“My Scar”: Posttraumatic Loneliness as a Source of Pain and Resource for Coping

Abstract

Contemporary understanding of combat trauma’s psychological effects emphasizes the interpersonal ways survivors process their experiences. Yet cases of incongruence between survivors who want to share their traumatic experience and close others who are not ready to take part in this challenging task are common. Hence, many trauma survivors are compelled to cope with the posttraumatic consequences mostly alone. The present study followed the interpretive phenomenological approach to examine the experience of loneliness, as described by 15 male combat veterans dealing with posttraumatic stress. Participants completed semistructured qualitative interviews in which they shared their knowledge regarding postservice distress, loneliness, coping, and growth. Two main themes emerged: “The Loneliness Complex,” highlighting this phenomenon’s multifaceted, layered, and cyclical nature; and “Emotional Growth after Loneliness,” presenting the positive potential of loneliness. These findings emphasize the importance of interpersonal relations in trauma survivors’ recovery process. Participants described how experiences with peers can serve as a pivotal point for coping with postservice distress and how internalization of positive interpersonal interactions seems to be a crucial psychological resource for further rehabilitation and growth. Being a multilayered and cyclical condition, loneliness might serve trauma survivors in their search of safety, while also bearing the potential to motivate them to act upon their condition and promote emotional growth. Clinicians should acknowledge the risks trauma survivors take by leaving their lonely yet safe place, as they are encouraged to process their traumatic experiences and share their inner world with others.

Introduction

Contemporary understanding of the psychological effects of exposure to potentially traumatic events emphasizes the interpersonal ways survivors process their traumatic experience (Leclerc et al., 2021). Such a relational approach to understanding trauma and posttraumatic symptomatology (Yalch & Burkman, 2019) posits that once survivors receive a validating response and perceive acceptance of their condition, they are encouraged to become more engaged in processing the consequences and making meaning of the traumatic event they endured. On the other hand, when the interaction between survivors and their social environment is characterized by patterns of emotional avoidance, they might tend to distance themselves proactively from processing their trauma with others. In response, community members often distance themselves from the survivors, establishing a mutual cycle of social isolation, emotional distress (Yalch & Burkman, 2019), and even common dissociation (Boulanger, 2018). Such patterns leave survivors to cope with the posttraumatic consequences mostly alone.

The current study explored this state of affairs, presented through combat veterans’ points of view. We first discuss loneliness and its relevance to combat trauma because it is one of the dominant emotions that trauma survivors experience when their relationships with members of their supportive systems are unsynchronized. We then discuss emotional growth and possible ways to help traumatized veterans move from social isolation toward sharing their personal distress with others.

Loneliness and Trauma

Loneliness is generally defined as an emotionally unpleasant experience that occurs when people perceive a discrepancy between preferred and actual social relationships (Cacioppo et al., 2015). Loneliness exists in the range between individuals and their social environment, affecting their physiological state (Wilson et al., 2018) and quality of life (Groarke et al., 2020). The relevance of this human experience became clearer than ever during the last few years of coping with the global COVID-19 pandemic crisis (Palgi et al., 2020). Veterans who experienced potentially traumatic events often experience trauma-related loneliness. For example, studies among Israeli and American veterans found it to be a major part of the posttraumatic sequelae (e.g., Guthrie-Gower & Wilson-Menzfeld, 2022; Solomon et al., 2014; Wilson et al., 2018). However, loneliness can be perceived differently among members of various cultural backgrounds and in times of stress, with people from collectivist backgrounds often feeling lonelier, for example (Heu et al., 2019). Yet research examining the relationship between military service and the experience of loneliness is scarce. To help fill this gap, the present study examined the experience of loneliness and its relationships with coping, emotional distress, and potential for posttraumatic growth among Israeli veterans who served in combat units and experienced potentially traumatic combat events during their military service.

Different definitions of loneliness represent different psychological approaches to this phenomenon. A common practical definition focuses on the gap between one’s desire for social relationships rather than his actual relationships (Russell et al., 1980), highlighting the basic emotional needs for social interaction. Loneliness is different than isolation; it focuses on a subjective experience related to an objective social situation. Hence, people can feel lonely even if surrounded by others or, on the other hand, feel socially satisfied even when involved in relatively few relationships and social interactions (Wilson et al., 2018). Loneliness is considered a biological mechanism that serves as an internal cue, activating behavior to prevent individuals from being harmed by directing them to look for essential social interactions or avoid unsatisfactory ones (Masi et al., 2011). Attempting to integrate the various approaches to this phenomenon, a social constructivist definition of loneliness suggests it combines seven basic elements to form this complex emotional experience (Stein & Tuval-Mashiach, 2015b): (a) a sense of isolation that is (b) felt in a relationship by (c) an experiencing self in (d) relation to others. This condition involves a feeling or estimation of (e) deficiency of relational needs that leads to (f) a sense of discrepancy accompanied by (g) psychological pain or aversion. Different combinations of these elements may produce different levels and subjective experiences of loneliness and may coexist with different related emotions (e.g., shame and anger).

Winnicott (1958) was among the first theorists to highlight loneliness as an existential truism that holds the potential for crucial psychological development. More recently, existential approaches described three types of loneliness (Ettema et al., 2010): interpersonal (e.g., social isolation), intrapersonal (within oneself), and existential loneliness. The latter refers to the emotional and cognitive experience of the inevitable gap between the self and others, which represents the separation of the self from the world (Ettema et al., 2010). Some of these aspects are at the core of the experiences of traumatized people: feelings of alienation, fear of being abandoned and forgotten, fear of not being able to communicate or not being understood, and a feeling of not-belonging. Events that produce such threatening existential loneliness are sometimes described as “small deaths” (Bolmsjo et al., 2019).

Naturally, people have an inherent need to avoid loneliness because complete loneliness and disconnection may lead to a mental breakdown (Ettema et al., 2010; Stein & Tuval-Mashiach, 2014). Accordingly, people constantly distract themselves from their lonely situation. During a traumatic event, this distraction is undermined and awareness of the individual’s loneliness is inevitably experienced (Stein & Tuval-Mashiach, 2015a). On the other hand, there seems to be a certain threshold of loneliness that once crossed, may lead to not only mental breakdown but also mental awakening and growth (Ettema et al., 2010).

Loneliness and Combat Trauma

Combat trauma might occur in many forms throughout a soldier’s service. Some potentially traumatic events are invoked by fear-based responses, such as experiencing life-threatening events, getting injured, or witnessing friends and comrades being injured or killed. Other traumatic experiences are invoked by other cognitive and emotional experiences, such as shame or guilt, which can lead to traumatic moral injury (Harwood-Gross et al., 2023). Various forms of combat trauma have been linked to loneliness (Gettings et al., 2022) and alienation (Stein & Tuval-Mashiach, 2015a): It can exist on the battlefield and may intensify long after the traumatic event has ended, upon returning home (Herman, 1992; Solomon et al., 2014). Indeed, homecoming is a central juncture in a veteran’s life (Guthrie-Gower & Wilson-Menzfeld, 2022; Stein et al., 2018).

How interactions between veterans and members of their social environment develop can determine whether these mutual relations grow into a source of support or create further mutual emotional pain (Guthrie-Gower & Wilson-Menzfeld, 2022). Sometimes, regardless of existing social support, trauma survivors feel and believe that no one can understand their trauma-related feelings, generating a sense of loneliness (Masi et al., 2011). This interpersonal interaction is an ever-active dialectical process of personally and socially complementary powers (Yalch & Burkman, 2019) that subsist in the individual through defensive mechanisms (such as denial or emotional withdrawal) and compensating mechanisms like active avoidance (Ornstein, 2011). The current study explored cases in which this complex interaction is prominent, aiming to highlight its nuances and further develop a thorough understanding of its psychological aspects.

Support and Loneliness in a Military Context

Soldiers usually develop close relationships with their peers with whom they serve and experience stressful and traumatic events (Guthrie-Gower & Wilson-Menzfeld, 2022; Harwood-Gross et al., 2022). Cohesion of the military team promotes the process of making meaning for the soldier’s experiences and enhances a positive internal locus of control (Mitchell et al., 2011). When veterans share a traumatic experience, they may gain a stronger sense of personal security through a deep sense of familiarity and the experience of a shared destiny (Weltman et al., 2018). Shared leisure activities and humor that naturally occur among soldiers can also support these feelings among veterans (Hinojosa & Hinojosa, 2011). Although these “buddies” provide a meaningful supportive environment, it usually does not continue after soldiers are discharged from service (Guthrie-Gower & Wilson-Menzfeld, 2022; Harwood-Gross et al., 2022) because each veteran usually returns to their home. Thus, discharged veterans are often deprived of their most important supportive resource.

Because they fear that people who did not experience the same trauma will not understand their condition (Rafferty et al., 2020), combat trauma survivors can experience a vicious cycle of loneliness that may worsen posttraumatic stress, hinder receiving necessary support, and delay recovery processes (McGuffin et al., 2021; Zeligman et al., 2017). Indeed, veterans with PTSD received less social support than those without PTSD (Sirati-Nir et al., 2018).

Added to this complex situation is the fact that veterans may find it difficult to function in civilian situations that require different vocabularies, as opposed to military language, slang, and social interactions (Hawkins et al., 2015). In fact, despite the communication it enables, language is another obstacle to overcoming posttraumatic loneliness. The lack of the ability to find appropriate words with which to express their inner world and share it with others often leaves trauma survivors with the feeling that they are doomed to remain alone in coping with the painful yet meaningful event they experienced (Payne et al., 2015). Added to this complex situation is the fact that it is difficult to convey words and use language solely as a tool for sharing combat experiences and feelings (Ali et al., 2020).

Loneliness and Posttraumatic Growth

Meaningful mental growth after trauma is common (Steinberg et al., 2022). Although different definitions emphasize different aspects of this construct, posttraumatic growth usually refers to positive psychological, social, or spiritual growth that occurs upon dealing with the effects of exposure to trauma (Mark et al., 2018). The relationship between posttraumatic growth and loneliness is complex because sometimes trauma survivors value their strengths and personal coping as part of their growth, but they have difficulty trusting others who lack similar strengths. Accordingly, these survivors may avoid relying on others and tend to cope with their hardships in a more individual way, thus establishing emotional distance between them and their close others. For example, Israeli veterans who presented higher degrees of personal growth in the aftermath of war or captivity were more likely to withdraw from their social connections and thus become lonelier. Veterans who exhibited less posttraumatic growth perceived themselves as better socially connected and reported lesser degrees of loneliness (Stein et al., 2018). These researchers suggested that veterans’ loneliness was related to the lack of synchronization with their social environment and the belief that they would be misunderstood by others. Given that this study used a quantitative methodology, qualitative exploration may shed additional light on these issues.

Study Aims

The present study sought to deepen the understanding of the relationships between veterans’ experiences of combat trauma, loneliness, and growth in the years after service. We used qualitative methods to address these research questions:

• 1. Is postdeployment loneliness a part of Israeli veterans’ lives, and if so, how does it manifest and how do they perceive it?

• 2. What are the interrelationships among exposure to trauma, loneliness, and posttraumatic growth among Israeli veterans?

Method

The present study used a qualitative, interpretive phenomenological approach (Smith & Osborn, 2015), an approach most suited to revealing the perception and interpretation of participants’ emotional experiences (Smith, 2019). Phenomenology research aims to uncover the structures of experiences of a certain phenomenon, as perceived by the person who experiences it (Lumma & Weger, 2023). This method is designed to enhance integrative notions stemming from various levels of interpretation of the data; therefore, it was suitable for this study, which aimed to gain a deep understanding of the complex interactions between participants and people in their social surroundings, along with their perceptions of these interactions. Because loneliness is a contextual experience formed by subjective interpretations, interpretive phenomenological tools were an ideal way to explore the participants’ levels of meaning thoroughly. This method had been previously used when studying veteran populations (e.g., Pearson et al., 2019; Ray & Vanstone, 2009).

Participants

We used criteria sampling combined with comfort sampling (Patton, 2015) to recruit 17 male Israeli veterans who served in combat units and experienced potentially traumatic events during their service, experienced various levels of postdeployment stress, and agreed to take part in this study. We followed the Diagnostic and Statistical Manual of Mental Disorders’ definition of trauma (American Psychological Association, 2022), meaning that all participants were exposed to life-threatening events during their military service, in which they faced life-endangering conditions or witnessed others in such conditions. However, most of them were not diagnosed with a severe condition or major psychopathology (e.g., PTSD and major depression).

Two participants found it hard to complete the process, and although they agreed to share their knowledge, they refrained from meeting with the interviewer. Three attempts to schedule an interview were made with each of them, and after they did not appear for these scheduled meetings, they were excluded from the study. Thus, 15 veterans completed the study interviews. Participants were graduates of a group intervention program for Israeli veterans. This program is designed to help combat veterans process their exposure to traumatic events that occurred during their military service through nature-assisted group interventions. Among other approaches, these interventions include psychoeducation regarding trauma, resilience, and recovery; practicing physical and emotional mindfulness skills (e.g., yoga, focusing, and balancing); and sharing personal trauma narratives and coping experiences.

All participants served between 3 and 20 years as combat soldiers in the Israel Defense Forces as mandatory service and later as reservists. All of them participated in battles that involved fellow soldiers being killed or wounded. Participants’ mean age was 30.9 years (SD = 5.0). Nine participants were married or in a long-term relationship, five were single, and one was divorced at the time of the interview. Nine participants had an academic degree; the rest had a high school degree. All of them were either working or studying by the time of the study.

Procedure

Ethical Considerations

The study was approved by the affiliated faculty board of ethics (#435/21). The first author, who volunteers as the head of research at the organization from which the participants were recruited, informed the organization’s staff members about the study and asked them to refer potential participants who might share their experiences. The first outreach to potential participants was made through a phone call by a counselor known to the participants from the group intervention in which they participated. During this outreach, the staff members checked participants’ willingness to share their knowledge in this study. Potential participants were informed that rejecting the invitation to join the study would not carry any negative effect. Only after participants agreed did the staff members provide the participants’ contact information to the third author, who contacted them to set up a time for an interview. During the two primary calls, the participants were informed of the study’s rationale and planned course, highlighting both its lack of danger and the fact that it would deal with sensitive issues and therefore might cause some distress during and after the interview. Available resources for stress reduction and management were provided should emotional distress increase after the interviews.

Data Collection

Semistructured in-depth interviews (Patton, 2015) were scheduled and conducted with 15 veterans who agreed to participate and completed written consent forms. Two additional participants did not attend the scheduled interview and were excluded from the study. The researcher contacted them to check their emotional condition and ensured their safety.

The research interviews were conducted by the third member of the research team, a skilled clinical social worker who is familiar and trained in qualitative research methods. To obtain a reflective state, the interviewer–researcher received continuous guidance from the first author throughout the data collection period in the form of weekly meetings.

At the beginning of each interview, the interviewer explained the rationale of the research and its planned course again, ensured the participant completed the informed consent form, and addressed possible challenges of dealing with sensitive issues. In addition, resources for future support were offered. Most interviews took place in the participants’ homes, except for two that were conducted via a secure internet platform, according to the participants’ preference. Interviews lasted 1.5 hours on average.

All interviews were recorded and later transcribed verbatim. Participants’ names and additional private information were changed during the transcription process to ensure protection of their privacy.

Data Analysis

Data were analyzed in accordance with thematic content analysis (Clarke et al., 2015) and in keeping with an interpretive phenomenological approach (Nizza et al., 2021; Smith & Osborn, 2015). Upon completing the first three interviews, the interviewer transcribed the interviews, and then the researchers read the transcripts thoroughly and performed open coding. During this process, each researcher marked separate meaningful content units arising from the interviews and shared these materials with two other researchers (first and fourth authors). Then, these researchers read all the interviews and performed open coding in a parallel process to ensure thorough understanding of the materials through various points of view and examination of multiple interpretations. As the first three authors analyzed the findings, they discussed the suggested conceptualizations until achieving agreement through scheduled meetings. Data analysis was conducted in ATLAS.ti.

Rigor

The interviewer used an interview manual to help stay focused on the topic (Patton, 2015). To maintain an observant, inquisitive, and unbiased attitude (Finlay, 2009), the interviewer kept an interview diary in which they shared their thoughts and feelings during the data collection process. The interviewer shared their experiences and significant ideas for improving the interviews with the other team members during periodical research team meetings.

To ensure participants’ privacy once they confirmed their participation, no personal identity details were provided to other members of the research team. Interview content was only shared after participants’ names were changed to secure their confidentiality.

Interviews continued until achieving theoretical saturation (Hennink et al., 2017; Patton, 2015). We determined code, and meaning saturation had occurred once the three researchers who performed the coding process agreed that theoretical categories were repeated and sufficiently grounded.

Findings

Two main themes were detected, representing participants’ insights regarding their experience of loneliness. All participants reported loneliness feelings that developed as they coped with their posttraumatic experiences. An interesting general finding was the fact that some of them were unaware of the meaning and relevance of loneliness to their lives before they reflected on their experience through the research interview.

Theme 1: The Loneliness Complex: Safe Haven or Prison Cell?

Participants described loneliness as a homogenic part of their postservice experience. They described it as a “safe place” that sometimes promoted inner peace, alongside other coping methods for dealing with posttraumatic stress. For example, Moses, 27 years old, stated, “I am comfortable in loneliness. It was my refuge, my safe place. … It’s a familiar place. … To this day, I find myself escaping into loneliness in order to deal with emotional challenging situations.”

Moses chose social isolation, a condition in which he felt emotionally safe. This state was followed by loneliness, to which he related as a familiar emotional experience that helped him become calm. At the same time, these experiences of self-imposed loneliness seemed like a pattern of emotional avoidance. It occurred in the presence of others, and relying on it had its price, as Jonathan, 39, described:

Being among friends and family members, I felt lonelier. … I was kind of cut off from them and felt like I couldn’t communicate. I felt like I was oppressing them with my presence. In such times, turning inward towards loneliness felt more comfortable for me.

Although Jonathan did not confirm his interpretation of the situation with his friends or family members, he automatically behaved as if it was a fact. This is a main feature of the cyclical complex of loneliness, involving an emotional experience, a cognitive interpretation, and a behavior. As Jonathan pulled away from close friends and family, they also retreated and kept their distance, thus expanding the cycle from within the individual toward an interpersonal experience. Consequently, Jonathan became socially isolated, sometimes calm but alone, as the vicious cycle continued. Norman, 37, explained the rationale for this choice:

For me, every day is so full of ups and downs and all kinds of confusing, powerful emotions that I can’t even grasp and contain it. It’s complex enough for me in itself. That’s why I like being alone in silence. … It’s a bit like a desert, but there is also something very beautiful in this desert.

This condition seemed to involve mixed feelings—safety and sadness, potency and weakness—that blended into each other. These participants clarified the importance of loneliness in the short term because it provided a singular emotional experience different from the previous emotional storm of feelings all felt at once. However, its long-term presence created emotional distress. Shame was a significant part of this condition and seemed to be a major factor in the experience of loneliness, which fueled this vicious circle. Shon, 35, described how dominant feelings of shame combined with disappointment from his comrades and commanders made him become entrenched in his loneliness, hence making the cycle more extreme:

I was very ashamed. For many years after the events, hardly anyone knew what I had endured. My mother and my wife knew a little, and that’s it. … The loneliness and shame in the military, during the service, [was particularly difficult], as if they turned their back on me. No one ever called to ask me, “How are you?” … I always expected that someone would call to ask me how I was doing, and the fact they didn’t call made me realize no one understands what I’m going through, and this made me feel terribly lonely. It seemed as if no one even wanted to understand.

It seems that the experience of shame led the participants to deal with the consequences of the exposure to trauma on their own. Rani, 34, also described how shame made it difficult for him to share his experiences with loved ones:

This is mainly due to shame. I’m ashamed that I react to it like that [with posttraumatic symptoms], when I know there are people who don’t. Guys who were in the Jeep with me [at the time of the traumatic event] reacted differently to it, so it’s awkward and embarrassing for me. Like, what, am I weaker than them? Was I a worse fighter? It makes you ask a lot of questions about yourself, so I just keep it in, blocking it within myself, so as not to be perceived as weak. … I want to process it without being judged, and right now the only person who won’t judge me is me.

According to these participants, shame was connected to loneliness as a developmental stage in their posttraumatic sequelae. They described why they dwelled on loneliness as an adjustment to others’ behaviors. They talked about the process as a holistic experience that included emotional, cognitive, and behavioral components. This complex condition led to inevitable interpersonal consequences, which further escalated the vicious cycle in which the participants seemed to be trapped. Joel, 27, described how his effort to share difficult personal experiences led to further disappointment when his friends were not attentive to his plight:

It takes time and lots of energy for me to open up and trust anybody. And once it happens, if anything gets in my way, it throws me back to feeling lonely. I find myself thinking that they don’t understand how hard it is for me or how much effort it requires. Once I’m opening up, I need the eyes to be fixed on me, and that they listen to me very attentively, and try to experience what I went through.

His words present the paradox of how despite efforts to disclose, sharing can lead to intensifying feelings of loneliness. Exposing and sharing the inner, personal world demands the ability to be vulnerable, intimate, and dependent. Naturally, it might lead to emotional pain, stemming from the disappointment of others’ reactions. Ofir, 28, also mentioned this trend of reaching out to the social world and then pulling back during social interactions:

Even if someone reaches out for me, sometimes I avoid and don’t let anybody in. But then I feel angry and disappointed that no one cares and no one is coming to help me. … So, I try to be aware of this paradox.

Regarding this complex interaction between the trauma survivor and social environment, Ofir expressed a wish that his close others would not pull away from him, despite his social avoidance. He described his pain and anger as a way to reach out for connection from his side, which in a tragic yet well-understood way made people in his surrounding refrain from connecting with him. Not surprisingly, these participants said that they were unaware of this circular trend of action and aware only of its consequences. For them, once trapped in this cycle, they feel like there was nothing to be done to break free. Ronen, 27, described this condition:

I didn’t want to accept my condition, even though I knew it wasn’t right and I shouldn’t feel that way. I felt this was my scar. … I was constantly pendulating between knowing I don’t want to spend my life feeling this way and hesitating about turning for help. And eventually I never sought help. … Now when I look at it, I think it would have been better if I would have talked about it and understand things at an earlier stage.

Ronen’s words shed light on the inner struggle between distress and rational, intellectual understanding, making it difficult for him to acknowledge his vulnerability and seek help. The difficulty of experiencing weakness or being dependent prevented Ronen from sharing his distress with others. Thus, he did not address his emotional needs and remained caught in the painful cycle of loneliness. However, this coping method sometimes supported the feeling of competence as the participants endured their emotional hardships. Breaking out of this loop was accompanied by ambivalence toward the emotional difficulties that arose when they sought to change an avoidance pattern and give up its advantages.

Theme 2: Emotional Growth After Loneliness

Participants described that once they identified their state of being trapped in a loop of social withdrawal, fueled by emotional pain and loneliness, they searched for ways to break free. Nonetheless, this shift is not an easy process, demanding practical effort and taking an emotional toll. Jeremy, 28, referred to early stages of this process:

After the war, me and my best friend both noticed we experience similar postservice difficulties, and it strengthened our relationship. We both felt similar incomprehension on the part of society; that nobody understands us and what we experience. We found comfort in each other because we had a common language.

This common language seemed to be a primary base that made it possible to create closeness and secure relationships with another person. As in safe attachment relations, these safe experiences counteracted loneliness and provided hope. Other participants described the need for an external other to facilitate their rebuilding of confidence and direct their way out of the loneliness cycle. Many of them found this help in the form of the nature-assisted group intervention (which some termed “the journey”). Shon, 35, described his experience in such a group:

When I arrived at the journey, I felt for the first time that I was no longer alone, … I am with people who have experienced similar things to what I endured, so we share a very important common characteristic. And the huge barrier of shame collapsed as if in one swoop. Following this, a feeling of belonging arose, and I no longer felt alone. … It was a big contrast to the world I lived in at the time, where I felt lonely and ashamed, that I couldn’t even share these things with my wife, the person closest to me. … I built a protective wall around me, thinking: “I can’t share my experiences with her because she won’t understand, and then she will look at me in a judgmental way.” … But once the shame barrier collapsed, I have shared my experiences with her and others—dozens of times.

Shon’s description highlights the importance of loneliness as a safe emotional place where he could meet himself more fully and from which he reached out from his inner world to meet his social environment. As such, the ability to feel lonely seemed to be an important, complementary characteristic of the ability to be with others. It seems that sharing experiences of coping with posttraumatic challenges in a safe environment enabled learning about the possibility of reconciliation, both inward and toward close others. Naturally, because loneliness is a complex condition involving the feeling of disappointment toward others who do not fulfill the individuals’ emotional and social needs, repairing it needs to occur in a social context. Once initial interpersonal safety is obtained, rebuilding of supportive relationships expands beyond the contextual group and social resilience seems to become more meaningful. Other participants emphasized this aspect, including Norman, 34:

Knowing that I have friends who understand how to contain my pain gave me a lot. … And I wanted to maintain this experience. So, I initiated a group where we meet once a fortnight and talk about our day-to-day coping and how we handle this shit called reality.

Participants expressed growth through the ability to identify personal emotional needs and act on them for the benefit of self and others. In this way, a positive cycle is created, described as reciprocal movements of the participants toward their close others, and vice versa. These social successes seemed to encourage participants to fuel this trend. However, to enjoy this desired product, they had to depend on others, to trust them and trust the process. Breaching the circle of loneliness requires activation of inner strengths. Letting go of former coping methods, to experience better coping and growth, is sometimes perceived as threatening. Participants described their group journey experiences as a “developmental healing stage” in which they managed to achieve a delicate balance between these contradicting powers, for example, Jonathan, 39:

When I joined the group journey, I was already two years in a good individual therapy. But what I gained during this week with the group in terms of normalizing how I feel, I could not achieve with individual therapy. The journey was a week’s respite from loneliness and from the feeling that a stranger will not understand. For a week, I felt like I belong and I am understood by everyone. And that led to a shift within me that later on enabled me to communicate my hardships with my parents as well.

Exposure to other people who experienced similar feelings enabled Jonathan’s positive important feelings of safety and security. Under the auspices of the ability to share his inner world with others and realizing his reaction to the trauma he faced was normal, he gained insights regarding his condition. Described by other participants in similar ways, these insights seem significant in that they encouraged them to test their coping skills in different social settings, leading to more positive social experiences and beliefs toward the self and others. These served as important resources on the continuum of recovery because they maintained a “recovery vortex,” as opposed to remaining in the cruel cycle of loneliness. Shon, 35, shared his notions regarding the development of this process:

My wife and I will always have this barrier between us. … But I realized that just as she has her issues that I will never be able to understand fully, so it is the same with me. … We can be and feel unite, but it will still be my issue. And that’s OK. That doesn’t mean I’m alone. I realized that it is good to share your experiences without expecting the other person to wear your body and get inside your experiences to fully understand what you feel. … Now it is good enough for me to know that my wife is with me and by my side.

It seems that through this personal, emotional, and existentialist notion, Shon realized and accepted his relationship with the social world. Other participants described similar notions. This process appeared to be a significant step for participants regarding their ability to accept and make sense of their posttraumatic reality. According to these participants, feelings of competence, closeness, safety, and growth sprouted and existed through their interpersonal relationships, significantly changing their posttraumatic sequelae.

Discussion

The findings of the current study broaden the previously described circular characteristic of loneliness by emphasizing the positive aspects of this phenomenon, which participants described as their emotional safe haven. It is important to acknowledge trauma survivors’ need to regain a feeling of control over their shattered world, which they sometimes gain through individual coping and loneliness experiences. According to our participants, only after they established safety in their “loneliness stronghold” could they trust their strengths to reach out and rebuild trust in their social world. In this process, experiences of loneliness enabled dialectic movement between inner and external psychological aspects and between cognitive and affective aspects, which are situated in temporal contexts (Stein & Tuval-Mashiach, 2015b). As Moustakas (1961) pointed out: “Experiencing a solitary state gives the individual the opportunity to draw upon untouched capacities and resources and to realize himself in an entirely unique manner” (p. 14). This combines various emotional qualities, from pain and terror to beauty, compassion, and growth (Moustakas, 1961). Trauma and close encounters with death can intensify these experiences, and it seems that implementing these emotional shifts enhanced empowerment and growth for this study’s participants.

Heidegger acknowledged the circular nature of moods and emotions in Being and Time, clarifying that moods are one way of communicating to and with the world (Dreyfus, 2013). More recently, other scholars and clinicians highlighted the importance of examining what leads individuals to experience loneliness and what they gain from this state, both good and bad (Wachtel, 2014). Accordingly, although most previous research has emphasized loneliness as a negative experience, the findings of the current study support and emphasize the understanding of this phenomenon as multilayered.

Various forces act on trauma survivors in their social context, influencing and shaping the bilateral interaction between these players. When society’s reluctance to deal with trauma and its effects is stronger than the individual’s capability to process the trauma or when people in the social environment do not have the strength needed to help the survivor process the trauma, emotional distress might rise (Shorer et al., 2022). In the case of combat-related trauma, the motivations for this trend can be either personal circumstances among members of the veteran’s support system or stigma and cultural codes that restrain emotional intimacy or expressions of weakness by the veteran (McGuffin et al., 2021). As our participants described, at these times, they tended to dwell in loneliness, finding shelter in the cyclical nature of this emotional experience. According to their descriptions, they remained in this emotional state until they could find a way to move from dwelling, to being with others authentically. This movement is described in Figure 1, which represents the process of moving in and out of loneliness, as a result of ongoing individual transitions from moments of coping alone to moments of being able to share his world and be emotionally engaged with others. As seen in the model, there are various positions one can hold—representing the non-dichotomous character of this process.

Figure 1.

Loneliness developmental spiral.

The transition from trauma to recovery and growth requires psychological resources that trauma survivors sometimes lack. When the transition is possible, emotional posttraumatic growth is experienced, serving as a resource for further psychological development. As the participants in the current study reported, once their needs for safety and help were synchronized with their social surrounding, they could progress in their recovery. Growth occurred mostly in the form of moving from loneliness to fuller engagement in interpersonal relationships, including emotional readiness to communicate and share their hardships with others (family members, spouse, and peer group members). Our participants made clear that for this process to exist, both the trauma survivors and their close ones should acknowledge the two ends of the social continuum, from emotional loneliness to emotional sharing. Finding words to express themselves in a milieu that enabled this experience was a significant part of this process (Ali et al., 2020). Because many times these moments first existed in the frame of the group intervention, they could help others at the same time, which seemed to validate their value further and support their escape from psychological stagnation. In this context, existential notions could also arise.

Naturally, this circular motion is not self-sustaining. To initiate it, trauma survivors have to acknowledge their condition, including the accompanying existential loneliness. This recognition is a continuous process that involves facing personal limitations in a constant tilt between feeling vulnerable and resilient (Ettema et al., 2010). Participants in the current study described such movement: between the desire to share their experiences and the frustration that stems from the recognition that it is not possible in a complete and satisfactory way; between the ability to express themselves in words and the limitations of words to describe their feelings; and between the ability to feel in the presence of others and the limited possibility of others to understand their feelings. Scholars noted similar conditions in previous studies (Schuman et al., 2019), which presented the emotional exposure some veterans choose to make via video logs, or vlogs. By using these vlogs, veterans could express intimate trauma-related moments with strangers while feeling understood and connected because this platform allowed them to reach out to others familiar with the posttraumatic condition. Thus, it enabled them to achieve moments of belonging, which contrasted with their existential loneliness.

Events of inadequacy between trauma survivors and their social environment that produce experiences of threatening existential loneliness have been previously described as “small deaths” (Bolmsjo et al., 2019). Accordingly, enormous anxiety arises whenever they occur. The current study’s findings add to this body of knowledge and describe unique features of this phenomenon. When death is an actual element of the trauma and what the survivor has to share, this existential anxiety is doubled—by both the actual death that took place during the trauma and these inevitable moments of small deaths that occur whenever the disconnection in human relationships occurs. Participants of the current study described similar experiences (e.g., Joel and Ofir). At the same time, this anxiety seems like a dominant force that motivated them to achieve a better connection with their close others. Throughout this process, movement occurred between moments of recognition, which liberated and awakened creativity and vividness in the face of loneliness, and moments when growth was not possible due to surrendering to fear and sadness as part of a rising awareness and acknowledgement of existential loneliness (Ettema et al., 2010).

Although this paper does not aspire to discuss the full psychological experience of loneliness and being alone (for further reading, see Galanaki, 2014), we comment on this experience among veterans. According to Winnicott (1958), the basis for the adult ability to be alone is the infantile experience and ability of being alone in the presence of a significant other. Coping with this experience creates a special type of relationship between the individual and close others. These relationships consist of recognizing the other as a unique, meaningful person and creating a lasting experience of self-worth through the creation of symbols (language) and internalized objects (Galanaki, 2014). However, the participants of the current study described how experiencing trauma evoked a different kind of loneliness. Following a traumatic event, anxiety, shame (from others), or guilt (toward others) might develop, which might lead to a defensive organization of seclusion in which the desire to be alone is accompanied by substantial fear. This differs substantially from Winnicott’s (1958) description of the child’s ability to feel safe in loneliness and grow from this developmental achievement. However, it seems that the group intervention provided participants with an opportunity to restore confidence in their ability to be alone in the presence of others. In this context, relationships with other members of the peer group and the group itself can serve as a pivotal point for reference and belonging. Internalization of these positive experiences seems to serve as a future psychological resource for rehabilitation of important interpersonal connections. Discussing the emotional aspects of the trauma and its aftermath with their peers during the group intervention helped these participants move toward a new, more balanced self-organization, which further enabled posttraumatic growth (Buchholz, 2015). It seems that this movement in and out of their loneliness stronghold allowed reconnection with their social world.

Study Limitations and Recommendations for Further Research

This study relied on a specific, relatively small cohort. The participants of the present study were all male Israeli veterans and graduates of an intervention program to process military experiences. This may have influenced how they expressed themselves and described their experiences. In addition, it is possible that veterans who belong to different cultural societies where other cultural codes are observed experience loneliness and its nuances differently. For example, it is possible that female veterans have different service experiences of dealing with trauma and associated loneliness. However, given loneliness is a circular experience, it is likely that even people living under different cultural codes will experience at least some of the characteristics described in this study.

Clinical Implications

Despite recognition of the importance of loneliness among veterans, it has received only partial attention in current therapeutic models (Wilson et al., 2018). The current study provides evidence in favor of adding loneliness as a basic emotional state that characterizes traumatized people’s emotional experience, nested in a social context. Particularly important is the notion that loneliness is a multilayered condition. It can serve trauma survivors in their search for safety, but this sense of safety is paradoxical because it is built on emotional avoidance. At the same time, it also bears the potential to motivate trauma survivors to act on their condition to promote their rehabilitation and growth. To support this movement, more effort should be invested in informing soldiers and veterans about common emotional and behavioral reactions after exposure to military trauma and the treatment options available to them. Emphasizing that the convergent response, including the choice of solitude, is familiar and natural is particularly important to convey the message that solitude can be beneficial in the short term but also harmful in the long term. Moreover, clinicians should acknowledge the risks that trauma survivors take by leaving their lonely yet safe place to expose their inner world to others.

Ethical Statement

Ethical Approval

This study was approved by the Faculty of Social Welfare and Health Studies, University of Haifa Board of Ethics, # 435/21.

ORCID iD

Shai Shorer https://orcid.org/0000-0002-1436-1013