Why Former Surgeon General Vivek Murthy Thinks Loneliness Is A Public Health Crisis

Long before coronavirus spread around the world, former Surgeon General Vivek Murthy was sounding the alarm about a different, quiet epidemic: loneliness. We’ll talk to him about why so many Americans are suffering from loneliness and what we can do to take better care of each other even as we’re asked to be physically apart.

Guests

Vivek Murthy, physician and former surgeon general of the United States. His forthcoming book, “Together: The Healing Power of Human Connection in a Sometimes Lonely World,” will be released next month. (@vivek_murthy)

Jack Beatty, On Point news analyst. (@JackBeattyNPR)

THREAD: As #COVID19 forces us to physically distance from one another and as our contact with other people drops, society is at risk for a *social recession*. A social recession is marked by an increase in #loneliness and isolation. (1/x)

— Vivek Murthy (@vivek_murthy) March 19, 2020

Interview Highlights

On why loneliness is an invisible epidemic in America

“When I began my time as surgeon general, I started to recognize that many of the stories that I was hearing from people in small towns and big cities all across America were stories about addiction, about violence, about depression and anxiety. But behind them were threads of loneliness. And people wouldn’t say to me, you know, ‘My name is Meghna. I’m struggling with loneliness’ But they would say things like this. They would say, ‘I feel like I have to deal with all of these problems by myself.’ ‘I feel like we’re out there all alone and no one’s looking out for us.’ ‘I feel like I’m invisible.’ And time after time, when I began to hear this, it struck me that there is a much deeper pattern here, a pattern that I began to see as loneliness.

“And when I delved into the data, I began to see that this was not just me that was observing this, but that researchers who had been studying loneliness and using rigorous scales to assess the degree of loneliness that people were facing had found, in fact, that large percentages of our population, more than 20%, in fact, of the adult population in America admits to struggling with loneliness. That’s more people than have diabetes in our country. That’s more adults that smoke in the United States. And so that’s when it dawned on me that there is something much, much bigger happening here than I had previously thought.”

On our very human need for human connection

“We all need this and we’ve needed them for thousands of years. Now, it turns out when we were hunters and gatherers roaming the tundra in various parts of the world, we depended on each other. We depended on each other for protection from predators. We depended on each other for a stable food supply. You were better off sharing, pooling your food so that everyone could have a little bit each day then enduring the booms and busts of your food supply on your own. And it just turned out that we were better off together.

“Now over thousands of years, that became baked into our nervous system, such that if we were separated from our tribe, it placed us in an automatic stress state because we knew we were separated from our tribe. We were at greater risk of either starving or being caught by a predator. And even though our circumstances have changed dramatically since those hunter-gatherer days, our body, our nervous systems, our biology, is very similar to what it was back then. And when we are separated from people, when we feel separated, regardless of how many people we have around us, we enter into a similar stress state.

“Now I want to be clear about what this stress state actually does, because in the short term it can be beneficial. In the short term if I feel loneliness, it’s like any other biological signals. It’s like hunger or thirst. It’s alerting me that something that’s critical for my survival is missing. And in that case, I either go find food or water because I’m hungry, thirsty, or in the case of loneliness, I seek out greater social connection. The problem is when loneliness persists for a long period of time. And when it is chronic, then we enter into a chronic stress state. And that is what has dramatically consequential impacts on our health. Because in chronic stress, we also increase our levels of inflammation in the body, which damage tissues and blood vessels and increase our risk for heart disease and other chronic illnesses.”

On the long term social consequences of the coronavirus outbreak  

“What we haven’t, I think, paid as much attention to is the social impact that this will have. And I think that unless we recognize that it is going to impact our social health that we are at risk of incurring a social recession. By which I mean an increase in loneliness and the health consequences thereof as people become more and more isolated from each other.

“But I don’t think it has to be that way. I think that if we recognize that we are at risk for a diminishing of our social ties. There are things we can do, I believe, to proactively strengthen social connection. We can, for example, make it a point to spend at least 15 minutes each day talking to or writing to someone we love. This is something that we often don’t even do in our day to day life when there is no pandemic, you know, around us. But the consistency of doing that each and every day can be enormously helpful in making us and helping us feel more connected.

“The second thing we can do is to focus on the quality of the time that we’re spending with each other. We live in a world where distraction abounds, we can often be talking to a friend on a phone, but then also flipping through our e-mail and checking social media and watching the news on TV. We all have done that. I have done that, too. But what happens is in this effort to convince ourselves that we can multitask, which science tells us we actually cannot, we end up diluting the quality of our connections with each other. And we spend 30 minutes on the phone and realize that we barely remember what we said. Just focusing on the other person. Eliminating distraction when we’re calling or videoconferencing or writing to someone else can be enormously impactful in terms of how it makes us feel and the quality of the overall interaction.

” … One of the things that I found in the writing of this book, to be a surprising but enormously helpful solution to loneliness, is service. It turns out that when we reach out and help someone else, that that not only enables us to connect with another human being, but it reminds us of our value and of our purpose in life. It turns out that giving and receiving both strengthen our social bonds. And in the time of COVID-19, that could mean checking on a neighbor. It could mean seeking advice. It could mean giving advice to a colleague who might be struggling to balance teleworking with caring for and homeschooling their kids. This is not easy, but this is a place where technology, if used right, can actually help us to fend off some of the social consequences of this pandemic. And can hopefully, if we do this right, maybe even give us a deeper appreciation for our relationships and leave us stronger than when we started.”

On how people can help their loved ones, colleagues and community

“When we think about service, we often will think, ‘OK, it’s going out to an organization in my community and volunteering or volunteering in a soup kitchen.’ And that is one form of service, for sure. But there are many other ways we can serve in our day to day life. We can look for a colleague at work who may be struggling and see if we can help them, either practically with a problem they’re dealing with, or simply by listening and being fully present. We can look to other people in our life, in our family even, who might be having a hard time and we can just sit and listen to them and try to understand the difficulties that they may be having. In this time of loneliness, many people feel that they are struggling alone. And simply showing up — being present — is a lost art.”

From The Reading List

Excerpt from “Together: The Healing Power of Human Connection in a Sometimes Lonely World” by Vivek Murthy

“When it comes to our relationship with loneliness, specifically, it’s important to understand how our relative introversion or extroversion informs our preference for social interaction. These two terms describe the opposing ends of a wide spectrum. While there are relatively few extreme introverts or extroverts, most of us lean in one direction or the other. If we lean more toward introversion, we’ll generally prefer less social activity than more extroverted people. One inclination is not ‘better’ than another, but our culture can make it seem as if extroverts have a social advantage. Commercial images tend to focus on gregarious people as if they were the norm. Universities hold mixers for incoming students as if every newly arriving freshman must be eager to network with crowds of strangers.

“Politicians are required to meet and greet casts of thousands as if a gargantuan social appetite were a fundamental qualification for wise leadership. And social media users often seem to be basking in friends, dates, nights out with friends. If you accept these implicit messages, you might understandably think that extroverts have more fun. What is true is that extroverts are naturally hungry for human company. If you’re very extroverted, you’ll prefer larger crowds and lots of social engagement.

“You probably love meeting new people, and when no one else is around, you may feel driven to actively seek out companionship. From stadium concerts to group outings, fun for you looks like one big social event. For strong introverts, fun looks more like a deep conversation with one good friend in the corner of a library. Or it might look like a solitary browse through the library stacks. If you’re very introverted, you prefer to spend much of your time alone, and when you do connect, you’d rather get together with one or two close friends than face a crowd.

“You like solitude. To better understand the distinction, I sought out Dr. Susan Cain, author of a groundbreaking 2012 book about introverts: Quiet. She explained that the difference between introversion and extroversion has a lot to do with how we naturally get our energy. Extroverts can feel drained and bored at the end of a solitary evening but invigorated after several hours at a large gathering, even if everyone there is a stranger. By contrast, introverts feel energized by solitude and quiet conversation, but large groups quickly exhaust them, even if they’ve had a good time. ‘Introverts might not wish to connect by having more block parties or getting together with church groups,’ Cain told me.

“’It doesn’t mean they don’t feel elevated by connecting, but that just isn’t their way of doing it.’ Introverts and extroverts alike can get lonely, just not in the same way. ‘We all have different needs,’ Cain said, ‘and when those needs aren’t met, we get lonely.’ So an extrovert may feel lonely if physically isolated for too long, while an introvert is more likely to feel lonely in a sea of strangers. To be clear, everyone needs meaningful relationships; it’s just that the preferred pace, frequency, and intensity of engagement vary depending on where we fall along the spectrum.

“No matter how introverted or extroverted we may be, it can be challenging to find the right balance between time with others and time alone. Some of this balance is dictated by the social realities of daily life. For the sake of work and family, most of us must participate in events such as meetings, group meals, and the occasional birthday party. At the same time, most of us will spend some portion of each day commuting, working, waiting, or simply daydreaming by ourselves. The important thing is to pay attention to our responses to these different situations. Which feels calming? Which unnerving? There are no right or wrong answers, but it’s important to know so that we can find ways to honor our own preferences while also maintaining the connections that secure our personal and professional lives. The more clearly we understand our true nature, the less stressful it becomes to perform this balancing act.”

Excerpted from “Together: The Healing Power of Human Connection in a Sometimes Lonely World” by Vivek Murthy © 2020 by Harper Wave, an imprint of Harper Collins. Reprinted with the permission of the publisher, Harper Collins. All rights reserved.

Yale Daily News: “KEEGAN: The Opposite of Loneliness” — “We don’t have a word for the opposite of loneliness, but if we did, I could say that’s what I want in life. What I’m grateful and thankful to have found at Yale, and what I’m scared of losing when we wake up tomorrow and leave this place.

“It’s not quite love and it’s not quite community; it’s just this feeling that there are people, an abundance of people, who are in this together. Who are on your team. When the check is paid and you stay at the table. When it’s four a.m. and no one goes to bed. That night with the guitar. That night we can’t remember. That time we did, we went, we saw, we laughed, we felt. The hats.

“Yale is full of tiny circles we pull around ourselves. A cappella groups, sports teams, houses, societies, clubs. These tiny groups that make us feel loved and safe and part of something even on our loneliest nights when we stumble home to our computers — partner-less, tired, awake. We won’t have those next year. We won’t live on the same block as all our friends. We won’t have a bunch of group-texts.”

The Atlantic: “The Coronavirus Could Cause a Social Recession” — “In early March, as cases of the novel coronavirus were increasing far more quickly than doctors in the United States could detect, the two of us knew we had to change how we and our two small children were living our lives. We canceled birthday parties, medical conferences, restaurant outings, and our children’s classes.

“We began greeting people without physical contact—not an easy task for two people who are inclined to hug friends and colleagues. We limited time outside our home to essential trips for groceries or work. We joined millions around the world in the unsettling new normal of a physically sequestered life.

“As physicians, we understand: The unprecedented drop in human contact across the planet is our best chance to save lives. Much of the discussion of COVID-19 has rightly focused on the millions of lives that could be lost and on the economic recession that may be unleashed as businesses and households cut back their spending. Yet the pandemic could trigger something else: a social recession—a fraying of social bonds that further unravel the longer we go without human interaction.

“This can have harmful effects on people’s mood, health, ability to work and learn, and sense of community. Just as a strong economy bolsters all of us against losses, social connection is a renewable resource that helps us address the challenges we face as individuals and as a society.”

NPR: “Coronavirus: Former U.S. Surgeon General: Vivek Murthy” — “We’re going to begin today again with the latest on the coronavirus outbreak and efforts to contain its spread here in the U.S. Today, thousands of Americans who are returning to the U.S. on flights from overseas are having to wait hours in crowded lines at airports while officials screen them for symptoms of the virus. We’ll have the latest on that in just a few minutes.

“Later in the program, we’ll also hear from someone who was diagnosed with COVID-19 and has now recovered. She’ll tell us what it was like and also what she had to go through to get tested. And we’ll talk with the director of a health ministry initiative on how he’s advising religious congregations to adapt their practices to the crisis. All of that is coming up this hour.

“But first, the former surgeon general of the United States, Dr. Vivek Murthy. He served under President Obama and briefly in the Trump administration. During his time in office, Murthy dealt with the spread of Ebola and the Zika virus among other public health challenges. This week, he’s been visiting hospitals to observe how they’re dealing with the rise in the number of people seeking care during the current crisis. And he said he’s found a big gulf between what people need and what health care workers are able to provide.”

This article was originally published on WBUR.org. [Copyright 2020 NPR]