Hello and welcome to House Calls. I'm Vivek Murthy and I have the honor of serving as U.S. Surgeon General. This week we're doing a special episode of House Calls, a Q & A style conversation about loneliness. Loneliness is an experience so many of us have, and it impacts both our mental and physical health. Hello, House Calls family. I'm so glad that you're joining us today. I wanted to do this special Q and A session of House Calls on a topic that I am passionate about, and that is loneliness and isolation. This week, I released a new Surgeon General's Advisory on our country's epidemic of loneliness and isolation. This is the first time that a Surgeon General has issued an official publication on this topic. Now the reason I'm doing this is because loneliness and isolation are at the core of so many of the health issues that we're facing as a country, and we truly are experiencing a crisis of disconnection. Around half of people in the United States have reported experiencing loneliness, with some of the highest rates among young people. And over the years, the number of people with close friends is decreasing. As I've been traveling the country talking about this as part of our broader mental health challenge, there are some common questions that have come up. People ask, "What does it mean to feel lonely? "How does it actually impact us? "How is it different from being alone?" And there are many more questions. I've decided today to answer some of these questions right here. And I also want this to be a two-way conversation over time, so as questions come up for you, please reach out, at firstname.lastname@example.org And please do read the Surgeon General's Advisory on Loneliness at surgeongeneral.gov/connection Let's get started. So one of the most common questions that I get is about how loneliness and isolation affect our health. Now many people are surprised to know that loneliness is more than just a bad feeling. It has a real impact on both our mental health and our physical health. It turns out that people who struggle with loneliness and isolation are at increased risk of depression and anxiety. But they are also at increased risk of cardiovascular disease, dementia, and of other physical conditions, including diabetes. Now think about that for a moment, that's really striking, because we think about obesity and about tobacco use as real public health concerns. But it turns out that loneliness and isolation are on that level as well, and they should also be public health priorities, because of their impact on our physical and our mental health. Now the flip side of this is that when we strengthen connection in our life, it can have a real positive impact on our health and on the wellbeing of our communities. You know, in addition to reducing our risk of heart disease and dementia and diabetes, it can also strengthen our immune response, it can improve wound healing, it can reduce our risk of depression and anxiety. And when this happens at a population level, then we find that the the benefits are really quite extraordinary, in the workplace, for example, we find that greater social connection can aid in creativity and in productivity. We find that when kids are more connected in school, it actually helps their performance in school. So however you put it, being connected to one another is foundational, it's at the core of what we need to have as human beings in order to show up in our lives and in our communities. That's why addressing the crisis of loneliness and isolation is so important. Another question that we often get is about types of loneliness. Are there in fact different types of loneliness that we experience? And the answer is yes, and I'll start this by also saying that there's a difference between being lonely and being alone. Being lonely is about how you feel. It's feeling that the connections that you need in your life are actually greater than the connections you actually have. It's feeling that you may not have someone to share important moments with, or to reach out to if you need help, or to support you during difficult challenges, or simply to experience the highs and lows of life together. And that's different, though, from being alone. Being alone is an actual objective description of how many people you have around you. And the reason this distinction is so important is because I remember, very early on, when I was serving as Surgeon General back in 2014, traveling to communities across the country, and realizing that they were young people on college campuses, where they were surrounded by many people, but were saying that they felt really lonely. So you can be surrounded by a lot of people, but if you're not feeling connected to them, if you're not feeling like you can be yourself around them, or you can be open around them, then you may feel lonely. And the converse, though is also true, that you may only have a couple of people around you. But if you're actually deeply connected to them, then you may not feel lonely at all. Now there are different types of loneliness I think of in three buckets. I think about intimate loneliness, that's when we are lacking in these deeper connections that we have, let's say to a spouse or to a best friend. There are also relational connections or relational loneliness, which is what we experience when we don't have the kind of friendships, where we may have somebody over for dinner from time to time, or we may get together with people, for vacations, or simply to to watch a game together, or to enjoy a birthday party. And then there is collective loneliness, and that's when we lack a sense of community. Now community can come from being part of a faith organization, it can come from the work colleagues that you have, it can come from a volunteer organization that you're a part of. But we need these different types of communities, we need intimate connection. We need a relational connection, those are our friends. And we need a collective connection, that's our sense of community. And the reason this is so helpful to understand is because knowing that you need all three explains why some people can actually be in a great marriage, let's say, or a great relationship, but still feel lonely if they don't have a good circle of friends, or if they don't have a sense of community, either through work or through volunteer activities. And if you don't know this, then you might think as a partner, that "Hey, if my partner is lonely, that it's my fault, "that something is lacking in our relationship," but that's not necessarily the case. We need these different types of connection in our life to feel truly connected, and to not experience loneliness. Now another question that people are often curious about is how bad the problem is. Are we really lonely in great numbers in our country, or is this just a problem that's affecting a few people? Well if you had asked me the same question 10 years ago, I would've probably told you, yeah, this is probably an issue for just a small group of people. But I've learned a lot since then, I've learned a lot in part by talking to people around the country, who helped me realize that loneliness was something that people across age groups were struggling with, and people in urban and rural areas, people who were working in large companies surrounded by lots of people and people who were working alone at home, that they all seemed to be experiencing. And when I dug into the data, I realized that it's around one in two Americans who are in fact experiencing loneliness. And the numbers in fact seem to be greatest among young people. This might be counterintuitive, because we think about folks who are younger as more connected on technology, whether it's through their phones or on social media. But that doesn't necessarily mean that you are more connected. And in fact, depending on how you use your devices, and how you use social media, sometimes that can actually be harmful to your sense of connections, or to the quality of your connections. The bottom line is, loneliness is extraordinarily common. And it does look like, particularly during the pandemic, that loneliness did increase for many groups. There are also trends that have been taking place for decades in our country where participation in the organizations that typically brought us together, like community-based organizations, bowling leagues, faith-based organizations, that participation has decreased a lot in the last five to six decades. And that's part of what has contributed to the loneliness that we're facing today. Now how do you know if you're lonely? Well we all feel lonely from time to time, that's important to state from the outset. Loneliness is like hunger or thirst, it's a signal that our body sends us when something that's essential for our survival is missing. Now if you feel lonely, and you pick up the phone and call a friend, or get in your car and go see someone you love, or adjust your life in some way that allows you to spend more time with people you care about, then your loneliness may be short-lived. But for many people, loneliness persists for a long period of time. So, a lot of people are walking around and they may seem like they are perfectly fine, that they've got lots of people around them, you may look at their social media feeds and see that they're at parties or at events and they constantly seem surrounded by other people. But don't let that fool you into thinking that all of those people are not experiencing loneliness. Because a lot of them in fact are, and we know this from the data and I know this from so many stories that I've heard from people around the country who feel like they have to put on a brave face, who feel like there's a stigma around being lonely and that they don't want to somehow make it seem like they're not likable, or not lovable, by admitting to their loneliness. But the reality is that this is a real experience that many of us are going through, and there's nothing to be ashamed of, if you're feeling lonely, it's important to know that it's just common, but it's also something that we can address. Now related to this, people often wonder about technology and relationships. In particular I get the question "Do online friends count? "Are they the same as having friends who are offline?" And there is a difference between the interactions that we have online and offline. Technology has been an incredible boon. It's helped us connect in ways that we otherwise wouldn't have been able to. When I was growing up as a kid, I remember writing letters to my grandparents in India. And those letters took a week or more to get there, and then they would write back and it would take a week or more to come back. Now I can use the power of my phone to video conference in a moment, with relatives halfway across the world. It's really extraordinary what technology has enabled. But we also have to recognize that there are different types of technology, and how we use technology makes a difference in the quality of our interactions with one another. For example, if we're online with a group of friends, whether in a text thread or whether we're on a social media platform, and we're sharing openly with one another, we're having fun with one another, we're talking about what's actually happening in our life with one another, we're building connection with one another, those relationships and interactions can be really powerful. If, on the other hand, you find that you're primarily scrolling through your friends' feeds, and just looking at what they're doing, without really interacting with them, without being able to share openly with them, those connections might feel like you're doing something with somebody else, or engaging with their life, but they may not necessarily make you feel less lonely, or allow you to share deeply, or feel like you belong. And so there is a difference, in these types of online interactions, and regardless, it's important to know that in-person interaction is incredibly important. There's really no full substitute for that. And so we have to think about how we build hybrid interactions, now, in this new world that we're living in, where we can use online tools and online platforms to augment our connection with people. But whenever we can, having time for in-person interaction really makes a difference. And it doesn't have to be long, keep in mind. Sometimes just stopping by someone's cubicle on the way out of work, just to say hi for a minute or two in person can make a big difference. Sometimes just swinging by to see a friend, for a few minutes, in the middle of your busy day, can also make a big difference. Because we are hardwired to connect with one another, a little bit of interaction goes a long way to helping us feel more connected to other people. Now, in the modern world, one thing that we've seen is that there are more people who are living alone. And people often wonder, "Am I at a disadvantage if I live alone?" And this is something I have some experience with, because for many years I actually lived alone myself. It was shortly after my medical training, when I was living in Boston. And I lived in a place by myself, and I would go to work every day and I would come back, but I lived alone. I don't think that there's anything wrong, necessarily, with making a choice to live alone, but, we do have to keep in mind that when we live alone, that there are certain things that we have to be more proactive about doing, to ensure that we are building connection in our lives. Because what the studies do show is that isolation, which can also result from living alone and not having interaction with others, is associated with worse outcomes, in terms of mental health and physical health, so, in order to address that risk, one of the things I did when I was living alone, is I made a particular point to spend time with my friends in person, to call family and friends every day, to talk to them on the phone, because I knew, knowing my own personality, that if I didn't do that, if I didn't make it a point to proactively build in that interaction time, that I could go days, sometimes, without seeing or talking to another person. Now if that's what you enjoy, and you need that solitude time, that might be one thing. But we can easily fall into that spiral of isolation if we're not careful about building in opportunities to connect with other people, particularly in person. Now here's a common thing people wonder about. How do I know if someone else is lonely, and what can I do about it? This is a really important question, because loneliness can look really different in different people. Sometimes it could look like people being quiet, and withdrawn, and looking sad, other times, loneliness can manifest as irritability and anger. And so it's hard to know, sometimes, from the outside, which is why it's so important to check on people, to not assume that just because they may be posting pictures with other people around them, or because they seem to have lots of folks around them at work, that they're not feeling a sense of disconnection from other people. You know, people have often also asked me about what to do in their relationships if their partner is feeling lonely. And I can relate to this because of my own life experience. There was a time when I was struggling with real loneliness, actually, after my first stint as Surgeon General. And it was my wife Alice who really recognized what was going on, and I'll in fact tell you how she helped me, because I think that that's a useful model for others. You know, one of the things she encouraged me to do, is, number one, just to talk about it, to talk about what I was going through and to think about what I needed, and just being able to talk to her about that sense of disconnection I was feeling was important, because the truth is, I felt a little bit of shame around it, and some of that shame was specific to my situation, because I had neglected a lot of my relationships and friendships in the prior few years, when I was in government, and I felt some hesitation to reach out to folks now, but being able to talk through that with her was really important. The second thing she did, which was great, is she really encouraged me to spend time with my friends and to reach out to them again. And that was great, because sometimes in a relationship you can feel selfish to be takin' more time out like that, but she gave me the permission to actually go and spend more time with my friends, even though there was a lot going on in the house, because she knew that that was gonna be an important part of how I rebuilt my sense of connection. And that was really invaluable. But the other thing that she did is she also encouraged me to engage in activities where I would meet new people, and build a stronger sense of community. And sometimes we did that together, you know, activities with friends or friends of friends. Sometimes it was things that I did alone. But in all those ways, she was incredibly helpful as a partner in giving me a chance to talk about this, in recognizing what was happening and proactively putting it on the table, without judgment, and with compassion, and in creating this space for me, to be able to reach out again, to old friends, and to spend time with family as well, like my parents and my sister. So these are just a few of the things that you can do to help others out, but make no mistake that when other people are struggling with loneliness, there's a lot that you can do, as a friend, as a family member, as a work colleague. Because the truth is, you don't need to have a mental health degree to be able to help folks who are struggling with loneliness, you just need a willingness to recognize that they may be struggling, a willingness to listen without judgment, and somebody who's willing to create space in your life so that they can help connect, in some cases, reconnect, with the people that they need. And I'll finally just say that even our interactions with strangers have an impact here. You know, when you're getting coffee, at the local coffee shop, the 10, 15 seconds of interaction you have with a barista, or with somebody who's in line next to you. The interaction you may have with somebody you're sitting next to on a plane, or on a train. These are interactions which might seem like they're not that important. But they actually are, because if you just take a moment, for example, to smile at the person who's next to you in line, or to ask the barista who's getting you your coffee how their day is going, or if you just choose to even say hello to somebody that you're standing next to in an elevator. That brief few moments of interaction can go a long way toward boosting your mood, and helping you feel, again, more connected to your community. So all these different types of social connection matter, in how connected we feel. And we shouldn't underestimate their power. And again, because we are so hardwired for connection, that even a little bit of connection, even if it's something we experience for a few seconds or a few minutes, can go a long way to helping stave off loneliness, and actually making us feel more connected, and like we belong. I've said that everyone feels lonely sometimes, and some people often ask me, "Well what do I do when I'm feeling lonely?" Now this is something I've had to think about, because loneliness is something that I have struggled with over the course of my life, starting from when I was a child. Loneliness was a key part of my elementary school experience, and I remember being scared to come to school many days, because I just didn't wanna feel like I was by myself and I was alone. Especially at lunchtime, which was, for me, one of the scariest times of the day, when I walked into that cafeteria, I wasn't sure who to sit next to. And, you know, at times as an adult, though, also, I have had bouts of loneliness as well. And so I've had to think about what to do. And so a few things that I hang onto, so one is, when I'm feeling lonely, I now have a few friends that I reach out to, just to say hi, just to let them know how I'm doing, and just to check in on them, and see how they're doing. These are friends who I've actually talked to about my challenges with loneliness over time, and an interesting thing that has happened to me is, as I've been open with them, I've realized that they too have struggled with loneliness, because keep in mind, this is incredibly common. Around half the people in our country have struggled with loneliness at some point. The other thing that I do, is I also schedule time, whenever I can, to do something fun with my friends down the line. Now why do I do this, because it turns out that having something fun on your calendar, that you're gonna do with your friends. It's not just good 'cause you're gonna do something fun, it's good because of the anticipation of it. In fact, I think that 90% of the benefit that I get from these kind of get togethers is in the anticipation of it, so putting something on your calendar where you know, "Okay, it's something that I can look forward to, "where I'm gonna do something with someone I care about," that can go a long way. And then the other thing that I do, is I often call my family, you know, my family is incredible, and I'm talking not just about my wife and my kids, but about my parents and my sister and my brother-in-law who have been just rocks for me. And a lot of times, even if I just have a minute or two here or there, I'll give them a call and just see how they're doing, and see what they're up to. It happened to me this morning, for example, I was walking to work, and I finished the work call that I was doing and I had about three or four minutes before I arrived at the building. And so I just called my mother, just to check on her and see how she was doing. It was a brief conversation, but I can tell you it just made me feel more connected to her, again. It's not about the quantity of time that we spend, it's really about the quality of time that we spend. And finally, one last thing that I keep in my back pocket also, is protecting time for solitude. Now this is gonna be a little counterintuitive, 'cause you might think "Hey, if you're feeling lonely, why do you need more time alone?" Well it turns out that solitude is different from loneliness, solitude is a state of welcome aloneness, it's a state where we actually get benefit, where we feel peace, where we feel a sense of calm and reconnection to ourself, and I've realized that sometimes when I'm feeling disconnected from other people, it's 'cause I'm out of sorts with myself, you know, I'm being pulled in a direction that's different from where I really wanna go, or I'm being sort of influenced too much, perhaps, by somebody else's standards of success, and I just need a moment to just reground myself. And so what I've got in my back pocket are a list of passages that I like to read, and inspiring speeches that I like to listen to, and music that helps me feel really connected, and inspired. And I'll turn to some of those, and sometimes it'll just be for a minute or two, sometimes it's for five or 10 minutes. But in those moments of solitude, I'll use that time, to just remember who I am, to feel good again, and to just reconnect with the things that I really love and care about. And sometimes that's all I need, in order to stave off that moment of loneliness that may have crept into my life. So, however we do it, we all need a toolbox of things that we can reach for that help us feel more connected, when we're feeling lonely, and we're all going to feel lonely from time to time, again, there's no shame in feeling that. But whether it's reaching out to a friend for a minute or two, whether it's scheduling something that you can do, with family or with friends down the line, or whether that's just spending a few minutes in solitude, listening to something that's inspiring, reading something that brings you comfort, and reconnecting with what matters to you, all of this can be helpful, and these are all tools I've reached for when it comes to addressing loneliness. Finally, people often wonder, once they recognize just how powerful loneliness is, how important it is, in our lives and in society. Sometimes people ask me, "What's the most important thing we can do, as individuals and as a society, to help address the loneliness epidemic?" Well, we've gotta do, certainly, more than one thing. But it starts with what we do in our day-to-day lives, with where we put our time, our attention, and our energy. And something as simple as keeping 15 minutes aside each day, to reach out to someone we love, can go a long way toward helping you build greater connection in your life. And when you are more connected, you are actually contributing to greater connection in other people's lives as well. Making sure, also, that we are paying attention to people when we're talking to them can also make a big difference, this is a really small thing. But simply put putting our phones and devices away when we're talking to a friend, whether it's in person or on the phone, putting our devices away when we're having dinner, or lunch, with our family or our friends, this can really elevate the quality of the conversation. And it's why I often feel that our attention has the power to stretch time. It can make five minutes feel like half an hour. Because if you've ever had the experience of being in conversation with someone where they were truly present, they were listening to every word that you were saying, and they were taking it in, and then sharing themselves openly, and with their presence, you know just how incredible that feels. And that's something that we need to do more in our conversations with one another. So these are small things we can do, but that go a long way to helping contribute to connection in our lives, and in the lives of other people. But finally, one last thing that we don't often think about, is finding moments to serve each other. This is, for me, one of the great lessons of studying loneliness, has been recognizing that service is one of the most powerful antidotes that we have to loneliness. And that might seem, again, counterintuitive, 'cause you might think, "Hey, if I'm struggling with loneliness, "don't other people need to help me?" And certainly it's the case that we need to be more comfortable asking for help, because again, a lotta people are struggling and there's no shame in feeling alone. But it's also true that when we help other people, that helps us feel connected to them in that moment, but it also reminds us that we have value to bring to the world. And as simple and as obvious as that may sound, when we experience loneliness for a long time, it actually erodes our sense of self worth. It chips away at our self-esteem. And so service is a powerful antidote to loneliness, and service doesn't have to always look like volunteering for an organization in your community. Service could look like helping a colleague at work who might be having a rough day. It can look like reaching out to a friend who you know is struggling, to check on them, and see how it's doing. It could mean reaching out to help a stranger, who drops their belongings on the street and is struggling to pull 'em all together, these are small moments, but again, one of the real lessons about loneliness is that it's in the small actions and small moments that we make big progress in feeling more connected to one another. Now I recognize we're having this conversation after several years of going through the COVID-19 pandemic, when so much about our lives changed, but in particular, about our work. So many more people are working remotely, or they're doing hybrid work. And a common question that I often get about this, is how to manage connection in a work environment where we may not be seeing each other all the time? Now this is really important, because we spend so much time at work, or with work, that whether we feel connected or not at work has a real impact, not only on our productivity and creativity in the workplace, but on how we feel just more generally about connection in our lives. So at a time where we may be working in hybrid environments, may not be seeing each other, all the time in person, it's important to think about proactive strategies that we can use to strengthen connection in the workplace. Now, that could look like making more proactive efforts to spend time one-on-one, or in small groups, with work colleagues, and we may have assumed in the past that that time just happened in between meetings, or we'd run into people in the hallway, or see them in the cafeteria. But if that's not the case, then making time to actually have lunch, with folks, whether that's in person, or whether that's even virtually, is important, so you have a time to actually just be with one another without having to talk about work all the time. The other thing that can help is for workplaces themselves, to structure opportunities for people to learn about one another. This is something that we actually do in our office, in the Office of the Surgeon General, where during our weekly meetings, we pick two people to interview one another, and it just takes about 10 or 15 minutes. But the interviewer will often ask their colleague questions about their life that often don't have to do with their current job, could be about where they grew up, about what it was like to grow up in their family, about what they dreamed of doing when they were young, about other careers or hobbies they may have had outside of work. It could be about any number of things, but it helps us to get to know somebody else in ways that may not have otherwise happened. And I can tell you, having done now many of these conversations, over the years, in the Office of the Surgeon General, that it's incredible to me how just 10 or 15 minutes, of watching and listening to those conversations, can make us all feel so much more connected to the person who's being interviewed. A couple other things just to keep in mind, is that I know it can often feel scary to reach out to people, and that can sometimes be even tougher to do in a virtual environment where we can't read people's body language as much. But there are two things that I learned from one of our prior House Calls guests, Marisa Franco, that I want to remind you of. One is called the Acceptance Prophecy. And this is the lesson that tells us, it's important to assume that people want to be friends with you. Because when you do that, it turns out you actually act warmer, and therefore make a better first impression. So don't expect rejection, because again, that can become a self-fulfilling prophecy. But there's another important lesson that Marisa taught us, which is about the Liking Gap, the Liking Gap. And that is about the fact that we all underestimate how much strangers like us when we first meet them. Even when we assume that we are unlikable, it turns out that people actually still like us more than we think. So the bottom line is, don't sell yourself short. You're more likable than you think, and if you go in expecting a warm response, you're much more likely to get it. I want to leave you with one last thought. Here's how I think about social connection. If I could tell you that there was a pill which could improve your health, reducing your chances of experiencing anxiety or depression, that could lower your risk of heart disease, of sudden death, of dementia, that could strengthen your immune system and even speed up your wound healing. That could do even more than that, increasing your productivity in the workplace, increases the chances that you do well in school. And if I told you that that was free and it was available to you whenever you wanted, what would you think? Well, it turns out that this pill is social connection, and it's a medicine that can help us heal in our lives, that can enhance our performance, that can enhance how we feel on a day to day basis. At a time where so many people are struggling with loneliness and isolation in our lives, with one in two Americans, in fact saying that they are struggling with loneliness, this is the time for us to rebuild social connection and community in our lives and in our country. Now, I do have one ask to build a broader movement, to live more connected lives, takes all of us. So think about one person that you can share this episode with and pass it along. It's going to take all of us working together hand in hand, to build a more connected world. Thanks for joining House Calls. Take care and take the time to connect. Take care and take time to connect.