Loneliness among older people as a social

problem: the perspectives of medicine, religion

and economy

Werner Schirmer and Dimitris Michailakis

Journal Article

N.B.: When citing this work, cite the original article.

Original Publication:
Werner Schirmer and Dimitris Michailakis, Loneliness among older people as a social
problem: the perspectives of medicine, religion and economy, Ageing & Society, 2016.
36(8), pp.1559-1579.
http://dx.doi.org/10.1017/S0144686X15000999
Copyright: Cambridge University Press (CUP): HSS Journals
http://www.cambridge.org/uk/

Postprint available at: Linköping University Electronic Press

http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-131665
 Loneliness among the elderly as a social problem:

The perspectives of medicine, religion and economy

By Werner Schirmer & Dimitris Michailakis

Please cite as “Schirmer, Werner; Michailakis, Dimitris (2016). Loneliness

among the elderly as a social problem: The perspectives of medicine, religion
and economy. Ageing & Society, Vol. 36 Issue 8, p1559-1579”

Abstract

This article offers a theoretical framework for studying loneliness among the elderly from a

social problems perspective. The framework is a combination of the constructionist approach

to social problems by Spector and Kitsuse and the theory of social systems by Luhmann. With

the first we understand the social problem of loneliness among the elderly as the result of

claims-making activities by different key actors. These activities are guided by cultural

themes, images and causality constructions. With the second, we can explain how these

claims-making activities are framed differently within different social systems. Due to their

distinctive viewpoints social systems construct loneliness among the elderly in unique ways.

Variations of meaning attributed to loneliness depend on the operative logic and the semantic

stock of the respective social system. The argument of the article is illustrated with respect to

three different social systems: medicine, religion and economy. In terms of underlying

morality, causes and consequences, responsibilities and solutions loneliness among the elderly

appears as something different from each of these perspectives: as a matter of health and

illness, as a matter of spirituality, and a matter of incentives and commodities, respectively.

The value added of combining constructionism and systems theory for research on elderly and

loneliness is to give justice to the non-objective, observer-dependent nature of social

problems. The relevance for both researchers and practitioners working with loneliness

1
among the elderly on a policy-level is the increase of awareness of the multiperspectivity

behind constructions of social problems. The failure of current intervention methods against

loneliness is, at least partially, due to the lack of knowledge about the variation of (potentially

contradictory) problem definitions of loneliness among the elderly. Ignoring this variation has

practical consequences for the efficiency of possible measures against the social problem of

loneliness.

Keywords

constructionism, economy, elderly, loneliness, medicine, religion, social problem, systems

theory

Introduction

This article proposes to study loneliness among elderly people from a social problems

perspective. Such a perspective understands social problems such as loneliness among elderly

people as the result of claims-making activities which are guided by representations, concepts

and images. Images of loneliness are produced within communicative contexts, and

depending on context and perspective, these images differ.

Prevalence of loneliness among old people has been reported in many Western

countries (Golden et al. 2009, Nyqvist et al. 2013, Tiikkainen and Heikkinen 2005, Victor,

Burholt and Martin 2012). Loneliness is said to be problematic, first and foremost, because it

increases their risk to mental and physical illness (Hawkley and Cacioppo 2007). Loneliness

of elderly also puts pressure on their relatives. It burdens both the healthcare sector and the

welfare services. On a societal level, loneliness among the elderly questions the strength of a

society's value system and its sense for solidarity(Durkheim 2012[1893]).

Existing research on loneliness among the elderly mostly focuses on psychological

and medical causes and on the consequences that loneliness has at the individual level. Based

2
on a frequently used definition by Weiss (1973), many authors (Dahlberg and Mc Kee 2013,

Liu and Rook 2013, Pettigrew and Roberts 2008, van Baarsen et al. 2001, Victor, Grenade

and Boldy 2005) regard loneliness as a two-dimensional phenomenon: emotional loneliness

(felt, perceived loneliness) and loneliness as social isolation, i.e. the feeling of having a too

narrow social network. In both cases, loneliness is primarily seen as an individual experience,

more a psychological problem than a social one. Typically, researchers are interested in why

some individuals suffer from the experience of loneliness while others do not, and how lonely

people suffer from it both emotionally and physically.

Roughly speaking, the findings in the literature can be divided into two main groups.

The first one covers causes of loneliness, understood both as emotion and social isolation.

Among the most important determinants researchers have found are loss of partner (Jylhä

2004, Victor et al. 2005), living alone (Nyqvist, Cattan, Andersson, Forsman and Gustafson

2013), lack of friends and social network (Peplau and Perlman 1982), ill health (Hawkley and

Cacioppo 2007), handicap, both own or partner's (Alma et al. 2011, Korporaal, Broese van

Groenou and van Tilburg 2008) as well as having an ethnic minority background (Victor,

Burholt and Martin 2012).

In the other group of research findings, consequences of loneliness for the mental and

physical wellbeing, and more generally, quality of life (Dykstra 2009) are highlighted. It has

been shown many times that involuntary loneliness has negative effects on individuals'

wellbeing. The most common effect is depression (Golden, Conroy, Bruce, Denihan, Greene,

Kirby and Lawlor 2009, O'Luanaigh and Lawlor 2008), quite frequently leading to suicide

ideation, particularly after the loss of a spouse (Eriksson and Svedlund 2007, O'Luanaigh and

Lawlor 2008) but also a number of physical illnesses such as high blood pressure,

cardiovascular illnesses, decreased cognitive functions and limited immune system have been

singled out in research to be the resultants of loneliness (Cacioppo, Hawkley and Berntson

2003, Hawkley and Cacioppo 2007).

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 In sum, the bulk of research on loneliness among the elderly has a clear focus on

psychology or medicine. However, to our knowledge there is a lack of studies from a social

problems perspective, i.e. a perspective that discusses how loneliness among the elderly is

framed and communicated by various actors and in a variety of forums as a social problem.

The classical literature on social problems has been dominated by the functionalist approach

(Merton and Nisbet 1971), the value-conflict approach (Fuller and Myers 1941) and some

variations of Marxist-inspired and critical conflict theories (Feagin 1986, Mills 1959). Despite

obvious differences concerning theory architecture and conception of society, these

approaches agree insofar as they consider social problems as objective conditions that are

somehow at odds with central societal values (how things ought to be), have adverse effects

for (parts of) the population or society as a whole, and can be alleviated by therapeutic or

political interventions. Moreover, there is agreement that problems are social insofar as they

are assumed to have social causes and/or social effects, and consequently there must be social

solutions. Much of the contemporary literature shares this understanding (Alessio 2011, Dello

Buono 2013, Glynn, Hohm and Stewart 1996, Horton et al. 1997).

With a "social problems perspective", however, we do not simply mean to assert that

loneliness among the elderly is a social problem, i.e., that it needs to be understood as an

objective condition with social causes and/or consequences. Drawing on the constructionist

approach in the social problems literature (Best and Harris 2012, Loseke 2003, Spector and

Kitsuse 1987 [1977]), we argue that there is always a "subjective nature of social problems",

as Best (1995: 4) put it. Social problems are what particular key actors, so-called "claims-

makers" (Spector and Kitsuse 1987 [1977]) view as social problems. Claims-makers construct

particular (putative) social conditions as problematic, violating widely shared values, harming

particular groups of people, and in need of remedy.

Approaching loneliness among the elderly from a social problems perspective, then,

means to study how the phenomenon is discovered, framed, judged, discussed, problematized

4
and tackled by different key observers in society. The understanding of loneliness as a social

problem always involves an empirical observer (i.e. an observer that itself can be observed) –

using some standards in order to verify loneliness. Due to differentials in various observers'

social positions and functions they fulfil, one can expect a variety of different images of

loneliness among the elderly as a social problem.

Furthermore, in order to study loneliness among the elderly from a social problems

perspective, we argue that the constructionist approach as such is not sufficient and should be

complemented with a theory of society. We suggest the theory of social systems by Niklas

Luhmann (Luhmann 1995, Luhmann 2012, Luhmann 2013) which explains how different

social systems – due to their distinctive viewpoints – construct objects within their range of

observation differently. Regarding the study of social problems this view is highly relevant

and adequate because it gives a theoretical account for the variations in how and why different

key actors construct "loneliness as a social problem". In the next section this theory and the

constructionist perspective will be explained in more detail.

A basic assumption for this article which follows from these frameworks is that there

is not a single and for all actors same problem definition of loneliness among the elderly;

instead there is a big variation of problem definitions. Despite the fact that such an approach

is missing in the literature on loneliness among the elderly, there are some articles that either

take up stances (at least partially) compatible with our proposed framework or present

findings that are supportive of it. Some authors argue against the dominance of quantitative

research in the literature that treats loneliness "in terms of linear and cause-effect relationships

and prescriptive interventions" (Karnick 2005: 11), criticizing that loneliness mostly is

regarded as a pathological or deficit condition (Graneheim and Lundman 2010, Rosedale

2007, Victor, Scambler and Bond 2009); they suggest the discussion of alternative notions of

loneliness, drawing on Frankl's psychology and philosophy where loneliness is also seen as a

phase of personal discovery and growth (Karnick 2005). In a similar vein, there are

5
phenomenological studies of loneliness among the elderly examining "variations of lived

experiences of loneliness" (Dahlberg 2007, Graneheim and Lundman 2010, Long et al. 2003).

Furthermore the qualitative interview study be Stanley et al. (2010) needs to be mentioned

because it not only accounts for variation among older adults' experiences of loneliness, it

also introduces what systems-theorists call "multiperspectivity" as they show differences

between the descriptions made by the elderly themselves and care personnel. The study that

comes closest to what we here call a social problems perspective is the one by Uotila,

Lumme-Sandt and Saarenheimo (2010), who explicitly analyse "loneliness among the

elderly" as a social construction. Although not drawing on the constructionist approach by

Spector & Kitsuse etc., they emphasize how constructions of elderly persons' loneliness as a

social problem are contingent on the social and cultural contexts, and how these constructions

vary in terms of meanings, causes, and consequences (Uotila, Lumme-Sandt and Saarenheimo

2010: 109). Their focus is on mass media, treated rather as a forum for different societal

actors (and commentators), than as a constructor in its own right (Luhmann 2000b). In our

view, this leads them to emphasize too much the "themes" with which loneliness is connected,

rather than analysing in a systematic manner which social actors rather tended to what

problem definition of loneliness among the elderly. However, we agree with them that:

"it is important to know more about the construction of loneliness and identify all dimensions which are

attached to it in our society. When loneliness in better understood and conceptualised, it would be also

easier to build effective programmes aimed to relieving loneliness" (Uotila, Lumme-Sandt and

Saarenheimo 2010: 124).

The insight from all of this research for a constructionist approach is not whether loneliness is

a negative or positive experience but that there is variation in meaning and evaluation,

particularly when taking different observer's points of view into account. This is less trivial

than the assumption that there is wide variety of definitions, operationalization and

measurements scales (such as the "de Jong Gierveld-scale and the UCLA-scale) as it points to

the core structural characteristic of modern society. In our understanding modern society is
6
horizontally differentiated in function systems; this implies that society has neither a top nor a

centre from which universally valid and binding descriptions of whatsoever phenomenon

could be provided.

In this article we want to provide a theoretical framework for the empirical study of

how different social actors (observing systems, in Luhmann's terminology) construct

loneliness among the elderly as a negative social condition that harms a certain amount of

people, is at odds with widely shared societal values and requires socio-political counter-

measures. On the basis of their different social positions and functions, interests and

performances, it is reasonable to assume that different social actors understand and frame

loneliness among the elderly as a social problem in differential ways regarding causes,

consequences and solutions. As this article is of a theoretical nature, we offer empirical

material only for the sake of illustrating our argument. We will discuss the views from three

different societal function systems: medicine, religion and economy. As many observers point

out there are tangible negative effects of loneliness on the physical and mental wellbeing –

and given the frequent references to health issues in research of all disciplines – it seems

reasonable to take the medical point of view as a starting point. This perspective we want to

contrast with constructions made from two other perspectives that at first sight seem less

relevant (at least in the research literature) but have important tasks in society as a whole, and

come to completely different views on loneliness among the elderly in terms of meanings,

causes, consequences and solutions. These are the perspectives of economy and that of

religion.

The article is structured as follows: Section 2 provides a detailed presentation of the

theoretical framework. First, we elaborate on the constructionist approach in social problems

theory; second, we introduce Luhmann's conceptualization of modern society being

functionally differentiated in autonomous social systems; and third, we briefly discuss some

implications of combining constructionism with Luhmann's theory of society. Section 3

7
presents the viewpoints of the social systems medicine, religion and economy according to the

Luhmannian theory and shows how this can be a starting point for the analysis of variations in

the problem definitions of different observers regarding old people's loneliness. This section

makes use of illustrations from empirical data. The concluding section discusses the benefits

of the proposed framework to study loneliness among the elderly from a social problems

perspective and its implications for research.

2 A social problems perspective: Constructionism and systems

theory

Constructionism on social problems

Despite their disagreements most constructionists endorse the proposition that the world

cannot be experienced directly, and independent of an observer. Every observation implies

selection and interpretation; observations do not represent but construct reality. Based on

these assumptions the constructionist approach to social problems considers itself as a direct

response to objectivist theories of social problems such as functionalism or critical theory as

well as to positivist mainstream research on social problems. Constructionists argue that the

latter often uses common-sense notions of social problems (Best 1995) when studying issues

such as inequality, racism, homelessness, substance abuse, etc. Such notions start with the

taken-for-granted assumption that there are objectively determinable social conditions which

are somehow harmful to a specific group of people, that these conditions are somehow

adverse and that they should be countered. The three mentioned approaches vary with respect

to the justification of combating adverse social conditions, i.e. they differ from each other at

the normative level. Thus, depending on the applied framework, social problems should be

tackled either because they are a) harmful to society and social order (functionalism), b)

injustices to the benefit of ruling classes (critical theories) or c) generally morally undesirable

8
(mainstream). Objectivist approaches treat social problems as facts, thus they embark on

measuring the magnitude of the problematic conditions as well as the determinants and

consequences of these conditions.

By contrast, constructionism points out inherent methodological problems with any

attempt to define a social problem in objective terms (see Spector and Kitsuse 1987 [1977]:

31ff). While there exists a large amount of potentially harmful conditions in society, only a

limited number of these are given the status of social problems. Researchers need to ask under

what circumstances some conditions receive the status of social problems while others do not.

Constructionism therefore departs by asking how and by who is determined what counts as an

adverse objective condition i.e. as a potential social problem. Constructivists argue that there

are always interpretations and subjective evaluations involved which preclude a neutral,

merely factual understanding of social problems (Best and Harris 2012). Objectivist

approaches have difficulties in accounting for the normative standards from which

problematic conditions deviate. One might question whose standards; based on which values;

how are the harmed groups delimited; how is harm defined, etc.? While it is possible to give

determined answers to these questions, it is impossible to do so in a universally valid way.

Not only have certain conditions received or lost their status of a social problem in the course

of time (Spector and Kitsuse 1987 [1977]) or the meanings of conditions have changed. There

is, furthermore, "no necessary relationship between the measurable characteristics of any

given condition or the people in it and a definition of that condition as troublesome" (Loseke

2003: 9). Most important for the argument of this article is the circumstance that different

people, groups, and social systems (e.g. politics, science, or medicine) might make different

judgments on what counts as a problem. Against this background, constructionists give up the

idea of looking for objective conditions of social problems.

As a consequence constructionists argue that for social problems to exist socially,

people first need to recognize and define them as such and help the definition to enjoy

9
widespread recognition (Best and Harris 2012, Loseke 2003, Spector and Kitsuse 1987

[1977]). As Loseke puts it: "Conditions might exist, people might be hurt by them, but

conditions are not social problems until humans categorize them as troublesome and in need

of repair" (Loseke 2003: 14). Therefore, constructionists focus on the social activities that

render any (putative) social condition into a social problem in the first place. Spector and

Kitsuse, the "founding fathers" of this approach, speak of social problems as the result of

"claims-making activities" (Spector and Kitsuse 1987 [1977]: 75f). Claims-makers – for

instance movements, professional associations, interest groups – point out putative social

conditions as violating ethical standards or other shared values, concern or harm certain

groups, and require counter-measures. As a rule, there are several claims-makers competing

with each other for interpretative primacy and scarce attention of audiences (supporters as

well as policy-makers).

One key insight of constructionism is that different claims-makers typify social

problems differently. Not only do they use different arenas, different strategies and rhetoric to

persuade their audiences (Best 1995: 350). More importantly, claims-making activities vary

along four dimensions or parameters. First, constructions of social problems vary in terms of

the causes and conditions: what is portrayed as wrong/bad, what is part of the problem, what

is excluded, what are the deemed causes of the condition? Second, problem constructions

address cultural themes, i.e. conditions violating widely shared values. The variable here is

the underlying morality within which the putative condition appears as a reason for

indignation. Third, claims-makers vary in their construction of people as victims and villains.

Victims are those who suffer unfairly from the condition, are not responsible and deserve

sympathy. Villains deserve condemnation, as they are held responsible for the condition;

these do not need to be persons but can also be institutions, social structures or social forces.

Fourth, problem constructions vary in terms of the proposed or demanded solutions, thus a

line of action based on parameters 1 and 2 (underlying causal schemes and moralities) which

10
legitimizes certain solutions (while excluding others) and which holds certain people or

organizations responsible for providing these solutions.

Theory of social systems

Luhmann's theory is a very complex framework comprising several building blocks such as

theory of communication, general theory of social systems, theories of interaction systems,

organizations, and not least, a theory of modern society. The latter is of particular interest for

our argument, despite the fact that it consists of various building blocks (evolution,

differentiation, communication, self-descriptions; for an overview see Lee 2000). Most

important here is Luhmann's analysis of modern society as the differentiated unity of major

social systems. Examples are the systems of politics, law, economy, science, religion,

education, medicine, mass media, families, etc. Because each of them fulfils a unique and

necessary function for society as whole Luhmann (2013) calls them function systems. The

term function refers to the circumstance that these systems provide solutions to particular

reference-problems (Bezugsprobleme). For example, science solves the problem of providing

reliable knowledge to society; politics the problem of taking decisions that are collectively

binding and enforcing them, economy the problem of allocating scarce resources, law the

problem of stabilizing mutually conflicting expectations, etc. A paramount characteristic of

function systems is that their operations centre on the fulfilment of their function, thereby

observing and interpreting everything that falls into their field of vision in a particular,

function-specific way. For example, the legal system observes any social event in terms of its

conformity or violation to currently valid laws; from the viewpoint of the legal system, any

event, be it a simple everyday action, a business trade, or a scientific study, is rendered into a

matter of legality/illegality: are laws violated, contracts breached, frauds committed?

Likewise, from the perspective of science, the everyday action, the trade, and the study

become a potential research object accessible with theories and methods. Similar statements

11
apply to the other function systems (Section 3 will deal more extensively with the three

function systems medicine, religion and economy).

In this regard, the perspectives of function systems are total but not universal: they can

deal with any social event or thing, but there is always a multiplicity of other perspectives

available from which the very same thing/event appears differently. As Luhmann argues, this

multiplicity of function-system perspectives constitutes the structure of modern society which

Luhmann describes as functional differentiation: a horizontal structure of coequal social

systems within which none is more or less important, dominant or central than the others. In

other words, modern society lacks both a centre and a top that pre-modern stratified societies

had.

The consequences of this analysis of modern society for our purposes of studying the

loneliness among elderly people, as a social problem is obvious: there is no privileged

position/social system that can define in a manner universally valid and binding for everybody

how loneliness among the elderly is supposed to be understood. Not politics, not medicine,

not science, nor any other system can do so because the same reference object is constituted,

i.e. constructed differently contingent of the observing perspective.

Combing constructionism and systems theory

The constructionist approach to social problems helps us shifting the focus from (whatever)

objective conditions of social problems toward the communicative activities of social actors

that aim to point out putative social conditions as violations of the normative order, and in

need of alleviation. Especially in regard to the four parameters of conditions/causality,

cultural themes (moralities), people (victims/villains), and solutions, the constructionist

approach provides a framework for the empirical study of social problems. However, it lacks

a theory of society that can explain on the societal level why some actors construct social

problems in particular ways while other actors construct them in different ways. What are the

12
societal prerequisites for these different constructions? Following Luhmann's theory of

functionally differentiated society, we assume a society that consists of a multiplicity of

observing systems, each equipped with a distinctive perspective. In that way, we can give

accounts for the social locus of particular claims-makers contingent on function-systemic

background from which they raise their claims. As we will illustrate in the next section with

the perspectives from medicine, religion and economy, the problem constructions of

loneliness among the elderly will differ not only in terms of the four parameters provided by

constructionism but also in line with function-systemic perspectives. We argue that the

combination of the constructionist approach and Luhmann's systems theory leads to a fruitful

framework to study variations in claims-making on loneliness among the elderly as a social

problem and at the same time give structural explanations on why certain claims-makers

frame the conditions, causes, solutions and involved people in the way they do. Combining

the two approaches into one framework helps us to see that each of the involved key actors

(claims-makers) represents speaker roles of particular social systems (AUTHOR; AUTHOR).

Each of them has a genuine observational perspective, rationality and interest to have the

social problem defined in a certain manner.

3 Three perspectives on loneliness among the elderly

In this section we illustrate our argument with three systematically different views on older

people's loneliness as a social problem, namely the function-systems perspective of medicine,

religion and economy. Each subsection begins with a short description of Luhmann's theory

of the respective system, then proceeds to develop the argument by providing excerpts from

our empirical data (documents and in-depth interviews), and ends with an analysis of the

excerpts from the proposed social problems perspective. The presented empirical examples

have the purpose of illustration. They were chosen because they demonstrated the different

function-systemic logics in a more ideal-typical way than most claims-making texts.

13
Researcher need to be aware that the applied logics are not always as straight forward so more

in-depth text analysis will be necessary for excavating the underlying rationalities when

examining how loneliness among the elderly is constructed as a social problem.

Medicine

It seems reasonable to us to start with the viewpoint of medicine, because many contemporary

problem descriptions of loneliness mention the latter's association with health issues. From a

Luhmannian view, the system of medicine reproduces itself by means of communications

related to health and illness (Luhmann 2005). In contrast to other systems which include

persons as citizens, pupils, buyers, etc. into their systemic operations, medical communication

addresses persons as patients. Therefore, they mostly become relevant as bodies (Saake 2003),

and only insofar as their condition is judged as a pathological deviation from predefined states

(defined as health) on bio-physiological and/or behavioural-psychological levels. The main

focus of medical observations is on the individual (with the exception of epidemiology) but it

becomes a matter for the collective level when non-medical (e.g. political, financial, legal)

constraints hamper the execution of medical operations (such as in the case of healthcare

priority setting; Schirmer & Michailakis, 2011), or when the occurrence of illnesses is

attributed to social causes and future illness needs be prevented. Particularly in the latter cases

can be a matter for social problems construction. We can expect that social problems

constructed within the context of the medical system have a clear reference to illness, be it

illness as an effect of social causes, illness as cause of social problems or problems or

restrictions of the medical system due to societal causes. The following excerpt, taken from a

blog posted by medical doctor, illustrates how loneliness among the elderly is framed as a

social problem from the medical perspective:

Excerpt 1

14
Nearly 1 in 7 American adults are living alone and this isolation may provide additional stressors such as

depression, anxiety and additional economic pressures. These stressors certainly may contribute to

cardiovascular events in susceptible patients. Moreover, social isolation has been associated with changes in

health behavior and access to care among patients. Patients who live alone may be less likely to seek care for

recurrent symptoms and may not be compliant with drug therapy or other medical recommendations without

support. […] Our patients today are sicker and have more limited resources. Financial pressures are forcing

physicians to tackle larger clinic schedules with overall increased workload demands. But, as providers of health

care, we must assess social isolation and loneliness in our patients. We must identify “at risk” patients and make

attempts at intervention. Since these studies suggest that living alone is an independent prognostic factor for

mortality and CV disease, clinicians must work to counsel their patients about seeking appropriate medical

attention when needed and, in appropriate cases, refer patients to programs with psychological intervention.

Many of these patients have no families, no adult children and no support group. In these cases, we must do our

best to fill in the gaps (yes, all in a busy office full of patients). Healthcare costs in the US continue to skyrocket

and there are no easy fixes in the works. I believe that a simple, although potentially time consuming,

intervention such as talking with lonely and socially isolated patients when they are in the office for a visit, is a

low cost preventative measure. By taking time to hold a lonely patient’s hand, we may potentially make a

positive impact. Data such as those presented in the Archives this month certainly point out the risks of

loneliness and suggest that patients without social support in place do very poorly and develop significant

cardiovascular illness.

(Loneliness and The Elderly: Dying of a Broken Heart, Posted by Dr. Kevin Campbell

http://ncheartvascular.com/loneliness-and-the-elderly-dying-of-a-broken-heart/

As explained earlier, social problems refer to conditions that violate core social values, have a

defined group of victims suffering from certain conditions and possible solutions to remedy

these conditions. Typically for a perspective from the function system medicine, the problem

is constructed as a matter of health and illness. Accordingly, lonely elderly are portrayed as

victims of the condition, but particularly in terms of the negative effects for their health. To be

precise, at the core of the problem are the negative medical consequences. The societal value

at stake is the right to be healthy and free from harm. Typically for claims-making in order to

15
amplify its case, the text establishes a clear-cut causality by drawing on research data which

suggests that lonely people suffer not only from loneliness itself and the direct detrimental

consequences for their health (especially cardiovascular illness) but they adopt lifestyles that

are more prone to ill health. In terms of solutions, the causality is straightforward: Loneliness

needs to receive medical attention; if the problem is untreated, lonely people will suffer from

diseases or die. Accordingly, this claims-making addresses the medical profession as target

group who is portrayed as the responsible force to provide solutions and fight the

consequences of loneliness, respectively. The proposed solutions are typically in line with the

tasks of the medical profession, namely the identification of at-risk persons, counselling and

medical treatment where appropriate.

Religion

From a modern, rational and secular point of view, religion might have lost the powerful

position as the central instance of legitimation, social integration, and solidarity that it had

until the end of the middle-ages in Europe. However given the millions of people who are

members of religious associations or believe in supra-natural powers, and the role that

religious congregations play in civil-societal movements, it would be premature to lose

religious viewpoints out of sight when studying social problems. In the course of sociocultural

modernization and rationalization and the shift to functional differentiation as the primary

structure of society, the descriptions of other newly autonomous function systems (in

particular science, politics, economy and arts) had started to challenge the religious monopoly

of explaining and justifying the world. During this process of mutual competition and

struggles over meanings, the societal function of religion also sharpened, maintaining the

primacy of distinct view on the world that no other function system can offer: the relation

between immanence and transcendence (Luhmann 1977). This relation refers to inherent

paradoxes of modern society to which religion offers answers: explanations of the

16
unexplainable, observations of the unobservable, definitions of the indefinite, the meaning

behind the seemingly meaningless, and the meaning behind meaningfulness. Therefore the

religious system is more ambiguous and nebulous than other function systems (Beyer 1998:

98). Central in all religious communication is the reference to something beyond, something

transcendent, be this a God, a spirit, a force, the sacred. This "something" beyond is definite,

and only therefore is the source of all meaning in an indeterminate immanent world

(Laermans and Verschraegen 2001). Things and events in the immanent world acquire a

religious meaning when viewed from transcendence (Luhmann 2000a), that is, from an

external observer that can observe the entity as entity, just something that is not possible from

an immanent, this-worldly perspective. As for loneliness among the elderly, we can expect

religious viewpoints constructing it as problem of the relation between immanence and

transcendence as well as searching interpretations, guidelines, explanations and solutions in

light of transcendental forces. The excerpt below shows a religious view on loneliness as a

social problem.

Excerpt 2

Yet for others longing to be with brethren, the lack of handshakes and fellowship can take its toll, sowing the

seeds of loneliness. When allowed to germinate, these seeds can sprout into feelings of discouragement, and will

eventually mature into a state of despondency. […] This becomes a fertile field for Satan to sow seeds of doubt

and a perfect climate for his negative influence. Satan preys on the lonely, who are perhaps his easiest victims.

You can be sure he will take every opportunity to heap on more negative thoughts until he has the person so

“down in the dumps” that he or she will want to quit altogether. This is at least a part of the reason God intended

we all have Christian fellowship. […] We must realize that although human fellowship is important in combating

loneliness, it is not the most important. The apostle John wrote, “That which we have seen and heard we declare

to you, that you also may have fellowship with us” (I John 1:3). John wanted the brethren to have fellowship

with one another, but notice the primary stress: “And truly our fellowship is with the Father and with His Son

Jesus Christ.” Without contact with God, you might have friendships, but not true Christian fellowship. Our

spiritual closeness with God guarantees that our contact with each other will be profitable and edifying. No

human or group of humans can substitute for contact with God. Many of us might like to see our needs met by

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other humans from what is termed “the human connection.” But the human connection is not enough. Simply

stated, we cannot and will not be close to each other as members of the Body of Christ unless we are first close

to God! As we draw closer to Him, we will inevitably draw closer to each other. Conversely, when we drift away

from God we will find ourselves forsaking each other. Recognize that our first line of defense against loneliness

and every other negative emotion is our personal contact with our Creator. Fellowship with God is the best kind

there is.

http://rcg.org/pillar/0801pp-btsol.html

This excerpt is taken from a Christian blog discussing loneliness and the way out of it. In a

passage not in the above excerpt, the text mentions a couple of social causes to loneliness,

such as changes in family structures, values and lack of intergenerational contacts, as well as

medical and bio-psychological causes. While acknowledging mainstream views on loneliness

as a social problem, the text is interesting for our purpose insofar as there is a genuinely

religious way of addressing consequences of loneliness and solutions to it. Loneliness is said

to put people at risk for influence by the Devil. Depression and suicide are presented as the

work of the Devil pushing “dark thoughts” on the lonely. The proposed solution to loneliness

is then seemingly simple: a Christian fellowship, which is a community with God, protects

against the dark thoughts lonely people get implanted by the Devil. A community with God

not only dissolves the individual experience of loneliness but at the same time, albeit more

implicit, also wipes out loneliness as a social problem: if people are more inclined to find a

way to God, they will find a way to each other. The underlying causal logic is like this:

although loneliness can be triggered by different (social, medical, etc.) factors, the cause of it

is lack of contact with God. Accordingly, contact with God is the supreme action plan to get

out the misery because it will enable contact to other human beings as a consequence.

The perspective on loneliness in this excerpt makes only sense in a religious contexture, i.e. a

social system for which the distinction between the immanent, this-worldly realm and the

transcendent realm where entities such as God and the Devil prevail is central. The latter exert

18
forces beyond human control and understanding, and, one of them, the evil one, can only be

countered by submitted to the other, i.e. the good one. Therefore, the community with God

(with God one is never lonely) is seen as superior to this-worldly human fellowship.

Economy

With the exception of the protestant ethic pointed out by Weber (2009[1904]), religions

always had a problem with economics as an end in itself. In this regard, the perspective of the

economic system can be understood as a counter-view to religion which can focus on the sin-

free accumulation of wealth in an immanent world without any regard to transcendence.

For the economic perspective the world appears as a space full with commodities to be bought

and sold at the right price. People, things and events become relevant in terms of investments,

profits and losses, gains and costs. The societal function of the economic system is the

provision and allocation of future resources under the conditions of scarcity, and this is

accomplished with a differentiated self-referential system of exchanges based on money

(Luhmann 1988). We can expect that loneliness among the elderly is portrayed as a matter of

costs, particularly for the public sector, but also as a market for businesses.

Excerpt 3

Perhaps it’s time to review our obsession with keeping older people “independent” and our fetish about “keeping

people in their own homes”. Now don’t get me wrong, I am not recommending a return to the era of asylums for

people who can’t cope on their own. Nor should anyone who wishes to remain independent and on their own be

prevented from doing exactly that, if it suits them. […] What I am saying is that, as a society, we have insisted

that everyone should have a little box to call their own, be they a young single mother, a professional so-called

“first-time buyer”, and even vulnerable or elderly members of our society whose needs are met by “care in the

community”. We ensure that these people have a roof over their head and their physical needs are met, but we

seem to be missing out on the better quality of life that having a shared living space can bring for those who

want or need it. […] A start would be a reform of the taxes […] that affect families when two generations live

together. At present, if an older person sells their home and gives the money to a younger family member so that

19
the two generations can buy a home together, there may be either inheritance tax implications under the “gift

with reservation of benefit” rules or an income tax liability under pre-owned assets rules or both, depending on

the arrangement. The reason is that the older person who makes the gift is treated as if they haven’t given the

money away, because they are still enjoying the proceeds of a purchase made with it. Similarly, an older person

cannot give away their home tax-free to a son or daughter who moves in with them to care for them, because in

this case they continue to live in the house alongside them, benefiting from the asset that they have intended to

give away. This must be a huge disincentive to the generations living together. Why would you want to give up

your own home to move in with Granny, only to find yourself hit with a bill for inheritance tax when Granny

passes away, potentially leaving you homeless if you now need to sell the house you live in to pay the bill?

https://www.saga.co.uk/money/experts/could-inheritance-tax-reform-help-combat-loneliness.aspx?pid=mn

Excerpt 4

Many seniors would like to have a partner of their hearts who provides emotional support. Being old does not

necessarily mean loneliness. Dating for 50plussers can mean that you meet people who lead their lives actively

and open-mindedly. Your career is on its climax. Alone, sports, culture, travelling are of course only half the fun.

The familiarity of partnership and the talking are missing – the joint experience makes our life richer and nicer.

[…] Loneliness verifiably shortens the life. Those who live in a steady relationship live longer. Love makes our

life simultaneously richer and simpler, as science confirms. Successful couples are strong teams that can counter

the adversities of life. Grant yourself this attitude to life! Together against the rest of the world is a goal which

you can achieve with our First Partner Forum for Seniors.

https://www.partnerforum-fuer-senioren.de/vorteile.aspx

Excerpt 3 starts out as a critique of current society which is said to put pressure on people to

live their own while disregarding the loss of life quality that goes along. Elderly's loneliness

needs to be seen in this context. In this example of claims-making it is clearly seen as a social

problem, and it is an undesired outcome of wrong incentives posed by faulty tax rules.

Because with the tax system families get financially punished when elder parents sell their

house and bequeath or present their children with the revenue, it seems more rational to let the

elderly keep their own home and lead separate households. The result is lonely elders. In other

20
words, loneliness is a consequence of families saving money; it can be combated with a

revised tax system that promises higher payoff when moving together. Loneliness among the

elderly is framed in terms of economic causes and economic solutions and as an outcome of

people living in economically rational ways. The addressee of the claim, however, is the

government which is institutionally responsible for changes in tax laws.

Considering excerpt 4 as an example of claims-making in terms of social problems might

seem a bit odd at first sight because it is actually an advert text of a dating agency for people

beyond 50. However, advert texts work in way structurally very similar to claims-making:

pointing out a problem in need of remedy, make use of science to increase respectability,

using simplified causalities and exaggerations as well as call for actions and solutions. The

difference is (similar to political claims-making, see Michailakis & Schirmer 2014, Schirmer

2008), that the authors portray themselves as the solution to the problem, and the claim to

action is directed to the reader. Although economic concepts and words (such as costs, price,

market) are completely absent in the excerpt, the logic is clearly an economical one. The offer

would not make sense without the logic of demand and supply, commodities, customers with

needs and suppliers selling the commodity. The customer is the lonely elderly, if not already

suffering from loneliness then attempted to be convinced by the advert that his/her life could

be so much better, thereby amplifying the need. Naturally, the agency is the supplier of the

commodity fulfilling this need, while the unquestionable fact that the customer has to pay for

the supply is kept tacit. This kind of text is claims-making because of its clear causality and

demand for action. In contrast to much of other social problems claims-making, the addressee

is not the welfare state but of course the customer who has to do something. The message to

the lonely person is clear: all you have to do is join us, and we will provide you with what you

seek, namely love and togetherness. From a social problems perspective it is interesting to see

21
how private enterprises benefit from loneliness among the elderly by amplifying and

exploiting a need and themselves acting up as the solutions to the problem.

Conclusion

In this article we have tried to give a theoretical account for how and why the social problem

of loneliness among the elderly is constructed in different ways by different observers.

Drawing on the theory of social systems by Niklas Luhmann and the constructionist approach

to social problems, we argued that the “same” issue is brought into existence i.e. made

meaningful differently by different function systems. According to the constructionist stance

there is no true description of loneliness to which everybody must agree. This is a

consequence of the condition in modern society. Different actors and function systems create

their own descriptions of reality. The validity and accuracy of these descriptions cannot be

judged with standards from other systems (see Schirmer & Michailakis 2011). Every function

system processes “meaning” according to its own semantic stock. It is the logic of the

particular system that determines the meaning the particular phenomenon receives. Thus,

loneliness as a social problem becomes meaningful in different ways for different function

systems, as we demonstrated with religion, economy and medicine.

The content of our argument has implications both for research and policy. It was

pointed out by others that research on intervention methods against loneliness hardly shows

promising results (Cattan et al. 2005, Findlay 2003, Savikko 2008). It is reasonable to assume

that the failure of intervention methods is, at least partially, due to the lack of knowledge

about this variation of (potentially contradictory) problem definitions of loneliness among the

elderly. Ignoring this variation has practical consequences for the efficiency of possible

measures against the social problem of loneliness. Both researchers and practitioners working

with elderly or deal with loneliness among the elderly on a policy-level need to be aware of

the multi-perspectivity behind constructions of social problems: Whose description is it? On

22
which criteria (values, causalities, expectations) is it based? What would be the implications

for solutions or accountability claims when building a particular intervention method or

policy program on a particular problem-description? How would this look like when taking a

different problem description as basis? As other researchers noted, there is a so-called "social

problems industry" (Loseke 2003: 31, for the case of loneliness, see Uotila, Lumme-Sandt and

Saarenheimo 2010: 123) that has a vested interest in promoting a certain problem definition of

loneliness among the elderly that excludes or ducks others. Maybe the extent of loneliness is

smaller than proclaimed by some claims-makers (Dykstra 2009, Schnittker 2007, Wenger and

Burholt 2004)? Claims-making is part of a power struggle over definitions and the severity of

a certain problem. Researchers, practitioners and policy-makers blind for the multi-

perspectivity of the different involved key actors will miss a major part and will produce

flawed results or detrimental interventions.

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