Surgeon general on loneliness epidemic and his own struggles

The first Monday of the new year marks the first day back at school or in the office for lots of Americans, and often conversations around the water cooler begin with the question, ‘How were your holidays?’

For many, that’s a difficult question to answer.

One National Alliance of Mental Illness survey found that 66% of respondents feel lonely during the holiday season, and according to a recent Gallup poll, one in five American adults report feeling lonely every single day. It’s something that U.S. Surgeon General Vivek Murthy has called a “national epidemic of loneliness and isolation,” something that can have a profound effect on sufferers’ physical and mental health.

Murthy explains that he didn't think about loneliness as a public health issue during his years as a medical student and resident, but was surprised to see how many people were struggling when he started treating patients.

“They may have come in for an infection or for a heart attack, but yet when you sat down to talk to them long enough, they were struggling with loneliness,” he says.

“And when I became surgeon general,” he continues, “and I started traveling the country, I started hearing this everywhere I went, students telling me they were on campus with thousands of others, but yet nobody knew them. Parents were saying this. CEOs were saying this.”

Murthy says he quickly realized two things: loneliness was ‘exceedingly’ common — he estimates about a third of adults and 5% of young people were sufferers — and that the condition is taking a toll on their health.

Being socially disconnected increases your risk of depression, anxiety and suicide, as well as heart disease, stroke, dementia and premature death, “so much so that the mortality impact of social disconnection is on par with smoking or obesity,” he says.

Why the connection between loneliness and health? Murthy cites evolution as a major factor.

“Over thousands of years, we evolved to be in relationship with one another, and that was critical for our safety and survival,” he says.

“So imagine thousands of years ago when we were hunters and gatherers taking turns around the fire at night to make sure that there weren't predators coming, making sure we were sharing our food,” he continues. “These were all methods through which we learned to survive together.”

But when separated from the tribe, he explains, survival was at risk and we went into a stress state, which was helpful “back then” to keep us vigilant. Now, with no saber-tooth tigers on the horizon, that chronic stress state can cause inflammation which, over time, can damage tissue and blood vessels and increase our risk for heart disease and other conditions.

Still, Murthy says loneliness is not a disease. Instead, it’s a subjective feeling that the connections we need in our lives are greater than the ones we actually have.

“I would think about it like hunger or thirst,” Murthy explains. “It's a signal that our body sends us when we're lacking something that we need for survival, and if we're able to respond to that and seek out connection, then it may dissipate.”

Murthy says there are concrete steps that can be taken to mitigate against loneliness. Among them are spending time with other people and expressing gratitude to others.

But, Murthy notes, there’s a big difference between in-person and online connections.

“When we're talking to somebody face-to-face, we're picking up so much of what they're saying, their facial expressions, their body language, like all of that is feeding into our connection with them, and we lose a lot of that when we're primarily texting with somebody or communicating primarily through social media,” he says.

Still, Murthy says that even when it cannot be in person, it’s important to take just 15 minutes a day to reach out to somebody you care about and check in on them.

“If you do one thing each day to help someone, that is powerful too, because service is one of the most powerful antidotes to loneliness,” he says.

He adds that while it may seem counterintuitive to reach out to help others when you yourself feel the need for help, two critical things may happen: You can forge a meaningful connection and remind yourself that you have value to bring to the world.

Murthy notes that one of the downfalls of loneliness is a blow to our self-esteem where sufferers start to believe “that we're lonely because it's our fault.”

He confesses that that’s how he felt as a child struggling with loneliness.

“I was so ashamed and embarrassed that I never told my parents about it or other friends because I thought something was fundamentally wrong with me,” he says.

He says he would love to tell his younger self, “that one, you're not the only one who is struggling with this, and two, that you're fundamentally still worthy and valuable as a human being. Just because you're struggling now doesn't mean you're not worthy of love.”

Murthy’s policy advisory lays out a framework for the U.S. to establish a national strategy to advance social connection, including more parks, libraries and playgrounds, all environments designed to create social connection. He also urges the evaluation of our relationship with technology and a mobilization in the health sector to look for and recognize loneliness. This can be as simple as asking patients, “Are you lonely?”

Murthy says it’s also important to pay more attention to loneliness in schools.

“We assume sometimes that you just grow up and you know how to make friends, and the truth is you have to learn that. So we need to invest in the social-emotional learning,” he says.

The bottom line, he says, is that we have a choice: The status quo — disconnected and divided with disease on the rise — or a world of connection, health and fulfillment.

“That's a choice that I want us to make in the new year,” Murthy says, “a choice for connection, recognizing it's good for our individual health and it's good for our collective well-being.”

Murthy adds that by reaching out to others, each one of us can become healers.

“I've been privileged to sit with patients at the end of their life when they're in their final reflections, and when I think about what they talk about, they don't talk about how many followers they had on social media or how many dollars were in their bank account,” he says, “What they talk about were people: the people they loved, the people who loved them, the people they served.”

“It's so clear that in those final moments of life when only the most meaningful strands of our existence remain, it's the people that rise to the top,” Murthy says, “and we don't have to wait till the end of our life to realize that we can start acting on that wisdom right now.”

Karyn Miller-Medzon produced and edited this interview for broadcast with Mark Navin. Miller-Medzon adapted it for the web.