Jacqueline Olds, MD: How to Overcome Loneliness & Build Stronger Relationships

As a practicing psychiatrist at Mass General assistant professor of psychiatry at Harvard Medical School, Dr. Jacqueline Olds has spent decades working with patients of all ages and life stages, helping them through life’s challenges. And while no two people or patients are the same, Dr. Olds has identified one theme common among her patients—they are lonely. And, often they are embarrassed to admit it, finding it easier to look instead to issues like anxiety or depression as the source of their troubles. 

Over the past 25 years, she and her husband, Dr. Richard Schwartz, also a practicing psychiatrist, have worked to bring loneliness out of the closet and help us understand the importance of building positive, supportive relationships, both romantic and platonic, and better understand what makes a relationship last. 

So welcome Jacqueline

 Jacqueline:   Thank you very much.

Q:   So to start off, can you tell me about what inspired your work with loneliness, and how you got into that area of study?

A:   Well, because, as a family, we moved around a bit when I was a child, it meant that I was often the new kid in town. And we lived in four or five different places before I was 12. And so I did feel lonely at the beginning, and I had to go about making friends. And each time I thought it was going to be impossible. But somehow, it worked out, about a year or two later. And then my parents would decide to move.

So I had had personal experience with loneliness. And as I became a psychiatrist, it became very clear that everyone has some experience of loneliness. And this isn't just patients, this is people in life. There's no way you can go through life and grow up and leave your family and start again without some experiences of loneliness.

But I was shocked by how little had been written about it. And also, I was surprised that most people didn’t really let me know that that was an important problem until several months into psychotherapy. And instead, they were willing to explore all sorts of diagnoses before they wanted to just say, “You know, I feel horribly lonely.”

And it was also interesting that some of these people were surrounded by people. So it wasn’t just that they were all by themselves in the woods. They could feel very lonely, even though they were in the middle of a group of people on a regular basis. So it seemed, to me, that it was a topic that needed to be, as we said, brought out of the closet, so people could understand that it was universal. They didn’t have to feel so embarrassed about it. They could talk about it and talk about how to solve it.

Q:   It’s a little bit surprising to hear you say that, you know, people are more willing to jump to something like anxiety, depression, than loneliness. Because there is stigma around mental health. So why do you think that happens?

A:   Well, I think two things are true; that when you go see a psychiatrist, you know you're supposed to talk about anxiety and depression. You don’t know that you're supposed to talk about the fact that you're having trouble with social connecting. But that is, in fact, a totally reasonable thing to talk over with the psychiatrist. I think in its own way, in the past, loneliness was more stigmatized than anxiety or depression. There has been so much written about anxiety and depression, and only recently has loneliness started to be written on.

So people just assumed that if they felt lonely, a lot of the time, it was their own fault. They were a loser. And if they were anxious, they felt there might be something very interesting and psychiatric there. [laughter]

Q:  And when you think about loneliness, is it inherently negative?

A:   Well solitude is not bad at all. Many people want time alone. And that’s a very reasonable thing to want. And, as long as you know it won't go on forever, it doesn’t seem half bad. And often, it seems good, especially if you're at a job where you're surrounded by people all day, then going home and having a little bit of peace and quiet is terrific.

But loneliness has a kind of different charge than solitude. And it’s interesting that there's a researcher out in Utah who has studied the effects of loneliness. And she has found that there are three groups of people who show the effects of loneliness in their physiology.

There are people who live alone, and they're not even complaining about being lonely, necessarily. There are people who say, “I feel lonely,” and it doesn’t matter what their living situation is. And then there are people who are socially isolated. And so all three of those groups have effects that are very similar, which is quite surprising. But usually, by the time somebody says, “I feel lonely,” they're not meaning that it’s okay. They mean something negative.

 Q:  And you said, when you started thinking about this in a research sense, there hadn't been a lot of other writing or research in the field.

A:   There had been some. But there wasn’t as much as around anxiety and depression, not even close.

 Q:   Do you have a sense of why that was?

A:   Maybe because people in the way past thought that loneliness was maybe a more typical condition of coming to America, which was a huge country. And, you know, Little House on the Prairie and Daniel Boone were the kinds of myths that Americans read about. And they thought being a little bit alone and sort of independent was the way to go. It was the American way, as opposed to everybody being in each other’s pocket in Europe.

And I think, as more and more people lived in cities, surrounded by people, and still felt lonely, perhaps even more lonely than they had when they lived with their family, that it started to be a more American problem; where, because everybody feared being mutually dependent, and having to ask too many favors, they tried to be staunchly independent. And they overshot.  

A:   I think sadly it’s becoming much more prevalent in all the prosperous countries of the world. And probably that prosperity has allowed so many people to live alone, that they end up feeling lonelier than they expected. 

Q:  Can you talk a little bit more about how your clinical work has laid the foundation, or sort of fed into your research work in this area?

A:   Well, it was in 1996 that we wrote our first book called Overcoming Loneliness in Everyday Life. And I have to say that it corresponded with many things. One was, I was a doctor and a mother of very young children. Two is, that I had my office at home. My husband had his office at the hospital. Most people had their office in some kind of office building. And there I was, on my little street in Cambridge.

So it had the potential to be very lonely. And I realized that I was going to have to get to know people in the neighborhood, if it wasn’t going to be extremely lonely. I loved having my patients come, and being able to be helpful to them, but it’s not quite like being in a social web. You're a professional, and you have to make sure that you're as helpful to them as possible without being their friend.

So I started to make all sorts of little networks in the neighborhood. And we had something called neighborhood camp, where several families would have a—couple of teenagers take care of the kids all together. And there were a variety of things that I did, that made the neighborhood knit together. And I was so pleased about that, that to some extent, that book Overcoming Loneliness in Everyday Life was a response to my plight of —being in a somewhat isolated profession, being a psychiatrist. You can't go around talking about your work.

Being at home, and having two young children, and I tried to work part-time and fit their schedules, but I couldn’t always. I certainly couldn’t be with the mothers in the neighborhood who weren't working. And I couldn’t really be with the mothers who were working full-time, because there I was, in my little street, in my little office.

So that was a book that was probably as much determined by my life situation, as it was by the fact that my patients were lonely, and I had to help them with that problem. And the bottom line of that book was, that you have to build in ways in everyday life that you see people and work together with them on joint projects. And, if you do that, that regular contact will pan out in friendships, and eventually deep friendships.

So it has to be kind of a regular thing, where you're working on something that is mutually beneficial, and you can't expect that you’ll somehow be able to invite people over whenever you want to see them, because that’s just not part of modern life.

Q:   Is there advice that you’d give, in the spirit of that sort of building in these connections or ways to work with people? What are the first steps that they can take if they're trying to build in those things and to prevent loneliness?

A:   Well, I suppose the very first step, and this is true for many young people who start a degree program in the Boston-Cambridge area, but they come from California or somewhere very far away, is I say they have to make sure that they regularly reconnect with their oldest friends, even if it’s by telephone or Skype, and with their families, so that they have that sense of the network they have, and they're not trying to pretend that they're going to manage just fine completely solo, without anybody that they can be themselves with.

Then, when you start on the road of maybe doing some volunteer activities, or maybe taking a course, or if your work has a once a week mixer or get-together, making sure that you go to that, even though it’s a torture because you don’t know anybody. All those things are excellent to do. But you have to have the strength that you get from connecting with the people who know you best.

And, thank God we have so many ways to communicate with them. But I really do suggest something as lively as a telephone call, rather than just texting with your favorite people, because texting can be so sparse.

 Q:   So the two activities, sort of feed one another?

A:   Exactly. And that if you can do something with a group of people that you like, that is an activity you would want to do even if you never met a single person. And you do it regularly, the chances are very good that you will gradually have some acquaintances, and then eventually friends.

 Q:   Yeah. I've thought a lot about this, in my own life. And there's a lot of discussion in the media in the last few years about the challenges of making friends as an adult.

A:   Yeah, absolutely.

 Q:   You know, when you're younger, and you're in school, and you're open—

A:   It’s no problem.

Q:   Can you talk a little bit about why that is, and how you think about that, and how to approach it?

A:   So first of all, I think though that decade of the 20s, after you finish school, and before you make your own significant relationship, if you do, is a particularly difficult year, because you're trying to not be too dependent on your family of origin. But you have absolutely no guarantee that anything will ever work out in the future with your own family. So you sort of are floating free. And you have this sort of nibbling of panic that maybe it’s something won't work out. Everybody says, “Oh, don’t worry. Of course it’ll work out.” But you don’t have any guarantee.

And you know, if you are a shy person, it seems even less likely that it’ll ever work out. And plenty of people—15 percent of the population is very shy. And that shyness trait is not a trait that changes over a lifetime. You can pretend not to be shy, and it can go really well.

So I think those 20s are particularly difficult.

And you have to try things, and experiment, and tolerate the fact that plenty of those experiments don’t work out. And you think, “Well, is it me? Is it the world? Why is everything so difficult?” And plenty of people came from wonderfully nurturing families and small towns or places where they knew everybody. And they didn’t necessarily learn the skills of how you make friends.

Now one of the things I go on and on about is how the basic rule in making friends is taking turns. That if somebody does the smallest thing for you, you know, they come over to your office, and they bring you a candy bar because they have too many candy bars; they come over, and they say, “Can I water your plants when you have to be out of town next week?” That is a favor. And it is your job, next, to return that favor, and not to just say, “Hah. Isn't it nice how people are so nice to me?”

It is your job in the old kindergarten way to take turns with that kind of thing. And if you study gift theory in anthropology, it’s all about reciprocity. 

But it’s also true that, every now and then, you have to do something that just makes you horribly anxious, like take a friendship to the next level by asking somebody to come out to supper with you. And that is sometimes agonizing. But if nobody ever does it, it’ll never happen. So you sort of have to take risks.

And, a good percentage of the time, the risks won't work out. And you’ll feel foolish. But if everybody is risk-averse, then not much happens. And everybody is quietly going back to their own lonely houses. 

And what we said in our second book, which was called The Lonely American, was essentially that it’s very easy to start thinking, okay, well I'm not going to depend on other people. I’ll step back from this hubbub that I have to encounter all day at work, and I’ll just have peace and quiet when I go home. And it’ll be much better. I don’t need other people.

And pretty soon, those same people start to feel left out. And it turns out. There's a whole syndrome that everybody else knows about. What is it called? FOMO?

 Q:   Mm-hmm.

A:   Okay. So once you start feeling left out, you don’t just feel neutral about other people, you start to hate them, because you think they're having a blast and you're not. And social media just fuels that fire. And so, what started out as a stepping back because you thought it was too much for you, and it wasn’t going so well, and you have so many people around all day, so you’ll just step back a little bit, can work out to be a real problem, where you start feeling like, you know, nobody likes me. And I don’t even know why. And actually, I hate them too.

And so to some extent, the tiniest little decisions can work out to be really problematic. Because once you get that left out feeling, it’s a little hard to work your way out. And that’s often what we have to do as psychiatrists, is help people understand what got them feeling left out to begin with, and how they can work their way back in.

Q:   You mentioned social media as a part of this. And I'm wondering, if someone realizes they're in that space, you're looking at everything with kind of a nasty feeling towards it, and realizing, okay, this is probably about me, not them. As you said, fueled by social media. Do you think—

A:   That’s probably that they're all bragging on social media.

Q:   Yeah.

A:   So, if they're all bragging all the time, it’s not that much fun.

 Q:   Yeah. And how do you counsel people to—

A:   Step away?

Well just an hour and a half ago, I was talking with somebody who was saying that he used to be addicted to Facebook. He’s about 35. That he used to be addicted to Facebook, and be on it two or three hours a day. And now he barely goes on it an hour a day, and he thinks he’s made huge strides. And he’s happier. But he, nevertheless, gets sucked in, and is shocked by how mean people can get to each other really fast on social media.

And so he hates how quickly people can get mean to each other because they're not looking each other in the eye. And that if you had a discussion with somebody, where you were looking at them, you know, you wouldn’t forget all civility and politeness.

And I said, “Well, why do you go on it at all?” And then he explained to me all the reasons he had to go on it at all, and that there were several friends he couldn’t possibly communicate any other way with.

But it is true that, back in the days before Facebook, you didn’t have to have in your face all the parties you weren't going to, all the fun people were having without you. It was really calming to not know. If people gossiped about you, you never had to hear it.

Q:  In addition to working with patients, you’ve also worked a lot with trainees and teaching young practitioners in the field. How do you see loneliness impacting that group of people? If someone’s entering medicine, are there unique loneliness challenges within that sphere?

A:   I think there are. I think not only does going into medicine mean that you sort of give up the idea of free time for a while, especially when you're in your training, and that free time would be the time where you’d have both time and energy to connect up with the people that you want to connect up with. But, in addition, you're doing such grueling and exhausting and sometimes tragic work, that the only people you want to talk to are other people who are doing that kind of work, too.

So it means that it’s a little like making friends during wartime. That, you know, you're in the trenches with other people, and you might make friends with somebody that you're trying to stop the bleeding of somebody who just walked into the ER with. But you have a little trouble shifting gears, and making small talk with your roommates who are, you know, studying library science. [laughter]

So it’s—it’s a complicated thing. It offers the chance to make lifelong friends with other people who are studying medicine. But it’s hard to find the time to be with anybody you're not working with.

 Q:   And how do you advise them? 

A:   So because I'm of a different generation, many of the young doctors say, “Jackie, how did you ever find time for self-care? How did you find time to go to the gym when you were training?” And it never even occurred to my brain that I would ever go to the gym. You know, I was running around chasing my tail, and working extremely hard. 

It just wouldn’t have occurred to me to do any self-care which, you know, was a problem, probably, in its way. But I think it was such an active profession, and you felt so lucky to be able to get into it, and to train well, that self-care just wasn’t made time for. And I think plenty of young people do a much better job of taking good care of themselves. And they think about health a lot. But sometimes to the detriment of thinking about their social life, which is one part of self-care.

And if you're always at the gym or at work, then there isn't any time to see people. And that is a terrible problem.

Q:  That’s interesting. It feels like, you know, going to the gym is responsible. But just maybe hanging out with friends is goofing around.

A:   And it’s just not. It’s—It is every bit as essential to our sense of well-being as going to the gym.

Q:  You mentioned working in a field where you can't, at the end of the day—

 A:   --decompress and tell everybody everything about what you did.

 Q:   Yeah. How do you—How do you—

A:   Well, that’s one of the terrible parts about being a psychiatrist. And that’s why you have to talk to other psychiatrists occasionally, just so you can decompress. 

It’s a great honor that people tell you about the things that matter most to them. But part of that honor is that they expect you to absolutely keep confidentiality. And you have to. But most people get to talk about their work all the time, and they like talking about their work.  

But I think—I think that is one of the downsides of being a therapist of some sort.

 Q:   How have you combatted that for yourself?

A:   That’s a very good question. I do think that my husband and I can talk about problems that come up in our work. And even in the court system, there is a spousal privilege that you can talk about confidential matters with your spouse. So, thank God for that. 

I also think that it’s important to have very good friends. And, even if you can't talk about your work, it’s wonderful to have some friends that take you completely away from your work.

Q:   You mentioned being married to a psychiatrist. And I'm wondering if you can talk a little bit about that relationship, and how that’s become not just your personal relationship, but your professional relationship, and what that partnership looks like.

A:   Well, I think because the nature of our marriage, that it would have been hard on one of us to have a huge project with somebody else, while the other person felt left out, so it seemed easier to have a project with each other. But I think, because these topics were so important to us, and you know, we wrote a middle book about lasting relationships called Marriage in Motion. 

That book was hard to write, because it was about a topic so close to us. But it also would have been hard to write with somebody else. So I think it’s been quite wonderful writing books together. But if you saw us when we’re actually doing it, it didn’t always look so great. In fact, we sometimes argued.

 Q:   What was it like initially? I think a lot of us—you have kind of your home self, and your social self, that you present to the world. And then you have kind of your work self. And there's probably commonalities in those various selves. But they're not—

 A:   --exactly the same.

 Q:   -- exactly the same. So what was it like to mesh those parts of you and your relationship? 

A:   Well, sometimes it was. One of the things, you know, we’ve been asked to give lots of talks on love.

So one of the things we write about is how often in marriage—is that the husband will say about the wife, “Well, you know, I come about 15th on her list.” And I’ll say, “Well, why do you think you come 15th on your wife’s list? I mean she’s married to you. She must love you.”

And he’d say, “Well, I listen to her talking to everybody on the phone. And she is so animated, and interesting, and entertaining, and funny. And then she talks to me in this kind of deadpan voice. You know, “The dog needs to be fed,” And that, to me, means that she doesn’t really care about me.”

But, when you think about the initial notion of love, that people had when they were growing up, of, “I can be my true self, and I don’t have to be on,” to some extent, that deadpan voice is not a voice of, “I don’t really like you,” it’s a voice of, “I don’t have to be my absolutely best self all the time with you. I'm not asking favors. We’re just at home, talking from the heart. And sometimes it doesn’t sound all animated and gussied up.”

So that, I think, is true for me and my husband. But it’s true in every significant relationship, that you have to help each other to understand the way being on doesn’t necessarily mean you love everybody that you're onto, so to speak.

Q:   Are there other things that you’ve learned through this work that, when you think about either your relationship or other relationships that have lasted over time, are there particular characteristics that set up that long-term success?

A:  One thing I think is that you have to—Basically, every time you feel very close and connected, each person sort of goes their separate way for a little while, and they might go off to work. They have all sorts of other people they have to see in their life. And then they come back to reconnect.

But not everybody does that automatically, and there can be a drift, where people, you know, might have to be on a project for three weeks, where they barely get home. Or they might have to take care of a relative who is ailing, and they can't quite be unpreoccupied. 

And so, in those cases, somebody has to have what we call a distance alarm, saying, “Hey, we haven't connected in weeks. What's the problem? We ought to be connecting much more often.”

And sometimes that can take the form of a fight. Sometimes it can take the form of a kindly remark. But you have to get the other person’s attention. Children have no problem with this. [laughter] But grownups are always trying to do it the nice way, and sometimes it doesn’t work. 

Most couples need to reconnect and have some time alone, a minimum of once a week.  But they often let things go too long, and then there needs to be some kind of distance alarm that brings it to somebody’s attention.

It’s also true that couples do much better if they are part of a social network. So what's interesting is, that even though time alone is so important, time with other people is important too. And so you have to make room for both. There has to be cocooning, and there has to be going out with other people, and seeing other people, and getting to see your significant other through other people’s eyes.

So each of those is quite important. Joint projects are quite important. Kindliness is extremely important. Knowing how to make up is important.

Q:   Can you talk a little bit more about the joint projects?

A:   Well, for most people, living in the same apartment, or maybe having children together, or trying to support themselves as a couple, or trying to learn how to cook, or trying to ask other people over, and find people that both people like, all of those are little joint projects. Children are not a little joint project, they are gigantic joint project.

But there are plenty of times in life where the children are kind of grown up. You’ve figured out how to live together and support each other. And the money problems and learning how to cook is not a problem. And then, sometimes you have to think of a joint project, like you know, we want to climb all of the mountains in New England. Or we want to go to all the heavy metal concerts that happen in Boston.

Or, we want to learn wildflower names. And we’re going to go on wildflower walks. And so having that kind of thing, where both people are kind of on, they both see something appealing about it, and then they schedule it in, is a great thing.

Q:   The other thing I'm curious, you mentioned before, learning to make up. I feel like that’s something that is so important.

 A:   It’s so important.

 Q:   Don’t necessarily learn it.

A:   Nobody teaches you.

 Q:   Yeah. So what advice do you give about that?

A:   Well pride is one of the big things that gets in everybody’s way in relationships. When somebody refuses to make up, or they keep bearing a grudge, or they feel like they’ve been wronged so much that they can never get over it, it’s mostly their pride. And pride is a little bit the enemy of a good relationship, in that it makes people more silent. It makes them less likely to explain how they tick. It makes them get vindictive over time.

What often happens is, that a fight will seem to come out of nowhere. And it really was because one person accidentally hurt the other person’s feelings. Well, the other person doesn’t like admitting what hurt their feelings. So they attack on a new front. And this person who accidentally hurt the other person’s feelings has no idea why they're suddenly being attacked. And suddenly, the fight has a life of its own. And nobody knows why it happened.

And in order to understand these fights, the first person whose feelings were hurt that didn’t want to admit that their feelings were hurt, has to come clean. And it’s usually their pride that gets in the way of their explaining that. So that pride is a dangerous thing. And the more you can dampen it down, and turn it way, way down in a relationship, the better the relationship will be. 

But it’s a hard thing to give up. And, you know, when I talk about making up, I'm saying, I am so sorry that I was wrong when I said X. I didn’t mean to hurt your feelings. It was—might have been how I felt at that moment, but I certainly don’t feel that way most of the time. And thank you for telling me what it was that made you so mad.

 Q:  It’s hard—

A:   It doesn’t always work.

 Q:   I know. And I'm thinking, too, I've had those moments where, you know, it can be hard to admit your fault. And it can be hard to apologize. But then it can also be hard to accept it when you're so invested in being angry.

A:   I know. Anger has a whole life of its own. And it’s kind of hard to switch gears. But then, there are resets that everybody sort of knows, but they don’t quite admit. With something that we’re obsessing about, that hurt our darling little feelings, you know. The fact is, you could watch a good movie. You could watch a good movie that made you cry. You could have a good cry. You could, you know, go play with a dog, or go play with a child, or do all sorts of things that are such compelling activities, that you can't remember what you were so mad about. And that is exactly what you ought to do when you're sort of stuck being so mad. 

Usually, that kind of anger is terrible for you, and not so good for the other person. And you have to kind of figure out your own reset ways.

 Q:   Yeah, kind of someway to shake it out of your system almost.

A:   And sex isn't so bad, by the way, as our reset mechanism. It’s actually—You know, people always say, “Oh, makeup sex is terrible.” Well, it’s not. It’s one of the ways you can reset the relationship.

 Q:  And it’s like that connection piece.

 A:   Yeah.

Q:  How do these two areas of your work fit together, this thinking about loneliness and thinking about relationships? 

A:   I think everybody, now and again, even when they're in a relationship that’s judged by everyone else to be pretty good, feels horribly lonely. Because really, we’re all kind of alone. And there are some things you can't talk about. It’s not like when you're in love with somebody, or you're living with somebody over decades, that you can say every little thing that enters your mind.

So sometimes it is just objectively a little bit lonely. So first of all, it’s kind of important to realize that loneliness is part of all experience. There are going to be moments of loneliness, but it might be nothing to write home about. But, once you know that it’s part of everybody’s experience.

There are times where you're going to feel estranged from your partner. And that doesn’t mean it’s a disaster and it’s not working out. It means you have to work to reconnect and not let it go on too long. So in that sense, loneliness is very relevant, even when you're part of a relationship.

I think the other thing is that recognizing how much loneliness is a kind of medical hazard, that if you let it go on too long, it will actually shorten your life. It’ll make you more prone to heart attacks, and cancer, and various things. It means that it’s not something you should just keep to yourself as a kind of terrible secret. You should recognize that it’s something other people want to solve too. And just put yourself through the anxiety of trying to solve it.

 Q:   Great. Well, thank you so much, Jackie.

 A:   Thank you.

 Q:   It’s been a pleasure talking with you. Before you go, I have my final five questions. What rituals help you have a successful day?

A:   I love having a good breakfast. And I love reading the paper while I'm having my breakfast, and having at least 15-20 minutes to sit still. And I love having lunch. I guess these rituals are very closely connected. [laughter] I love having enough time to kind of catch my breath and have lunch and often a walk.

 Q:  If you weren't a doctor, what would you be?

A:   I think I might be a designer. I love designing things, and I like art. So I think that’s what I’d be.

Q:  What was your first job?

A:   My very first job, when I was 16, was at the University of Michigan. I was a coder for Sociology Department at the University of Michigan. And it was the world’s most boring job. But it was only a summer job, and I didn’t keep doing it.

 Q:   And didn’t go into sociology.

 A:   Right.

 Q:   Do you have any guilty pleasures?

A: Electric bicycles, because what’s great about electric bicycle, is when there's an incredible hill in front of you. And you think, “There's no chance I'm going to get up there without going apoplectic and dying” then you just push the little button. And the next thing you know, you're zipping in front of everyone else, and you feel like you're being pushed by a very gentle angel. [laughter] It’s really terrific.

Q:  What are you curious about right now?

A:   Well, I love reading. I've been reading about climate change. And I am very curious about whether anybody is going to come up with a really good way of solving it. So that’s one of the big directions of my curiosity.

Amy: Thank you so much for being here today, Jacqueline. It’s been wonderful talking with you.

Jacqueline: It’s been a pleasure talking with you.