Kate Bowler: I’m Kate Bowler and this is Everything Happens. I don’t know exactly when it started. Maybe it was moving away for school and moving again and again. Maybe it was when I got a job and the first circle of friends came and left and the second came and left. I think that’s what happens in university towns. Or maybe it was when I got sick and I felt like I had invented the category of feeling isolated, which of course I didn’t. I just felt that way, but I never said it out loud until last year. “I’m lonely,” I said to someone out of the blue, and I could tell immediately how pathetic it sounded, but it was true. I was lonely. I’ve only just begun to be more curious about loneliness and how it’s more than just a feeling. Loneliness can affect anything from your psychological to your emotional, to your physical wellbeing.
So I went out looking for someone who understood this topic from the inside out. So I am so fortunate that my guest today is Dr. Vivek Murthy. Dr. Murthy served as the 19th Surgeon General of the United States, appointed by President Obama. His work on loneliness has drawn attention to our ways of being disconnected from one another, which has profound implications on health and happiness. Dr. Murthy, I am so excited to be speaking with you today.
Vivek Murthy: Oh, it’s such a treat to be with you today, Kate. Thanks for having me on.
K.B.: Oh, my pleasure. I saw that you were born in England too, and we’re almost the same age, so I like to think that we were somehow baby friends.
V.M.: How nice would that have been?
K.B.: Your parents were also immigrants and then you all came to the United States. You couldn’t have known what a big life you would have here, but I wonder if looking back, there are lessons you’ve drawn from your parents that have changed how you think about medicine.
V.M.: Mh-hm. When I was a young child, I spent a lot of time in the medical office that my parents ran. My father trained as a family medicine doctor and he provided primary care.
K.B.: Oh, wow.
V.M.: And my mother was not formerly trained in medicine, but we like to always say that she was a doctor nonetheless, because her capacity to build relationships, uh, with the patients and the clinic and to contribute to their healing was I believe just as important as what my father was doing in the clinic rooms. And together they ran this beautiful medical practice. And as a child I would spend time there on evenings and on weekends opening mail, filing papers. I didn’t know much about what was happening from a science perspective.
K.B.: Yeah.
V.M.: But what I did understand was that people were coming in looking stressed and anxious and they were leaving looking a little less worried knowing that they had a partner, uh, in their healing process.
One of the things that my mentors taught me in medical school is that we have to approach this sacred job that we have as doctors with a heavy dose of humility, recognizing that there are some things we are going to be able to… To fix. There are a lot of things that we won’t be able to, but that it’s not about fixing.
K.B.: Yeah.
V.M.: It’s often about witnessing as well, about being partners in a healing process.
K.B.: I love that you used the word witness ‘cause that’s exactly right. To have someone stand alongside, to be able to help you tell the story of your life and then marshal your own resources to open you up. I just love that… That vision of this kind of partnership. It’s really beautiful.
V.M.: There is something extraordinarily powerful about being seen by someone else…
K.B.: Yeah, yeah.
V.M.: Seen for who you truly are, appreciated for you in your authentic form.
K.B.: Yes.
V.M.: And, it has struck me with great sadness that many a time with the patients I’ve cared for, that as I’ve sat down and listened to them, they have come to realize that there isn’t actually anybody else that they have to speak to or who they feel they can be themselves with, either because they don’t have a family or perhaps they, you know, have lost the friendships that they may have had earlier in life. Or maybe they have people who love them, but the fear inside them does not allow them to open up.
K.B.: Yeah.
V.M.: Um, and so I’m reminded, you know, often in those circumstances that despite the culture in medicine, which sometimes can feel like it values knowledge and technical skill above everything else…
K.B.: Yeah.
V.M.: That it is our ability to sit with someone, to listen with compassion and to see them for who they are. That may be the greatest contribution and service that we can provide to them.
K.B.: Yeah.
V.M.: As somebody, a friend told me recently, he said, “To be loved is not enough. You have to both be loved and to be known. And when we are both loved and known and we can be healed, then we can truly flourish.”
K.B.: Yeah. Then we’re talking, yeah. When you were, um, tapped to be America’s doctor, uh, you decided that you needed more on the ground experience to know what people were facing. I’d love to know what you learned.
V.M.: Mm-hm. So I knew that this was an important moment, you know.
K.B.: Yeah.
V.M.: And I also wanted to get started in the right way. And so we decided to do a listening tour and to spend a few months traveling to big cities and small towns all across the country. And my question to people is very simple. It was how can I help? And I tried as much as possible just to sit back and listen…
K.B.: Yeah.
V.M.: Uh, to what they had to say. I still draw on the conversations I had during those months because they were so rich and they impressed upon me, not just the kind of issues that people were dealing with, issues like addiction and mental illness and violence. But there was this spirit of cautious optimism. There was a desire to want to be hopeful. And what I was most inspired by was that there was a willingness, more often than not, to step up and to want be a part of the solution to these problems, not just for one’s own sake, but for one’s community. That’s the real treasure, uh, that we have in our country and in our communities, that willingness to take a risk and to be kind and compassionate even if we don’t fully understand who other people are. It’s something I think we can’t take for granted. That’s I think, who we are instinctually, but we’re not always those people.
K.B.: Yeah.
V.M.: And so part of, as I think about what we have to do as a country and as a planet to move forward, as much as structural solutions are important, I think it is… It’s actually those deeper spiritual solutions that I think matter even more now than ever.
K.B.: Yeah, returning to a place of agency.
V.M.: Yeah.
K.B.: Yeah. As a result, you created really innovative programs around opioids and fitness and others, but you also became famous for one of your passions in particular, what you called the epidemic of loneliness. Can you tell me a little bit about that?
V.M.: Like many issues, the issue of loneliness was one that I was educated on by the people that I met across the country and not directly. It’s not cause they sat me down and said, “Okay, I want to talk about loneliness.”
K.B.: Yeah.
V.M.: It was more so because in their stories, whether it was stories of addiction or abuse or stories of struggling with violence in their communities or worrying about their children, in those stories, often behind the scenes were stories of loneliness and experiences of deeper emotional pain. And what I found, which was really fascinating is that it didn’t take very much to bring those stories out. Uh, it just took often surfacing it explicitly.
K.B.: Yeah.
V.M.: Sometimes I would go places and people would ask me to speak about, for example, the opioid epidemic or speak about tobacco or e-cigarettes and I might in an one hour long discussion, I might spend like, two minutes mentioning something about loneliness, but afterward it was all people wanted to talk about. This would happen with mayors. It would happen with people in communities. It would happen with all kinds of folks. And so it was just another signal to me that there’s something deeper happening.
K.B.: Can you give me a sense of the scope of the problem?
V.M.: When you look at the data on loneliness, Kate, it’s hard to pinpoint exactly how common loneliness is.
K.B.: Yeah.
V.M.: But most of the surveys that have been done point to a prevalence that’s quite high. I’m talking about somewhere around 20% of adults in the United States who on surveys admit to struggling with loneliness.
K.B.: Wow.
V.M.: 20% of adults is a massive number.
K.B.: Yeah.
V.M.: That’s far more than the number of adults who have diabetes, for example, in the United States. It’s far more than the number of adults who smoke in the United States. And this is just a number of people who admit to struggling with loneliness.
K.B.: Yeah.
V.M.: There are far many more, I believe, who are likely dealing with loneliness, but don’t feel comfortable admitting it. And what also impressed me is why this matters. It’s- loneliness is more than just a bad feeling from time to time, but when we feel lonely, often it has an impact on our health and on how we show up in the world.
K.B.: Yeah.
V.M.: So people who struggled with loneliness live shorter lives, and the amount by which their life is shortened is about the same as the amount by which smoking 15 cigarettes a day shortens your life. It’s greater than the impact of obesity or not exercising. And so it’s hard to escape the fact that loneliness is an important issue when you recognize how common it is…
K.B.: Yeah.
V.M.: How consequential it is to our health, and lastly, how much it matters to issues unrelated to health as well. People who struggle with loneliness in the workplace are less engaged and that has the potential to impact their productivity and their creativity. Kids who struggle with loneliness – and there are sadly many – are also… Are more likely to end up having complications in terms of substance use disorders, in terms of behavioral disturbances. They often don’t do as well in school.
K.B.: Yeah.
V.M.: But what I realized, uh, was that at the root of many of these issues were threads leading back to loneliness and to our social connection…And to the fact that social connection is powerful. It’s healing. It’s the foundation on which we build our ability to collaborate, to communicate, to support and help each other. And when we lack that…
K.B.: Yeah.
V.M.: And when we struggle with loneliness, then we build everything else on a shaky foundation.
K.B.: Yeah. This is a deeply individualistic society and as a historian, I know that the decline of participation in civic organizations since the 1970s has only exacerbated it. What kind of ideas do you see fueling this crisis?
V.M.: That’s a good question, Kate. There’s no single reason that we’re struggling with loneliness, but I think it’s a confluence of factors. And it’s worth also saying that loneliness is not a new phenomenon. It didn’t just crop up –
K.B.: Sure.
V.M.: 20, 30 years ago.
K.B.: Yeah.
V.M.: People had been struggling with loneliness for… For generations and generations. But there are, I believe, some different forces in the modern world that are contributing to it. Uh, one of those is that… Is that we’re more mobile than we have ever been. And while that’s wonderful… In many ways, it also means that we move for work and we leave communities that we know behind.
K.B.: Yeah.
V.M.: The other thing factor that’s important here I think is technology. And I’m not a believer that technology should be banned or we should somehow go back to a pre-cell phone, pre-digital age. But I do think that how we use technology matters.
K.B.: Yeah.
V.M.: And we see great examples of how technology can be used to augment connection. Like when I, for example, used social media years ago to find old friends from graduate school that I loved dearly but had lost touch with and then was able to find them and reconnect with them in person and now have a great friendship with them. To me that was a wonderful use, you know, of technology and social media.
V.M.: But more often than not, I fear the way that we are using, uh, technology, whether it’s social media, or whether it’s our phones, uh, is we’re using it in ways that dilute the quality of our interactions with people and that often substitute lower quality online relationships for what used to be higher quality offline relationships.
K.B.: Yeah.
V.M.: The truth is we only have 24 hours in a day and if we’re spending a good chunk of that interacting with people online instead of in person, that has consequences for the quality of our connection.
K.B.: Yeah, I have mixed feelings about that too. The cancer community online has really opened me up to all kinds of ways that social media creates, I mean, some pretty intense opportunities, especially for people who have mobility issues or they’re immunocompromised or they’ve got like, a really, really specific illness and they want like, a message board and, you know, some folks that they can connect with. I mean it’s why we’re having this conversation. It’s made me so much less lonely in some ways.
V.M.: Mm-hm.
K.B.: But on the other hand, I mean everything you’re describing about like, too many weak ties, like, too much mobility, too much everything. I- I just, I really feel that. It feels harder and harder to make like, durable connections.
V.M.: It does. It feels somehow that we are living more on the surface and that the strength of our roots has dissipated to some degree.
K.B.: Yeah.
V.M.: I do think that online communities can be very helpful to us, but like anything else, Kate, it’s where we draw our boundaries that ultimately determine whether technology is helpful or harmful.
K.B.: Yeah.
V.M.: You know, using technology to connect us, you know, in ways that can help us be heard, but also that can translate to offline connection can be really powerful. But when we find that we’re spending more and more of our time living, uh, you know, online – You know, when we, for example, don’t go out on a Friday night because we don’t have anyone to spend time with and we think, well, let me go on Facebook and just look at my friends’, uh, posts and then-
K.B.: Yeah.
V.M.: I’ll feel connected to them. That rarely works.
K.B.: Yeah, it does. Yeah.
V.M.: And with social media, unfortunately what happens is we often end up comparing our average days with other people’s best days. And we often, we often end up coming up short.
K.B.: …right. That’s a horrible and true way to put it.
V.M.: Yeah.
K.B.: You know, I don’t know why, but it- that it took me so long to admit that I have had my own struggles with loneliness. It felt a little bit like admitting to being unpopular? I don’t know what it is. Why do you think it’s so hard to talk about this topic?
V.M.: Gosh, I mean, I think you’ve put it so well, Kate. I think that is the fear, right? If we say we’re lonely, it means that we’re not likable.
K.B.: Yeah.
V.M.: It means God forbid, that we’re not lovable.
K.B.: Yeah.
V.M.: Uh, and that we’re not popular and especially, you know, we tend to think of popularity as something that like, kids worry about. But the truth is like, throughout our lives, all of us, you know, to some extent are worried about whether people like us.
K.B.: Yeah. Is there a gender component to this?
V.M.: I do think there are different cultural influences I think that lead men and women to experience loneliness somewhat differently.
K.B.: Yeah.
V.M.: One of the things I found with men for example, is that men often feel that their sense of masculinity is tied up in being independent and in not needing anyone. And it’s not that they just plucked that out of the air.
K.B.: Yeah.
V.M.: That’s what society tells us being a man is about. It’s about being stoic. It… not being emotional. Uh, it’s about not letting, you know, anyone get to us. It’s about not showing that we’re vulnerable in any way.
K.B.: Yeah.
V.M.: And it’s about showing that we don’t need anyone, that we can be self-sufficient.
K.B.: That’s the goal.
V.M.: And I think that that is both inaccurate in terms of how human beings function. And I think it is also harmful to think about our roles and to think about masculinity in that way.
K.B.: Yeah.
V.M.: Because the truth is that we are not self-sufficient.
K.B.: No.
V.M.: We evolved to be interdependent beings. And the truth is also that all of us have, you know, a spectrum of emotions and we- we need places and spaces where we can be vulnerable, where we can be open.
K.B.: Yeah.
V.M.: And, by and large, uh, men are not as good as maintaining strong, deep, open friendships-
K.B.: Yeah.
V.M.: Uh, as- as women are. You know, the only place, you know, in- in sort of the conventional modern world for a guy to do that in an acceptable way to be vulnerable is with their spouse.
K.B.: I totally, um, love, uh, cheesy Christian jokes. And there’s this one I read the other day that said nobody talks about Jesus’s miracle of having 12 close friends in his 30s and I thought that was-
V.M.: Oh my God, I love that.
K.B.: …totally hilarious. ‘Cause I found that too with like, uh, you know, um, guys with young kids is in times of sort of episodic isolation that people can feel even lonelier than they expected to.
V.M.: That’s true. That’s certainly true. And, you know, the thing is, I went to a physical therapist, uh, some time ago because I had some sort of injury in my knee. And I remember he said, “Strength is the padding that you need in life. It makes you less susceptible to injury.” And I’ve thought about that often in the context of loneliness, because I think that relationships are the padding in life that allow us to sustain, uh, ourselves through a lot of the ups and downs that inevitably come our way.
K.B.: Yeah.
V.M.: They allow us to better handle adversity and for many of us, we just, we just don’t have a lot of cushion. And- but this notion that, uh, having friends in your 30s is tough for both men and women is a reality. And I hear this all the time. And when we have major life changes, like having a child, for example, uh, those could be both sources of joy, but incredibly stressful…
K.B.: Yeah.
V.M.: When it comes to our relationships. So few, very few parents actually talk about how lonely it can be after they have a child. And, you know, part of the reason parents aren’t talking about that is not just ’cause loneliness is stigmatized, but also they don’t want to seem ungrateful. You know, they just had this beautiful child.
K.B.: Sure.
V.M.: And now they’re talking about how they’re lonely? That seems kind of selfish.
K.B.: I feel like there’s so many times in which people, loneliness is created by people having to just say, “No, I’m so lucky!”
V.M.: That’s right.
K.B.: “No, no, no, no. I’m so lucky. Thanks.” Yeah.
V.M.: That’s absolutely right. And you can be lucky and be lonely too. I mean, you can…
K.B.: Yeah.
V.M.: These things can coexist in our life. You can be grateful for your child, but also struggling with, uh, with a sense of disconnection from others. And it makes sense, right? You have a child and all of a sudden you’re not sleeping. So it’s… You’re tired, you’re exhausted. It’s harder to be fully present with other people.
K.B.: Yeah.
V.M.: Your time is also, uh, now, you know, shifted dramatically.
K.B.: Taken up by this little baby vampire. Yeah.
V.M.: Yeah. So your evenings and your weekends and your nights that you’re with your child and you’re not out, you know, painting the town red with your friends. And so this is, uh, your life changes dramatically. And so it’s actually not shocking that people might experience a fair amount of loneliness, but people don’t talk about it as a new parents. And as a result, we haven’t, nearly as often as we need to, come together to figure out…
K.B.: Yeah.
V.M.: How to be there and create that kind of community, uh, for others.
K.B.: Yeah. How interdependence can work in these different seasons. Yeah. Yeah. When I was, uh, in grade 10, I wrote my very first life-changing essay for English class and it was about interdependence. And I gave this rock solid argument about how we’re born as like, fragile little, you know, jelly beans. And then we pretend we’re independent for a while and then we sort of become fragile little jellybeans again. And, uh, it was like a pretty airtight argument I thought would, uh, win essay contests for, uh- from the beginning to the end of time. But… You know it just reminds me, like, we begin and we end in so much fragility and what you’re describing is a really beautiful argument for belonging to one another.
V.M.: Yeah, I love how you put that, that we begin and end with so much fragility. And the thing is, it is our fragility, it’s our imperfections and our sort of broken edges that end up forming our points of connection with each other. It’s not a coincidence that when people are vulnerable in a speech, for example, or in a piece that they write, that that draws lots of listeners and readers and pulls people in because we are in some interesting way, we are all struggling to connect more deeply with each other.
K.B.: Yeah.
V.M.: But the very things that afford us the greatest opportunity to connect, we’re afraid to share. And that’s a great irony about loneliness is exactly when we need to open ourselves up…
K.B.: Yeah.
V.M.: And connect more deeply with others, we actually pull back and shut ourselves off because we’re scared.
K.B.: Yeah.
V.M.: And, and we’re all scared to some extent. And whether we’re men or women, whether we’re old or young.
K.B.: Yeah.
V.M.: Loneliness is a problem that affects people of all age groups. And we tend to think that, you know, it’s just older people, you know, who after they retire and when their friends are no longer with them, that they get lonely. This is actually not the case. It’s not only the elderly, but, uh, it’s people throughout, uh, the lifespan who are now struggling with loneliness. And in fact people in their 60s, 70s who are sort of in that, you know, early stages, uh, you know, of elderly life, they actually have lower, uh, loneliness rates in, according to some recent surveys than youth and young adults. And certainly than people who are in the throes of middle age. And so, you know, this is a far more common challenge than many of us have realized.
K.B.: Yeah.
V.M.: But what makes me optimistic about it, Kate, is I think that addressing issues like loneliness push us to ask far more fundamental and deep questions, uh, about society than trying to address a seemingly more simple issue, like how do we get a certain type of medicine…
K.B.: Yeah.
V.M.: Uh, to people or how do we get a treatment more affordable? While those kind of technical solutions are important, I think to address loneliness, we have to ask deeper questions about like what is our purpose? What is the nature-
K.B.: Yeah.
V.M.: You know, of life?
K.B.: What do we owe one another? I mean really.
V.M.: What do owe one another?
K.B.: Yeah.
V.M.: And, you know, I think we live in modern times, in societies that tell us that the most important question we have to ask is who am I? What is my purpose? What is my destiny? What is my strength? But I’m starting to wonder more and more if the most important question is not who am I, but who am I in relation to others and what is my duty, uh, and obligation to them? Um, what can we build, create, experience together?
K.B.: Yeah, that’s right. That’s right. And what I’m really taking away from this too is, I mean that- that what seems like the problem, loneliness, from what you’re saying is also the prompt. It’s the reason to reach out and to know that we are… We are each other’s solution.
V.M.: Interestingly, I think at the heart of our ability to connect deeply with others is- is our ability to connect deeply with ourselves. It’s our understanding, uh, of our self-worth, of our value. Um, you know, if we don’t believe that we are people who have worth and value, if we don’t believe that we matter…
K.B.: Yeah.
V.M.: Uh, then why would we think that others would want to actually connect with us?
K.B.: Yeah.
V.M.: We always doubt and we- we always end up sabotaging…
K.B.: Yeah.
V.M.: Actually our potential relationships. And so the challenge with figuring out how we address loneliness is- is also figuring out how can we locate our sense of self-worth. And I think that it’s tied in, uh, most fundamentally to our capacity to give and receive love.
K.B.: Yeah.
V.M.: That is what makes us human. That’s what makes us worthy. That’s what makes us matter is the fact that we can give and receive love.
K.B.: Yeah.
V.M.: You know, we are born with that ability, but something happens to us, Kate, along the way, people tell us that we can’t be as open ’cause others will take advantage of us.
K.B.: Yeah.
V.M.: Other people tell us that to express love or even to talk about love is- is being weak, and so we don’t want to do that. But at our most basic, fundamental core, I believe, is this very human desire to both give and receive love. And that to me is what makes us all matter.
K.B.: Yeah, absolutely.
V.M.: It’s what ensures that we all belong.
K.B.: Yeah. And it sounds like solving loneliness is just another way of saying that we plan on being loved by one another.
V.M.: Yeah. Because the opposite of loneliness, um, is love. Uh, love in our lives, for ourselves…
K.B.: Aw, when you said that, I could feel my heart melting. Thank you. That’s exactly right. Oh man. Thank you so much for sharing with me today, honestly. It was both beautiful and I think exactly the right call to be… To be for one another. So thanks so much.
V.M.: Thank you, Kate.
K.B.: A friend of mine had a baby last month. She and her husband were in a new city in a new job and they had their little baby and then…nothing. I mean, not nothing. People sent them baby blankets through Amazon and texted recipes for baby mush. But no one actually came to their door with a tuna fish dish with noodles and said, here. I made this. No one threw her a baby shower because she didn’t know enough people yet. She reminded herself that she had tons of friends, but they just weren’t there. Which was fine… usually.
Every time I watch a cell phone commercial I am reminded that there are entire businesses devoted to selling us the experience of connection (Can you hear me now?!) but the truth is, not all connections sustain us equally.
We can have a million people in our contacts list and no one to bring us a casserole when we actually need it. I’m starting to realize that I need to look more closely at the kinds of connections I am making… do they bring life? Do they bring meaning? Do they bring casseroles?
I loved what Vivek said when he talked about the cure to loneliness. “We can be the medicine that each other needs,” he said. “We can be the solution other people crave. We are all doctors and we are all healers. The question is, do we have the courage to speak up and stand up for others, to reach out to them when we feel they may be in need.” That’s what I needed to hear right now. Loneliness may be the disease, but we are all medicine.
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