Where is Eleanor Rigby when we need her? Paul McCartney and John Lennon didn't answer where she and all the lonely people come from, or where they belong, for that matter. I think I know where they all come from. They come from everywhere. As the title of the travel guide says, this is a "lonely planet." Where they go is up to us.

There are the more obvious loners who sit by the window waiting for someone — anyone — to come. No one shows up to their funerals. But there are lots more if you just look. You may be one yourself.

For me, the definition of a lonely person is one who is alone with others. They feel little understood and disconnected from others, be it at a large party or with a small group of friends. They sense no one is near, even when others bunch up and bump against them. They are alone talking to their spouses or children. They can be alone in love and prayer. It is the great contradiction. That is why lonely people can be the life of the party without being alive. Being on stage keeps an actor apart from the audience while he keeps them laughing. It is the clown's "happy face" on the outside but sad on the inside. Being lonely is needing others so much they struggle to say they need anyone at all. And when someone steps forward to be close, they are rebuffed and told to go away. Meanwhile, inside they are screaming, "Come back."

Being alone is not the same as being by one's self or being a single man or woman. It is not the same as being solitary or without others. Being alone is a state of mind, a state of feeling. It is the void of relationships borne out of a bath of multiple contributing causes. Fear and insecurity are major ingredients. Fear of rejection, fear of hurt, fear of intimacy are all reasons to feel alone in a packed room or in a restaurant with a single friend. This state of isolation emerges from primal relationships of mother and child. Imagine how lonely it is for a baby when, in the midst of panic or physical anguish, the mother is not there, a caregiver is not aware or the guardian has left her post. It is that repeated loneliness that is emblazoned on their nonverbal protective memory that will live with them forever and often guide them to corners at parties or even the corner office.

There is a saying that it is lonely at the top. The buck does stop somewhere. But it is also likely that loners aspire to be at the top. Being at the top is their placebo. If one is "el supremo," or king of the hill, then the distorted thinking follows that they therefore must not be alone. How can one be alone when the masses come to you for advice or to adore you or if you are in charge or in control? Yet, when the board meeting is over, the fans depart and the term ends, or there is no more space on the blouse for all the medals, you are still all by yourself and alone. For these loners, power is the supposed antidote to lonesomeness. Titles are the elixir for loneliness. Neither are cures.

The therapy for loneliness is learning how to trust. There needs to be a healing from worry and the past. To be afraid is primarily a focus on self-preservation, a focus on you. Therefore, if worry is a trait or a current state of being, it is critical to learn how to down-regulate. To repair past mistrust requires that a person understand the first of all their relationships with their parents and siblings. The past cannot change, but the history can be rewritten. We are the co-authors with the past of our memories. Relationships can be practiced. Connections can be made. Perhaps Father McKenzie could help.

Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for more than 25 years and an adjunct professor of pediatrics at the University of Utah. He can be reached at [email protected]