3 Simple Tools That Banish Loneliness and Strengthen Connection – Dr. Vivek Murthy with Dave Asprey : 756

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You're listening to Bulletproof Radio with Dave Asprey. Today is going to be a really interesting interview for you, and it's because we're going to talk about loneliness, but we're going to talk about loneliness with a former Surgeon General of the United States named Dr. Vivek Murthy. And Dr. Murthy spent time under Barack Obama, where he was appointed by Barack Obama and has worked a lot on, well, the health of the nation. But the fact that he wrote a big book that's very much worth reading about loneliness, frankly, surprised the heck out of me. Because of all the things you could think about when your brain is full of the health of a nation, why would you go to loneliness? And I said, well, let's. Let's ask him. So, Dr. Murthy, welcome to the show.

Well, thank you, Dave. It's great to be on with you today.

I wanted to talk about loneliness because I'm dealing with it. I live on an island on a farm, and I have my family, clearly, and we have some sheep and some pigs roaming around on the farm, maybe some chickens, but it isn't a highly populated area. And I used to travel 150 days of the year, and I have, you know, an active social life, but my friends are highly distributed, and we get together for a healthy event or something, and then we move on. And I haven't seen him in a while, and I noticed that I kind of, you know, you wake up in the morning and there's nothing going on. So I'm feeling it. But how are most people experiencing loneliness today, given all the stuff, you know? And then I want to go into your book about why and what we can do about it. But how is the state of loneliness in. In the world right now?

Well, Dave, it's such an interesting time to be asking that question. It's such an interesting time to be asking that question because when I sat down to write this book, which was coming off of my time as surgeon general, a time when I had unexpectedly seen so much loneliness in the United States and observed it in communities around the world, I knew that loneliness was common, that it was a great challenge and one that had actually profound health consequences as well that we'll talk about. But what's interesting during this time of COVID during this global pandemic, is that people have actually been pulled even further apart. In some ways, we're not able to see each other as readily as we were able to before. That has introduced an even deeper element of loneliness into many people's lives. And my worry is that if we don't do anything differently, we don't recognize what's happening, then we will experience a deepening of that loneliness and trigger something that I think of as a social recession, if you will, marked by more and more separation and isolation between people, which will have consequences for our health and well being. That would be just as profound as the physical health consequences of COVID and the economic challenges that we're facing. But it doesn't have to be that way. And part of the reason I wrote this book on loneliness and social connection is not only because I wanted to pull the curtain back on a deeper public health issue, loneliness, which I think we've been facing for a long time, but also because I believe there was a much more optimistic story to tell as well. A story about how if we harnessed the power of social connection, if we recognize just how much it could impact our health, our performance, and our sense of fulfillment, then we could improve our lives in extraordinary ways. And I think we have an opportunity to do that during this pandemic as well.

You talked about social connection, and we've all been told, okay, it's time for social isolation. Not even physical isolation, but social isolation, where you sort of lock yourself in your house, even if you could go out. Is there a way to have that social connection when we're social isolating?

It's a great question, David. And I think the terminology is important here, because from a public health standpoint, what we need people to do to reduce transmission is to physically distance. But the notion social distancing is actually a bit of a misnomer. Now, if you're not careful, physical distancing can lead to social distancing. And the operative question is exactly what you frame, which is how do we strengthen and maintain our human connections during that time of physical distancing? And I think there are ways to, in fact, do that. And thankfully, we have technology to assist us in that regard. And that wasn't always the case. I think back to. I think back to 1992, when I was living and growing up in Miami, Florida. I was in high school at the time. And Hurricane Andrew swept through South Florida, tore down power lines, ripped roofs off houses, and just devastated the landscape. And we didn't have power for three weeks. We didn't have phone for six weeks. This was pre cell phone era as well. It was effectively pre Internet for most people.

You had a pager if you were lucky. I remember those times.

Yeah. The Cool kids had pagers in school. I remember that I was not in that group, just to be clear. But in that time, it was physical isolation, truly was social isolation. But in this moment of COVID because we have the ability to use technology to our benefit, what we can do, for example, is we can still reach out to people and talk to them by phone. We can video conference with close friends. We can connect. The question is, are we intentional in doing that? Because unless we are, what we'll find is that the chaos of this pandemic will sweep us away and we will become just more and more isolated. So a few concrete things I like to think about is as follows. Number one, I think we can all keep 15 minutes aside each day during which we reach out to people that we care about. That could be a phone call. It could be a message saying, I'm thinking about you. It could be a short video conference in the morning just to see how someone we love is doing. The second thing we can do is we can make the time we do spend with other people count and count for more. And we can do that by eliminating distraction during our conversations with people we care about. If you are like me, then you probably spent more of your fair share of conversations multitasking while you're going through your mail or looking at your inbox or refreshing your social media feed or googling a question that popped into your head, thinking to yourself, you know, I'm paying attention to the conversation. I can do both things at one time. And science tells us very clearly we can't multitask. But one of the most powerful ways to enhance the quality of our interaction with others is to give them the gift of our full attention. And there's a third thing that we can do, like, in this moment of physical separation, and that is to actually look for ways to serve one another. This, Dave, was actually one of the most interesting realizations for me in the research I did in the writing of this book, which is a recognition that service is one of the most powerful antidotes we have to loneliness. And there are actually very interesting biological reasons why that is the case. It's not just a philosophical statement. It's actually a statement about our evolution and our biology. But what we find is that in this moment of COVID when so many people are struggling, you can be sure that nearly everyone has a way, you know, in which they are hurting and everyone can be served in some way. And so service doesn't have to look like going to a soup kitchen to volunteer. Doesn't have to look like going to build a house for Habitat for Humanity. But it can look like calling on a friend who you know is struggling to see how they're doing. It can look like checking on a neighbor who may be older and worried about going to the grocery store and is having trouble getting food. It could even look like volunteering to virtually babysit just for 10 minutes for a friend who has small kids and is struggling to telework and homeschool at the same time and just needs a few minutes to sit down, to breathe and to just be. So these three simple tools, keeping 15 minutes aside a day, making sure the quality of our time with others counts by eliminating distraction and seeking each other out for ways to serve. These are small but simple ways and powerful ways that we can strengthen our connection during this pandemic.

The idea of service to others is fascinating because there's a lot of research that shows if you want to get into a flow state, that service to others is one of the best ways to do it. You can clearly do high speed mountain biking and things that put you at risk of going to the emergency room. And there are people who say, oh, I'm going to get into a flow state where with pharmaceutical means or, you know, fasting or whatever, but the idea of help someone else and that actually changes your state to be more positive is, is really neat. And I did not think of that as a, a direct amplifier of social connectedness. So that, that's a really cool angle, one that I appreciate from your book.

It might be worth actually, Dave, just if spending just two minutes explaining why that's the case, because it's so much fascinating if you think about how we lived thousands of years ago. We lived in small tribes during our hunter gatherer phases. And in those times there was truly safety in numbers. So if you were together with others in trusted relationships, then you could better keep an eye out for predators. You could share your food supplies so that people were less likely to starve on any given day. You could help with childcare and support one another. Life was easier and it was also safer. And so when you became separated from your tribe, what happened is your chances of survival automatically dropped. And people knew that and their bodies entered into a stress state, a state where they were hypervigilant. They were looking for threats around them because they wanted to be able to respond. Even if there was only a 1% chance that the twig that cracked behind them was a predator. They wanted to interpret it as such. Right, because their life could depend on it. And the other thing that happened because of their concern for safety is their attention swung inward and in focus increasingly on themselves. And if you think about that, that makes sense in a threat state, right? But think about the modern world now, like where our circumstances are very different. We're not so worried about predators, you know, in the, in the forest, sneaking up on us at night. And imagine that you're lonely and your nervous system goes into the same state of hypervigilance and focus on self. Because it does. Very interestingly, even though our circumstances are different, our nervous systems are very similar to what they were thousands of years ago. In the modern world, though, that response doesn't necessarily help you. In fact, it can push people away if you're more suspicious of them, if you're looking for threats that maybe aren't there, if you're too focused on yourself and not thinking enough about other people. And what happens when that continues over time is it can actually erode people's self esteem. Because the lonelier you are, the lonelier you can become as you start to convince yourself that the reason you're lonely is because you're not likable, or you're not lovable, or you're broken in some way. The reason service is such a powerful antidote to loneliness is because it breaks that downward spiral. It shifts your attention from yourself to, to someone else in the context of a very positive interaction. An interaction that's often disarming and that helps reduce your sense of threat. The other thing it does is it reaffirms for you that you have value to bring to the world and serves as a boost for one's self esteem. And in that way, it can be one of the most powerful tools we have for indirectly but powerfully addressing loneliness.

Loneliness is a feeling that certainly I feel like I know what it's like, but it may be felt differently by other people. Is there a medical definition of loneliness or a descriptive thing? That's how a physician sees loneliness.

Guys, there's a couple of interesting points in what you just raised. So yes, there is a way to think about loneliness in terms of a simple definition. And this is how I think of it. I think of it as a state of being where the connections you feel you need in your life are greater than the connections you have. And that is a subjective state. It's not defined by how many people you have around you, whether you live in a big city or a small town. It's not defined by how many people you see on a given basis or how many, how many times you get together with friends. It is a very subjective state. And for that reason, you can have people who are surrounded by thousands of people on a daily basis. The example would be a student on a college campus, but who still feels lonely. And you can have people who only have a couple of people they might see on any given day, but they feel profoundly connected. It is the quality of connections that ultimately matter. And the connections that are often the most powerful in helping us feel connected are those where we feel we can truly be ourselves, where we feel we are seen and understood, where we are valued for who we are, where we can show up truly as ourself and not have to be someone else or fulfill someone else's expectations. What's interesting, you raised the question about how a physician sees loneliness. And I'll just say briefly on that. The reason that I find that fascinating is because as somebody who trained in medical school and in residency, I never was trained to think about loneliness or think about how to assess it, how to address it. We learned about a lot of things in school, but this was not one of them. And I was really struck, Dave, when I first entered the hospital as a third year medical student and started being more involved in patient care, I was struck by how many patients would come to the hospital by themselves, even at critical, critical moments when we had to make a really big decision about their treatment pathway or when we had a really tough diagnosis to give them. I would sometimes go to my patients and I would say, you know, is there somebody you'd like me to call to be with you? Because I know this will be a tough conversation and far too often they would say, I wish there was somebody, but there's not. So I'll just have the conversation by myself. So doctors encounter loneliness a lot, but they don't often know what to do about it in the moment.

If you could wave a magic wand as a former Surgeon General and you could zoom in on that situation in a hospital and be able to do something for those patients, what would it be?

Well, there's something I'd like to do in the moment. There's like a longer term way in which I would like to participate in their healing in the moment. I would like to be able to spend as much time as they needed listening to their story and witnessing their journey.

So more doctor patient time would be a part of it?

Yes. And the reason is that one of the most powerful things we can do as human beings is not necessarily to fix someone else's problem or try to amend what is broken about them or what we perceive as broken. It's to be there as a witness to their journey. It's to listen to them and give them the gift of our full attention, to make them feel seen and heard and valued. I would like to do more of that. And in the world of medicine in which we live, time like that is actually increasingly rare. But what I would love to do on a more macro level is to have a system where we, number one, understood that loneliness had profound health implications. So we looked out for it, we screened for it, and where we then had partnerships with community organizations where we could connect patients to resources in their neighborhoods and in their communities, whether those were faith organizations, organizations like the YMCA or others that had social programs in place to help build community, especially for those who were struggling with loneliness. That's ideally the kind of partnership that I would love to be a part of as a community definition.

It feels like if I go back to when I was a kid, we talked about being teens in the 90s, there were a lot more people who went to church, and there was the Lions Club and the Veterans of Foreign wars and all of these social organizations, none of which have ever been a member of. So to me, that all feels like, I wonder what they do in those buildings. But they have buildings. And a lot of those organizations, I think, have almost disappeared. Do you see a resurgence of community organizations where, oh, you're lonely, you go to church and people in church take care of you, or you go to yoga class or whatever it is. Are we going to fix that? Is that coming back?

I hope we fix that, Dave. It's not coming back yet, though. In fact, the decline that you're mentioning in civic organizations and in engagement in faith organizations, that decline has actually continued over the last several decades. Something that. A decline that Robert Putnam, you know, had addressed in his famous book Bowling Alone, and he's written about it since then as well. But I do think that. That we are hurt, actually by having those institutions be weaker. I think we're hurt by people not having an institutional organization that they feel constitutes home. When I was growing up, I was not part of a Rotary Club or Alliance Club. My parents weren't, that is. But we had a temple in our community that we were actively involved in, and that was an incredibly important source of community for us. But right now, I think there are many people who don't have an organization that serves as a default source of community. And, you know, in the, in the book I talked about sort of three types of societies that generally speaking are out there. I call them three bowls, if you will. Like the bowl that is narrow but deep, which would be like the traditional societies my parents grew up in in India, where you have many different structures which help people feel like they're part of something. The extended family, the village that people have often grown up in for generations, in some cases a religious organization, various other sort of community networks and structures. And even if you don't do a whole lot, those are often. You're just part of many of those organizations, but they're often narrowly defined. And so if you stray outside of expectations, in my parents state, for example, if you did not want to get married at the right age, if you happened to be gay, if you wanted to pursue a profession other than what your parents said was appropriate, you would quickly be cast outside these social networks and you would feel very alone. And the contrast to that is the society in the modern world, which is, I think of it as a very wide bowl, but it has only modest depth in the sense that we can be who we are, we can choose our identities, but we actually, what we've lost is a lot of those structures that naturally capture us and hold us. What I think of as a true social safety net. And the loss of them, whether it's in the loss of faith organizations or alliance clubs or Rotary clubs or bowling clubs, that has, I think, resulted in many people not having an anchor. And I think what we're called to do at this moment is to ask if we can build a third bowl society, a bowl that is both wide, wide and deep, that allows people to assume and take on their individual identities, to be who they are, who they want to be. But a society that has those layers, those structures, those organizations that truly allow people to feel like they belong to something. And if we don't, the thing is, if we continue in our current path, if we don't recognize how important those are, if we don't recognize how consequential loneliness is for our health, our performance and our fulfillment, then we'll continue to see a dwindling of these structures. So something very different has to happen. A very proactive shift in what we prioritize in society. If we want to rebuild that true social safety net and build a more connected society.

There are some spiritual practices like vipassana, where people will go and they'll spend 10 days really, with no talking, right? And you're in a little room, you might see another person every now and then, but there's definitely some loneliness. And I'm just finishing a book that I've written on the spiritual and physical aspects of fasting. And I brought up that fasting from human connection as a way of showing yourself how much you need it and to value it more. It also feels though, like social media has almost created that every day where you kind of have this fake connection that's out there, but you have no real connection. So it's like you're hungry every day for connection and you're getting this fake connection that isn't real. And it feels like there's a connection between going out and really experiencing disconnection from the world and experiencing a fake connection. Is there some kind of social media fasting or some sort of. Yeah, we should all lock ourselves away for a weekend and really just turn the volume down. Something like that. That makes us value real connection more. That you've ever come across in your research?

Yeah, it's a fascinating question and it actually raises a somewhat counterintuitive point point, which is that one of the keys to strengthening our connections with other people has to do with strengthening our connection with ourself, with being more comfortable with ourselves, more grounded in who we are. And it turns out one of the keys to doing that is actually protecting time for solitude. On the surface, some might say, well, why is being alone helpful in actually being together? Because it's when we actually have time for solitude that we have a chance to truly reflect, to let the noise around us settle. And there is a lot of noise around us coming at us all the time. It's also when we can grapple with certain challenges. I mean, we may have pushed under the surface. It's when we can just appreciate the moment as well, to truly be present. And those moments of solitude may look very different for different people. For some people, that solitude may be a few minutes of sitting, you know, outside and being in nature. For others, it may be time in meditation or in prayer, or time listening to music that puts you in a good state. But however you find that solitude, it is important. And one of the things that has happened to us in the modern world is that, number one, that solitude has often has become very rare. Because much of the time for solitude we had was not necessarily the seven day retreat that you take away from your family. It was the few minutes that you had at a restaurant while you were waiting for your friend to arrive, or the time that you had sitting at a bus stop waiting for the bus to come. And all of that white space in our Life has been. Has disappeared. It's been soaked up by this sponge that is our, our phones, our mobile devices, which allow us to just check our email, check social media, check the news whenever we have a million minute or two to spare, or maybe even.

Listen to a podcast. Oh, wait.

So that time, in many ways, has disappeared. But the other thing I think that's happened, Dave, is people have become uncomfortable with being alone. It's a scary thing for many people. And some of that is because social media, I think, and our devices give us the illusion that we never have to be alone, that we can always be somewhat connected to others through their profiles, their updates, through news stories. But I also think in our current world, we live in an extroverted culture. And I say this as somebody who is an introvert, but if you think about being on when you were in college, let's say, for the first time, and you think about what was acceptable to do on a Friday night or a Saturday night, the acceptable thing to do is to go out to a party, was to hang out with friends. If you were the person who wanted to stay in and read a book on a Friday night, people may have called you a loser or maybe even something worse, right? But there's nothing wrong with that. And so we live in a culture that also tells us that if you're alone, you dine alone, if you watch a movie alone, if you read a book alone, if you're alone, that something must be wrong with you, that you must not be likable, desirable, you must be broken in some way. And so for all those reasons, I think that our time alone, that critical, those critical moments of solitude in our life, which we need to deepen our connection with ourself, which in turn helps us connect deeply with others, that time has diminished. And part of what we have to do going forward is recapture those moments of solitude. But, you know, the good news is, Dave, is that it doesn't need a lot of time, these moments of solitude, to actually create great benefit for us. And when I, when I forget that sometimes, you know, just like anyone else, I'm trying to manage a crazy life with two small kids who are 4 and 2, and trying to figure out just, you know, how to get through the day without breaking anything, doesn't always happen. And sometimes I tell myself, gosh, you know, I don't have enough time to meditate today, I don't have enough time for solitude, etc. But in those moments, Dave, you know who I remember? I remember my nephrology Teacher from medical school who taught me about the kidney. And she had this practice that she used to use, this solitude practice. And she was a woman that who was incredibly busy. She was a mom, a teacher, a doctor. She was helping run parts of the medical school. If anyone was busy, it was her. But what she would do before she walked into a patient's room is she would turn on the water to wash her hands. And then for 20 seconds, she would just feel that warm water running over her hands. And she would think about all that she had to be grateful for in that day. Maybe it was the hug that her sons gave her that morning when she said goodbye. Maybe it was a medical student she was teaching that morning who finally got a concept that he had been struggling with for a long time. Maybe it was the patient. She was about to see the opportunity to be a part of his or her care. Then she would turn the water off, she would take a deep breath, and she would walk into that patient's room feeling more grounded, more centered, more clear about who she was. In that 20 seconds, she gained so much. I think to myself when the days feel busy, that I have 20 seconds. All of us have 20 seconds. And in a little bit of time, solitude can be extraordinarily powerful in grounding us and helping us to feel more centered.

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That is an amazing story. I love how you can bring gratitude into that. So you've got a period of solitude which is different than loneliness, and you've got gratitude stacked on top of it. So it's actually highly efficient when you think about it, as you'd expect from someone as busy as your teacher was.

It is. And I think she would think of those moments of solitude as not lonely at all because so loneliness is a subjective state. Being alone during your moments of solitude isn't necessarily lonely because solitude is a state of joyful and peaceful aloneness and because of the feeling that surrounds it, because you're not feeling a sense of loss or a craving for being with others. It's, interestingly, not a state of loneliness, even though it's a state of being by yourself.

It's really cool that you're bringing this up and that you brought this up in your book, which is called Together. I don't know if I've mentioned the title because I look back on this in my life in my 20s and I was so afraid of being alone. I didn't know I was afraid of it, but I just knew that I would do anything to not be alone. That I was very happy to be in bad relationships and just go out and pretty much do anything possible to not face that, oh, I'm going to be alone. And then I look at where I am now in life and one of the reasons that you just made me think about that I like business travel as much as I do. I get to Go be with my friends who are out writing books and improving health for people and all that. But then I'm at a hotel and I'm actually by myself and I get that solitude, which is a part of it. So I'm getting the right kind of connection and I'm getting some time without interruption. And I hadn't really thought of the value of the alone time when you're on an airplane even no one bothers you on an airplane or when you're out there. And that is a time to recharge. And there's something else though, and I want to ask you this. The difference between loneliness and boredom. How do you draw the line between those two? Because it feels like those are almost mixed up or like, oh, I'm bored, but you're actually lonely.

Yeah, that's a very insightful question, Dave, because loneliness gets confused with lots of different things, boredom being one of them. I actually, I think about loneliness as the great masquerader, if you will. It can look like anger and short temperedness, as it often does in elderly men and men. More, I would say more broadly, loneliness can look like depression, it can look like anxiety, it can look like boredom, it can look like despair. So loneliness can look like all these different things. And so when we look at the world around us, we might say, gosh, I don't know anyone else who's lonely. I feel like I'm the only one. But we don't see as easily what's under the surface. And we don't often recognize that what we might be seeing as depression or short temperedness is in fact is loneliness. And boredom is one of those things. You know, I think of boredom as a state where we are looking for more meaning, more purpose and more excitement. But that lack of something, that sense something is missing. Sometimes what's missing is people and we're experiencing loneliness, but we don't realize it and we say we're just bored. I need something in my life, I'm not quite sure what. And so I do think that's important to recognize. Otherwise we undercount loneliness. But the other thing I think to say about this, and I was struck by something you said at the very beginning of this interview, which is you said to your listeners that you were in fact feeling lonely at times yourself. And I was one, I appreciated that you, you said that. And I wondered how it felt, you know, like for you to sort of say that maybe you're feeling lonely now versus when you were in your twenties. Does it feel weird to Say it. Does it feel okay? Like it's normal? But I'm curious. It.

It didn't feel weird to me. But I also recognize I'm. I'm not that normal. I've spent a lot of time doing nervous neurofeedback to replicate advanced Zen states, so I can pretty much say whatever I want about myself without getting knots in my gut. But that's just a lot of personal development work I also have. I'm in the habit of putting myself forward for listeners after 800 episodes where, you know, I'm just gonna say it like it is because there's nothing else to say. So it didn't cause me pain to say that I didn't feel like I was being extra vulnerable or exposing myself. But there are many times in my life where I would have never said that because it would have felt like a failure. I just. I don't walk that way anymore. But that's through conscious action, not through. Not through avoidance. And it does feel to me, though, now that I think I see where you're going with that. Most people wouldn't want to admit that they were lonely because it's some sort of a failure, and we don't like to admit that we failed at it.

Something.

Is that kind of what you're thinking?

Ab. Absolutely. No, you're right. And the truth is, I. I was one of those people for many years, including from my time as a child in elementary school. You know, each. Yeah, each day when my mom dropped me off at school, I had this sickening pit in my stomach. And I wasn't scared about tests and teachers. I was scared about being alone on the playground, like in the classroom, and, you know, did. My scariest part of the day as a child was lunchtime. I was walking into the cafeteria and not knowing if there'd be anyone to sit next to. And I remember that vividly. And even though I don't feel lonely in the same way, I have had bouts of loneliness as an adult. And the reason I love this story you just shared is you are proof positive that we can go from being ashamed about our loneliness to feeling comfortable about who we are. And recognizing that loneliness is part of the human condition is something all of us experience. It is not evidence that we are broken or deficient in some way. It's evidence that we are human and that we're going through a common experience. Part of the reason, David, I wrote this book is because I wanted to pull back the curtain on what loneliness actually was. I wanted to help address this unfortunate stigma that surrounds loneliness and help people see that loneliness is actually very similar to hunger or thirst. It's a natural signal that our body sends us when we're lacking something that we need for survival. And in this case, that's human connection. And in the same way that I wouldn't feel uncomfortable saying, I'm thirsty, I need a drink of water, that doesn't make me, you know, a bad person or a deficient person, the same way like, you know, saying that I'm lonely doesn't make me deficient either. But just like hunger and thirst, if we allow our loneliness to persist at a deep level for a long period of time, it can be harmful to us. What we see in the case of loneliness is that people who struggle with chronic loneliness do experience a higher risk of adverse health outcomes. They have a higher risk of premature death, of heart disease, of dementia, of depression, anxiety, and a host of other conditions. But the flip is true as well, which is that social connection is an extraordinary source of healing and in our lives as well. It can reduce our risk for illness, but it can also enhance our performance in the workplace, which is very interesting. And in school, it can also facilitate dialogue as well. And if you are one of the millions and millions of people out there, including me, who are concerned about the state of dialogue in our world and about the political polarization that we experience, it's actually very relevant to think about how we foster stronger connections between people in a time like this, because it is the key to our survival, not just as individuals, but more broadly to our thriving as a society.

It's curious that you mention hunger and thirst, and I think you're referring to the work of a guy you call Dr. Loneliness in your book, Dr. John Cacioppo. I hope I'm saying his name right.

Okay, absolutely.

It's an Italian name, so I probably had it wrong. And you reference his work in there in your book as the guy who says hunger and thirst. But you look at fasting now, which intermittent fasting is a big thing. I helped to put that on the map. And it's a part of the practices that I recommend for listeners. So you're saying, oh, I'm going to learn to be comfortable with a brief period of no food or even no water. Right. People do that during Ramadan. And you can go a whole day without drinking water. You shouldn't do it regularly because that's called dehydration or dying of thirst. And it's called starvation if you over fast. Right. But these brief periods of this are the same thing as a brief period of solitude where my son, when he was 10, said, Daddy, I've seen you fasting. I want to do a fast, a 24 hour fast. And I said, you're not going to do that regularly, but you can try it. And I said, why don't you have a little bit of coffee in the morning? Because it makes fasting way easier. And my kids get a small amount of coffee they have since I were young. And he said, no, daddy, I don't want to do that. I want to feel the full. I don't want to cheat, I want the full experience of the fast. And at the end of it, he said, you know, daddy, the best spice on earth is fasting. Because whatever he ate first when he was done fasting was so delicious because he said, wow, this is the best I've ever had. And it was so cute on one level. But on the other level, that brief period of solitude makes you value the connection that you do have even more. And so this is kind of coming together for me as I'm talking with you because you focus so much on loneliness. And I feel like now that I just submitted my manuscript, I should have written even more about that aspect of it. I did talk about taking some time off fasting in a cave, which is what I did when I first fasted. But the idea of looking at maybe a part of the antidote to loneliness is sitting with yourself for a little while and then going out and being of service to another person, which is going to foster that connection. That, that creates a very strong dichotomy, a big space where you're much more likely to feel it when you do connect. I hadn't thought of this until. You're really pushing buttons for me with what you're sharing there. If you were to come out of, say, you take a day for yourself, if you're lucky enough to be able to do that. If you're quarantining with two young children, as you are and as I am, you probably aren't going to do that. But let's say that you get to do that. The highest impact would be finding someone who's lonely and then doing something nice for them. How do you spot someone who's lonely if you're not in the emergency room and getting to interview a patient? So how would I know which of the people around me is experiencing. Experiencing loneliness?

That's a great question, Dave. And it's not easy to know. A lot of times you just can't Tell from the outside because the stereotype is that the lonely person is the person sitting in a corner at a party by themselves. But in reality, I'm finding more and more that lonely people are often surrounded by lots of people. Sometimes they're the ones who are the loudest and most engaged in the room, but you don't really know what's happening underneath. So I think you have to assume that everyone around you is at risk for loneliness because all of us experience it at some point in our lives. And if you look at the statistics around loneliness, what they tell you is even if you look at the more conservative ones, and I don't mean that politically, I mean in terms of the lower numbers, this would be like a 2018 Kaiser Family foundation survey that put the number percentage of adults who are lonely in the United States, it's somewhere around 22%. Wow. So it's a lot. So just to put that number in context, 22% of adults is more than, than much more than that number of adult adults who have diabetes. It's more than the number of adults who smoke in the United States. And that number is almost certainly an undercount. Right. Because many people just don't feel comfortable even to a str, admitting to, even to a stranger on a survey that they're lonely. But there have also been many other surveys since then which have put the number at far higher, in some cases at more than double that rate. And it is not just an American phenomenon. You know, in Australia, for example, they've pegged their percentage of, you know, population as being lonely at 25%. The UK is similar. Many other countries in Europe and in Asia and in Latin America are seeing double digit percentages of their population who are admitting to struggling with loneliness. And one of the peaks that we see in across the age Spanish is actually among youth and young adults. And we think about, you know, kids as being so hyper connected. Right. You think, oh gosh, they're God, they can't ever be lonely. They're always with somebody, talking to someone, texting with someone, etc. But given that we know that it's the quality of the connection that matters and not the quantity, we're finding now that there are many young people who are actually struggling and feeling really alone despite all of that contact. And I think it's connected to why we see such high rates of depression and anxiety among adolescents and young adults as well. Wow.

Well then. And you touch on this in your book, but I'd like listeners to hear your answer and I think you probably have more than you wrote about if you were to stack rank all the causes of loneliness. We have some kind of biological hardwiring. We have genetic, psychological, situational and other. What percentage of loneliness is caused by each of those things or something I didn't even mention.

I don't know how to assign a specific percentage to them. But what I could tell you is that of the many contributors to loneliness in the modern world, I think that the couple I put at the top of the list is the biggest ones, I think is number one, I think, in the modern world are, I think, almost excessive focus on the individual as opposed to the group. Because there are a lot of downstream effects of that, right? Once you say that the individual is. Is what determines, you know, outcomes and that, you know, we are the sole determinant of our destiny. Well, what you're telling people is that if they need help that something is wrong with them, that they're weak. You're telling them that if they fail for some reason that is 100% a reflection, you know, of their own worth as a human being. And the reality is that we know that human beings did not evolve to work alone, Right? We evolved to work together. That has been true for thousands of years. But that focus, you know, excessively on the individual, I think not only creates those, I think, unrealistic expectations, but it also makes us feel, I think, embarrassed to ask for help when. When we need it. And so that, I think culture is. Is very important for us to be aware of because it's not actually how we've always lived. That culture is relatively new in the history of, you know, of sort of human civilization. The other big contributor here, though, I think has to do with. And this is actually somewhat connected, has to do with the culture around work and around. Because with work, like we, like, if I were to ask you, Dave, like, what are. What are your. What's your top priority in your life? I have a feeling I know what you would say. But let me just ask you though, like, what are your top priorities?

I actually wrote it down and I share it with my administrative assistant so that I can enforce this in my life. And number one is my health. Because if I don't manage that, I can't help my family, which is my second priority, right after my health. And if I don't do those right, I'm not going to do a good job as an entrepreneur in the several companies that I'm running, which is my third priority. So I put it in those orders. The Old put the oxygen mask on first. But I didn't used to do that because I hadn't learned from people much smarter than me.

Well, so what you said is just, is a beautiful articulation I think of, of, of, of I think many of our priorities, which is that and what the way they should be, which is that it is our connection to self and others that determines ultimately how we experience the world in our life. It's what drives our fulfillment and it's what enables us to be great entrepreneurs, to be great authors, to be, you know, great workers and any of, in any sort of facet of, you know, of employment. But in reality, Dave, I think the culture of work in the modern world flips our priorities.

Yes, it does.

Like how many people do you know that actually put people ahead of work? Right. And if we vote with our, our feet, so to speak, with where we put our time, attention and energy, then I would say for many people, including myself for many years, work was actually their lived priority, even though my stated priority was people.

Yeah.

And so I think that culture around work, I think is a major contributor. And then the last thing I'll mention, which I think is perhaps the most insidious of all, is the impact of the current culture and social media in particular on our sense of self, on our self esteem. And so we know now that the foundation for connecting to others is connecting with ourselves. But what happens when the messages that we're getting at an increasingly accelerating pace right through social media and other venues are constantly telling us that we're not enough, that we're not good looking enough, we're not thin enough, we're not athletic enough, we're not smart enough, we're not popular enough, and then offering to try to sell us a product or service to fill that gap. But when we get those messages all the time, and when we also enter the sort of atmosphere of hyper comparison that is the social media experience, an atmosphere that makes us feel, no matter how good our life is, somehow we don't measure up to other people, then that's a recipe for us feeling worse and worse about ourselves. And I worry about this in particular for our children and for young people whose identities are being developed. But this is really a challenge for everyone, is that if your sense of self is constantly being eroded, if you don't feel that you're worthy, that you have value, it makes it very difficult to not feel lonely. It makes it really hard to connect with someone else. Because think about it, why would you think someone would genuinely want to connect with you. When you yourself don't feel worthy, you. You find yourself questioning that relationship. And when you approach somebody for conversation, when you are not centered, you're not sort of secure in who you are, then you find yourself often trying to be who that other person wants you to be, how to live up to their expectations, say the right thing, et cetera. And that doesn't make for a strong social connection either. So when you put these things together, a culture that is centered around work, a culture that's centered almost excessively, I believe, on the individual and not enough on the collective. And a culture that, because in part of the accelerating use of social media technology, has undermined, I think, even further, people's sense of self. I think you have a setup for people feeling lonely, regardless of how many people they're surrounded by.

You're reminding me of something that I noticed the other day. Zoom has this little feature that smooth my appearance. So you actually get used to seeing yourself on Zoom, run through a filter that isn't real, and then you step away from Zoom and you go look in the mirror and you're like, ugh, like, what's going on? Like, you know, there's a pimple right there, or, you know, I need to shave or whatever it is. And I've actually made a practice now of taking my picture on Zoom and actually making it so I don't. I block it, clock it out so I don't see myself running through filters all the time, because it actually was making that, like, what, what? Something's wrong with how I look. Right? And I, I feel like if you take that and you multiply times, social media, the way you're talking about and all, if your self image is that I, I'm not as good as other people see me, then that feeling of worthlessness that I've certainly carried with me for so many years, it. It can come back. And then if you're feeling worthless, like I said, you're not worth connecting to. And then you end up feeling lonely in the middle of a crowd, which would describe at least the first half of my life very accurately. And that's why I think your book is so profound. And I thought it was also really profound that given all the medical stuff you have to deal with as a surgeon general, like you said, diabetes, which is a major thing, that of all the things you could have written about that, you chose this relatively esoteric but terribly important topic. So thank you for prioritizing things in that way, because it's highly unusual.

Well, Dave, you know, that was. Well, first of all, thank you for saying that. It's very kind of you. And I will admit that that was not my plan when I began my tenure as Surgeon General. In fact, when I was going through my confirmation process, I had to testify before the United States Senate and talk to them what my priorities would be. And I listed out a number of priorities that would have absolutely made sense to anybody who understood public health based on the data and my own clinical experiences. But that list did not include loneliness. It was really my conversations with people around the country during my time in office that helped me realize that there was something much deeper going on here than I had even realized. And I had certainly seen and experienced loneliness as an individual. I had seen it in the lives of my patients. But what I had not appreciated, which is how widespread it was. And I was hearing from college students on college campuses about their loneliness. Their parents were talking to me about how they struggled with loneliness. People in remote fishing villages in Alaska, CEOs of companies, members of Congress in Washington, D.C. all of these people would tell me behind closed doors that they were struggling with loneliness. And as I delved into the science around it and came to see just how profoundly loneliness impacts our physical health and our mental health, how it affects how we perform in school and in the workplace, and how we show up for the people we care about, it became clear to me that if we actually want to address so many of the front page issues that we read about every day, whether it's the opioid epidemic, whether it's violence in our communities, whether it's rising rates of chronic disease, or frankly, whether it's the challenges we have with polarization and lack of dialogue in our country, that we've got to do something about strengthening our social connections with one another. Because it's not enough anymore, Dave, for us to say, yes, of course we value people. Because what's happened is not that we necessarily don't care about people. Everybody, you know, almost everyone, if you stop them on the street, would give a similar list of priorities as you and I did when talking about their life. They would name some group of people that would be at the top of their list before work. But the reality is that how we live our lives has become different. So when I came out of government, Dave, I had a bit of a crisis myself, and it was actually partly a crisis of loneliness. I suddenly didn't have the amazing team that I worked with. I didn't have that source of meaning. My work as Surgeon General I hadn't gone back to practicing medicine up in Boston. I was in limbo, trying to figure out how to make heads and tails, you know, of my life and the world and what to do next. And. And it was a very lonely time because one of the things I had not done is I had not built a real community when I was in office. I had allowed a lot of my relationships, in fact, to wither because I hadn't put the time in to maintaining them. And so I felt profoundly alone afterward. But as I came to, to grapple with that and to think about everything I had been through, an office, I realized if there was one thing I could do, one thing, Dave, to help create a better world for my children, my son Tejas and my daughter Shanthi, and for all of our children, it would be to help create a world where people cared more deeply about each other, where they looked out for each other, where they supported one another. Because the. The reality is, Dave, that regardless of what, regardless of what culture we come from, what country we grew up in, we all have three core needs. We all want to be seen for who we are. We all want to know that we matter, and we all want to be loved. And when I think about my kids, I know that even though I'm probably overly protective parent, and I try my best to shield them from, you know, disappointment and being upset, I know I can't always be there right for my children. I know that their overall happiness and fulfillment in life will depend in part on their own perception of themselves and how. How worthy they feel they are. And it will also depend on how the world receives them. So when they stumble, when they make a mistake, will there be somebody to lift them up, you know, when they make an error in judgment, will there. Will there be somebody who gives them the benefit of the doubt and realizes that we are all more than our worst mistakes? Will there be people who embrace them and who give them a shot, recognizing that all of us deserve a shot at a good life and an opportunity? Those are the questions that will determine whether or not my children have a fulfilling life or not. And I came out firmly believing that focusing on strengthening our connection with one another was really the key to helping build a healthier, stronger world. And if I could do that for my kids, if there was a small way in which I could contribute to doing that for all our kids, then to me, that is at the heart of what it means to build a people centered life. Because that's what this is about, Dave, for me and for hopefully, as many people as I can convince about this, that the key to our health and fulfillment is about building that people centered life, where our relationships are what we prioritize with our time, attention and energy. And if we build a people centered life, then we make it possible to build a people centered world, where the curricula we design in schools are designed to strengthen relationships for our children from the youngest age, where the cultures and structures that we build in the workplace are designed to actually strengthen human connection. And where even our approach to policy is made with a recognition that it's not just the financial impact of our policy that matters, it's how our policies impact our connection with one another, the strength and health of our neighborhoods and communities that ultimately makes a difference in whether they do make us better off or ultimately make us worse off. Wow.

Very, very well said. And it's one of those things that's so hard to measure and it's so hard to legislate, and it's hard to build into our lives. I'm maybe in a minority here, but I'm hopeful that some of the things we can do with artificial intelligence and with algorithms and with consciously designing systems that help us, if we plug loneliness and connection in as variables and goals, and in those systems, we can actually build the kind of world that we want. But if we don't value them and we don't measure them, we certainly won't optimize them. So I'm hopeful that your book and your work talking about loneliness is going to get the people driving the algorithms. And yes, Mark Zuckerberg, I'm talking about you to, you know, maybe build this in where it's not lip service and it's not a check mark because, you know, know, someone liked my post. We're socially connected. It has to go deeper than that. And there's actually social science that we've got to do as a society to figure that out so that we can really say, all right, are people connected enough that we've addressed this epidemic as opposed to ones that are easier to measure because there's, you know, a nasal swab for it or something? Because they both matter. They matter greatly.

You're right. And the thing is these so many companies now, especially social media platforms, have taken the world's most talented psychologists and engineers and have had them design platforms that maximize the amount of time we spend on a platform. But what I would love is for that expertise to be directed not at the quantity of interaction, but at the quality of interaction, if you can. And that's my challenge to tech entrepreneurs. Can you help us design technology that strengthens human connection? Not that dilutes it, weakens it. Can you make and build a business model around strengthening relationships? Because that is ultimately where we need not just our tech entrepreneurs to go, but it's the question. I feel that it's at the heart of how we need to think about designing schools and workplaces, and we need to think about designing neighborhoods as well as our individual lives. And that's where this becomes so central that, Dave, which is that culture change is always really hard, right? It's the hardest piece of anything that we do. But this is fundamentally about that, because our culture is ultimately about what we value. And if we put people at the center of our culture and if we want to truly build technology workspaces, you know, neighborhoods and communities and policy that support relationships, then that should be the metric that we use to decide whether or not we're being successful or not. But that is still not at the center of how people think. But what makes me optimistic and hopeful, Dave, is that of all of the subjects that I worked on during my time as surgeon general and since then, from everything from Ebola to zika virus to COVID 19 to chronic illnesses to violence, even the opiate epidemic, there is no subject that has resonated more clearly and deeply with people than this subject of loneliness and social connection. Wow. And that's because even though it might not be something we normally talk about, it is something that nearly all of us have experienced at some point. And whether you're a parent who's worried about your child, they were worried about yourself. Whether you're a boss who's worried about your team, or whether you're a teacher who's wondering how to help the next generation feel more secure in themselves and more connected to one another. It turns out that building a more connected society is at the heart of what we need to do, and it's at the heart of, I think, how we need to make our decisions. So, and, you know, and this isn't about politics or the workplace or about religion, but it does involve all of those. You know, we have to see our faith organizations as not only a vehicle for. For understanding and deepening connection to God, but also as a vehicle for strengthening our connection to each other. And we have to see our politics that way as well. See, politics feels like a dirty word, right? But actually, in its best moments, politics is about bringing people together to take on big issues, whether those issues are healthcare or climate change or economic disparities or other challenges that we may be facing as a society. The question is, how do we design a politics that actually brings people together? How do we value human connection and nurturing our relationships with each other enough that we vote for people at the ballot box who do that, who value human connection? That's ultimately what this, as I think of it, this movement toward human connection is really about.

Amazingly well said, Dr. Vivek Murthy. Thank you for your service to the country as Surgeon General and thank you for this time on Bulletproof Radio. And thanks for writing a great book about something that I haven't paid enough attention to. And you really highlighted that for me and I think you just did it for hundreds of thousands of people right now. Much gratitude.

Thank you so much, Dave. I really enjoyed this conversation with you and I appreciate you spending time focusing on an issue like this. I do believe it. It's at the heart of what will make us stronger and better, and we'll do it together.

We're aligned on that. Your new book is called Together. People can find it anywhere books are sold. And guys, if you read Dr. Murthy's book, you owe it to him. Just like you owe it to your barista. You tip a barista and for an author, you leave a review. It's a requirement. If you don't do it, you're a bad person. Okay, not really. But please do it. Have a great day.

Foreign.

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