U.S. Surgeon General Vivek Murthy is an expert on the science of loneliness. He offers advice for how we can build stronger, more meaningful social connections.
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Pushkin. You know, if I told you there's this pill that you could take that's available for free in pharmacies all across the country, that if you take it will reduce your chances of feeling depressed or anxious, that will reduce your risk of premature death and heart disease, and might actually make society more peaceful and less vitriolic. You would say, gosh, well, where is this thing? Sign me up. That's doctor Vivic Morphy, the US Surgeon General, And what he's prescribing here isn't actually a pill. It's more meaningful social connection, something many of us are lacking right now. Loneliness is not something it's just affecting a few people here and there. It is affecting an ordinarily high portion of the population. There are more adults who are struggling with loneliness than have diabetes in the United States. So we have to help people recognize that this is a public health threat, one that we can address, but we've got to put it on the map of critical issues and priorities for our country. On today's show, our nation's doctor tells us just how dangerous loneliness can be for our health and gives us strategies for building stronger social connections. I'm maya Shunker and this is a slight change of plans, a show about who we are and who we become in the face of a big change. In addition to serving as a certain general, doctor Morphe is also the author of Together, The Healing Power of Human Connection in a sometimes Lonely World. He's an expert on the science of loneliness, which is something he never thought would be the focus of his work. After all, he's trained as a medical doctor. But back when Viveik was a practicing physician, he met a patient who made the link between physical health and loneliness impossible to ignore. I saw him in clinic one day and one of the first things he said to me on our first visit, well, doctor, you might be surprised to know that I've actually won the lottery. And I thought he was speaking in a metaphorical sense, but he wasn't. He's being quite literal. And he said, yeah, you know, I won the lottery, but I got to tell you it was probably the worst thing that happened to me, and that really surprised me. So he had my attention before, but now he really had me leaning in, and he proceeded to explain to me that prior to winning the lottery, he was a chef at a restaurant in Boston, and you know, he wasn't rich, but he did okay. He was able to pay his rent. He had neighbors that he liked, he had people he worked with in the kitchen who were great, he had clients who really loved his food. And he worked incredibly hard and that was his life. But after he won the lottery, for a number of years he had very large checks coming to him, and he sort of decided, gosh, I don't need to work anymore. I don't need to live in the neighborhood that I live, and I can move somewhere that's like big and fancy and I have a large house all to myself. And so he did. He quit his job. He moved to a part of Massachusetts, metic Sea, where wealthy folks typically live, and he found over time that he was profoundly alone. And he would describe this to me. He said, you know, I don't have like my co workers anymore to hang out with. I wasn't getting the satisfaction of people eating my food and saying, oh, my God, how did you create this? This is incredible. But he didn't have his neighbors to chat with. He wasn't just seeing people walking up and down his street anymore. Instead, he was living in a house where they were big walls between the houses and fences and it was just him and his dog. And he said it was after that that he started to develop high blood pressure and diabetes, and that you are sort of experiencing mental health concerns as well. And he chalked it up to the lonely and isolation that came from that experience, a major shift in his life. Yeah, and you've said that you were so humbled in this moment because your medical training had not prepared you to help patients struggling with loneliness. It was a sobering moment because you go into medicine wanting to relieve suffering. I went into medicine because I wanted to do what I saw my parents doing when I was growing up and the medical clinic they ran down in Miami, Florida, which is I wanted to be able to take care of the problems that patients had. And I realized that I learned about a lot of those problems in medical school, I learned about everything in the structure of cells and mechanisms of inflammation, to how to manage somebody's diabetes, how to adjust their blood pressure medications, how to treat them if their hearts stopped. Like, I learned a lot, but I wasn't recalling a single thing that I had really learned about loneliness because it wasn't part of our curricula. It wasn't something that we understood to be one of the most common challenges our patients would face, even though it turned out that's exactly what it was. So I did feel a sense of sadness in that moment, but it was also a realization that Gosh I needed to figure out how to fill this gap in my medical knowledge. Time after time, seeing patience in the hospital, I came to realize that so many of them were struggling with loneliness. People would come into the hospital alone in ten moments where we had really difficult information to give to them. Maybe it was about a new diagnosis, or maybe it's a hard decision we had to make about whether or not to go for surgery or start a new treatment regiment, or whether or not to stop a treatment for a condition that wasn't responding. In those moments, I would often ask, patience, is there somebody I can call? Who you want to be here while we have this conversation. No, might be tough, but far too often they would say, gosh, I wish there was somebody, but there isn't anyone. Just have to have a conversation by myself. And I think most heartbreaking though, for me, was the final moments of life during people's death. There were so many times where the only people witnessing those final moments for a patient was me and my colleagues in the hospital, but there was no family member or friend who was actually there by the bedside. So seeing that time and time again just made me realize that loneliness is more than a passing concern. It's more than an isolated issue that only affects a few people. It was affecting so many of the people that I saw, and later when I became sort of gentle I came to see that it wasn't just unique to my experience, but loneliness is impacting people all across our country. Yeah, impacting them in manifesting in the form of lots of medical conditions. Right like high blood pressure, diabetes, And that is, I think, something that many people don't recognize. Even if they appreciate that loneliness is incredibly common, they may not necessarily know how consequential it is both for our mental health and our physical health. It increases our risk of anxiety and depression, but also our risk of premature death, of heart disease, of dementia, and of a host of other physical illnesses that we care deeply about. But it also has an effect that's comparable and in some cases even greater than what we see with other conditions we care about. Take, for example, smoking, Some great studies actually about bringing young University have showed us that the mortality impact of loneliness in fact is comparable to the mortality impact of smoking fifteen cigarettes a day. It's even greater than the mortality impact that we see with obesity and with substance use disorders. Now just pause for a second and think about how much time, effort, and energy we spend in combating smoking and obesity and substance use disorders because of extraordinary toll they take on society. But think about how little we actually tackle loneliness, or little we invest in thinking about our strategies for addressing it. So we have to help people recognize that this is a public health threat, one that we can address, but we've got to put it on the map of critical issues and priorities for our country. Yeah, to help us better understand loneliness and its consequences. I'd love to hear why we as humans have come to need social connection in the way that we do. We evolved to need each other and to depend on one another because it turned out that we could do far more together than we could do alone. So simple example, like when we were a hunter gatherers. You know, if you were one of those folks who said, you know what, I'm going to do it on my own, I don't need anyone else. What happened to that person is they either got eaten by a predator, they starve because of an insufficient food supply. And it turned out that when we actually helped one another, when we looked, took turns looking out around the you know, at night, for predators, When we shared our food supply so that none of us start on any given day, when we help each other with childcare, when we did these things, we actually were all more able to survive and thrive and prosper, and so it became then part of our nervous systems wiring, if you will, that when we were separated from one another, it actually put us into stress. Day. Yeah, one of the most fascinating insights that I gleaned from your book is that loneliness can be self perpetuating. Right, So, being in a lonely state of mind can actually sabotage our ability to meaningfully connect with others. This is one of the counterintuitive things about loneliness. But when we feel lonely, there are mechanisms triggered in our body that can actually perpetuate loneliness. One of them is that our threat perception increases, and what that means is that we are more likely to perceive what might be normal everyday interactions or gestures around us as threats. So, for example, if I'm feeling lonely and I'm in this state of elevated threat and you approach me, my Dusty, Hey, big I was wondering do you want to have lunch together today? Normally I might say, Hey, that's really nice. She's reaching out, and maybe you notice that I'm lonely, but in a state of elevator threat, which shifts my perception. I might think, does she have another motive here? Why she reaching out to me? And she's just trying to take pity on me? And she going to make fun of me, and she's trying to ridicule me in some way to sh have an ulterior motive. I might start asking questions which might either lead me to say no or alter my interactions with you in a way that may be unpleasant. So you start to push people away at a time where you need to pull them in. The second thing that happens is that our focus shifts in work toward ourselves. And if you understand loneliness is a state of stress and threat, you start to understand why that makes sense. If we're under a threat, we do want to focus on ourselves and make sure we're well. But that increased focus on self in some case excessive focus on self can also be off putting to others who might think, oh, that person is aloof for their too self absorbed, or they seem narcissistic. And there's a third dynamic that's happening here too, which is that the lonelier we are, the more we come to believe that we're lonely because we're not likable, so loneliness chips away at our self esteem, which can make it even harder to take their risk of going out and talking to people new people, but also folks that we know, and that can perpetuate loneliness. And that's why we have to want to recognize that, and that if we understand that, that may give you an added reason to be empathic and understanding towards others who may seem might they are self absorbed, or or may seem might they're or aloof, they in fact may be struggling with loneliness. I know that has been true for me, and I'm not proud of those moments where I have been aloof and have pushed other people away at times where I really needed them. We all have, but we all have, and I will tell you I so deeply appreciate the people who stuck by me, yeah, despite me being who I was, and who reminded me what we all need to be reminded of, which is that we are not alone. That there are people who see us for who we are and who still care about us. I was reflecting back the other day on my own periods of loneliness and anxiety and everything, and being like, oh my god, your souls self absorbed and your friends back then are still your friends today, So you should just like give them all huge hugs because they deserve it, a golden medal for sticking by me when I was at my peak narcissism. You know, it really feels. And the research corroborates this that our minds are wired for social connection. And there are these fascinating neuroimaging studies that I read about in your book The Ones by Matthew Lieberman. Yea. So one interesting thing that Matthew Lieberman found is that when our brains are effectively shut off, like when we're not interacting with other people, that our default mode is actually to process and make sense of, if you will, the social connections and relationships that we have, whether we're introverts or extroverts, whether we're interacting with people or not, our brain is processing those connections and using them to make sense of the broader world. It's actually another indication of just how we are hardwired to connect as human beings. And again, sometimes people hear them and think, oh, we're all meant to be extroverts. No, We're not all meant to be extroverts, and I say that as an introvert myself, but we are all meant and designed to thrive in part because of our relationships, and we need those, and in the absence of those, we struggle and we suffer. And you know, it's interesting because it's tied into how we experience pain as well. You know, we think about pain as a purely physical phenomenon. Well, one of the things that people like Matthew Lieberman and Callie have found is that when you experience emotional pain, it registers in your brain as well as pain. We used to hear people say often when people were struggling with emotional difficulties in life and where they've felt actually physical manifestations, you would hear people say, yeah, it's all in your head, right. Yeah. It turns out that may be literally true, but in a way that makes it even more real, which is a yes, that emotional pain does register in your brain, which is where all pain registers. For what it's worth exactly, and it can feel as real and as hard to manage as a physical pain that we endure. I mentioned this because one of the reasons I've been so concerned about loneliness is I see this as one of the most common sources of emotional pain that people are experiencing right now. And people are in pain, then we have to talk about how we address that. After the break, the vehicle will give us strategies for building more meaningful social connections with others. We'll be back in a moment with a slight chain of plans. We're back with us, Surgeon General the vague morphy. In order to create a culture of greater connectedness, the Vague says, we first have to understand what loneliness really looks and feels like, because there are many misconceptions out there. We have this stereotype of loneliness. We think about the person who's socially awkward, who's sitting in the corner of a room at a party of all by themselves. Yeah, and that is so not the picture of loneliness. And as Surgeon General, when I was in the Obama administration, I was surrounded by people all the time, you know, And I was constantly at events, as constantly in meetings, as constantly at all kinds of engagements. But I was struggling with a profound sense of loneliness during that time because I had made what I recognize now critical mistake, which I had convinced myself that in order to make the most of this opportunity to serve, I had to give up everything else. I had to sacrifice my time both family and friends, and always, always, always put work first. But what I realized is that came at an extraordinary cost to me personally, and it turned out that I was not as well sustained in the work as I otherwise would have been if I had realized that I needed to focus on keeping my relationships present and keeping them close. Yeah, you talked about the stereotypes that day, and one thing you clarify in your book, which I think is so helpful for us as we build mental models of what loneliness is that loneliness is a subjective feeling. Right, It is a state of mind that we are lacking the social connections that we need. Right, we feel we are missing trust and closeness, or might feel abandoned. But it really is defined by this internal feeling, and you make it a point to distinguish that from other states like isolation and solitude. It is very important. Loneliness is a subjective term. It's when the connections we need in our life see the connections that we actually have, and in that gap we feel lonely. Isolation is a more objective description of the number of people we may have around us, for the number of social contacts that we may have, but one could be relatively isolated. You can have few contacts, but you may not feel lonely at all, because it's really about the quality of those connections, and solitude is different altogether. Solitude is a welcome state of a loneness. It's a state which can be renewing. Solitude is those moments where we may be physically alone, but where we actually connect with something that replenishes us and nourishes us. That might be just time in silence, meditating. It might be time in nature. It may be time that we spend in prayer, maybe time that we spend writing. However, we find it that time in solitude is actually very important for everyone, whether an introvert or an extrovert. What differs maybe how much time in solitude we need in our lives. But there's one last thing here that is really important to recognize, which is that if you recognize that loneliness is subjective state where the connections we need are great. In the connections we have, one question is how do we know what connections we need, how much connection we need? It turns out that this is something that can be influenced in ways that can be harmful to us. So imagine that we live in a relatively extroverted culture, which we do surrounded and immersed in platforms like let's say social media, for example, which may lead us to think that the kind of optimal social engagement we need is incredibly high. Where we're going to parties all the time, where we're constantly going on vacations with friends, or we're surrounded by people that can affect Sorry, what is this party of which you speak? I don't know. It turns out I didn't attend many of them in college either. I missed out. But you know, if you are growing up in an environment where the bar is shifted for you and you're made to feel like you need to be engaging with people all the time, that's an optimal level of engagement. Then even if you are engaging with people at the pace that feels right to you, you might feel like something is wrong. And this part is incredibly important because when you feel worse about yourself, it makes it harder for you to reach out and connect with other people, especially new people, because it feels like taking your risk. And again, if you are struggling in terms of your self esteem, those risks become much much harder to take. Yeah, so let's give listeners some hope for fake because we're all feeling in this moment a little bit verdened by the consequences of loneliness. And so, you know, one thing you say when it comes to staving off loneliness, the first thing that we all need to just accept is that loneliness is this natural signal to us that we need to connect with other people. I love you say, it's akin to feeling hungry or thirsty, and the fact that those signals tell you, oh, I probably need to eat or drink something. And so there's just this acceptance that we have this vital need for social connection and we should just lean in. What are other techniques that people can use to try and stave off loneliness in their lives. There are few things that I think about in this regard. So one is to recognize that connection to self is a foundation for connecting with other people. What does that mean to connect with yourself, Well, it means to know that you have worth and that you have value. And look, if you're like me, you've gone through many periods in your life where you've questioned that you know, because it's not about how much money you have in the bank or how longer list of accomplishments are. Like, all of us have moments of self doubt, but that's actually when we need things that we can reach for that remind us that we have worth and value. Connecting with other people is also really essential, of course, in the battle against loneliness. But again, small steps can go a long way. So just taking, for example, a few minutes each day to reach out to one person that you care about. It could be a quick phone call that you make on the way to work. It could be a quick text message that you send to check in on someone. It could be a video call that you make before you go to sleep to talk to your parents or your kids. Those few minutes can make us feel so deeply connected. But the other thing that helps us is to be present when we are connected with other people. So if you're like me, you've probably made the mistake of catching up with their friend. But then somehow, like your hands sneaked into your pocket, you've got your phone. You're like checking the scores on ESPN dot com or freshing your inbox, doing all kinds of things on your phone that you really don't need to do that are an urgent, but your head is just distracted. And we all convince ourselves we can multitask. It turns out we actually can't. There's more and more science to back that up. But it turns out that if you can just be fully present with someone for five or ten minutes, if you can give them one of the greatest gifts you can give anyone else, which is a gift of your full attention, it can be so deeply fulfilling, you know, for the listener who's hearing you say the recommendation of try to even find small moments in the day to connect with people that you care about, right the quick phone call. But they're thinking to themselves that I don't even have one person that I can do that with. I want to give them hope. A couple of things I would say to those who feel like they don't have people in their life right now. One is to recognize that the connections that matter to us in our life are not only connections let's say with people in our intimate circles with a spouse or a best friend, but it's also our connection with a community. These are the people that we may see in passing, you know, maybe when we go to temple or church, you know, if you go to religious gatherings, or people who may be folks who may encounter in the workplace. But those connections matter too. And simple acts of kindness with those individuals, simply acknowledging people, greeting them, offering, just checking in on them, seeing how they're doing, those are moments of connection that are very powerful. They feed our soul in ways that our body is hardwired to receive. It feels good to use that muscle of kindness and compassion that we are designed to use and operated by, but which we often forget because the world around us will often tell us that if we're too kind and too nice and we'll get taken advantage of right. But it turns out reaching for that, using that muscle, it can make us feel good. One last thing they would just remember is something that is not my wisdom or my sort of knowledge. It's something that was given to me by a good friend in Boston when I was finished my first term as certain General was really struggling a lot with loneliness, with having really no sense of real community. I had lost connection with so many of their friends that I had been close to before during my first tour of duty. And I remember lamenting this going to Boston and seeing a friend from my residency training and she said to me, she said, Vibe, you know what your problem is. She said, Your problem is not that you don't have friends. She said, your problem is that you're not experiencing friendships. She said, you have people in your life from years past who, if you reached out to them, would be more than happy to talk to you. And she knew that I felt a sense of shame and guilt because from not being in touch with them for years, from showing up when I was tied up with work at times where they really needed a friend, you know. But she said, Vivek, if you reached out to those people just to say hello and reconnect, guarantee you the vast majority of them would welcome the connection. And she was right. And I share this only to say that the connections from our past don't need to stay in our past, but sometimes they can be rekindled with a simple outreach, a simple message from me, a simple call, and more often than not, you may find that the people were reaching out to may be struggling with loneliness themselves and then finally looking for ways to serve other people. Why does this service matter, Well, it turns out that service is one of the most powerful ways that we break this cycle of loneliness because remember when we struggle with loneliness because of our elevated threat level, sometimes inadvertently pushing people away, and we're chipping away at our sense of self esteem. What service does is it allows us to connect to somebody else in an environment where we are truly helping in a way that's immediate. But we also reaffirm to ourselves that we have value to bring to the world. Right, so both lifts our esteem but also helps us forge an immediate connection with another human being. And service doesn't have to be quitting your job and joining an organization does charitable work, although certainly if you feel call to that, you should, but service can be stopping to check in on a coworker who maybe is struggling. It could be asking a friend how they're doing because you know that they are worried about losing their job. Yeah, and I love how this really helps to reframe what social connection even means and what it can look like. Right, There's one line that I found so stirring in your book where you say belonging involves more than being accepted, known and loved. It's about sharing in the concern and responsibility for others. So, you know, one of the people who I remember talking to is a woman named Sarah who moved to Texas away from our family and our friends, and she was really struggling. She felt really alone, and she ended up developing something that really helped her call the Neighbors Team. And this is a way through which she served her neighbors. She would bring them together periodically at her home. Her father helped her construct this really big table that she put outside on the grass wherever could come sit. She asked her one to just bring a dish, and then she became a host for people. She would walk around helping people learn a little bit about each other, saying, hey, you know, this is Maya. He's a little bit about her background. Like she would just walk around serving as a connector, and which she founds two things. There were a lot of people who were struggling with loneliness around her in her neighborhood, and just a little bit of structure and a little bit of an introduction allowed them to connect in powerful ways. But the other thing she found is that serving as a connector herself actually made her feel more deeply connected to her community. And it was a powerful example to me. I sometimes when we are feeling is like we're struggling, like we need help. Sometimes it is by us giving help to others that we find refuge and that we find solace. One other story I'll share is a very personal one about my mother and my father. This is what you know. When I was really young, I was woken up in the middle of the night by my mom who said, hey, we got to get in the car and go as quickly as possible. It must have been two in the morning, and I didn't know what was going on, and may have been seven years old at the time. As bleary eyed get in the car, and my sister who's eight years old is also bleary eyed in the car next to me, and my mom and dads are driving us and they tell us along the way that their patient, Gordon, had just died from a long struggle with metisatic cancer. And we were driving to go to the trailer park where Gordon lived because his wife, Ruth was still living there and they were worried she would be grieving alone. And I always remember that moment because my parents this was not in their job description to drive out to the trailer park at two am to check on, you know, patient's widow. It is what they felt that they needed to do. It's what they felt they wanted to do. I remember my mother. She was wearing us Sadi as you know, a tradition Indian dress, and she walked up the stairs of roots trailer and knocked on the door, and the door opened, and I saw Ruth come out and her hair was frazzled and there were tears streaming down her face and she just looked at my mother and didn't say a word, but they just embraced and they just held that hug. And looking at the two of them, I thought, these are two people who come from such profoundly different backgrounds, by immigrant Indian mother and Ruth, who had been in this country for generations from a completely different cultural background. But in that moment, there were two human beings forging this extraordinarily powerful connection and speaking the language of connection and love that I think we all speak in our best moments, And so I remember that moment often because it stands out to me as a reminder that we all need connection. We all have the power to build connection in our lives and the lives of others. And it's thought about the big moments. It's often about the small moments, the small decisions we make to show up for somebody else. Hey, thanks for listening. Next week we'll be off for the holiday, but join us the following week for our season finale. When we hear from Javier Zamora. At age nine, Javier left his childhood home in El Salvador and embarked on a harrowing immigration journey to reunite with his parents in the US. Now in his thirties, Javier has revisited his past and a memoir called Solito Spanish for a loan, and it's helped him see his nine year old self in a new light. In looking at this kid, I also realized that I was treating him how politicians and the news outlets treat immigrants, so I was believing them, and that also affected how I viewed my nine year old self. He had committed a crime. He is somebody that doesn't belong into society. He's an outsider, and slowly I was like, no, hold up, this kid is a g he's a gangster. He survived the unsurvivable. Rarely, rarely have I heard that term survivor be attached to immigrants. A Slight Change of Plans is created, written an executive produced by me Maya Shunker. The Slight Change family includes our showrunner Tyler Green, our story editor Kate Parkinson Morgan, our sound engineer Andrew Vestola, and our associate producer Sarah McCrae. Louise Scara wrote our delightful theme song, and Ginger Smith helped arrange the vocals. A Slight Change of Plans is a production of Pushkin Industries, so big thanks to everyone there, and of course a very special thanks to Jimmy Lee. You can follow A Slight Change of Plans on Instagram at doctor Maya Shunker