Coping with loneliness in southern Myanmar

Abstract Little is known about the experience of older adults’ loneliness in Southeast Asia. Situated in southern Myanmar, this study uses ethnographic interviews to shed light on coping strategies that older adults deploy to prevent and reduce loneliness. A resilient mindset was identified as essential to alleviating loneliness in older adults, a strategy described as including acceptance of loneliness and finding strength to fight against loneliness. Acceptance was facilitated by religious practices such as praying and meditating. Efforts to reduce loneliness included leisure activities “just to pass the time” and engagement in care provision. Culturally specific concepts such as prosociality and social harmony, as well as religious ideas such as karma and the desire for a non-lonely afterlife influenced the ways the people we interviewed coped with loneliness and adverse life events.


Introduction
Aging is a global phenomenon, but of course older adults' personal experiences are shaped by cultural values, norms, and life-course expectations that vary across regions. Such regionally specific factors are often not considered in quantitative studies published in the field of psychology and aging. Applying an anthropological perspective on aging by focusing on specific regional contexts around the world may help us understand what issues older adults experience and how they cope with challenges they face on a day-to-day basis (Briller and Carrillo 2021). As early as the 1960s, anthropologists such as Margaret Clark and Sharon Kaufman set the ground for understanding aging as "an interactive and socially embedded process that requires adaptation to specific sociocultural contexts" (Perkinson and Solimeo 2014, 104). More specifically, aging can be understood as a process that is shaped by local environments, access to resources (e.g. economic), and social relations (e.g. social support and social roles) (Buch 2015). In this article, we aim to apply Clark's notion of situated aging to the sociocultural context of rural Myanmar to try to understand how older adults cope with loneliness.
In Myanmar, one third of the older population is estimated to feel lonely during the past month (Knodel 2014). This finding may seem concerning, as loneliness is an established risk-factor for several adverse health outcomes (Cacioppo, Cacioppo, and Boomsma 2014;Holt-Lunstad et al. 2015). However, loneliness may be short-lived or persist for years (Cacioppo, Cacioppo, and Boomsma 2014) and is commonly described as a natural feeling that humans experience at some points in life, only becoming an issue when it turns into a chronic condition (Ozawa- de Silva 2021, 201): Loneliness is dual faceted: it prompts a desire for relationships and affiliation (belongingness, being accepted, being recognized), and it triggers feelings of threat and dread when it is experienced. If loneliness promotes a desire for relationships, then it is not necessarily negative, but when it becomes a chronic or intense level of loneliness, then the threat and dread of feeling socially abandoned might become debilitating.
The difference between transient and chronic forms of loneliness raises questions about the ability of adults to recover from loneliness, as related to their motivation, resilience, and coping techniques to prevent or reduce loneliness. Various studies have previously examined how people cope with loneliness (Kharicha et al. 2021;Rokach 2018), but their findings may not be generalizable across countries since experiences and reactions to loneliness may be influenced by cultural and religious concepts. In Southeast Asia, religion plays an important role for older adults' everyday life, often serving as a meaning system for coping with stressful life events (Xu 2018;Yap 2015). Only a few studies, however, have examined how older adults in Southeast Asia cope with loneliness (for example, Amzat and Jayawardena 2016). Looking at loneliness from an anthropological perspective may help us to understand why coping strategies may vary across different cultural contexts.
Loneliness is defined as a feeling arising from the perceived discrepancy between desired and actual social relationships (Peplau and Perlman 1982). From a psychological standpoint, loneliness is therefore an experience closely linked to the cognitive appraisal of individuals. Only recently has loneliness also drawn attention from anthropologists. In the thematic issue "towards an anthropology of loneliness" (Ozawa-de Silva and Parsons 2020) in the journal Transcultural Psychiatry, the editors argue that loneliness goes beyond the cognitive appraisal of a discrepancy arising within social relationships. Moreover, it is an inherently subjective experience fundamental to the human condition, formed by cultural expectations that may vary by gender, race, class, and age. Similar to psychologists, anthropologists distinguish between loneliness (a subjective and affective reality) and social isolation (an objective situation) as well as depression (a clinical disorder). However, authors from that special issue argue that loneliness is not the only term through which we can explore feelings of social disconnection. Feeling unneeded and insecure around one's social connections, lacking relational fulfillment, fulfilling social roles, or social recognition, and not being able to return social exchange practices, or even having an absence of meaning in life can also be studied in relation to loneliness (Ozawa-de Silva 2020; Ozawa-de Silva and Parsons 2020;Parsons 2020). From an anthropological perspective, loneliness goes beyond the individual experience to also involve the study of societal structures that promote loneliness, as closely linked to cultural expectations and structural violence. For instance, poverty and separation from families may reduce opportunities to participate in networks of community and care (Pike and Crocker 2020). Narratives of older adults during the Covid-19 pandemic help us to comprehend how loneliness is experienced (e.g. as a result of a compressed body locked up in space, time, and the self) in certain situations and geographical contexts (Diodati 2021;Galkin 2020). Thus, to understand people's emic, lived experiences, anthropologists call for ethnographic field work and interdisciplinary approaches that require relational, cultural, and contextual analyses of subjective experiences across the lifespan (Ozawa-de Silva and Parsons 2020).
In 2015, our last author, who is from Myanmar, Khin Myo Wai, conducted ethnographic fieldwork including focus group discussions and interviews on older adults' loneliness and social networks in Yangon, Myanmar (Wai 2015). From her findings, we began to obtain a better understanding of what loneliness means to older adults in Myanmar and what kind of structural and cultural factors are linked to this inherently human experience. In Burmese, the most widely spoken language in Myanmar, staying alone (tajau' hte: nei ta) means physically being alone. The word for loneliness is ã À hti: kjan chin:, which means emotionally being lonely. Thus, the Burmese language, like the current literature on loneliness, distinguishes between social isolation and loneliness. According to Wai's interviews, older adults' loneliness was expressed as emotional pain, closely related to feeling depressed and sad. Reasons for feeling lonely included abandonment, bereavement, poor relationships with children, and economic hardship. Several older adults talked about cultural changes pertaining to looser family ties, ageist stereotypes, reduced respect towards older adults, and weaker religious beliefs. 1 Religion was a theme that arose in focus group discussions, where interviewees suggested meditation, doing good deeds, and visiting religious places as possible ways of reducing their loneliness. Similarly, when the first author lived in Myanmar prior to conducting the fieldwork for this study, most people she talked to about loneliness in day-to-day conversations mentioned religion as an important factor.
Wai's research took place in an urban context; in the research for this article we have sought to explore older adults' loneliness in more rural settings, and also to ask questions not just about the experience of loneliness, but also about how our interviewees felt that loneliness may be reduced or prevented, centering on resilience. In an attempt to understand older adults' suggestions and descriptions of resilience in southern Myanmar, it becomes important to see resilience as a social process influenced by cultural concepts and religious practices, including Buddhists concepts such as compassion (Lewis 2020). In her book The Anatomy of Loneliness, Ozawa-de Silva (2021) hypothesizes that resilience may not only exist within individuals but also between individuals, in communities, and in societies. Given that Myanmar is a country where religion plays a major role in people's lives, this study, as illustrated by interviewees' words, is embedded within Myanmar's diverse religious and cultural contexts. We conducted semi-structured interviews with older adults from two geographical regions (the Tanintharyi region and Mon state) and different religious backgrounds. The interviews focused on older adults' personal experiences and advice about reducing and preventing loneliness. This ethnographic approach allowed a comprehensive understanding of loneliness in an understudied context.

The ethnographic setting
For a year in 2018-2019, the first author lived in Myeik, southern Myanmar. Before conducting interviews, she learned Burmese and had informal conversations with people across the lifecourse to understand how older adults are situated in society, particularly as related to family ties and social standing. This process helped familiarize her with the cultural context, as she, a psychologist from Germany, had certain expectations about how older adults were integrated into society. For example, there is a common misconception that feelings of loneliness are more prevalent among older adults from the Global North, as they may be more likely to be living alone or institutionalized in long-term care facilities, but this of course may or may not be the case. In Myanmar, older adults are not often seen alone, but rather are integrated into intergenerational living situations with daily contact with family members and neighbors. Yet, social isolation and loneliness are distinct phenomena, and older adults may indeed feel lonely as often as adults from other countries (Knodel 2014). After living in Myeik for several months, the first author met several older adults who had experienced severe adversity in their lives. It was not uncommon to hear older adults talk about their children who had died due to common chronic but treatable diseases such as diabetes. The "out-of-pocket" health care system prevented older adults who were living in poverty to get the care they or their family members needed. To provide a fuller sense of the ethnographic setting, we provide several photographs from the field site, illustrating older people aiding one another (Figure 1), engaging in religious volunteer activities (Figure 2), and working to support themselves ( Figure 3). Our interviews aimed at understanding how older adults coped with loneliness despite their often existential worries and adverse life experiences. Interviewees were recruited through contacts of the first author, mainly local organizations in Myeik and  Ye. Members of local organizations approached potential interviewees and inquired about the willingness to participate in an interview about loneliness with the first author and an interpreter. A total of 10 interviewees were approached; 9 agreed to participate (one had time constraints), and one decided that they did not want the interview to be recorded or documented. Six interviews were conducted in Myeik township, Myeik district, Tanintharyi region, and two interviews were conducted in Ye township, Mawlamyine district, Mon state. Both areas are predominantly rural, with a population of 284,489 in Myeik township and 152,485 in Ye township (Kil, O'Neill, and Grusec 2021;Department of Population 2017a, 2017b, 2017c. Although the majority of Myanmar's population is Buddhist, next to Rakhine state, Tanintharyi region and Mon state are the regions with the highest Muslim populations in the country, with approximately 5% in each region (Department of Population 2017c). Southern Myanmar has high rates of outmigration, with over 10% of older people living in skipped-generation households, with their grandchildren but no adult children (Knodel and Nguyen 2015). After informal conversations with younger and older adults about loneliness, the first author realized that meditation and religious coping strategies played an essential role for overcoming loneliness. Thus, we selected older adults from multiple religions (Buddhists, Christians, Muslims, and Hindus), as we were interested in the association between managing loneliness and religious beliefs.
We asked about our interviewees' families, health, social relations, and religious beliefs, but the main topics we discussed in interviews was preventing and coping with loneliness. In all interviews, we asked the older adult to remember and describe a situation when they had experienced loneliness (ã À hti: kjan chin:), how they felt when they were lonely, their response to these feelings, what kind of support they considered helpful, and how they managed their loneliness. Towards the end of the interview, we asked, "What would you like to suggest to people in order not to feel lonely in the future?" If interviewees did not talk about loneliness as the interview progressed, they were reminded of their responses to the first loneliness questions and asked to reflect on them. Seven interviews were conducted face-to-face by the first author and an interpreter in Burmese at interviewees' homes, and two interviews were conducted by the first author alone in English. Interviews were audio-recorded and lasted between 17 and 68 minutes. The interviews were analyzed using thematic analysis. 2

Preventing and reducing loneliness
Seven main themes on preventing and reducing loneliness were identified in the interviews: having a resilient mindset (accepting and finding meaning in loneliness, and finding strength to fight against loneliness), praying and meditating (thinking about God/Allah or the next life, listening to religious sermons), having a prosocial mindset (staying in social harmony, avoiding conflict, and remembering positive social interactions from the past), having basic material needs met, keeping an active lifestyle (participating in community activities, sports, games, and reading books), caring for others (volunteering, providing care to family members, sharing advice), and having a supportive social environment (being with family, having proximity to neighbors, appreciating social relationships). Although the different people we interviewed were shaped by common cultural ideas and attitudes, they differed as to how exactly they dealt with loneliness, as the following themes reveal.
Having a resilient mindset: "the mindset of trying" Being resilient was the strategy most mentioned in our interviews. There are two essential components to a resilient mindset, as described by six of eight older adults. The first part is to realize that one feels lonely and accept it as a natural feeling. Acceptance, often linked to religious concepts such as karma and redemption to give meaning to challenging life situations, was a common strategy older adults talked about when experiencing loneliness. For instance, Daw Nway 3 discussed how her religion helped her accept her current situation. She is an 80-year-old widowed Buddhist who lives together with her grandson in the small city of Ye. Her husband and daughter died, and her only son left eight years ago to work in Thailand as a fisherman. She feels lonely because she misses her son every day, fearing that he may be dead. When she sits at home and hears a motorbike coming down the street, she turns around to see whether the person could be him. Although she feels lonely, her religious belief helps her to accept her situation, as she describes with conviction: The second part of the resilient mindset went beyond acceptance. According to two older women, older people can overcome their loneliness by having a "mindset of trying" (kjou: za: chin te. sei'), i.e. having the strength to try to change this negative state. One of these older women, Daw San, is a married, 79-year-old Buddhist living with four family members in Ye. She has a big family with five children, 13 grandchildren, and two great-grandchildren. Daw San said that she never felt lonely. Although she takes care of her husband, who cannot walk, and does everything herself in the household, she does not need to worry about her basic needs because her children support her. Along with her family, Daw San's mindset plays an important role for coping. When she feels angry or sad, she tries to reduce these feelings using her knowledge from Buddhism. As she told us, "I try not to feel weak, even when I am sad. I encourage myself. Feeling lonely has no benefit for me, so why should I keep feeling lonely? I fight against sadness." Similarly, Sayama Moe explains how she manages to have a resilient mindset. Sayama Moe is "74 years old and glowing" (as she describes herself); she is a teacher and a Muslim, married and living together with 18 of her family members in Myeik. Her neighbors are mostly relatives, and due to her big family and community, she has never felt lonely, she maintained. Until now, she is healthy enough to take care of all the household work independently; she is not affluent but does not have financial worries. Although Sayama Moe does not feel lonely, she said that she can empathize with lonely people. She realizes that her situation is fortunate, and alleviating loneliness may be more difficult to achieve for adults who are older, socially isolated, and have impaired health (Schoenmakers, van Tilburg, and Fokkema 2012). Nonetheless, as she told us, If you feel lonely and don't do anything, then you cannot improve your situation. If people don't want to feel lonely, they should fight loneliness … .This is the mindset of trying. … We can raise awareness. We can talk to them about loneliness. "I'm lonely, I'm lonely," if you stay like that, you will feel lonelier. You need to try again and again, don't give up.
One's disposition to adopt a mindset of trying to overcome loneliness may be related to one's personal or cultural conception of karma. On the one hand, karma is sometimes conceptualized in a fatalistic sense to explain how one's experiences have been inevitable consequences of one's past actions, which may cause people to feel helpless (Phillips et al. 2012). On the other hand, in Myanmar, karma is often conceptualized as a motivating factor for performing good deeds. The premise that one's current actions may influence one's future situation is often invoked by Burmese monks to encourage people to practice good deeds, speech, and thoughts (Cassaniti 2018). Although both interpretations of karma can be found in Myanmar, there seem to exist individual differences in one's understanding of karma that affect how a person copes with loneliness.

Praying and meditating
The realization and acceptance of loneliness may be facilitated by meditation or prayer. In Myanmar, 95% of older adults meditate or pray at least once a month (Knodel 2014). In our study, six of eight interviewees reported praying and meditating as an immediate strategy to alleviate loneliness by achieving a sense of relief, distraction from negative feelings, and closeness with God. Praying and meditating were practices mentioned by interviewees from all religions. These religious practices were often used as a general coping strategy for difficult times, such as in the case of Daw Nway, who misses her son and feels lonely: "I pray every day for my son and meditate, that helps me feel better. Yes, it makes me feel less lonely." All interviewees who mentioned praying or meditating as a strategy reported not feeling lonely during this activity. For instance, Daw Htwe describes how listening to religious sermons and praying helped to relieve her loneliness. She is an unmarried, 56-year-old Hindu woman from Myeik, who has been living alone for over 30 years. She does not have any family, as her parents and siblings have died and she never married or had children. Next to the community in which she lives, Daw Htwe says that religion is the most important thing in her life. She does not always have time to go to the temple, but she prays at home twice a day, which helps her reduce loneliness: In the next life I don't want to be lonely again. So, I pray for my next life not to be lonely. … Whatever happens, I believe in hpaja: [God] and I pray, and everything will be okay. … If I feel lonely, I think about hpãjã: and that reduces my loneliness." 4 Praying and meditating helped older adults either forget about their loneliness (i.e. their mind was with God/Allah) or have hopes for an afterlife without loneliness. The notion of "impermanence" and of feeling "like the mind is washed" are common experiences that Buddhist monks in Myanmar have during meditation and may explain one mechanism through which older adults may relieve their feelings of loneliness (Cassaniti 2018). A preliminary review supports the idea that meditation can help reduce loneliness (Saini et al. 2021). Future studies are needed to further investigate how the practice of meditation among older adults in predominantly Buddhist Asian cultures, where meditation is usually based on religious motives and embedded in collective religious rituals, affect perceptions of the self and social relationships (Pagis 2021) and how these may lead to a reduction in loneliness.
Having a prosocial mindset: "where water goes, fish follow" Religious belief and meditation not only facilitate acceptance of loneliness, but may also enhance a prosocial attitude (Kil, O'Neill, and Grusec 2021), an attitude of being agreeable, flexible, grateful, and avoiding conflict by showing empathy, forgiveness, and appreciation towards others. Getting along with family members, friends, and neighbors, and sometimes putting personal preferences aside, may be particularly essential in Myanmar, where basic needs can often not be met due to a lack of government-provided social security. For example, U Htet is a 93-year-old married Muslim man who lives with 15 family members in one household in Myeik. He has four living children, 14 grandchildren, and three great-grandchildren. When he was younger, in the 1950s, he was transferred to different cities for work and separated from his family for several years. During this time, he felt lonely much of the time, but now that he lives with his family, he does not feel lonely at all, he maintaind. His family supports him practically and emotionally; U Htet knows that he needs this help, which is why he maintains that he carefully listens to them: I always listen to what they [my family] say to me, what to eat, how to live. Because I need help, that's why. … jei lai' nga: lai' [where water goes, fish follow]. You don't want to feel alone, the only one, you don't want to feel that. … You should stay with other people in harmony, give understanding and show empathy, and not be proud.
The saying jei lai' nga: lai', "where water goes, fish follow," is a common saying in Myanmar, which describes the culturally specific importance of living in social harmony and going along with other people's decisions, i.e. being agreeable and not insisting on one's own preferences. According to several interviewees, avoiding conflict could prevent disappointments in social relationships, and ultimately, prevent loneliness. Sayama Moe, portrayed above, who successfully lived with 17 household members, followed her father's advice to stay in harmony with others: she suggested going to a quiet place when feeling upset, as she did not want to let out her anger on other people. This strategy included staying in harmony with people from other religions and inviting them to various festivities.
The effect of containing socially disengaging emotions such as anger has been shown to vary by culture. For example, suppressing anger was negatively associated with conflict resolution in Belgian couples but not in Japanese couples (Schouten et al. 2020). Similarly, in her ethnography on resilience among Buddhist Tibetan refugees in India, Lewis (2020) writes that "diminishing and downplaying adversity in life is not seen as repression, but rather as skillful and realistic" (66). Lewis explains how Tibetans think of emotions not as bad or good but as helpful or not; in Myanmar emotions are categorized into hot emotions (negative affective experiences that result from a lack of mindfulness) and cold emotions (resulting from having a peaceful mindset) (Cassaniti 2018). As such, one may assume that the idea of containing hot emotions such as anger in Myanmar, when judged as not useful, may be beneficial for resolving conflicts with family members, and for reducing loneliness, whereas this may not be the case for societies where Buddhist prosocial concepts and social harmony play a less important role. Containing negative emotions requires skills in emotional regulation. A recent cross-cultural study reported that students from Myanmar had higher intra-and interpersonal emotional competence as well as higher relational qualities with family members than Japanese students (Min and Takai 2021). Older people in Myanmar (a culturally more Buddhist country than Japan) may be better at seeing adverse situations as opportunities, and thus becoming resilient (Lewis 2020). Myanmar may be unusual in the way that people value harmony, and how they practice containing negative emotions through meditation and going to quiet places, thus avoiding conflicts that may lead to loneliness.
Having a prosocial mindset was also associated with religion. Daw Thinzar, a widowed, 91-year-old Buddhist who lives with five family members in a village close to Myeik, described how her attitude about staying in harmony with others was influenced by Buddhist teachings. Even though she has a big family with five children, 27 grandchildren, and 17 great-grandchildren, she sometimes feels lonely. When she was younger, she was an actress and had money, and people cared for her, she related; however, now that she is old and poor, she sometimes feels that nobody cares about her. She copes with loneliness by reading Buddhist scriptures. Daw Thinzar used to often meditate, but with age it has become difficult for her to sit for long without going to the toilet, which is why she cannot go to the monastery. Instead, she prays at home every day and reads Buddhist teachings. Treating others well will lead to them treating oneself well, she relates: "everything is like a mirror … whatever you do, you will get back," a precept that if followed, she says, can enable better social relations and reduce loneliness. Other interviewees also emphasized that loneliness could be reduced by holding positive attitudes towards other people or life in general (such as being flexible, empathetic, agreeable, and grateful) and not holding grudges, but rather ignoring, forgiving, or overlooking perceived offenses to avoid conflict. As U Win, discussed later, told us, "If I keep my mind good, then good people will come … .If I only look at the positive things in a person, that person will be happy when they see me."

Meeting basic needs
When interviewees were asked about strategies to prevent or reduce loneliness, several older adults mentioned that meeting basic material needs such as housing and food, was an essential first step. 80-year-old Daw Nway, discussed earlier, lives with her grown-up grandson in Ye, but she must completely rely on herself. She sells rice noodles at the market every day, but the money is not enough to buy the medicine she needs for her eyes and back pain. She worries that she will not have enough money to buy food. If she did not have so many financial worries, she could feel happier, better, and less lonely, she relates: Older people, when they get old, if they don't have a good place to live or much to eat, they will feel lonelier. When people have a place to live and food, that will reduce their loneliness. … I'm not asking for much. Just enough to live on and eat.
Daw Nway is fortunate that her community helps support her, giving her free food at the market and noodle shop, knowing that she is poor and lonely. Her neighbors bring her fruit and snacks and make sure she has enough to eat in case she does not have money or cannot cook for herself. She would like to be more involved in the community, but her health is not good, and she does not have money to participate. Daw San, who lives a few streets away, talks about Daw Nway's loneliness and financial precarity, and hopes for government support in taking care of older adults who are poor, lack family to take care of them, or are not healthy enough to work. "If the government could build a nursing house for old people and support them every month, they would be happier … " Keeping an active lifestyle "just to pass the time" Engaging in leisure activities such as sports and dance groups, being physically active, and keeping up-to-date with news made some of the older people we interviewed feel protected from loneliness. U Kyaw is a Christian, 91-year-old married man who has lived separated from his wife for many years; he lives together with eight family members, including some of his four children and six grandchildren in Myeik. His wife worked for the government in the capital city Naypyidaw, which is why they could not live in Myeik together. When he was younger, this was a major issue for him and he frequently felt lonely, but getting older he learned how to cope with the situation. Despite being 91 years old, U Kyaw still keeps an active lifestyle because it has helped him pass the time, stay healthy, and prevent negative feelings such as loneliness. As an English teacher, he still works and teaches his young students twice a day, which he loves doing. When he has free time, his son takes him to a teashop. U Kyaw calls himself a sportsman. Despite his age, he plays tennis regularly and walks everywhere by himself; he is able to take care of household chores, like washing, and cleaning. Participating in activities has helped him overcome loneliness, which is why he advises other older adults to follow his suggestion "just to pass the time": They [lonely people] have to go and participate in games. They have to meet other old people. There is one place near the university, all the old people gather there and they sing and dance … .just to pass the time and relieve their worries. You cannot take medicine or something to relieve all this. When you take medicine, you can sleep, but you cannot relieve your problems. If old people go and sing and dance once or twice a week, they'll be healthy and they will enjoy themelves. Also, they can discuss things together … .so that their worries are gone.
His eldest son has asked U Kyaw to move to Yangon and stay with him there; but U Kyaw does not want to go, because he would not be able to walk everywhere by himself, find friends that are as close to him, and play tennis, because the court is very far away and nobody there would want to play with older people. Several adults who were not able to participate in social leisure activities like U Kyaw, because of health constraints, limited availability, or financial problems, recommended reading books or listening to music to alleviate loneliness.

Providing care contributions
From an anthropological perspective, loneliness is shaped by meaning in life: everyday social and relational practices with other humans and non-human beings, often involving care (Ozawa-de Silva 2020), and a sense of social, physical, and transcendent connectedness (Bos, Cornielje, and Laceulle 2021). In line with this definition of meaning, helping other people in the community, such as participating in social work or volunteering at religious events, counted as among the most frequent strategies suggested by the older adults we interviewed. Caring activities mentioned by the interviewees included cooking for monks at the monastery, taking care of one's spouse, teaching, sharing life advice with children, fixing umbrellas and shoes, cheering people up, giving people money, food, or clothes, and feeding animals. Older adults who were very active in their communities and valued helping others, like Sayama Moe, reported this as an effective strategy for not feeling lonely: "If you sit around, nothing will happen. If you help in just one place, loneliness can disappear." However, some older adults were not easily able to participate in social activities due to impaired health. This was the case for U Win, a widowed 96-year-old Muslim man living with his son's family and many grandchildren in Myeik. His wife and four of his seven children have died. Getting older, he maintains that he feels lonely more often. Still, despite his ill health, he has found ways to engage in caring activities to help alleviate this feeling. He tries his best to give small "donations" to all living beings. A few years ago, he used to repair shoes and umbrellas for free because he had time. People thanked him and he was happy to do them a favor. Also, until 2014, before his wife passed away, he took care of her, which gave him religious merit, he felt, and he continues to try to help others today: I am very happy when I can help somebody I know, or don't know, it doesn't matter. The donation doesn't need to be big … . I put my leftovers somewhere and the goats come to eat it. If I can feed them whatever I cannot eat, it makes me feel better. And then I'm happy and it's a success, and my donation … .Some girls came here recently, and seemed annoyed, and I told them various humorous things to cheer them up. When they don't feel well, they come to me. I look for food to give them and make them happy. This is my donation. We don't have to try hard. I treat everyone nicely, and give them good things.
This example shows how older adults can contribute with caregiving activities such as feeding animals or telling jokes to cheer people up despite impaired health. The importance of caregiving and contributing to society was one of the most frequently mentioned strategies to reduce loneliness. Older adults may have various motives to provide care, but it makes sense to think that fulfilling values of generativity (the desire to contribute knowledge and skills to younger generations) may reduce older adults' loneliness; in this sense, providing care is self-care (see Akhter-Khan 2021).

The importance of the social environment
When talking about protective strategies against loneliness, many older adults mentioned the importance of living with a family or having good relationships with neighbors. The social environment was particularly important for Daw Htwe, who lived alone. To her, her next-door neighbors were like her family who took care of her when she was sick, and she highly valued living close to them. Even though she feels lonely, Daw Htwe manages to reduce the feeling by keeping a positive mindset, praying for a non-lonely next life, looking for support within her community, and getting involved in planning funerals or weddings. For other interviewees, religious sites and old age homes were mentioned as important places for social integration and support exchanges. Daw Htwe, among other interviewees, advises younger generations to live with their family, get married, have children, and be integrated in the community to not feel lonely in the future, as she herself has felt: Live with your parents; don't go away from them, stay close to them. You should marry and build your own family; when you have a family, you won't be lonely. Love your family, when you have one. … If you stay far away from a community, you will have a very short life because you will be very lonely. When you have a good environment, you won't know what loneliness is.

Conclusion
This study has addressed the different ways in which older people in Myanmar deal with loneliness. From the interviews, seven strategies (having a resilient mindset, praying and meditating, having a prosocial mindset, meeting one's basic needs, providing care contributions, keeping an active lifestyle, and having a good social environment) were identified. Among those, the most frequently mentioned strategy was having a resilient mindset. This was described as a process of accepting loneliness and taking action to overcome this feeling. Many interviewees also talked about the importance of ensuring that older adults have food, shelter, and no existential financial worries. This finding raises the question of how mental health in Myanmar can be addressed when basic needs are not met (Akhter-Khan and Wai 2020; Lund et al. 2018). Considering that Myanmar's pension system only reaches a minority of older adults (Knodel and Teerawichitchainan 2017), financial support for local community organizations and volunteers is vital. Several interviewees recommended that younger people find a family and stay close to friends and neighbors, as they may assist in times of future impaired health. Yet, cultural changes such as urban migration threaten close relationships with neighbors and entail long geographical distances between family members, resulting in an increase of skipped-generation households across Southeast Asia and a risk of social isolation (Ingersoll-Dayton et al. 2018;Knodel and Teerawichitchainan 2017).
Although cohort differences in the prevalence of loneliness have not been reported so far (Drewelies, Huxhold, and Gerstorf 2019), with rapid societal changes in Myanmar (e.g changes in population mobility and family structure, new ways of communication, digitalization), the gaps between desired and actual social relationships (the definition of loneliness) could become larger, as older adults tend to hold on to traditional cultural values that have been internalized (Fung 2013). Another contributing factor to loneliness may be the increase in negative ageing stereotypes in Myanmar. Previously, it was common to send children to Buddhist monasteries over the summer holidays to learn about Buddhism and respect older people, our last author recalls. However, as this practice is now uncommon and younger adults spend more time on their phones-devices that many older adults in rural areas feel disconnected to and find hard to use-this may lead to more social exclusion and loneliness.
Our findings suggest that meditating and praying may immediately relieve loneliness, and over a longer time frame, religious belief may enhance acceptance of loneliness. For instance, according to Buddhist belief, suffering such as loneliness can be relieved by normalizing it as a part of life, facilitating its acceptance (Xu 2018). As described by several interviewees, the belief in an afterlife may also empower acceptance and hope for a future life without loneliness. One interviewee suggested training to raise awareness of loneliness as a natural feeling. These findings are in line with Ozawa-de-Silva's (2021) account of loneliness in Japan, where she identifies acceptance as the key factor of resilience to loneliness. She distinguishes between acceptance of loneliness, acceptance of others, and acceptance of oneself as three steps towards a society that normalizes loneliness, and at the same time fosters meaningful social connections, and emphasizes the value of each individual independent of their economic contributions (Ozawa-de Silva 2021). A similar process seems necessary in Myanmar from what we have found.
This study has several limitations. First, although we conducted and analyzed indepth interviews with older adults from four different religions, the sample size is small and not representative of many older adults in southern Myanmar and does not allow the drawing of conclusions about historical changes in experiencing loneliness. Second, as the relationship between meditation and loneliness has not been studied widely, we were not able to make cross-cultural comparisons beyond the country-specific context. Finally, most interviewees did not feel lonely at the moment of the interview but were asked to think about a past situation where they had felt lonely, which may have altered their recall of what helped them reduce loneliness in the past. Despite these limitations, our findings, in the first study investigating older adults' resilience to loneliness in Myanmar, contribute insights to the experience of loneliness by older adults in Myanmar and perhaps elsewhere in Asia. Although older adults used similar strategies to prevent and reduce loneliness, there were also individual differences, with some older adults implementing a more diverse range of strategies than others. Our findings resonate with Kharicha et al.'s (2021) call for considering older people as meaningful social contributors when creating person-centered interventions for loneliness, instead of using a one-size-fits-all approach. Future programs could promote conversations about loneliness among older people to share their personal coping strategies with other lonely people, so that, ultimately, persistent loneliness and its negative effects on physical and mental health can be alleviated in Myanmar, and perhaps elsewhere as well.
Johanna Drewelies is a psychologist and post-doctoral researcher at Humboldt University of Berlin and the Max Planck Institute for Human Development Berlin. In 2016, she graduated with a PhD from the Max Planck Research School on the Life Course. She has a strong interest in studying psychosocial and health development in adulthood and old age in different contextual settings from a lifespan perspective, and has a wide range of publications on mastery, perceived control, loneliness, and well-being in older adults.
Khin Myo Wai is a local research consultant in Myanmar who has been carrying out quantitative and qualitative research projects for national and international bodies since 2016. In 2016, she earned a Ph.D. in Demography at the College of Population Studies at Chulalongkorn University, Bangkok. She has published peer-reviewed articles on older adults' mental health and loneliness in Myanmar in the Journal of Demography and the American Journal of Geriatric Psychiatry.