which one can’t help feeling is something that is precious beyond words. Something to be envied.

In one scene Lance is talking to another character about his years of metal detecting. He says,

‘This was our escape from the rude world, the madding crowd…Do you know how often we find gold? Never. We never find it. And that’s what we’re looking for. We don’t say that. We don’t say that we’re looking for gold. We pretend we’re happy finding buckles and buttons and crap, but what we’re hoping for is gold.’

But what Lance is forgetting is the gold he has already found in the friendship he shares with Andy. The truth is that, because of that friendship, he really can be happy ‘finding buckles and buttons and crap’. Likewise, we too all need to sometimes stop our searching for things that don’t really matter and see what of value lies right in front of us but which we so easily overlook. Good relationships are the basis for happiness – if we have them, we are fortunate indeed. We should not underestimate their worth.

Despite having no interest in angling, another program that I have enjoyed immensely is ‘Gone Fishing’. Like ‘Detectorists’, whilst precious little takes place, we see a genuine friendship in action, this time a real one, between Paul Whitehouse and Bob Mortimer. They are long standing friends who have known what it is to support one another through the difficulties they have each known in their lives. And again, it’s genuinely heart warming to watch. Good relationships enable us to carry on when life seems to be falling apart around us – if we have them, we need to be careful that we nurture them well.

I have often thought that it is less important what we do in life than who we do it with.

Friendships can and do make all the difference but they need time to develop, time that is spent together, time that our frenetic lifestyles too often don’t afford.

Given that humans are meant to live in community, it is no surprise to learn that loneliness is bad for us. It is of no surprise to anybody that individuals who experience prolonged loneliness are liable to suffer low mood and anxious thoughts but it is not solely in terms of our emotional wellbeing that loneliness has adverse effects. Less appreciated is the fact that loneliness is also bad for our physical health with those experiencing it having higher rates of cardiovascular and cerebrovascular disease as well as poorer cancer outcomes. It has even been suggested that loneliness is as bad for us as smoking 15 cigarettes a day. The truth is that loneliness is deadly.

And what’s true for our patients is also true for us – being a GP can be a lonely experience too. The early years of being a doctor generally consist of a series of jobs each lasting just a few months before it’s all change and new acquaintances need to be made. It’s hard to establish good working relationships with colleagues in such circumstances and, even when settled in a job, work can be just too busy to allow time for real friendships to develop. What is more, the constant demands of the job can too easily play havoc with our relationships outside of work.

To have friends, both inside and outside of work, is vital – it is simply too important to leave to chance. In work, therefore, we must find time to support each another. We need to genuinely care for one another as friends rather than simply existing alongside each other as colleagues. It is not without good reason that GP partnerships have often been likened to marriages. Healthy partnerships, whether formalised as such or not, are grounded in the commitment that is inherent in those partnerships. They grow as a result of individual members of the team spending time alongside those with whom they go through life and with whom they can honestly acknowledge their weaknesses and struggles. They will not develop where individuals stay chained all day to their desk, constantly battling their own problems, all the while oblivious to those being experienced by others. Keeping doors open when not consulting, regularly taking time for informal chat and not neglecting the all-important daily gathering around the coffee machine all serve to build the working friendships that go a long way towards protecting those within medical teams from falling by the wayside. Informal practice meetings over dinner, annual away days and regular social events, all characteristic of healthy partnerships, will go still further. I consider myself fortunate indeed to be in such a practice.

And maintaining our home life, protecting it from the ever present threat of our work encroaching there, must also be a priority if our relationships outside of medicine are to have any chance of thriving and becoming another source of much needed support.

But to finish, let’s consider again those whom we come into contact with who are lonely. Because there are a lot of them about. Loneliness in the UK is at epidemic levels with, according to the Office of National Statistics, 2.4 million adult British citizens knowing what it is to be lonely. So if there are so many lonely people, and if loneliness is so bad for our health, why don’t we give it the same attention that we give to such things as blood pressure, smoking and cholesterol levels? Part of the answer, perhaps, lies in the fact that, with no pill available that can take away the isolation, there is no money to be made from these individuals who live on the edge of society. And where there is no money to be made, there is no incentive for those who decide what our priorities should be to make loneliness one of things that is considered important enough to tackle.

But there is another reason.

And that is that lonely go unnoticed – unless we are forced to see, they are so easily overlooked.

‘Eleanor Rigby

Died in the church and was buried along with her name

Nobody came’

And so the lonely remain, and the sadness continues. For me at least, far more than the physical consequences of isolation, it is this, the enduring sadness that inevitably accompanies loneliness, that concerns me most. The problem of loneliness is not, of course, ours alone to solve, it is all of society’s responsibility, but even though most of those affected will never dare to ask us for our help, we should, I think, be conscious of both the problem and it’s invasive and malignant consequences. And so we must always keep asking the question,

‘All the lonely people – where do they all belong?’

Because, somehow a place for them has to be found. But how? Personally, faced with someone who is desperately lonely, I admit to sometimes hearing again the words. ‘I don’t know what to do’. Only this time it is me who is whispering them quietly to myself.

It isn’t easy to find ourselves not knowing what to do, it is part of what makes it difficult for us to break bad news to our patients, it’s part of what makes it hard for us to tell them that there is nothing more that medicine can offer. But telling someone that we can’t do anything more for them as doctors doesn’t mean that we can’t do more for them as individuals – we don’t have to leave them alone just because we can’t solve their problem.

In ‘Out of Solitude’, Henri Nouwen wrote,

‘When we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares.’

‘All the lonely people, where do they all belong?’ The answer, surely, is with friends.

Though it may be the case that sometimes we can do no more than be a friend who cares, a friend who cares may be all that we are needed to be. Because, when we do what may seem to be nothing very much, that is when we may actually be doing a very great deal indeed. Sometimes we need to stop being the doctors who disappear when they cannot help and become instead the individuals who, when they don’t know what to do, know how much it can help to simply stick around.

For as long as it takes for the one who is lonely to become, perhaps, somebody’s ’very special one’, to become, perhaps, somebody’s treasure.

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