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It can mean two things: 1) To literally be in the presence of no other person. 2) To be surrounded by people, but said people are largely inconsequential, in that you take no interest in them and vice versa, and so the situation is as good as being alone. It can lead to intense feelings of hopelessness, and depression. One may feel that they will forever be alone. It's a feeling commonly associated with the inability to make friends or meet a girlfriend or boyfriend.
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