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BMJ. 2007 April 21; 334(7598): 854.
PMCID: PMC1853186
From the Frontline

Home alone

Des Spence, general practitioner, Glasgow

My brothers and I shared a room throughout our childhood. Not just a room but clothes as well: we had a communal pants and socks drawer. It held family heirlooms of grey cotton and stretched elastic, others were psychedelic polyester, but darker forces were at work—the purple “pants” lurked menacingly at the bottom. My mother swore blind that they weren't girls “knickers,” but we knew she was lying. Crammed together in one room we fought, teased, wrestled, studied, and laughed together. When I first opened the door of my tiny cell in the university halls of residence I thought myself royalty. One week later I was miserable; I hated being alone.

I consider that there are lies, damn lies, statistics, and then surveys. But the Office for National Statistics' annual report on social trends, released this month, seems to have the ring of truth, for a change. Apparently when we aren't living with our parents into our 40s we are living alone. Some seven million people in the United Kingdom now live alone, and this number is set to rise. So what? Well, this atomisation of society is a ticking time bomb for healthcare provision.

Having spent a more than a decade doing a weekly shift of night-time home visits, I am very conscious of the vulnerability of people who live alone, especially elderly people. There may be no one to nurse them or watch over them. Distant relatives are unable to offer practical support. The phone rings at emergency social work support. There remains the last and lowest common denominator: acute medical receiving. A trolley, unnecessary investigations, and bed blocking; perhaps a hospital acquired infection thrown in for good measure. This is no good for anyone.

Others have family acting as advocates. Crushed against the wall, inflamed by their body heat—so starts the game of family tag wrestling. Round after round of verbal slapping downs and head locks from 15 concerned family members all impossibly squeezed into the consulting rooms. Draining tussles with families are our medical auditors, the quality control. Paid “carers” are simply no substitute for a family.

But also there is the broader issue of loneliness. Gnawing, it inflames introspection, distorts perspective, and leads to deep unhappiness. Television and the media offer false companionship—a selfish acquaintance selling a one way mirror into someone else's life. I want to write a formal complaint about Margaret Thatcher's mis-selling of the “culture of the individual.” Nobody seems to have read the small print about the disintegration of community, and I fear that it is too late for compensation. I may not want to wear other people's underwear, but I will certainly never want to live alone.


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