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Former Surgeon General Vivek Murthy on America’s loneliness epidemic

Why Americans are so lonely — and what we can do about it. 

A man rests on an empty Staten Island Ferry on March 24, 2020, in New York City.
Spencer Platt/Getty Images

The coronavirus pandemic has created a loneliness epidemic. Social distancing, while necessary from a public health standpoint, has caused a collapse in social contact among family, friends, and entire communities — one that is particularly hard on populations already most vulnerable to isolation.

But Americans were experiencing a loneliness crisis long before anyone had heard of Covid-19. In a 2018 report by the Kaiser Family Foundation, 22 percent of all adults in the US — almost 60 million Americans — said they often or always felt lonely or socially isolated. The problem is even more concentrated among older adults: A major National Academies of Sciences report from February found that a little more than a third of adults over the age of 45, and 43 percent of adults over 60, felt lonely (other surveys have returned similar results).

Loneliness isn’t simply painful; it can be lethal. Several meta-analyses have found the mortality risk associated with chronic loneliness is higher than that of obesity and equivalent to smoking 15 cigarettes per day.

In 2017, former US Surgeon General Vivek Murthy called loneliness a public health “epidemic,” a term that medical professionals don’t throw around lightly. 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 hold across much of the Western world. It is also a searing — and quite radical — critique of the value system on which we’ve built modern society.

I recently spoke with Murthy by phone. A lightly edited transcript of our conversation follows.

Roge Karma

Reflecting on your time traveling to communities across America as US surgeon general, you write that “loneliness ran like a dark thread through many of the more obvious issues that people brought to my attention, like addiction, violence, anxiety, and depression.” Can you talk about that a bit? In what sense was loneliness a connecting thread?

Vivek Murthy

I didn’t expect to find this thread of loneliness in so many of the stories I encountered. People wouldn’t come up me and say “I’m lonely,” but they would say things like “I feel like I have to deal with all of these struggles on my own” or “I feel like if I disappeared tomorrow, nobody would even notice” or “I feel like I’m invisible.” What I realized is that whether people were struggling with addiction or depression or violence in their communities, what was weighing on them most was the sense of having to deal with these challenges all alone.

When we’re separated from each other, it’s painful. That’s one of the reasons why physical separation, isolation, and solitary confinement have been methods of punishment in societies for so many years. That pain can be intense when you’re living in a state of deep separation from other people — whether that’s physical separation or you feel 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 will respond to pain by reaching for a bottle of alcohol. Others will reach for a drug. Some will lash out at the people around them. Some will hurt others or themselves. Some will drown themselves in work. But in many ways, it’s that deeper pain that we feel when we’re lonely that influences our behavior — and, in turn, influences 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 is it that we feel lonely in the first place? What’s the biological function of loneliness?

Vivek Murthy

We should think about loneliness like we think about hunger and thirst — as a natural signal that our body gives us when we’re missing something that we need for survival. Relationships enabled us to take turns looking out for predators, to share food supplies, to share duties like child care. All of that helped us to survive and even thrive.

So when we were separated from people thousands of years ago, that placed us in an immediate stress state. In that stress state, several things happened to us: Our attention turned inward, our threat level shifted, we became hypervigilant. That was useful because without our fellow humans to protect us, we were in constant danger. That high level of stress helped us survive temporarily on our own and drove us back to our tribe.

Even though 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 out connections. And if not attended to, it can cause damage in the same way that hunger or thirst can if they are not attended to.

Roge Karma

You cite multiple meta-analyses in the book which show that the mortality risk of chronic loneliness is similar to obesity or smoking 15 cigarettes a day. That’s staggering.

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 destroying the body. When you have a protracted stress state, levels of inflammation rise. That inflammation starts to injure tissues and blood vessels, which increases our risk for chronic illnesses like heart disease. It can impair your body’s immune response. It can even cause long-term sleep deprivation, which puts us at greater risk of hypertension, obesity, and a host of other physical conditions.

What all of that points to is just how essential social connection is to our survival. Part of the reason I wrote the book was to help people see that our connections are not just nice to have, but necessary to have — and they should be much higher in our priority list. They also should be what policymakers and leaders are thinking about as they develop policy or design workplaces and schools. We need to ensure that all aspects of society support healthy relationships. That’s how we will ultimately thrive as a society.

Roge Karma

I want to talk about the shame around loneliness. A thread that runs throughout the book is not only that we’ve ignored loneliness as a social problem, but we’ve also placed a huge social stigma around it. Can you talk about 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 around some aspect of our life, it drives us further inward and chips away at our self-esteem. When you’re lonely, what you need most of all is to reach out and connect with others. But the shame around loneliness pushes you in exactly the opposite direction. The longer your loneliness persists, the harder it is to reach out to other people because you don’t feel you’re worthy. This is why the downward spiral of loneliness is very challenging to break.

This is where our culture makes things worse. In an individualistic culture, your successes and your failures are entirely yours. That can place an extraordinary burden on individuals who may experience failure, not simply due to their individual efforts but because of complex circumstances. There are some people who might respond well to that, but a lot of people end up doing worse because they just beat themselves up further. That leads to further erosion of self-esteem and confidence, and creates that downward spiral of loneliness.

One of the things I learned in writing that book, though, is that service is a very powerful way to break that downward spiral because it short-circuits some of these mechanisms. Our focus is predominantly on ourselves when we’re lonely because we feel threatened. Service shifts our focus away from ourselves to another person within the context of a positive interaction. It also boosts our self-esteem because it reminds us that we have value to add to the world. That’s why I refer to service in the book as a “back door out of loneliness.” It is such a powerful force when it comes to building a more connected world.

Roge Karma

What are some other major drivers of widespread loneliness, in your view?

Vivek Murthy

We already talked about our society’s focus on individualism, but I think our culture around work and achievement 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 somebody who has sold a company or invested money and made a tremendous return, we say they are successful. When we see someone who is famous or who has achieved a high position in government or business, we say that they’re successful. The implication of that is that if I don’t have wealth, power, and reputation, then my life has less worth. That is highly problematic because there are various circumstances outside of an individual’s control that often prevent us from having wealth, power, and reputation.

I think we have to recenter ourselves on the idea that each of us has intrinsic worth. This is at the heart of so many spiritual traditions and so many cultures: the idea that, as human beings, our value is rooted in our ability to give and receive love. And that love is most clearly manifest in our relationships — we experience love through other people.

As I think about my own kids, 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 is something that they were born with. It’s true to who they are. And they don’t need to acquire money or fame or a powerful position in order to augment their worth as a human being. What makes them human is their ability to love, their ability to build relationships, their ability to serve.

Roge Karma

This gets at something I appreciated about the book, which is just how subtly radical it is. The ideas that individuals determine their own destiny and that our moral worth is a function of our ability to produce — these are the base assumptions at the heart of our political and economic systems. And you’re basically saying they are wrong in a very profound way.

Vivek Murthy

It’s funny you say that — I actually almost titled the book “Radical Love.” That’s because I do think there is something fundamental that we have to transform about how we’re living. What I’m calling for is a much deeper and fundamental change that is not about transforming us into something we’re not, but a return to who we intrinsically are.

Every human being feels better when they’re giving or receiving love, regardless of political persuasion or the culture in which they grew up or anything else. That’s how we’re meant to operate. And, conversely, when we’re operating out of fear — which commonly manifests as anger or insecurity or jealousy or anxiety — it doesn’t feel good. We all know that deep down.

In many ways, this book is about how we return to being who we intrinsically are, which is beings that are grounded by, powered by, and driven by love. And it’s about how to create a society that is fueled by love instead of fear.

The book is not intended just to be a guide about how to build extra connections. It’s about fundamentally transforming our lives and our society toward being a people-centered life and a people-centered society. If I had a single credo with the book, it would be just three words: “Put people first.”

Roge Karma

I think one 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 plenty of problems, but loneliness generally isn’t one of them. They have a hard time even understanding how loneliness would be an issue for people. At the same time, they’re so deeply embedded in family and community that they tend to have a lot less of the individual autonomy and freedom that we’ve come to cherish and respect.

You have a really interesting discussion of this trade-off between liberty and community — and a potential synthesis that can help us reconcile it — in the book. Can you talk a bit about what you call first-, second-, and third-bowl societies?

Vivek Murthy

There are traditional cultures which I think of as narrow but deep bowls. They tend to have a lot of constraints around what is acceptable: It may not be acceptable to get married later in life, to be gay, to pursue a career that your parents tell you is not appropriate. But there’s a lot of depth in terms of social structure that allows you to feel that you are part of that network. It could be the extended family structure, or generations of families that live together in villages that have close ties with each other. If you remain within the narrow constraints of the community, you can often feel quite connected.

There are also more modern societies, which I think of as wide but shallow bowls. In many Western societies, there’s a lot more freedom to be who you are and a more open embrace of different identities. But the structures that ensure that people feel like they’re part of a community are limited — it’s largely left up to individuals to find friends [and] some structure that they can ultimately call their community. These societies, like the one we live in, tend to have higher levels of loneliness.

What I envision and hope for 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 that has great depth in terms of the structures in place which allow people to feel connected to each other and provide community for everyone.

Roge Karma

What would a third-bowl society actually look like in practice?

Vivek Murthy

What it looks like is organizations that build and design workplaces to strengthen human connection by creating opportunities for people to truly understand each other as human beings, not just as skill sets. It looks like schools that invest in social and emotional learning so they can give children a foundation for how to build healthy relationships. It looks like neighborhoods where we put more of a premium on reaching out to and getting to know neighbors. It looks like a society that recognizes that we are truly interdependent creatures who need each other, which means that there are times when we have the ability to serve and times where we need to be served.

I think a lot of this is a matter of deciding to make human connection a priority. The challenge is not that we have the wrong values — a lot of us do value human connection. It’s that we’ve ordered our priorities in a way that is inconsistent with our deepest values. That’s what we have to change.

Roge Karma

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

Vivek Murthy

I hope. This is such an unexpected and profound experience for us. It’s turning so many of our lives upside down. But despite all of the pain that this virus is causing, it also presents an opportunity for us to push a reset on how we’re living our lives, particularly when it comes to social connection.

There’s been a lot of concern that, among many other things, the physical separation that we’re being asked to observe could contribute to a deepening of loneliness and further straining of social ties. But I don’t think it has to be that way. I think we have the opportunity to choose social revival over a deepening of our loneliness. And we can do that if we step back and use this opportunity to reprioritize people and relationships in our lives.

Roge Karma

What would you say to people sitting at home right now in the middle of a pandemic who are feeling extremely disconnected? What would you recommend they do?

Vivek Murthy

One of the larger themes that I realized in the writing of this book is that building a more connected life is ultimately grounded in the small things that we do. It doesn’t require a wholesale inversion of your life. There are small steps we take so that we find much deeper connection and fulfillment.

Sometimes we forget that one of the greatest gifts we can give other people is the gift of our full attention. I know we’re an action-oriented society. We’re used to thinking that the way to deal with a problem is to voice and enact a solution. But there’s also great healing to be found in listening deeply to someone. That’s something that 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 where 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 with Habitat for Humanity. It can look like calling a friend to see how they’re doing. It can be checking on a neighbor who might be older to make sure that they have groceries. It can be FaceTiming with your friends’ children to virtually babysit them for 10 or 15 minutes so their parents have time to sit and breathe.

Related listening

Vivek Murthy and Ezra Klein discussed the loneliness epidemic on The Ezra Klein Show in October 2019. You can listen to the podcast by streaming it below or subscribing to The Ezra Klein Show or wherever you get your podcasts.

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