Next Blockbuster Drug: Busting Loneliness

By Dan Buettner, Blue Zones founder and National Geographic Fellow and Explorer

Back in the old days—a month ago—when we could hug a friend, accept our morning coffee from a Starbucks barista and belly up to a bar, human contact came as easy as breathing air. Now, the closest I get to most of the people who mean the most to me come on the receiving end of a Zoom cast. It’s not the same, but oddly, I find myself connecting with more people and in many cases more meaningfully. 

In the hurried, gotta-go, iPhone-pinging days of pre-Corona, I socialized constantly. But somehow, it lacked the soul that comes with focus and longing. Nothing like a good pandemic to slow us down, take stock, and really give our friends and family the commodity that matters most: the time of day. I thought I’d get lonely in lockdown, but I’m finding the opposite to be true. 

That’s because, as Dr. Vivek Murthy points out in his new book Together: The Healing Power of Human Connectedness in a Sometimes Lonely World, the true currency of social connection is not just social proximity, but rather vulnerability, empathy, and focused attention.   

Unlike toilet paper and Purell, these commodities are more abundant these days. And they fuel the type of human connect that can add up to eight years to our lives, make us measurably happier and even buttress our immune system [so that if COVID-19 attacks, our bodies are ready with a defense that the New England Patriots would envy].

I met Vivek when he was Surgeon General of the United States. He had come to California’s Beach Cities where I’d led a Blue Zones Project for nearly five years. In that time, this community of 125,000 saw their smoking rate drop by over 25% and their collective weight drop by some 15%. People reported to Gallup more physical activity (on newly walkable sidewalks and bikable bike lanes) more plant-based eating (in Blue Zones Approved Restaurants), and a greater satisfaction with their lives. 

Vivek is a gentle man with a powerful intellect. As Surgeon General he had the courage and prescience to focus on traffic and guns as public health menaces and set out to mitigate both. (In his first Surgeon General Report, he actually prescribed more sidewalks as a way to stem the Obesity epidemic.)

When we first met in California, he and his team spent the better part of the day touring the changes we made to the food and built environment. But in the end, what most impressed him was our Moais:  the committed social circles we organized around plant-based potluck dinners and walking. In his resplendent military uniform that with golden epaulets and a white hat, he walked with the 12 people in the “Birney Steppers Moai.”  He listened to their stories of supporting each other through tough times, of these once-strangers sharing Thanksgiving dinner together and the connection they’d get three times a week through an often disconnected world. 

Vivek’s recounts this experience in Together and goes on to reveal the powerful research behind loneliness; how it can cripple us, kill us, and make us sad. He also shows us how to fight loneliness and tells us compelling stories of the people how are helping turn around America’s loneliness epidemic. 

Last week I reconnected with Vivek and got him talking about his book in advance of its publication later this month.  I think you’ll find his answers a soothing salve in troubled times.    

Dan: In your book, you talk about three kinds of loneliness: intimate, relational, and collective. Can you just briefly describe each? In your opinion, which one is the most damaging? Which one do you want to look out for the most?

Vivek: I find these three types of loneliness are helpful to think about because they help us make sense of why somebody may be in a fulfilling marriage but still feel lonely. Or somebody may have a lot of friends that they spend time with on weekends and on vacations but still feel lonely. There are three types of loneliness—intimate loneliness is what you feel when you lack really close relationships with people who know you truly for who you are, with whom you can be fully yourself, and that often is a best friend or a spouse.

Relational loneliness is when we lack friendships, and the kind of friendships where you would spend time with people during weekends or evenings or you have a friend you would have over to a dinner party or go on vacation with. And collective loneliness is when we lack a sense of community-based or shared identity. That could be a community of parents who have kids who go to the same school. It can be a community of people who have a shared mission or it could even be colleagues who have loyalty to their organization and are committed to the mission.

But these different bonds all help sustain us in their own way. If we have intimate ties in our life, that’s deeply fulfilling. But if we don’t have friendships with people who can help extend those ties or with whom we can spend time, or if we don’t have a community that we feel a part of and identify with, then we can experience loneliness even though we’re in a fulfilling marriage or even though we have a best friend.

Dan: So, you kind of need all of these.

Vivek: Ideally, you need all of them. The question you asked about which one is most important, it’s sort of hard to say. I would say though, that in modern society which has such a focus on romantic relationships, many people who don’t experience intimate connection either in the form of romantic relationships or really close friendships can often feel, I think, particularly lonely. Again, it’s not to say that everybody needs to be married or romantically partnered. There are many people who are single and they have a deeply fulfilling social life and feel deeply connected. That intimate connection is not only extremely important, but it can be challenging in the modern age when we’re receiving signals from all around us that tell us and reinforce to us that we’re not enough.

They tell us we’re not thin enough, or we’re not good looking enough, or we’re not popular enough or smart enough, or rich enough. I worry in particular about young people who get these messages all the time, whether it’s through traditional media or social media because when you’re young, that’s when your identity is being formed and developed. That’s when you’re figuring out who you are and building your sense of self. If you are constantly feeling like you are not enough, that impacts your ability to connect with other people, because instead of approaching from a place of groundedness and centeredness and abundance, you’re approaching others from a place of insecurity and fear. That can interfere with the development of strong friendships.

That’s why one of the things I learned as I was doing the research for this book, and that has reinforced to me through the stories that I heard was that the foundation of building strong connections to other people is building a strong connection to ourselves, which means ensuring that we know our value, that we feel our self-worth, and that we bring that sense of confidence and groundedness to our interactions with other people.

Dan: Okay. Again, there are a couple of nuanced questions in there. Do you think kids should stay off social media then? I mean, it sounds like that would interfere with establishing the connectedness with yourself if you’re always kind of comparing yourself to others.

Vivek: I think when it comes to social media, there are opportunities for strengthening connection and there are dangers or risks of weakening connection, and it depends on how we use social media. People, for example, who may be a part of a marginalized group either based on the illness that they have or their race or ethnicity, they may find that through social media they can find a community of people with shared experiences with whom they otherwise may not connect. That could be an extremely positive experience. On the other hand, if you’re using social media passively, if you’re primarily scrolling through your feed and just seeing pictures that others are posting that are highly curated reflections of the life they’re leading, then you can start to believe that everyone else is living a glorious and glamorous life and that you’re the only one who’s struggling.

That can really damage your self-esteem and your sense of self. So, I think that if you’re a parent who’s thinking about your child and their use of social media, it’s important to talk to your child about how they’re actually engaging on the platform, and who they’re engaging with, and how much time they’re also spending on social media. If kids are on social media, but they’re balancing it with healthy in-person interactions with friends, then that’s good. If they’re using social media to communicate proactively with others and to share positive experiences which should be authentic and honest about who they are and about what they’ve been through, then that can also be really positive.

The danger also comes in when that insecurity and feeling of not being enough leads us to try to be somebody online that’s really not us. When we try to be more appealing to others because we think we need to shift who we are to what others want; that’s when we start to go down a path that can be dangerous. As a parent, I think it’s important to understand how your kids are using social media and to talk to them about how to approach it from the standpoint of authenticity, and how to balance it with in-person interactions.

[Related: Good Friends Might Be Your Best Brain Booster As You Age]

Dan: Okay, I’m wondering about communication technology and the Coronavirus. On one hand, this quarantine is driving people indoors and I could see that exacerbating loneliness for people living alone, for example. But on the other hand, and this is more anecdotal—I’m using Zoom in ways I’ve never done to have virtual happy hours and to talk to my family every night at eight o’clock as my parents are really at risk. All of a sudden, I’m connecting with my family every night. Your reaction to that? And then secondly, how can we use social media to mitigate loneliness as opposed to exacerbate it as adults?

Vivek: Well, I think what we’re going through with COVID-19 has the potential to make us more lonely or to strengthen our connections. I think it depends on how we respond to this moment. I think there is no question that people’s lives have been turned upside down by the restrictions that have been placed on everyone to keep distance from each other, to not go to school, or to work. And for many people, it’s helped them realize even more powerfully than ever the importance of the connections that we have with other people; not just with our family and our friends, but even with the strangers and community members that we cross paths with on a daily basis. These connections matter. They do something important for us.

They help us feel like we’re part of something. They help us feel and remind us, and especially in the case of good friends, that we matter and that we’re loved. In the absence of that, there’s a real possibility that we could sink deeper into isolation and loneliness. I think we can also choose to be intentional about how we respond to this moment. Even though we may not be able to go out and see people the way we were a few months ago, we can use technology to ensure that we are video conferencing with friends so we can see them and hear their voice, which is really important for creating a rich human experience.

We can call people, we can message our friends just to let them know we’re thinking about them, and that we want to know how they’re doing. Now, what I found is that when it comes to building stronger connections that a little bit of time and a little bit of effort go a long way. And so if you were to just spend 15 minutes a day reaching out to the people that you love via video conference, phone, or email to ask them how they’re doing or just to let them know how you’re doing—that can make you feel good in the moment. And when done consistently over time, it can help build a stronger and deeper connection.

Dan: When you say to make you feel good, you mean it’s the recipient feels good, or you feel good because you’ve reached out?

Vivek: Both. I mean, you feel good at reaching out to someone and hearing their voice or seeing their face. They also feel good because they know that you cared enough about them to check on them. This is one of those moments where everyone is trying to figure out how to make this work, and a lot of people are struggling. So, I think the usual barriers to being open or vulnerable or to admitting that you might be having a hard time are diminished right now because I think it’s safe to say that almost everyone out there is going through a bit of a tough time figuring out how to make sense of this world.

So spending just a little bit of time can go a long way. But I think there’s also something to be said about using this moment to refocus on the quality of time that we have with each other. Because with modern technology and in the age in which we live, people are often multitasking even when they’re communicating with friends. So, it’s not unusual to be talking on the phone catching up with a friend while you’re also scrolling through your inbox, checking out your social media feed, Googling a question that just came up, and maybe checking out the news on TV. These are common things that happen and I’m embarrassed to say I’ve done this in the past too. I’m not proud of it, and I’m trying not to do it anymore. One of the things that we know from the science around multitasking is that we’re not good at it as human beings and that when we think we’re multitasking, we’re actually switching from task to task and we’re not actually fully focused on two things at the same time.

That’s why many people have had the experience of having a half an hour conversation with a friend that was so distracted, you can barely remember what you spoke about. Or you can actually remember some of the words said, but you weren’t fully present and so you didn’t listen deeply to the meaning or to the tone of voice or to the nuance behind those words. This is a moment where we can actively choose to make the short or long amount of time we have with people really count by reducing or eliminating distractions.

So, what I try to do now as often as I can is when I’m talking to a friend, even if it’s for five or 10 minutes, I try to just talk to them—to not check my email, to not scroll through anything on my computer, to not try to sort through papers at the same time but to just literally talk to them. It’s not easy to do. Sometimes I get fidgety, and I want to reach for another device or I feel like I should be more productive and multitasking. Resisting that urge is important because what we’ll find is that even if we have a small amount of time, if it’s high-quality time then it can be really fulfilling. The other person knows that as well. People know when we’re present. They know when we’re not present. One of the greatest gifts that we can give other people is the gift of our full attention and we all have the ability to do that. So, I think it’s time, Dan, that we can focus more on the amount of time that we spend with friends, the quality of that time, and finally on helping other people as well.

“I think it’s time that we can focus more on the amount of time that we spend with friends, the quality of that time, and finally on helping other people as well.”

Dan: What is the most powerful prescription to combat loneliness?

One of the big points of learning that I took away from writing this book was that service is a powerful antidote to loneliness. When we help other people, we establish a positive and powerful connection with them in that moment. But we also reaffirm to ourselves that we have value to add to the world and to someone else’s life. The reason that’s so particularly important is that when people are chronically lonely, they can start to erode their self-esteem.

They can start to believe that the reason they’re lonely is because they’re not likable, or they’re not lovable. But when you engage in acts of service, whether that’s helping a neighbor who might be struggling during this time of isolation, or dropping food off at a friend’s house who might be struggling to figure out how to manage teleworking with homeschooling their kids, those small acts of service can break that negative cycle of loneliness and reaffirm to us that we have not only value to add but also connection that we can enjoy with others.

Dan: There’s a lot of research out there about our loneliness problem. How many people are lonely in America today? Is it getting worse or better?

Vivek: According to the Kaiser Family Foundation survey that they did with The Economist in 2018, about 22% of adults in America struggle with loneliness. There are other surveys including one from Cigna, the health insurer, that have put that number significantly higher. So, while we don’t know the exact number, what we know is that it’s a lot of people. Even if you take the lower end of that 22%, that’s more American adults that have diabetes or that smoke. So, loneliness affects a lot of people and it’s not just the United States. In the United Kingdom and in Australia, somewhere around 25% of the adult population are struggling with loneliness.

[Related: Does Your Microbiome Shape Your Friendships?]

Other countries in Europe and in Asia are also noticing double-digit percentages of their populations are struggling with loneliness. This is a global phenomenon. The question of whether it’s getting better or worse is a tough one to figure out because we don’t have really great data on this subject that we’ve been tracking for years and years. But we do know is that it’s common, we do know that it’s global, and we also know that it’s consequential. It has an impact on our health and as well as on how we show up in school and the workplace and in a public square.

Dan: I know the research shows that our bodies interpret the feeling of loneliness as an emergency. Besides the emotional toll, I read you don’t sleep as well. What are the health ramifications that most worry you about loneliness? Or about the impacts of loneliness?

Vivek: Well, I worry both about the physical and mental health effects of loneliness. It appears that loneliness puts us in a stress state. When that lasts for a short period of time, that isn’t necessarily a bad thing. Sometimes feeling lonely can just be a natural signal that we need more of something that’s essential to our survival, like social connection. And so if we seek out stronger connections, maybe spend more time with our friends or family, then that feeling of loneliness may pass.

The problem is when loneliness persists, and when the chronic stress that’s associated with it persists as well. That’s when we start to run into health problems because chronic stress can lead to elevated levels of inflammation in our body which can in turn damage tissues and blood vessels, increasing our risk for heart disease as well as for other chronic illnesses. We also are seeing that loneliness is associated with an increased risk of depression and anxiety as well as dementia and seems to be associated as well with a shorter lifespan.

When you put this all together including the reduction in lifespan that seems to be associated with loneliness, it’s similar in magnitude to smoking 15 cigarettes a day and it’s even greater than the mortality impact that’s observed with obesity or with sedentary living. All this to say that loneliness is consequential for our physical and mental health and conversely, social connection is one of the more powerful tools that we have to elevate our mood and to improve our health. If you want to think of it as a medicine, it’s one that we all have access to but you don’t need a medical degree to prescribe. And it can have a powerful effect on your health.

Dan: You point out in the book, which I thought was very insightful, that once you’re lonely, you’re in this agitated state, with lower self-esteem, and then less inclined to reach out. So, it’s this kind of double whammy of you feel lonely and then you’re less equipped to get out of your lonely funk. So, what do you do? What do you say to the 22% of Americans that are struggling with this feeling of loneliness? How do you get out of it?

Vivek: It’s a good question, Dan. What makes loneliness so tricky is that it can feel like you’re in a downward spiral with loneliness. When we’re chronically lonely, we actually become more focused on ourselves. And we also become more sensitive to potential threats or threat level changes. That might have been good thousands of years ago when we were stranded and alone in the tundra, separated from our tribe: that’s when you’d want to have a heightened sense of threat and a greater focus on yourself. In the world today, those tendencies actually impair your ability to connect with other people.

And so, the other challenge with chronic loneliness is that the longer we experience loneliness, the more we start to believe that the reason we’re lonely is because we’re not likable, or because we’re not lovable, or because something’s wrong with us. You put all those things together, and this contributes to a downward spiral of loneliness. This is why acts of service are so powerful. Because it breaks that cycle, it shifts the focus away from you and onto someone else—the person you’re helping. It gives you an opportunity to experience a positive human connection in that moment.

It reaffirms to you that contrary to what you may have come to believe that you are not worthy, or that you don’t have a value attached to the world, that you do, in fact, have something to give to others—that you have gifts that you can share with the world. What’s really powerful about service is it breaks that cycle and it can enable us to climb back up and start reconnecting with people in the world.

[Related: One in Two Americans Feels Isolated and Alone—5 Habits to Combat Loneliness]

Dan: That’s a good answer. In your book, you talked about several strategies to alleviate loneliness.  You talk about Facebook groups for moms or doctors and you gave a shout out to our moais, and thank you for that. None of them are perfect. So I’m going to ask you to synthesize them or cherry-pick the characteristics of the best programs. You’ve stressed this notion of service twice. Elsewhere in your book, I read about the importance of a “purpose community,” where people have a common cause rooted in a common belief.” If you had to design a loneliness program for a city or for a group of people, what would it look like?

[Related: Welcome to the Blue Zones Life^®]

Vivek: Good question. Very Blue Zones question, I like it.

Dan: I want to know how to put this to work.

Vivek: I’m just going to freeform think a little bit, so pardon me if it’s not too polished. But one thing I think is important would be to have a business service component built in — and not just opportunities for people to serve, but programs that would bring young people together to serve and would bring multiple generations together to serve and that could be in collaboration with groups like the YMCA. I would make that a sort of the central part of the program.

The second thing that I would do is I would build into the school system a curriculum for social and emotional learning. Because a big part of what kids struggle with early in life and then later struggle with as adults is even recognizing the emotions or experiencing and understanding what loneliness is. What does it feel like? What does loneliness look like in somebody else? And how do I respond to that? And how can I build healthy relationships? But if we can help build that foundation early on, it can be extraordinarily powerful. That would be a second component, and I think that would be important.

The third component that I would build in would be a more neighborhood-based, semi-structured approach to neighbors connecting with each other. When I profiled Mayor Tom Tate, he had his neighbor program which is a very simple program that he promoted for neighbors to get to know each other just by having a get-together at somebody’s house on a regular basis. He framed it as around not just building social connections so that we have friendships, but he framed it as a safety issue. In times of emergency when we know each other, we’re safer and we do better. Neighborhoods where neighbors know each other and look after each other actually experience less crime. So, I would have a semi-structured neighborhood type of program available to help neighbors actually get to know the people who live around them.

Those are three things. I guess the other piece that I would try to design here would be around workplaces. People spend a third or more of their lives at work. We know that when people feel alone at work, as many people do, that has an impact on their engagement, which in turn, has spillover effects on their productivity, on their retention, and their overall happiness. And so whether you care about the bottom line or you care about the well-being of your workforce, ensuring that they feel socially connected is important. But how to do that is not always so easy.

What I would try to design if I was setting up a new city program would be to try to design workplaces that facilitate connection, that have semi-structured opportunities like the “Inside Scoop” exercise that’s described in the book that we did in the office of the Surgeon General. That had exercises and some semi-structured opportunities for employees to get to know each other and understand each other beyond their skill set and their work identity. The traditional approach to this is let’s have happy hours or let’s have company picnics.

Those, as I think of it, are passive ways to create human connections that work, but they work slowly and they take a long time to percolate through to the entire population. They don’t work for all personality types as well, particularly if you’re not an extrovert. But exercises like these are very simple. The Inside Scoop exercises are ways that you can start to build time into the workday for people to step outside of their limited professional identity and to come together and relate to each other as human beings having human experiences. And so I would work to design workplaces that were built for connection.