Loneliness is a popular subject for songs and poems; you could probably name one sad love song that means something to you.

The reality of loneliness is more sinister. It has been described as an "invisible epidemic" that, when left unchecked, is believed to cause detrimental changes in one's mental and physical health. It affects people of all ages and backgrounds, from small towns to big cities.

There is a difference to being lonely for a few days while your family is out of town, and chronic loneliness where a person feels alone against the world. It often starts with an individual's ability, or lack thereof, to recognize the difference.

"The underlying element is self esteem, the lack of feeling good enough or strong enough, and that you should be able to do it on your own, and then you realize that nobody is around you," said Julie Canterbury of Quilcene, a licensed psychotherapist since 2012, now in private practice.

Her first professional experience was in the Jefferson Healthcare hospital emergency room in Port Townsend.

"I saw a lot of the suicidal people in the emergency room and it had a lot to do with loneliness," said Canterbury, a therapist now through Kitsap Mental Health. She noted that half the patients she saw through the ER had no previous mental health history.

WHEN TO ENGAGE

Loneliness is known to hit people of all age groups. It could be a childhood feeling that manifests itself later in life, or something caused by external factors. Psychosis is complicated and there is no blanket diagnosis, and no simple treatment or perfect prescription.

The change can be small and over an extended period of time that it doesn’t get noticed right away, said Craig Isenberg, a licensed therapist since 2011. Port Townsend Family Therapy is his private practice; he also provides therapy for Juvenile and Family Court Services as well as the state Department of Children and Family Services.

Not everyone is an extrovert, and some people simply prefer not to participate in large gatherings. Connections are important, however, and Isenberg would ask: Are you able to engage in activities that you need to in order to be successful in your life like attend school, hang out with friends, go to work, enjoy pleasurable activities, and periodically connect with friends and family?

“It's not a small thing if we are no longer able to attend to those functions,” Isenberg said. “Before these big obvious signs though, we might first feel the emotional impact of being disconnected with increased symptoms of anxiety or depression or perhaps more anger and irritability. Identifying those negative emotions for what they are is an important first step; are there actions that can be taken to promote more positive emotions, or do you need help?”

Isenberg said a helpful tool is to imagine all your problems solved, and how would that make you feel? What would you do? He suggested that professional therapy could help a client fill in the steps to achieve this preferred picture.

TIPPING POINT

A person can be years headed toward a major disconnect that could become a mental breakdown, or it could appear to develop suddenly. A person who tends to be withdrawn may be more susceptible to a disconnect because, Canterbury suggested, "There is no one to help reality check with them." Without a connection, someone to “bounce ideas or daily thoughts off of,” a person could be drawn into depression, anxiety, paranoia or become suicidal.

Each person has a limit; not everyone sees it coming.

"It's a perfect storm that can happen to an individual and they go past a certain point where they could have reached out but didn't or didn’t think they had access to support,” Canterbury said. "They try everything they can to cope and it creates a darker hole and they get lost.”

Indications of nearing a tipping point include not eating, not sleeping and self-medicating with alcohol and/or drugs. These behaviors may add to a person feeling disconnected and being withdrawn, and displaying a lack of trust.

“There is always a tipping point. If they don't get help before that tipping point, they may end up in a psychiatric hospital,” Canterbury said.

How could someone be lonely in a place like Port Townsend, or Quilcene or Port Ludlow, where there are so many friendly people, and opportunities to become involved with a club or project or volunteer effort? Unfortunately, it’s all too easy to be disconnected.

"There is a sense of knowing everybody but there is still a disconnect because everybody has their own lives," Canterbury said. "A person may not know if they should say anything about how they really feel, because that person doesn't want to seem like a burden to someone else."

SOCIAL MEDIA

Social media can help people form connections, but also add to one's personal despair. For someone with low self-esteem, rating your 65 Facebook "friends" while someone you know has 465 can be disarming. It may not be healthy to compare your situation with that of someone who posts photos from trips to Mexico and Las Vegas or seems to always be posing on a mountaintop.

“Facebook can be a great tool or a devastating handicap,” Isenberg said. “Facebook allows us to effortlessly join social clubs, connect with distant friends and relatives, and even get to know people that we otherwise may have never met. It can help bridge some of those typical more socially awkward barriers and bring community closer.

“On the destructive side, it can create a false sense that everyone is so much happier than you are. Many people present on social media how they want to come across to others but not necessarily an accurate picture of how they feel in the moment.”

Canterbury also observes that social media can help, and hurt. "On Facebook we show the glam of our lives, the best parts of our lives and we start to compare and that can reinforce feelings that we are alone, and really don't have a lot going on, or that we're not good enough to hang out.”

In terms of relationships, Isenberg has noted another downside of social media.

“A particularly relevant struggle I see with social media is the challenge of moving on after a breakup,” Isenberg said. “Often couples either remain in touch on social media or are still in touch with friends who are friends with the ex. Getting constant updates on your ex partner can make it really difficult to process the grief and move on.”

MAKING CONNECTIONS

If someone you know – either as a friend or just someone you see around – seem like they could use some help, give them a phone call – don’t text or email, personal contact is what’s needed. If there is no answer, leave a message, but call again.

It does not mean a call to ask prying questions. If you are the neighbor or acquaintance or a friend of someone you detect may be lonely, making a basic connection is OK.

It can be as simple as saying, “Hi,” and offering a smile.

“A small step may be engaging that person in an activity of common interest,” Isenberg said. “For someone wanting to engage more but not knowing how to take that next step might benefit from small changes. A walk on the beach with a friend is very different from joining a group of friends at a bar. Walking alone on the beach with a friendly dog can be a perfect excuse to make small talk with strangers.”

Likewise, if you feel a need to make a connection to combat loneliness, reaching out to a friend or relative does not mean you need to bare your soul.

"When you need help, you don't always need to say what's going on, you just need to say that you'd like to hang out and have some fun,” Canterbury suggested.

FINDING HELP

Recognizing a need to offset loneliness is a great first step. In Port Townsend and Jefferson County, it’s easy to find a volunteer opportunity.

“Volunteering can be a match for both the extrovert and introvert,” Isenberg noted. A multitude of clubs, groups, churches and nonprofits welcome newcomers.

“Even a shut-in can feel connected to community by not leaving their home," Isenberg noted. “Making a donation to a favorite nonprofit like Jumping Mouse or Dove House contributes to a sense of meaning and involvement even of your physical presence is limited.”

A therapy pet could be an answer for some, Canterbury said, or volunteering with an animal shelter.

Just like the sad songs that talk about taking things one step at a time, that’s good advice for confronting loneliness.

"An individual can make little tiny steps to connect” Canterbury said. “We think we have to make this giant step and share everything that is going on, but it's really a series of little steps. It can be done.”