In recent decades, social isolation has been recognized as a major risk to our health and long life. It's twice as bad for you as being overweight and nearly as bad as smoking. The rising number of people who say they are affected, across a wide range of ages, is shocking. In reality, you can suffer the ill effects of loneliness even if you are not socially isolated.

    Comedian Robin Williams made a striking observation in 2014: “I used to think the worst thing in life was to end up all alone. It's not. The worst thing in life is to end up with people who make you feel all alone.” Tracking large groups over time indicates that perceived（感知的）social isolation carries its own risk for morbidity（发病率）and mortality.

    The perception of isolation—from others of being in the social aspect-is not only a cause of unhappiness, it also signals danger. Fish have evolved to swim to the middle of their group when predators（捕食者）approach, mice housed in social isolation show sleep disruptions and reduced slow-wave sleep and prairie voles（田鼠）isolated from their partners then placed in an open field explore their surroundings less and concentrate on avoiding predators.

    These behaviours reflect an increased emphasis on self-preservation in the social aspect. For instance, fish on the edge of a school are more likely to be attacked by predators because they are easier to isolate and prey upon. Such observations reflect a more general principle that perceived social isolation in social animals activates neural（神经系统的）, neuroendocrine（神经内分泌的）and behavioural responses that promote short-term self-preservation. However, these responses bring a cost for long-term health and well-being.

    The range of harmful neural and behavioural effects of perceived isolation documented in adults include increased anxiety, hostility and social withdrawal; fragmented sleep and daytime tiredness; increased vascular resistance and changed gene expression and immunity; decreased impulse control; increased negativity and depressive symptoms; and increased age-related cognitive decline.

    Sadly, to date, attempts to reduce loneliness have met with limited success. A series of randomized controlled trials showed that they had only a small effect. Among the four types of interventions（介入）examined, talking therapy that focused on inappropriate thought processes had the largest impact. Social skills training, social support and increased opportunities for social contact were much less effective.