Former Surgeon General Vivek Murthy on America’s loneliness epidemic

The coronavirus pandemic has caused a loneliness epidemic. Social distance, while necessary from a public health point of view, has led to a collapse in social contact between family, friends and entire communities – one that is particularly harsh on populations already most vulnerable to isolation.

But Americans went through a loneliness crisis long before anyone had heard of Covid-19. In a report from 2018 by the Kaiser Family Foundation, 22 percent of all adults in the US – nearly 60 million Americans – said they often or always felt lonely or socially isolated. The problem is even more concentrated in older adults: a large National Academies of Sciences report February showed that just over a third of adults over 45 and 43 percent of adults over 60 felt lonely (Others to research returned similar results).

Loneliness is not only painful; it can be deadly. Multiple meta-analyzes have determined that the mortality risk associated with chronic loneliness is greater than that of obesity and equates to smoking 15 cigarettes per day.

In 2017, former U.S. Surgeon General Vivek Murthy called loneliness a “ public health epidemic, ” a term that medical professionals don’t lightly circumvent. Murthy’s new book, Together: the healing power of human connection in a sometimes lonely world, is a powerful account of this loneliness epidemic that has taken place in much of the Western world. It is also a blistering – and quite radical – critique of the value system on which we have built modern society.

I recently spoke to Murthy by phone. A slightly edited transcription of our conversation follows.

Roge Karma

Thinking about your time as a U.S. surgeon general to communities across America, write that “loneliness ran like a thread through many of the more obvious issues that brought people to my attention, such as addiction, violence, anxiety and depression. ” Can you talk about that? In what sense was loneliness a common thread?

Vivek Murthy

I didn’t expect to find this thread of loneliness in so many of the stories I came across. People didn’t come to me and say ‘I’m lonely’, but they said things like ‘I feel like I have to solve all these problems on my own’ or ‘I feel like I’d disappear tomorrow, nobody would even notice’ or “I feel invisible.” What I realized was that whether people were struggling with addiction, depression, or violence in their community was the most pressing on them, they felt they had to face these challenges all by themselves.

When we are separated, it is painful. That is one of the reasons why physical separation, isolation and solitary confinement have been punitive methods in societies for so many years. That pain can be severe when you live in a state of deep separation from other people – be it physical separation or feeling emotionally disconnected from them.

But we all deal with pain differently. Some people will respond to that pain by picking up the phone and calling a friend. Other people respond to pain by reaching for a bottle of alcohol. Others will reach for a medicine. Some will lash out at those around them. Some will hurt others or themselves. Some are drowning in their work. But in many ways, it’s that deeper pain we feel when we’re lonely that affects our behavior – and in turn, our health.

Roge Karma

I want to talk about where the pain of loneliness comes from in the first place and why it exists. You talk about loneliness as a ‘biological signal’. So why do we feel lonely in the first place? What is the biological function of loneliness?

Vivek Murthy

We must think of loneliness as we think of hunger and thirst – as a natural signal our body gives us when we miss something we need to survive. Relationships allowed us to take turns looking for predators, sharing food supplies, sharing tasks such as childcare. All of this has helped us survive and even thrive.

So when we were separated from humans thousands of years ago, it put us in an immediate state of stress. In that state of stress, several things happened to us: our attention went in, our threat level shifted, we became hypervigilant. This was useful because without our fellow human beings to protect us, we were in constant danger. That high level of stress temporarily helped us survive alone and drove us back to our tribe.

Although our circumstances have changed dramatically, our nervous system is still very similar to what it was thousands of years ago. When we are separated from other people, we enter that stress phase as a signal for us to seek connections. And if not taken care of, it can cause damage in the same way as hunger or thirst if not cared for.

Roge Karma

You quote multiple meta-analyzes in the book that shows that the mortality risk of chronic loneliness is comparable to obesity or smoking 15 cigarettes a day. That is amazing.

Vivek Murthy

The body’s stress response from loneliness can be very helpful in the short term. But when those stress states become chronic, they begin to destroy the body. If you have a prolonged stress condition, the inflammation levels rise. That inflammation starts to damage tissues and blood vessels, which increases our risk of chronic diseases such as heart disease. It can damage your body’s immune response. It can even cause long-term sleep deprivation, putting us at greater risk of hypertension, obesity, and a host of other physical conditions.

What that all points to is how essential social connection is for our survival. Part of the reason I wrote the book was to help people see that our connections are not only fun to have but also necessary – and they should be much higher on our priority list. They should also be what policymakers and leaders think about when developing policies or designing workplaces and schools. We must ensure that all aspects of society support healthy relationships. This is how we ultimately thrive as a society.

Roge Karma

I want to talk about the shame of loneliness. A common thread throughout the book is not only that we have ignored loneliness as a social problem, but we have also placed a huge social stigma around it. Can you tell how stigma and shame contribute to our loneliness epidemic, and perhaps the role our culture plays in facilitating that shame?

Vivek Murthy

What we see with loneliness – and also with addiction – is that when we feel shame about some aspect of our life, it drives us further in and takes away our self-esteem. When you are lonely, you especially need contact with others. But the shame of loneliness pushes you in the exact opposite direction. The longer your loneliness lasts, the more difficult it is to contact other people because you don’t feel you are worth it. That is why it is a challenge to break the downward spiral of loneliness.

This is where our culture makes things worse. In an individualistic culture, your successes and your failures are entirely yours. This can be an extraordinary burden for individuals who can fail, not only because of their individual efforts, but also because of complex circumstances. There are people who may respond well to this, but many people do worse because they beat themselves up further. This leads to a further erosion of self-esteem and self-confidence and creates that downward spiral of loneliness.

However, one of the things I learned in that book is that service is a very powerful way to break that downward spiral because it short-circuits some of these mechanisms. Our focus is mainly on ourselves when we are lonely because we feel threatened. Service shifts our focus from ourselves to another person in the context of a positive interaction. It also strengthens our self-confidence because it reminds us that we have value to add to the world. That’s why I call service in the book a “back door out of loneliness.” It is such a powerful force when it comes to building a more connected world.

Roge Karma

What do you think are some other important drivers of widespread loneliness?

Vivek Murthy

We’ve already talked about our society’s focus on individualism, but I think our culture around work and performance has also become problematic. And that has to do with how we define success in the modern world. Success is driven by your ability to acquire one of three things: wealth, power, or reputation.

When we see someone who has sold a business or invested money and made huge returns, we say they are successful. When we see someone famous or who has achieved a high position in government or business, we say they are successful. The implication of this is that if I don’t have wealth, power, and reputation, my life is worth less. This is very problematic because there are various circumstances beyond the control of an individual that often prevent us from possessing wealth, power and reputation.

I think we should rethink the idea that each of us has intrinsic value. This is at the heart of so many spiritual traditions and so many cultures: the idea that our human value is rooted in our ability to give and receive love. And that love is most evident in our relationships – we experience love through other people.

When I think of my own children, who are 3 and 2, I want them to grow up knowing that their value is based on their ability to give and receive love. That’s something they were born with. It is true who they are. And they don’t have to acquire money or fame or a powerful position to increase their value as human beings. What makes them human is their ability to love, their ability to build relationships, their ability to serve.

Roge Karma

This comes down to something I appreciated about the book, which is just as subtly radical. The ideas that individuals determine their own destiny and that our moral value is a function of our ability to produce – these are the basic assumptions at the heart of our political and economic systems. And you say in fact that they are wrong in a very profound way.

Vivek Murthy

It’s funny that you say that – I actually almost gave the book the title ‘Radical love’. That’s because I think there is something fundamental that we need to transform into how we live. What I am asking for is a much deeper and fundamental change that is not about transforming us into something we are not, but a return to who we are intrinsic.

Every person feels better when he gives or receives love, regardless of political affiliation or the culture in which he grew up or whatever. That’s how we have to work. Conversely, when we operate out of fear – which often manifests as anger or insecurity or jealousy or fear – it doesn’t feel right. We all know that deep down.

In many ways, this book is about how we return to who we are intrinsically, which are beings based on, driven by, and driven by love. And it’s about how you can create a society fueled by love rather than fear.

The book is not only intended as a guide to building additional connections. It is about fundamentally transforming our lives and our society into a people-oriented life and a people-oriented society. If I had a single creed with the book, it would be just three words: “Put man first”.

Roge Karma

I think a response to that idea of ​​building a “people-centered society” is that those societies already exist. My family is Lebanese and Palestinian. And when I visit my relatives in the Middle East, they have a lot of problems, but loneliness is not one of them in general. They even have a hard time understanding how loneliness would be a problem for people. At the same time, they are so deeply embedded in family and community that they tend to have much less of the individual autonomy and freedom that we have come to cherish and respect.

You have a very interesting discussion about this interaction between freedom and community – and a possible synthesis that can help us reconcile it – in the book. Can you tell us about what you call first, second and third bowl societies?

Vivek Murthy

There are traditional cultures that I consider to be narrow but deep bowls. They often have many limitations which is acceptable: it may not be acceptable to marry later in life, be gay, pursue a career that your parents tell you is not appropriate. But there is a lot of depth in terms of social structure that makes you feel like you are part of that network. It could be the extended family structure, or generations of families living together in closely related villages. Staying within the limited constraints of the community can often make you feel quite connected.

There are also more modern societies, which I consider to be wide but shallow bowls. In many Western societies there is much more freedom to be who you are and a more open embrace of different identities. But the structures that make people feel that they are part of a community are limited: it is largely left to individuals to find friends [and] a structure that they can eventually call their community. These societies, like the ones we live in, tend to have a higher degree of loneliness.

What I imagine and hope in the book is that we can build a third bowl – a bowl that is wide and deep. A third-bowl society is one that embraces people’s individual identity and freedom of expression. But it is also a society with a great depth of structures that makes people feel connected and provide community for everyone.

Roge Karma

What would a third-scale society look like in practice?

Vivek Murthy

What it looks like are organizations that build and design workplaces to strengthen the human bond by creating opportunities for people to truly understand each other as people, not just skills. Schools seem to be investing in social and emotional learning so that they can provide children with a foundation for building healthy relationships. It is similar to neighborhoods where we value reaching out to and getting to know neighbors. It resembles a society that recognizes that we are truly interdependent beings who need one another, which means that there are times when we have the ability to serve and times when we must be ministered.

I think much of this is a matter of deciding to make human connection a priority. The challenge is not that we have the wrong values ​​- many of us value human connection. It is that we have ranked our priorities in ways that do not match our deepest values. That is what we need to change.

Roge Karma

Do you think coronavirus could be the spark that forces us to rethink how we prioritized our values?

Vivek Murthy

I hope. This is such an unexpected and profound experience for us. It is turning so much of our lives upside down. But despite all the pain this virus causes, it also gives us the opportunity to reset the way we live our lives, especially when it comes to social connection.

There is much concern that, among other things, the physical separation we are asked to observe can contribute to deepening loneliness and further tension on social bonds. But I don’t think it should be. I think we have the opportunity to choose social revival rather than deepening our loneliness. And we can do that if we take a step back and take this opportunity to give people and relationships in our lives a new priority.

Roge Karma

What would you say to people who are now at home in the midst of a pandemic who feel extremely disconnected? What would you recommend them?

Vivek Murthy

One of the bigger themes I realized when writing this book is that building a more connected life is ultimately based on the little things we do. It does not require a general reversal of your life. There are small steps we take to find a much deeper connection and fulfillment.

Sometimes we forget that one of the greatest gifts we can give to other people is the gift of our full attention. I know that we are an action-oriented society. We are used to thinking that the way to deal with a problem is to speak out and work out a solution. But there is also great healing to be found by listening to someone deeply. That’s something we can do today, and it’s one of the most powerful things we can do.

Another thing we can do is service. This is a time when so many people are struggling. So service in a time of Covid-19 doesn’t have to look like going to a soup kitchen or spending a month at Habitat for Humanity. It may seem like you are calling a friend to see how they are doing. It could be a neighbor who may be older to make sure they have groceries. It can be FaceTiming with your friends’ kids to virtually babysit them for 10 or 15 minutes, giving their parents time to sit and breathe.

Related listening

Vivek Murthy and Ezra Klein discussed the loneliness epidemic The Ezra Klein Show in October 2019. You can listen to the podcast at stream it below or to which you subscribe The Ezra Klein Show wherever you get your podcasts.