llness and suffering are often also moments of loneliness. Loneliness, as an experience, is not the same as isolation. Isolation, as the absence of interpersonal relationships, can increase the feeling of loneliness, but without its typical features. One can, in fact, be isolated without feeling lonely, as those forced to work for long spells without interpersonal relationships are well aware. Loneliness instead is first of all an inner perception – one can feel lonely even when surrounded by people.
The perception of loneliness is, in the first place, the awareness of one’s powerlessness and weakness, together with the belief that nobody can share our experience, that nobody can help us.
Loneliness can be expressed in many ways, but what often dramatically emerges is the awareness of one’s uniqueness, which is unrepeatable.
Loneliness does not only express unease, it also highlights something we never focus on - our inner personality, that dimension of existence we are more used to experiencing rather than musing over. During an illness we are unable to express ourselves and we easily feel “misunderstood”.
Illness and suffering cause loneliness, but not just because they make us focus on ourselves - illness, physical pain, and inner suffering silence us, they make us aware of our weakness. Illness is never a topic of conversation, and when it is, we mention it only in view of getting better, as suffering cannot be communicated till it is invested with hope.
Such situations are generally defined by stating that illness is a “private” matter. But this definition risks being superficial, without considering the loneliness that accompanies illness itself. In practice, sickness is decidedly a “public” matter in our society, both in the sense that the whole society takes charge of the sick person, through drugs and hospitalisation, and in the sense that often public opinion takes an interest in disease and the sick, through the media.
Hence it would be better to restate that illness is first of all a “personal” matter and that it is always and “only” our illness - with these words we mean to say that illness introduces us into a dimension of loneliness, the condition of being alone with ourselves.
The modesty that surrounds illness is the sign that we are alone with ourselves.
Modesty is deeper and more genuine than “shame”, which still remains a social feeling. “Shame” expresses the unease we feel under the gaze of those who make an “object” of us, of those who “limit” us to our physical condition and behaviour, thus mortifying our personality. We feel ashamed of what really does not express us completely; we feel ashamed of wrong actions just as we feel ashamed of our weaknesses or our suffering body because we do not accept being limited to these aspects of our existence.
But modesty is another matter - it is our inner personality’s defence, the barrier that prevents a stranger’s gaze from really knowing who we are.
Modesty surrounds, first of all, the most intense experiences of one’s subjectivity; this is why it can emerge at the two poles of our inner life, and to be more precise, in the experiences of love and suffering. As a matter of fact no words are adequate to express what each of us is when he intensely loves and intensely suffers. During an illness, modesty’s first role is to conceal from others the sudden awareness of a uniqueness that does not seem able to find the room given to a relationship.
The modesty that conceals love protects the deep meaning of a relationship that is part of us; the modesty that conceals suffering defends the deep meaning of being alone with ourselves. The sick body thus conveys an experience of itself that could surface, and in fact does emerge, even when there is no illness. Loneliness cannot be easily defined in terms of a disease only because it often appears during an illness.

In practice the entire human existence wavers between the need for rationality and that for solitude. There is no time and room for genuine human communication if we do not also have the time to retreat into ourselves and come to terms with our humanity and uniqueness.
The balance between the room for silence and that for words, between moments dedicated to self and those spent with others, is greatly compromised in our society today. In many ways our social life fills the room and time we have in our personal existence and we often find we are acting like conscious robots, which repeat set habits.
The real self seems to retreat behind this. In this context illness sheds light on an extremely fragile and vulnerable human condition. Medicine helps us win illness and, when it fails, it helps us coexist with it, or carry on our lives in a less painful manner, but medicine does not help us coexist with ourselves; it does not help us reconcile ourselves with the meaning of our existence.
Loneliness is the experience of a deep need for inner balance - it is a deeply human experience, it is also our way of communicating and being with others.
The first allegiance with the doctor lies in the common battle undertaken against illness, but the asymmetry between the two personal situations is obvious and deep.
However great the solidarity and participation there may be between people, nothing can remove the sick person’s loneliness. Nevertheless this experience of oneself must not be considered in negative terms nor must it be censored; on the contrary it must be helped because, however paradoxical it may seem, the most genuine symmetry between man the doctor and man the patient is deeply routed in loneliness.
Beyond the medical profession and the pathological situation, there is room for communications between people who are experiencing the same human condition. But this communication requires that the doctor too must have found room inside him for solitude and balance – room we all should learn to develop without only being dragged by circumstances.
This solitude, which leaves us in our own hands and removes us from the distraction of acting, opens, if we so wish, the dimension of taking care of others as of ourselves.
Words and action then become the tools that can turn a period of solitude into one of interpersonal relationships, because each one stakes himself for what he is, beyond health and illness, situations that often merge into each other.

Adriano Pessina
Cattedra di Bioetica
Università Cattolica di Milano

Traslated by Interpres sas