US surgeon general Vivek Murthy: ‘Loneliness is like hunger, a signal we’re lacking something for survival’

As the 19th and 21st surgeon general, Dr Vivek Murthy has described loneliness as an epidemic on par with tobacco use – the antidote, he says, is human connection

by Katherine RowlandUS surgeon general Vivek Murthy Photo: Guardian Design / Getty ImagesMon 29 Jan 2024 14.00 CET

Dr Vivek Murthy, who is currently serving as the 21st surgeon general of the United States, is the first person in this position to have taken his oath on the Bhagavad Gita, the sacred Hindu scripture.

When he was first confirmed in 2014 under the Obama administration, he was, at 37, the youngest person to assume charge of the nation’s public health. He’s also the first person to have been confirmed twice, having been relieved of his post by Donald Trump, only to be sworn in by his successor. Today, he commands a uniformed service of more than 6,000 public health officers who work on issues as diverse as the opioid crisis, refugee resettlement, emergency preparedness and ebola outbreaks.

There is much that sets Murthy apart from his predecessors, but one detail stands out: he’s a high-ranking government official who insists on the importance of care, compassion and deep listening. Love, he says, is the foundation of good policies and needs to inform the nation’s public health agenda.

At first blush, this message sounds almost utopian – but Murthy’s own idealism is fortified by evidence. As he recounts in his 2020 book, Together: The Healing Power of Human Connection in a Sometimes Lonely World, it was in the course of talking to Americans across the country that he realized the extent to which people were suffering from sadness, withdrawal and isolation.

“Loneliness,” he wrote, “ran like a dark thread through many of the more obvious issues that people brought to my attention.”

As surgeon general, he has described loneliness as an epidemic on par with tobacco use and obesity, and is at the helm of a new World Health Organization commission to address the hazards of social isolation. Not only does it undermine physical and mental health, but, in his diagnosis, it underpins many of our more pernicious ills, including violence, addiction and extremism. The antidote, he says, is human connection.

https://interactive.guim.co.uk/uploader/embed/2023/11/archive-zip/giv-13425SACijDhlvmi7/

I spoke with Murthy over Zoom; this conversation has been edited for length and clarity.

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Before Covid, I imagine that most people did not view loneliness as a grave public health threat. It was a state of mind or an unfortunate corollary of our modern lives, but not something on the scale of an epidemic. But you started raising the alarms on this issue well before the pandemic. What circumstances led you to feel concerned about our state of disconnection?

Vivek Murthy: I’ve had my own personal experience with loneliness, which made me more sensitive and attuned to the issue. Having lived through it as a kid, then also as an adult, made me acutely aware of how painful loneliness is and how much shame is often associated with it.

But it was when I started practicing medicine that I came to see just how common loneliness was, and it wasn’t something I had learned about in medical training. I wasn’t quite sure, when I encountered patients who are lonely, what I was supposed to do.

So I did the only thing I knew how to do, which is try to respond from a human perspective: just to listen to people. But in the back of my head was this nagging feeling that there’s this deeper challenge that people are encountering that’s impacting their health, wellbeing and happiness.

It was back in 2015, when I was surgeon general the first time and travelling around the country, that I realized this is far more than an issue that was affecting my life, or my patients’ lives. This was a national problem, a national epidemic. And that’s what inspired me to dig into some of the data around it.

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I was really shocked to discover just how powerful the health implications of loneliness are. I hadn’t realized that being socially disconnected was associated with a marked increase in depression and anxiety, as well as in heart disease, dementia and premature death. These things underscored the point that loneliness is a public health threat – and one that affects millions of people across America.

Loneliness, while pervasive, can be hard to articulate. Going back to those clinical encounters and the conversations you were having around the country, how did you diagnose this collective condition? What sorts of feelings were individuals expressing?

It’s interesting you ask that, because very few of them use the term lonely. They would use other words to describe it. Many of them would say, I feel like I’m just invisible. They would say, if I disappear tomorrow, nobody would even notice, no one would even care. Many of them felt like nobody really knew them for who they were.

On college campuses a lot of students said, I’m surrounded by students, but nobody really knows me and I don’t feel like I can be myself. People didn’t feel like there were folks that they could truly be open, vulnerable and honest with.

So even though they didn’t use the word, they were describing exactly what loneliness feels like.

You mentioned feelings of shame and invisibility. Before this conversation, I scribbled a note that when I’ve been most lonely, I’ve felt culpable for my detachment. But you’ve described loneliness as more of a cue, like hunger or thirst, that directs our attention to what we actually need. How do we take steps to emerge from the enclosure of ourselves and attempt to service that need?

Part of the reason we feel a sense of shame is because of societal norms and expectations, which have made us feel like we always have to be engaged and surrounded with other people, and that if we are not, then something is wrong with us. It’s the same feeling that makes people feel that if you’re lonely, you’re not likable or you’re not lovable.

That’s what I felt as a kid, when I was struggling with loneliness. I thought it was my fault. I thought that something must be wrong with me. I didn’t realize that many other kids were feeling the exact same way. It’s so hard to tell from the outside how someone else is doing, which is one of the reasons why I always encourage people to check in on their friends, to not assume that because a colleague or classmate looks great that everything is fine. If we first recognize that this is a universal feeling, that helps take some of the sting off of loneliness and some of the shame away from it.

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The second [step] is to realize that loneliness is like hunger and thirst, that it’s a natural signal our body sends us when we’re lacking something we need for survival – in this case social connection.

Lastly, it’s important to recognize that it’s when loneliness persists for a long time that it starts to harm us, that it has negative effects on our mental and physical health. That’s why it’s important that we have tools to address it. That might be something as simple as reaching out to a friend to say hello or stopping by a family member’s house just to spend time together.

The more we talk openly about this, the more we tear down that wall of shame.

I’ve been thinking about where our conversations are taking place. We’re increasingly spending our time on platforms that are premised on connection and yet are driving us further apart. Between hate and violence and polarization, the stakes of speaking feel incredibly high right now. If open dialogue is central to healing the social fabric, how do we reclaim conversation as a way to actually know and hear and understand one another?

One of the things that has happened in recent years is that our capacity for dialogue has broken down. In some ways, we have forgotten how to talk to one another openly, honestly and respectfully.

That means not only that we can’t learn from each other, but that we become more siloed and isolated from one another. And that creates the fodder for anger, resentment and polarization.

It’s important to recognize that what we’re talking about is healthy dialogue. Sadly, what you see on social media all too often is not a healthy dialogue; it’s people talking past each other. It’s people trying to make a point in order to garner more attention, more likes.

Fulfillment comes from people and purpose. It comes from the relationships you have and from doing things in your life that give you a sense of meaning

What we also see is people hurling vitriol and attacks at one another. And whether that’s to express their own frustration or whether that’s being done in a performative way, it has a similar result, which is that it shuts down honest dialogue. The notion that social media is going to be the solution to our problems with dialogue is misguided and hasn’t been borne out by lived experience.

What we need instead is to focus on high quality interactions, where we approach engagement with one another with a fundamental sense of respect. We need to recognize that we may not have the same point of view as somebody else, we may not see the world in the same way or have the same life experiences, but every person is deserving of respect as a human being; that’s the one essential premise.

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Do you think our devices are interfering with this sort of exchange?

We just came off of this college campus tour. In talking to students across America, many of them say that they don’t see a lot of dialogue taking place in-person around them. The dining halls on college campuses, which used to be one of the loudest places I remember from when I was in college, have become much quieter. People are listening to something in their earbuds. They’re looking at their phones, they’re on their laptops. And young people are telling us that when conversations become uncomfortable or hard, it’s much easier to just pull out your phone.

So we really need spaces where young people can see healthy dialogue taking place, where they can participate in it without their devices. And I say that not because devices are all bad, but because we also need to be comfortable with talking to people face-to-face without the aid of technology. That is a skill that I worry is diminishing.

We haven’t always thought that learning how to communicate and start a conversation and deal with disagreement is a skill set that needs to be taught in school. We assume people just pick that up in the course of everyday life. We have created a fundamentally different environment where technology has transformed how we interact with one another and I don’t think we can make that assumption anymore.

How do you describe what healthy communication means to young people?

Something that I say to college students all the time is that quality matters so much more than quantity. One of the many harmful consequences of the age of social media is that it convinced us that quantity of connections is what matters. People began tracking, how many followers do I have? How many people are liking or reposting what I put up? What we used to think of as friends became our followers. But your followers are not the people who are showing up for you in the middle of a crisis. They’re not who you can call when you have a relationship breakup and you’re in turmoil and you’re wondering whether you’re worthy as a human being. The people you call your close friends are the people who understand you for who you are, who are committed to you. You don’t need hundreds and hundreds of people. Just having a couple of people in your life who understand and care about you for who you are can be enough.

I’m struck that a lot of our conversations around mental health nationally have centered on treating illness and dysfunction. We enumerate different diagnoses, and yet, we often overlook healing and wholeness and actually feeling good in the world. If you were to paint a picture of what promoting mental health looks like, as opposed to treating mental illness, what are some of the qualities that you would emphasize?

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That’s a really good question. You may not, for example, have a diagnosis of major depressive disorder, but you may not be feeling great about your life, you may not be bringing your best self to work, to your relationships, to school, to your community. Our goal should be to support mental health and wellbeing, which is a bigger goal than solely preventing diagnosable mental illness.

And what does that look like?

It does not mean that you’re happy every hour of the day, but it does mean being able to deal with adversity when it arises, in a healthy way. It looks like being able to approach a life with a sense of hope and optimism. It looks like being able to enjoy and appreciate and be grateful for things in your life, big things and small things, even during difficult times.

This is on my mind because I [recently] gave a commencement address and was talking to students about the importance of clarity in our lives, of understanding what matters to us for our fulfillment. I asked a group of young people, what is the world telling you about what you need to do to be successful? How will you know when you’ve gotten there?

And this young woman just looked at me and shrugged her shoulders, almost in defeat, and just said, more cars, more money, more fame. Clearly she didn’t believe that that felt right. But what she was saying is that the world was telling her that success is really about fame. It’s about power. It’s about money. You get those things, you’re successful. But as I was telling the students, success without fulfillment is not success at all.

Fulfillment comes from people and purpose. It comes from the relationships you have and from doing things in your life that give you a sense of meaning. That doesn’t mean you have to be saving the world or saving lives. It could be that you serve by making people’s lives better right around you, by taking care of your children, by taking care of your parents, by volunteering in your community. There are many ways to serve, to derive meaning.

You have such a deep lens into the state of the American people. You’ve observed a lot of pain and hardship. What do you do to offset the creep of despair as you take in the wreckage of routine violence and disconnection? How do you safeguard your own spirit as you take in this landscape?

For me, it’s a few things. Spending time with my small kids always lifts my energy. Small kids have a unique ability to be present, to appreciate small things and big things and they force you as a parent or a caregiver to bring your attention to them and to be present in the moment. I find that to be really powerful.

But they’re also very loving and affectionate. One of the great healing forces we have in our lives is love. If we can experience that through our kids, through our parents or our friends or other family members, that can be powerful and healing. We all need a dose of that in our lives.

I’m constantly seeking out sources of inspiration in my life to keep me in a good place. People who spend time with me will often say, you seem like you’re very optimistic about the world – and I am. But what they don’t always know is that since I was a child, I’ve had a tendency to get despondent quickly. And so as a response to that, over the years I’ve worked very hard to find sources of inspiration and to keep them ready at hand. Those might be speeches that have reminded me of what matters and touched my soul. Those might be biographies of people, spiritual leaders, humanitarian leaders, others who I have deeply admired and whose work revitalizes my spirit and my being.

Lastly, in the mornings I try to just take a very short time to meditate after I get up. One of the greatest challenges we have in modern life is tuning out the noise. There are so many things pulling away our energy and our vitality and our sense of optimism. Whether it’s through the news or social media or our environment, there is a constant flow of information that’s impacting how we think and feel to the point that sometimes we don’t even know what we feel. When I was growing up, you just turned off the TV and all that noise went away. It’s a lot harder to turn that off now.

So I found that meditating is my time where I can consciously shut everything out, and just remember something that I’m grateful for, and feel good about my life and the day. Everyone has their own tools. These are the things that I use to try to keep myself anchored and centered during tough times.

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