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FROMM-REICHMANN'S EVOCATIVE ARTICLE was published after her death. It is unclear what prevented her from fully developing and organizing her many original thoughts about loneliness into a complete paper.
Fromm-Reichmann notes that loneliness is poorly conceptualized and that such varied states as "aloneness, isolation, loneliness in cultural groups, self imposed loneliness, compulsory solitude and real loneliness are all thrown into one terminological basket." She challenges us to be specific, to address the distinctive and individual patterns of loneliness in our patients.
She knew, acutely, how psychotic patients experience severe loneliness which is inconceivable to others and cannot be shared by empathy. It is important to distinguish the excoriating loneliness of certain psychotic and borderline patients from the loneliness of the "normal." Fromm-Reichmann's work at Chestnut Lodge immersed her in the world of the isolated patient. She knew how hard it was to try to empathize with patients most hopelessly alone. Yet this barrier to empathy extends to all patients who complain of loneliness.
Fromm-Reichmann observes how we confuse loneliness with anxiety. She wondered whether there might be "a tacit conspiracy … to accept unchallenged the conceptual merger between anxiety and loneliness." In psychoanalysis, focus on anxiety as the trigger of defense, limited and obscured awareness of other feeling states