One is the Loneliest Number That You’ll Ever Do
By Rick Rader, MD, FAAIDD, FAADM, Editor-in-chief, Helen Journal
Regular readers of HELEN are aware that listening to “oldies” on my way to work often serves as the inspiration for my editorials. Today was no different.
As I turned onto a stretch of highway and hit the gas, the unmistakable sound of Three Dog Night’s 1969’s hit song “One” filled my car. The song is known for its opening line, “One is the loneliest number that you’ll ever do.”
Songwriter Harry Nilsson (known mostly as Nilsson) wrote the song after calling someone and getting a busy signal. He stayed on the line listening to the “beep, beep, beep, beep…” tone, writing the song. The busy signal became the opening notes of the song.
One is the loneliest number that you'll ever do
Two can be as bad as one
It's the loneliest number since the number one
[Verse 2]
No is the saddest experience you'll ever know
Yes, it's the saddest experience you'll ever know
'Cause one is the loneliest number that you'll ever do
One is the loneliest number, whoa-oh, worse than two
[Bridge]
It's just no good anymore since you went away
Now I spend my time just making rhymes of yesterday
[Chorus]
One is the loneliest number
One is the loneliest number
One could argue that “one” is indeed a lonely number, especially when it relates to people not having a number two (or three or four) to share life, explore, expand and enrich themselves.
It should be no surprise that “loneliness” is a factor in serious health problems. Research has demonstrated that it can lead to both short- and long-term negative side effects. While spending time alone can benefit one’s psyche, involuntary self-isolation can result in us feeling “less than human” and promote negative feelings.
According to the Covey Institute, “These side effects are magnified for individuals with intellectual and developmental disabilities (IDD); and indeed all people with disabilities. Because of their limited opportunities to engage in social and emotional relationships, people with disabilities report higher levels of loneliness than people without.
A 2016 report by Wang et al identified three components relevant to loneliness.
A painful experience that arises when there is a discrepancy between the individual’s expectations concerning relationships and his/her actual experience
The perception that an individual’s social and emotional needs are not being met by the quantity and quality of a social relationship
Multidimensional in nature, consisting of both a social and an emotional dimension.
Loneliness is the result of a disconnect. A disconnect between the individual’s expectations and reality, a disconnect between what is and isn’t being met to fulfill emotional needs, and being disconnected from the community on a social and emotional level.
Social integration, therefore, is critical to mend this disconnect. This means individuals with disabilities interacting with other people in their community who may or may not have disabilities. This community integration leads to improvements in quantity and quality of relationships, which reduces loneliness.
While the very nature of disability, its public perceptions and attitudes about it easily connect loneliness with the disability community the facts are noteworthy:
Of young adults with developmental disabilities, 85% say they feel lonely most days
Of the 87% of autistic adults who live with their parents, only 22% want to
Individuals with I/DD have an average of 3.1 people in their social network versus 125 social network members observed in the general population
Marriages occur less frequently than in the general population, and individuals with a severe intellectual disability rarely marry
Mental health disorders such as depression and anxiety may be triggered or worsened by loneliness.
Loneliness and social isolation reduce life span as much as smoking 15 cigarettes a day.
It’s no surprise that the World Health Organization has described social isolation and loneliness as a “global public health concern.” In the disability community, it is not only a significant contributor to negative health outcomes, but the antidote to loneliness seems to be low down on the list of initiatives—inclusion.
We have heard the ongoing reasons why “inclusion” may be on the top of the list for Individual Support Plans; the reality is that it is all too often overlooked, ignored and forgotten. We repeatedly hear about staff shortages, transportation needs, finances, self-determination, conflicting schedules. Community provider agencies (responsible for the residential care of individuals with disabilities) have strict policies regarding the administration of prescription medicines. Cases of errors are dealt with immediately and Direct Support Professionals (DSPs) are investigated, suspended, retrained, terminated and possibly face criminal charges if found guilty of the infractions.
“We have heard the ongoing reasons why “inclusion” may be on the top of the list for Individual Support Plans; the reality is that it is all too often overlooked, ignored and forgotten. ”
In many instances we have a higher level of evidence (and confidence) that “inclusion” prevents negative outcomes from loneliness than we have that certain medications prevent specific health problems. While we conduct investigations on the level of CIA operatives, we shrug our shoulders when we learn that individuals with IDD have spent months isolated in group homes with little or no opportunities to participate in the community. Perhaps “inclusion” should be prescribed, and cases of “non-administration” should be investigated with severe consequences for those who allow loneliness to prevail.
The late comedian Robin Williams had an observation that should be printed on the front page of the health record of everyone with (and without) a disability.
“I used to think the worst thing in life was to end up all alone. It’s not. The worst thing in life is to end up with people who make you feel all alone.”
Rick Rader, MD, FAAIDD, FAADM, Editor-in-chief, Helen Journal
Report: Blood Proteins Tie Loneliness to Serious Health Problems
(McKnights Long-Term Care News; 01/06/2025)
By Kristen Fischer
Social interactions may protect people from heart disease, stroke and type 2 diabetes, according to a study published January 3 in Nature Human Behavior.
Investigators examined blood samples from 42,062 UK Biobank participants between 40 and 69 years old. The team tabulated social isolation and loneliness scores as well. Social isolation is based on whether someone lives alone or interacts with others; loneliness is more subjective and about the way a person feels.
In the blood samples, researchers found 175 proteins that were associated with social isolation and 26 that were linked with loneliness. Many of the proteins studied are a result of viral infections, inflammation and immune responses — and the same ones that have been linked to cardiovascular disease, type 2 diabetes, stroke and early death. Researchers correlated people with high levels of the proteins to their loneliness scores to draw conclusions. About 85% of the proteins associated with loneliness were the same as those for social isolation.
“The proteins we’ve identified give us clues to the biology underpinning poor health among people who are socially isolated or lonely, highlighting why social relationships play such an important part in keeping us healthy,” Jianfeng Feng, PhD, a researcher from the University of Warwick, said in a statement.
The team found five proteins that they say were a product of loneliness. As an example, researchers found high levels of adrenomedullin (ADM) in people who were lonely. Previous research has shown that the protein plays a part in responding to stress and regulating stress hormones. Investigators noted a strong link between ADM and the volume of the insula, which is a part of the brain associated with interoception or a sense of what’s happening in the body. The higher the ADM levels, the smaller the insula. More ADM was also tied to lower volume of the left caudate, a part of the brain that contributes to emotional, reward and social processes. Higher levels of ADM were also associated with a higher risk of dying early.
“These findings drive home the importance of social contact in keeping us well,” Barbara Sahakian, PhD, a professor at the University of Cambridge, said in the same statement. “More and more people of all ages are reporting feeling lonely. That’s why the World Health Organization has described social isolation and loneliness as a ‘global public health concern’. We need to find ways to tackle this growing problem and keep people connected to help them stay healthy.”