The Rotarian Conversation:
Loneliness — the absence of human connection — is twice as prevalent as diabetes in the United States. A former surgeon general tells us what we can do about it
Vivek Murthy grew up helping out in his parents’ medical practice, filing charts and cleaning the office as he watched the way they built connections with their patients by taking the time to listen to what they had to say.
When he became America’s top doctor — the 19th U.S. surgeon general, a position he held from 2014 to 2017 — he went on a listening tour himself. Some of the problems people told him about were things he anticipated: opioids and obesity, diabetes and heart disease. He also talked to Elmo of Sesame Street about vaccines and called for addiction to be recognized as the health problem it is rather than a moral failing.
But one unexpected topic became a recurring theme: loneliness, which “ran like a dark thread through many of the more obvious issues that people brought to my attention,” Murthy writes in his new book, Together: The Healing Power of Human Connection in a Sometimes Lonely World.
A 2018 Kaiser Family Foundation report found that 22 percent of American adults say they often or always feel lonely — that’s 55 million people, twice the number that are diagnosed with diabetes. Australia pegs its problems with loneliness at around 25 percent of its adult population. The United Kingdom has a similar figure. And other countries in Europe and Asia are struggling with double-digit percentages. “My guess is that most of these survey numbers are underestimated, because most people still don’t feel comfortable admitting that they are lonely — whether that’s to an anonymous person administering a survey or even to themselves,” Murthy said in an interview with The Rotarian.
Before becoming one of the country’s youngest surgeons general at age 37, overseeing 6,600 public health officers in more than 800 locations, Murthy partnered with Rotary clubs and other service organizations in India to set up community events for an HIV/AIDS education program that he co-founded with his sister, Rashmi. He also co-founded the nonprofit Doctors for America and the software technology company TrialNetworks.
Murthy spoke with senior staff writer Diana Schoberg by phone in April from Miami, where he was staying during the COVID-19 pandemic.
THE ROTARIAN: Hypothetically speaking, is a Tibetan monk in seclusion lonely?
VIVEK MURTHY: Loneliness is a subjective state — it’s not determined by the number of people around you, but by how you feel about the connections in your life. People who are surrounded by hundreds of others, whether they are students on a college campus or workers in a busy office, may be lonely if they don’t feel those are people with whom they can fully be themselves. Others who may have only a few people around them may not feel lonely at all if they feel good about those relationships and good about themselves.
For a monk to exist in complete isolation and not feel lonely, he would have developed a very deep spiritual practice and built a strong connection to God and the divine.
“Service shifts our attention from ourselves to other people.”
TR: In your book, you describe someone who found his purpose and connection in the military. How can we find that sort of team environment?
MURTHY: People who have served in the Peace Corps together can often experience similar bonds. People also have that deep shared experience in times of natural disasters — not just the shared pain and trauma of a disaster, but also the shared joy and inspiration of the response to that trauma. People who have been a part of an organization where they have a deep sense of mission and where they’ve sacrificed together for the cause can also experience the bond.
How do we create more opportunities for experiences like that? Part of that has to do with how we prioritize social connections as we get older. To many people, it seems almost like an indulgence to prioritize their relationships. They have responsibilities to their families, their kids, and their work, and it’s a question of where relationships fit in.
TR: What role can Rotary play?
MURTHY: What is powerful about organizations like Rotary is that they are rooted in service. Service shifts our attention from ourselves, where it increasingly is focused when we feel lonely, to other people and in the context of a positive interaction. Service reaffirms that we have value to add to the world. One of the consequences of loneliness when it’s long-lasting is that it can chip away at our self-esteem and lead us to start believing that the reason we’re lonely is that we’re somehow not likable. Service short-circuits that.
Right now, people want to help. What they don’t know is where to go to actually do something meaningful. Organizations can provide those opportunities. That can be extraordinarily powerful. When I started doing community work, one of the principles I was taught is that people come to the table for the mission, but they stay at the table for the people. It’s hard to sustain even the worthiest mission without building a strong sense of connection between the people who are participating.
TR: What can we build into our clubs to foster that sense of belonging?
MURTHY: Shared experience, shared mission, and the opportunity to understand each other more deeply create deeper connections. We’ve touched a little bit on the shared experience and shared mission part. But the opportunity to understand each other more deeply is something you can facilitate with a little bit of structure.
When I was the surgeon general, we did an exercise called “Inside Scoop.” That turned out to be far more effective than the happy hours and group picnics that we had been doing before. At each weekly staff meeting, one person would show pictures to share something about their lives. It was so useful because it didn’t take much time at all — five minutes during a meeting. But it created an atmosphere where it was OK to share and it was OK to bring some part of yourself that was not work-related to the table. And that ended up being the key to helping people understand each other and learn about each other.
TR: How can technology help us connect in a healthy way?
MURTHY: Despite all of the tools we have for staying in touch with each other, technology is a double-edged sword. Just as it can be used for strengthening our connections, it can contribute to their deterioration.
When you use technology to strengthen social connections, it can happen in a few ways. For example, you can connect with people you might otherwise not be able to connect with. When I was younger, the only affordable way we had to connect with my grandparents or cousins in India was to write them a letter, which took two weeks to get there, and a response would take two weeks to come back. Now, we can talk much more frequently because we can videoconference with them at next to no charge. That is a great example of how to use technology for the better.
Another example would be when we use online platforms as a bridge to offline connections. So if I’m coming to Milwaukee for a talk, I can post that on Facebook. And if that helps my friends get in touch with me and meet up, that’s a great way to facilitate in-person connection.
“Loneliness is a natural signal that our body gives us when we’re lacking something that we need for survival.”
TR: Is there anything we’re learning because of COVID-19 about communication that will help us as we go back to being in-person communicators?
MURTHY: For many of us, the absence of physical contact with other people has made it all the more clear how essential in-person interaction is. And how there really isn’t a full substitute for it. We can get close with things like videoconferencing, but it’s just not the same.
Also, it’s become more apparent that it’s not just your family and friends that make a difference as to how connected you feel; it’s the interactions that you have with neighbors and community members and strangers. There’s something powerful in receiving a smile from someone. Those moments have a significant effect on lifting our mood.
TR: Is loneliness something that can be diagnosed? Is it medically recognized?
MURTHY: Loneliness can be assessed; the UCLA Loneliness Scale is one example. But it’s not the kind of condition that we currently would diagnose as an illness, per se. Loneliness is a universal condition that people experience for varying periods in their life. It’s a natural signal that our body gives us when we’re lacking something that we need for survival, which is social connection. In that sense, it’s very similar to hunger or thirst. Our social connections are just as vital to our survival as food or water. If we feel lonely in the absence of adequate social connections for a short time, we can use that signal to reach out and spend more time with a friend. But when loneliness lasts a long time, we start to run into trouble with it affecting our mood and having a long-term effect on our physical health.
Doctors and nurses should be aware of loneliness, because it’s likely present in the lives of many of the patients that they care for and likely having an impact on the health outcomes that they’re trying to address. But we should be cautious about making people think that loneliness is an illness. There is already a fair amount of stigma about loneliness that makes people feel that if they’re lonely, they’re socially deficient in some way. Not everyone who is lonely is broken. Nor do we need a new medication or medical device to solve the problem of loneliness. I think what we need is to re-center ourselves and refocus our lives on relationships.
TR: Because of the coronavirus, people are staying home for the good of all people — not necessarily for themselves, but so they don’t pass the virus to vulnerable populations. Why doesn’t that message translate for vaccines?
MURTHY: It’s a fascinating and disturbing phenomenon. There were times when people were more accepting of the need to vaccinate in order to protect not only their own kids, but also other kids. What has happened over time is that misinformation has proliferated. Some of it has been based on erroneous studies. Some of it has capitalized on fears that parents had about their children developing conditions like autism around the same time they were getting vaccines, even though the two aren’t related. It is emotionally charged — we’re talking about people’s children here.
When a threat is new, people tend to come together because there is an immediate danger and they’ve got to figure out how to save themselves. But the longer that threat continues, the more likely you are to get misinformation, especially if the effort to contain the threat is painful. And in the case of COVID-19, it is painful.
While the response to COVID-19 and the resistance to vaccines feel very different, there are similar risks. All of us want this to end as quickly as possible, and if a source that we trust starts to tell us that this is a hoax or there’s an easy way out, some people are going to believe that. Not because they’re bad people or uneducated, but because in the face of continued pain, all of our minds will look for a way out.
TR: What are the best responses to someone who refuses to vaccinate their children?
MURTHY: We have to understand what’s driving people’s concerns. Is it because of a personal experience? Is it because someone that they trust had a bad experience? One of the worst ways you can deal with misinformation is to shut other people down and to make them feel that they’re ill-informed or that you don’t respect them.
The second thing that’s important is to be vulnerable and open to sharing your own story. If you have a child and struggled with a similar decision, or if you felt the pain of seeing your child being poked with a needle, it’s important to share that. It’s easier for two people who share a human experience to talk about a complicated issue than for two strangers to do that.
Beyond vaccines, I’m thinking about political polarization in our country and in the world. We have lost so much of the power of our connection with each other. We’ve allowed our relationships to be edged out and deprioritized — not just with family and friends, but also with our neighbors and community members. As a result, it’s become harder for us to talk about difficult issues like health care, climate change, or any number of big issues that we’re facing as a society. If we can’t engage in healthy dialogue, we can’t solve big problems.
• Rotary Action Groups connect Rotary members and friends who want to work together toward a shared mission such as water or the environment. Find out more at rotary.org/actiongroups.
• Illustration by Viktor Miller Gausa
• This story originally appeared in the August 2020 issue of The Rotarian magazine.