My patient and I both knew he was dying.

我和我的病人当时都知道他将不久于人世。

Not the long kind of dying that stretches on for months or years.

不是那种会拖上几个月甚至几年的濒死状态。

He would die today.

他可能会在当天死去。

Maybe tomorrow.

也可能是明天。

And if not tomorrow, the next day.

如果不是明天，那就是后天。

Was there someone I should call? Someone he wanted to see?

我应该电话通知某个人，某个他想见到的人吗？

Not a one, he told me.

这样一个人不存在，他告诉我。

No immediate¹ family.

没有直系亲属。

No close friends.

也没有亲密的朋友。

He had a niece down South, maybe, but they hadn’t spoken in years.

他或许在南部有一个侄女，但他们好多年都没交谈过了。

For me, the sadness of his death was surpassed only by the sadness of his solitude².

在我看来，唯有他的孤独所带来的伤感，能压过他的死亡所带来的伤感。

Every day I see variations at both the beginning and end of life: a young man abandoned by friends as he struggles with opioid addiction³; an older woman getting by on tea and toast, no longer able to clean her cluttered⁴ apartment.

每一天，我都会在生命的起点和终点看到这类情况的种种版本：一个年轻的男人在竭力对抗毒瘾之际遭到友人的抛弃；一个上了年纪的女人靠茶和烤面包片度日，再也不能清理她那杂乱的公寓。

In these moments, it seems the only thing worse than suffering a serious illness is suffering it alone.

在这些时刻，唯一一件比承受严重病痛更糟糕的事情，似乎就是独自承受严重的病痛。

Social isolation⁵ is a growing epidemic⁶ — one that’s increasingly recognized as having dire⁷ physical, mental and emotional consequences.

社交孤立是一种不断升级的流行病——人们日益认为它会对身体、精神和情感造成可怕的影响。

Since the 1980s, the percentage of American adults who say they’re lonely has doubled from 20 percent to 40 percent.

自从上世纪80年代以来，说自己感到孤独的美国成人的比例已经从20%上升到40%，整整多了一倍。

About one-third of Americans older than 65 live alone; half of those over 85 do.

65岁以上的美国老人约有三分之一独自居住，85岁以上者则有一半是如此。

People in poor health — especially those with mood disorders⁸ like anxiety and depression — are likelier to feel lonely.

健康状况差的人——尤其是有焦虑、抑郁等情绪病的人——更有可能感到孤独。

Those without a college education are the least likely to have someone they can talk to about important personal matters.

想要谈论重要的个人事务时，没接受过大学教育的人最不可能找到倾吐对象。

A wave of new research suggests social separation is bad for us.

一系列新研究表明，社会隔离对我们有害无益。

People with less social connection have disrupted sleep patterns, altered immune systems, more inflammation and higher levels of stress hormones⁹.

社会交往较少的人睡眠模式会紊乱，免疫系统会发生变化，更容易出现炎症反应，体内压力荷尔蒙的水平也更高。

One recent study found that isolation increases the risk of heart disease by 29 percent and stroke by 32 percent.

最近的一项研究发现，孤独会让罹患心脏病和发生中风的风险分别增加29%和32%。

Another analysis that pooled data from 70 studies and 3.4 million people found that socially isolated¹⁰ individuals had a 30 percent higher risk of dying in the next seven years, an effect largest in middle age.

对来自70项研究和340万人的数据进行了汇总的一项分析发现，处于社交孤立状态的个人在接下来的7年内死亡的风险比普通人高30%，这种效应在中年人身上最为突出。

Loneliness can accelerate cognitive¹¹ decline in older adults, and isolated individuals are twice as likely to die prematurely¹² as those with more robust¹³ social interactions.

孤独可能会让老年人认知能力下降的速度有所加快，孤立的人过早死亡的风险比交际广泛者多出一倍。

These effects start early: Socially isolated children have significantly poorer health 20 years later, even after controlling for other factors.

这些影响的种子可以在很早的时候种下：即使调整了其他因素，处于社交孤立状态的孩子在20年后的健康状况也非常差。

All told, loneliness is as important a risk factor for early death as obesity¹⁴ and smoking.

所有这些都表明，与肥胖、吸烟一样，孤独是导致早亡的重要风险因素。

The evidence on social isolation is clear.

关于社交孤立的事实证据颇为清晰。

What to do about it is less so.

但人们对于该如何应对社交孤立还不甚了然。

Loneliness is especially tricky¹⁵ because accepting and declaring our loneliness carries profound stigma¹⁶.

孤独是一个尤为棘手的问题，因为承认并宣示我们的孤独会让我们深深地感到羞耻。

Admitting we’re lonely can feel as if we’re admitting we’ve failed in life’s most fundamental domains¹⁷: belonging, love, attachment¹⁸.

承认我们是孤独的，就好像是承认我们在生活的某些最基本的方面遭遇了失败：归属感，爱，依恋。

It attacks our basic instincts to save face, and makes it hard to ask for help.

它会触及我们想要保全脸面的本能，从而让求助变得更加困难。

I see this most acutely during the holidays when I care for hospitalized patients,

在假期照顾住院治疗的患者时，我对这一点看得尤为清楚。

some connected to IV poles in rooms devoid¹⁹ of family or friends — their aloneness amplified²⁰ by cheerful Christmas movies playing on wall-mounted televisions.

有些患者待在一个亲友也没有的房间里打着点滴——壁挂式电视上放映的欢快的圣诞电影，尤为突显了他们的孤独。

And hospitalized or not, many people report feeling lonelier, more depressed²¹ and less satisfied with life during the holiday season.

此外，不论住院与否，很多人都表示，他们在假期会感到更孤独、更沮丧、更不满。

New research suggests that loneliness is not necessarily the result of poor social skills or lack of social support, but can be caused in part by unusual sensitivity to social cues.

新研究显示，孤独不一定是社交技巧糟糕、社会支持缺失的结果，但在某种程度上可以由对社交提示不同寻常的敏感引发。

Lonely people are more likely to perceive ambiguous social cues negatively, and enter a self-preservation mindset — worsening the problem.

孤独的人更有可能对模糊的社交提示做出负面解读，并进入一种自我保护的思维模式——从而让问题变得更糟。

In this way, loneliness can be contagious²²: When one person becomes lonely, he withdraws from his social circle and causes others to do the same.

这样，孤独就具有了传染性：当一个人变得孤独的时候，会退出自己的社交圈，导致其他人也如此行事。

Dr John Cacioppo, a psychology²³ professor at the University of Chicago, has tested various approaches to treat loneliness.

芝加哥大学(University of Chicago)心理学教授约翰•卡奇奥波(John Cacioppo)博士对各种应对孤独的方法进行了测试。

His work has found that the most effective interventions²⁴ focus on addressing maladaptive social cognition — that is, helping²⁵ people re-examine how they interact with others and perceive social cues.

他经研究发现，最有效的干预以应对非适应性社会认知为重点——意即帮助人们重新审视他们与人互动和感知社交线索的方式。

He is collaborating²⁶ with the US military to explore how social cognition training can help soldiers feel less isolated while deployed²⁷ and after returning home.

他正与美国军方合作，研究社会认知培训如何能够有助于减少士兵在服役期间和退役后的孤立感。

The loneliness of older adults has different roots — often resulting from family members moving away and close friends passing away.

老年人的孤独有着不同的根源——常常是由家庭成员从家里搬走或者亲密的朋友过世引起。

Ideally, experts say, neighborhoods and communities would keep an eye out for such older people and take steps to reduce social isolation.

专家称，理想状态下，邻居和社区会密切关注这样的老年人，并采取措施减少他们的社交孤立感。

Ensuring they have easy access to transportation²⁸, through discounted bus passes or special transport services, can help maintain social connections.

通过提供公交车票折扣或者特殊交通服务，确保他们有便捷的出行方式，可以帮助他们维系社会交往。

Religious older people should be encouraged to continue regular attendance at services.

应该鼓励信教的老年人继续定期参加宗教仪式。

Those capable of caring for an animal might enjoy the companionship of a pet.

有能力照顾小动物的人或许会享受宠物的陪伴。

And loved ones living far away from a parent or grandparent could ask a neighbor to check in periodically.

住在离父母或者祖父母辈很远的地方的人，可以拜托邻居定期查看其状况。

But more structured programs are arising, too.

但更加有组织的项目也在涌现。

For example, Dr Paul Tang of the Palo Alto Medical Foundation started a program called linkAges²⁹, a cross-generational service exchange inspired by the idea that everyone has something to offer.

例如，帕洛•奥尔图医疗基金会(Palo Alto Medical Foundation)的保罗•唐(Paul Tang)博士受人人都能有所贡献这一理念启发，创建了一个跨越代际的服务交换项目，名为linkAges。

The program works by allowing members to post online something they want help with: guitar lessons, a Scrabble partner, a ride to the doctor’s office.

项目成员可以把自己想要求得帮助的事项发到网上：学吉他，找猜字游戏玩伴，搭车去看医生。

Others can then volunteer their time and skills to fill these needs and bank hours for when they need something themselves.

然后其他人可以志愿贡献自己的时间和技能来满足这些需求，再把相应的小时数存进银行，等到他们自己需要帮助的时候便可以提现。

In America, you almost need an excuse for knocking on a neighbor’s door, Tang told me.

在美国，几乎连敲响邻居的房门都需要一个好理由，唐告诉我。

We want to break down those barriers.

我们想打破这些藩篱。

The program now has hundreds of members in California and plans to expand to other areas of the country with a recent grant from the Robert Wood Johnson Foundation.

该项目目前在加利福尼亚州有数百名成员，最近收到了来自罗伯特•伍德•约翰逊基金会(Robert Wood Johnson Foundation)的一笔资助，打算向美国其他地区拓展。

We in the medical community have to ask ourselves: Are we controlling blood pressure or improving health and well-being³⁰? Tang said.

我们这些医学界的人必须自问：我们是在控制血压，还是在提升人们的健康状况和幸福感？唐说。

I think you have to do the latter to do the former.

我认为只有做到后者才能做到前者。

Increasingly, research confirms our deepest intuition: Human connection lies at the heart of human well-being.

一系列研究日益表明，我们内心最深处的直觉是正确的：人与人的交往在人类的幸福感中居于核心位置。

It’s up to all of us to maintain bonds where they’re fading, and create ones where they haven’t existed.

当关系变淡的时候，要靠我们所有人去维系；当关系尚未建立的时候，要靠我们所有人去建立。