Why Loneliness Is a Health Issue | Hidden Brain Confined to our homes, many of us are experiencing a newfound appreciation for our social relationships. What we may not realize — and what physicians and researchers have only recently started emphasizing — is the importance of these connections to our physical health. This week, we talk with former U.S. Surgeon General Vivek Murthy about why he considers loneliness a matter of public health, and how we can all deepen our social ties.
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A Social Prescription: Why Human Connection Is Crucial To Our Health

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A Social Prescription: Why Human Connection Is Crucial To Our Health

A Social Prescription: Why Human Connection Is Crucial To Our Health

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SHANKAR VEDANTAM, HOST:

From NPR, this is HIDDEN BRAIN. I'm Shankar Vedantam. Vivek Murthy was 7 years old when his mom woke him up one night long after he'd gone to sleep. She rushed him and his sister into their car.

VIVEK MURTHY: I remember piling back into the backseat, and my sister was sleepy sitting next to me.

VEDANTAM: Vivek's parents, who were immigrants from India, ran a medical practice in Miami. His dad was a physician. As they raced through the night in the car...

V MURTHY: My parents told me that their patient, Gordon, had just died after a long struggle with metastatic cancer. And we were driving to a trailer park in Miami where Gordon lived because my parents were worried that his widow, Ruth, would be grieving alone. And to this day, I will never forget, like, the image of my mother in her traditional sari standing on the steps of that trailer illuminated by the moonlight and embracing Gordon's wife, Ruth, as they both cried and cried. And in that moment, you know, it struck me that their lives were so different, Ruth's and my mother's, but in that moment, they were family; like, not the kind of family that's chosen for you but the kind that you choose for yourself.

VEDANTAM: Vivek is now a physician himself. He has experienced what it's like to be at the bedside of sick patients, to comfort the families of the dying. One lesson that has stayed with him is something he learned that night when he was 7.

V MURTHY: In the final moments when only the most meaningful strands of life remain, it's really our human connections that rise to the top. That's the clarity that we get at the end of life. But it was my parents who taught me from the earliest ages that we don't have to wait until the end of life in order to recognize and act on the power of connection.

VEDANTAM: This week on HIDDEN BRAIN - the importance of relationships, the hazards of loneliness and how we can all live more connected lives.

(SOUNDBITE OF MUSIC)

VEDANTAM: Many years after the night when Vivek Murthy watched his parents comfort the grieving widow of a patient who had died, he left Miami to pursue his own medical career. That journey took him to Boston and New Haven, Conn. In 2014, he moved to Washington, D.C., for a new role - surgeon general of the United States. Based on what he learned as surgeon general, he's written a book about a major public health problem that is often hidden from view. The book is titled "Together: The Healing Power Of Human Connection In A Sometimes Lonely World." Vivek Murthy, welcome to HIDDEN BRAIN.

V MURTHY: Thanks so much, Shankar. It's good to be with you.

VEDANTAM: When I think of the Office of the Surgeon General, Vivek, I think about famous reports that have come out of that office about smoking and health or dealing with the opioid crisis. Shortly after you became surgeon general, you went on a listening tour of the United States. And the stories you heard prompted you to think of an issue that has received much less attention. In Oklahoma City, for example, you write that you met a couple who had just lost a son to an opioid overdose. What did they tell you, Vivek?

V MURTHY: In Oklahoma, what I heard from the couple that was kind enough to speak to me after the death of their son due to an opiate overdose, they told me that their neighbors who had lived near them for years and years and years had always come by during difficult times. When they lost a job or got sick, they had brought over food, had stopped by just to sit with them and see how they were doing. But when their son died, nobody came over, and they were really surprised by this. Later, they realized that no one came because they thought that the parents may be embarrassed because their son died of a, quote-unquote, "shameful disease." And so at this time that these parents were dealing with an extraordinary amount of pain due to the loss of their son, they were also confronted with a deep loneliness because they didn't have their usual sources of love and support around them.

VEDANTAM: So something very similar happened in Flint, Mich., where people told you they were worried about the safety of their water supply. But besides the health and the environmental issues, they were also suffering from a problem that was fundamentally emotional. What was that, Vivek?

V MURTHY: Many of the people that I met in Flint at the height of the water crisis felt abandoned. They felt that there was nobody looking out for them. They felt abandoned by government. They felt abandoned by people around the country who they felt had perhaps turned their back on Flint and moved on after the new cycle had completed but even after the problem of lead contamination persisted in their communities. And so at a time of great need when many of these parents in Flint were feeling guilty about the fact that they had allowed their children to be poisoned even though it wasn't their fault, they found themselves battling that problem all by themselves.

VEDANTAM: You were also talking during this time with your fellow doctors and with nurses and other health care workers in Boston and Nashville. And many people were telling you about the burnout that health care workers often experience. But as you listen to their stories you also picked up an undercurrent of something else. What did you hear?

V MURTHY: What was so interesting to me about the experience of colleagues in medicine was that so many of us went through medical school and residency training as part of a group. The group were our classmates or the residents that we trained with in the hospital. But shortly after training, everyone scatters to the wind, and they end up feeling largely like they're working alone. And so I found that many of my colleagues were struggling with this sense of being isolated. And they didn't necessarily say that they were struggling with loneliness, but the words that they used, the phrases that they uttered so often, phrases like I feel like I'm dealing with all of these problems on my own, I feel like I'm interchangeable and that nobody recognizes me for who I am, I feel like we're invisible in the system, these all conveyed to me again and again and again that these doctors felt that it was just them working alone trying to take care of patients. And they felt frustrated by this. And I think it contributed to the burnout that many of them are experiencing.

VEDANTAM: So there's a connection here obviously between what you heard in Oklahoma City and what you heard in Flint and what you were hearing from your physician colleagues. There's a subtext that runs through all these conversations. Was there a moment when you sort of realized that there was a common theme that ran through all of these ideas that you said, you know, what we're dealing with here is actually really, really big?

V MURTHY: Well, Shankar, it was a gradual recognition for me that the common theme in so many of these stories was, in fact, loneliness. And, initially, when I heard these stories, I didn't put all the pieces together for the first couple of conversations or even the first five or 10. But at the end of each day when I was on the road, I would go back to my hotel room after a full day and nights' worth of meetings and I would just take a little time to reflect on what I had heard. And time and time again, what bubbled to the top where these conversations around isolation and people feeling all alone and feeling invisible. That experience of going on this listening tour and hearing the loneliness in conversations that I was having all across the country helped me realize that the experience of loneliness was far, far more common than I had realized.

(SOUNDBITE OF MUSIC)

VEDANTAM: A 2018 survey by the Kaiser Family Foundation found that 22 percent of adults in the United States struggle with chronic loneliness. That's more than the number who smoke or who have diabetes. People who struggle with such loneliness seem to have a greater risk of cardiovascular disease, dementia, fragmented sleep and depression. The list goes on. Lonelier people may even live shorter lives.

V MURTHY: Studies done by Julianne Holt-Lunstad from Brigham Young University have demonstrated that there is an association between loneliness and a shortening of the lifespan. And the amount of shortening or the mortality impact seems to be similar to smoking 15 cigarettes a day and even greater than the mortality impact that you see from obesity or sedentary living. You know, I think about this often because as surgeon general, I and my predecessors spent a significant amount of time in terms of speeches, reports and other kinds of campaigns addressing the issues of smoking and obesity and sedentary living, yet it had not occurred to me until I heard these stories from around the country and delved into the research that perhaps loneliness was an equally challenging issue that was a threat to our health that also needed to be addressed.

VEDANTAM: I was very moved by a personal story you told in the book about a family friend that you call Rajesh (ph). Paint a picture for me of how Rajesh came into your family's life and what happened to him.

V MURTHY: So Rajesh was a relative from India who came over a little bit later in life when he was perhaps in his 50s, early 50s. And he was also a very shy person. I remember him staying at our house for the first few months after he came. He and I would spend time walking around where we were having construction done renovating the house to add on a little bit more space. What was interesting about Rajesh, he was also - he was an engineer by training, so he was fascinated by the construction that was happening. And those walks that we would take around the construction site were when I would often hear him speak the most. He would tell me about the concrete that was being poured, about the trusses that were being put up, about the different types of construction that could be used to build a house. It was only years later when I realized just how lonely Rajesh was that I thought perhaps those conversations were one of the few that he was having with anyone.

VEDANTAM: Eventually, Rajesh found a job and a home. When Vivek was in high school, however, Rajesh lost his job. It was a terrible blow. It came at a time when he was sending money back to India to pay for his daughter's wedding.

V MURTHY: It hurt his pride, and he didn't want to tell people in India, the family back there, that he had lost his job. So he kept it a secret from them, didn't even tell us, actually, for a significant amount of time. But he continued to try to look for jobs. My father, when he found out, tried to help him find additional jobs as well but without much luck. You know, Rajesh was not only shy, but his English was not so easy to understand. And that made it challenging for people to communicate with him. And from a job interview perspective, it was quite a barrier to surmount.

VEDANTAM: In time, Rajesh came to see that barrier as insurmountable. A warning that this next part of the story involves a discussion of suicide.

V MURTHY: What happened one day as I was working at home on a Sunday with my sister - we were doing homework at the dining table. I was in high school at the time, and the phone rang. My parents were not home. They had gone to the temple on that particular Sunday. And I picked up the phone, and it was Sophia (ph) who was my uncle Rajesh's roommate. And Sophia said, we're knocking on the door, but he's not opening the door. Now, I figured he must just not have heard her because he was extremely hard of hearing. And when his hearing aids were out, you know, you could - you know, you could set off a bomb, and he wouldn't hear it. He was just incredibly hard of hearing, and so I was pretty sure that's what it was.

So I said, just bang really hard on the door. And if you need to, just go outside and bang on the window. I'm sure he's in there. So she did that, and she came back a few minutes later and said, he's still not answering. Then I started to get worried. So I said, well, if he's not answering, maybe you should call the police and have them come and break down the door. And she said, let me do that. And she hung up. And those next few minutes, which were maybe five or 10 minutes, felt like hours. I was so worried. I didn't know what was going on, and my sister and I were just huddled by the phone until it finally rang. And then we picked it up, and it was Sophia. And she said, we broke down the door, and we found him. He's dead, and he's hanging from the ceiling.

And that moment, it was like somebody had punched me in the gut. I had never experienced suicide in the family or among a close friend. I had no idea that this was even a possibility for Rajesh, that he was feeling as lonely and as sad as he must have been feeling. I was just paralyzed for a few minutes there, not sure what to say and not sure what to do.

We struggled for months, if not years, to make sense of that moment, of what had happened. It was only with time that I came to realize that Rajesh had been struggling with a well of sadness that was far deeper than many of us probably imagined. So we felt a lot of guilt, wondering did we miss a sign? Should we have been more supportive of him? I think back on those days as a child when I would walk around the construction site at home and have those conversations with him, and I now realize that perhaps those conversations meant more than I had thought. I feel grateful that I had the opportunity to have those exchanges with him because those are the few moments where I saw joy on his face and heard it in his voice as he talked about what he loved, which was architecture and construction.

(SOUNDBITE OF MUSIC)

VEDANTAM: I want to talk for a moment about the general connection between social isolation and loneliness and the phenomenon of suicide. The numbers are really staggering, Vivek. Forty-five thousand people commit suicide in the United States every year; worldwide, it's about 800,000 people. It's really astonishing that we don't pay more attention to the problem, not just in the United States but around the world.

V MURTHY: Well, it is. And suicide, sadly, although it's been improving in some countries around the world, has been worsening in others, including the United States. And I think part - there's so many reasons why I think we don't talk about or deal with suicide, as profound an issue as it is. I think it makes people uncomfortable, No. 1. And I think it also makes people feel helpless.

The roots of deep depression and suicide are complicated, and it's not always easy to understand where they come from. There are also lots of mixed feelings that people have about suicide, whether those are rooted in religious belief or in cultural norms. But the bottom line is, when it comes to suicide, when it comes to depression, that one of the greatest resources we have, one of the most powerful sources of healing that we have in our back pocket are relationships with others. Those relationships may not always feel available in the moments that we want them, but it stands out to me, despite being a doctor who has prescribed a number of medications over the years, that one of the most powerful medicines we have is love. And the vehicle through which that love is delivered are relationships.

And at a time where we are struggling with such high levels of suicide, at a time where we're seeing such high levels of depression and anxiety, particularly among young people, I think it's more important than ever that we rethink and harness the power of relationships and recognize that they are not just nice to haves but they are necessary to haves. They're an essential part of the foundation that makes us healthy, well and strong.

VEDANTAM: I'm wondering how, as a doctor and as former surgeon general, you see these issues playing out in the context of the coronavirus pandemic. We're all being told to practice social distancing. We are meeting few friends. We are hunkered down with family or, many of us, hunkered down by ourselves. Can you see this pandemic increasing social isolation worldwide?

V MURTHY: I think there's a real possibility that the physical distancing we're being asked to observe to tamp down this wave of COVID-19 infection could very well contribute to more loneliness. I think it could contribute to a social recession, if you will, marked by deepening levels of loneliness as we stay apart for longer and longer periods of time.

But I don't think it has to be that way. In fact, I think this is potentially an opportunity for us to rethink and recenter our lives around relationships, to recognize once again and perhaps even more deeply appreciate the role and power that relationships have in our lives, not just to our spouses and our family members and our close friends but also the relationships we share with colleagues at work, with classmates at school and even with strangers in our community. And I'm struck that in a moment like this, when we're all being asked to separate, that when I go for a walk around the circle in which I live and if I see somebody walking in the opposite direction, they wave furiously and smile as if they're just so hungry for human contact. And you know what? I wave back just as enthusiastically because I too am hungry for human contact. I feel a renewed appreciation for the strangers in my life, for the faces that I don't recognize but for the relationships that I now see are actually quite valuable.

So I think that if we approach this moment with intentionality, if we approach this time as - with a mindset that we are going to double down and focus on both the quality of our time with other people as well as the quantity of time that we dedicate to the people we love, then I think that we may be able to come out of this much stronger, in terms of our human connections with each other, than when we began. We may be able to use COVID-19 as a way to reset how we approach relationships and to revisit the place that relationships have in our lived priority list.

(SOUNDBITE OF SAMUEL MCAVOY AND BENJAMIN MCAVOY SONG, "BRIGHT SIDE")

VEDANTAM: When we come back - why loneliness often begets loneliness and how we can begin to break the cycle.

(SOUNDBITE OF SAMUEL MCAVOY AND BENJAMIN MCAVOY SONG, "BRIGHT SIDE")

VEDANTAM: This is HIDDEN BRAIN. I'm Shankar Vedantam. I'm speaking today with physician Vivek Murthy, the former surgeon general of the United States.

Vivek, researchers have offered many theories to understand loneliness. One of the most provocative has to do with our evolutionary history. What does this theory say about why being lonely hurts so much?

V MURTHY: Well, the evolutionary theory around loneliness tells us that we were designed to be social creatures that relied on each other for survival advantage. Thousands of years ago, when we were hunter-gatherers on the tundra, being together in trusted relationships increased the chances that we could pool our food and all have some food day to day as opposed to starving. It made it more likely that we could protect ourselves from predators because we could take turns taking watch at night, for example. It also helped us do things like share responsibility for child care and watch over other people's kids so that they could go out and hunt or gather fruit and vegetables.

When we were separated from each other, that placed us in a state of danger, and that danger resonated through our body in the form of a stress state that was marked by an outflow of stress hormones, which, in the short term, could be beneficial because they could focus your mind and ensure that you could react quickly if a predator was indeed behind you. But in the long term, that stress state can be harmful.

When you transport yourself back to the modern day, what you find is that - even though our circumstances have changed dramatically from those hunter-gatherer days - that our bodies are not so different, and the way our nervous system reacts to being separated from people, the way we react to feeling lonely is remarkably similar in terms of experiencing an elevated stress state. And again, in the short term, this can be beneficial. We can think of loneliness, in fact, as a natural signal, like hunger or thirst, that come about when we're missing something that we need for survival - in this case, social connection. And if we use that signal to then seek out meaningful human connection, the feeling of loneliness may subside. But if that feeling persists for a long period of time, if it becomes chronic, the stress that comes with it can ultimately lead to higher levels of inflammation in our body and increase our risk for chronic illnesses like heart disease.

VEDANTAM: One of the peculiar consequences of loneliness is not just that you feel miserable but that you feel shame at what feels like your own social ineptitude. I want to ask you about your own experience here, Vivek. When you were a kid, you got a pit in your stomach every day when your parents dropped you off at school. Why was that?

V MURTHY: Well, elementary school was a difficult time for me. It was a time of great loneliness. You know, as a child, I felt amazing at home. I had two parents who loved me dearly, and I knew it. I had a sister who loved me very much and took care of me. I felt wonderful at home. But school was an entirely different matter because as an extremely shy child, I had a hard time starting conversations with other kids and approaching them. And I wanted to spend time and build friendships, but they were just hard to come by. And so each day at school was, in fact, a lonely experience, and perhaps the most scary part of the day for me was lunchtime, when I would walk into the cafeteria worried that I would have no one to sit next to or that there would be no empty stools available by the tables.

So that was true for a number of years. I still remember during those years that I would just be waiting for the bell to ring at 3 o'clock so that I could rush back to the front of the school and find my mother waiting in her car and jump in and be taken back to the safety and security of home. So that remains, you know, even to this day as a very deeply seared memory. And even though I don't feel the same deep loneliness that I did back then in school, it reminds me of how painful loneliness can be and of how many people suffer in silence with feelings of loneliness, whether they're a child or an adult.

VEDANTAM: You say that you were very close to your parents, and your parents loved you, and you trusted them. Did you ever confide in them and tell them that you were lonely at school?

V MURTHY: You know, I never did tell my parents because I was ashamed. I worried that if I said that I was feeling lonely at school and having a hard time making friends that it would seem like I was socially deficient in some way or that I somehow wasn't likeable. And I was embarrassed. I didn't want to have that conversation with them. And it was hard enough to admit it to myself.

VEDANTAM: So there's a deep irony here, Vivek, and it goes beyond your personal story, which is that lonely people often have a really difficult time reaching out and asking other people for help and other people who would be glad to help and in fact want to help don't know how to reach out or don't even know that there's a problem. And so there's a real sort of sadness here, which is that you have a profound problem where you have people eager for a solution at both ends of the spectrum and yet it doesn't happen.

V MURTHY: That's exactly right, and this is one of the conundrums of loneliness, one of the paradoxes which leads people to spiral deeper and deeper into a well of loneliness as they withdraw further and further in shame because they're lonely and end up moving farther away from the human connections that they need. The irony is I think that also that there is often more help out there, more compassion and support that we may be able to get from others in our lives if we were open with them about what we were experiencing. But the shame around loneliness makes it hard to do that.

There's something else, though, that's going on in addition to this shame, which is that at a deeper biological level because loneliness is a state of threat in a state of stress, we find that there are a couple of phenomena that take place here that end up being counterproductive. One is that as our threat level rises, we tend to perceive people and even acts of outreach around us with greater suspicion than we otherwise might do. We also tend to shift our focus when we're a chronically lonely more toward ourselves and away from other people. And that makes sense from an evolutionary standpoint because when you're in a threat state, you want to focus on yourself to make sure that you're safe. That can also make it harder when you're interacting with other people to form a strong connection.

But perhaps most insidious of all when we struggle with chronic loneliness, it chips away at our self-esteem, and we start to believe that the reason that we're lonely is because we're not likeable or not lovable. And so in these ways, loneliness builds on itself, and that's why looking at it from the outside, one might wonder, well, if you're lonely, why don't you just go meet people? Why don't you just go to a party? Why don't you just reach out to friends and tell them that you want to connect? Well, it seems like the rational thing to do. But when you understand the mechanisms of loneliness and the shame associated with loneliness, it quickly becomes apparent that that downward spiral is not so easy to break.

VEDANTAM: In your conversations with people around the country, Vivek, you came to the conclusion that very often loneliness does not always manifest itself as loneliness, that it manifests as other things. It shows up in lots of other ways that actually have profound effects on our behavior and our health. Like what? What did you have in mind?

V MURTHY: I spoke to many family members of older men who had recently retired or experienced illness and who - it became clear that they were dealing with a decent amount of loneliness. But that was manifested as anger and irritability. With some people, loneliness shows up as a depressed mood; with others, it shows up as anxiety as they worry more and more about why it is that they're not connected with other people. And so we may walk away thinking, you know, this person struggles with anxiety or that one with depression or this person has anger issues or a mood disorder. And in some cases, that very well may be the fact, but it can often be the case that it is loneliness manifesting like in these different ways.

What I also realized is that many of the front-line issues that we read about in the papers today, issues that I worked on quite a bit during my time as surgeon general, including the opioid epidemic and addiction more broadly and the issue of violence, that these are also fed by loneliness. Loneliness may not be the entire cause of all these challenges, but loneliness contributes to the rise of addiction and violence. And it often is a consequence as well of these conditions.

Interestingly enough, if you look at the writings of the founder of Alcoholics Anonymous, one of the interesting things that he says is that loneliness is one of the origins of alcoholism. You know, he says that loneliness is the companion, if you will, of the alcoholic as he put it. And he says that as we think about how to address our challenges with alcohol addiction, we have to think about how we build community and connection into people's lives because that is an equally important part of the healing process as is the traditional medical care that they may receive.

VEDANTAM: When you became a doctor, you met a patient early on. His name was James, and he told you that the day he won the lottery was the worst day of his life. What did he mean by that, and what have you taken from his story, Vivek?

V MURTHY: This was one of the more striking conversations I had with patients over the years. And it happened very early on in my career when I was in primary care clinic, and James walked in. I was meeting him for the first time. I had reviewed his chart and found out that he had diabetes and high blood pressure. He was struggling with obesity as well. And one of the first things that he said to me was that he won the lottery, and it was one of the worst things that ever happened to him. And the surprise must've shown in my face because he said, oh, you want me to explain why. And I said, I would love for you to. I've never met somebody who won the lottery but also didn't expect that it would be the worst thing ever. What he said is that before he won the lottery, he used to work at a bakery. And he had colleagues in the bakery that he loved. He had customers who loved what he made. He didn't make a lot of money, and so he lived in a modest neighborhood in the Boston area, but he knew his neighbors, and he liked them. And so he had a modest life as he described it. But after he won the lottery, he figured, gosh, I've got everything that I need. I don't need to work anymore. So he quit his job. He sold his house, and he moved to an expensive neighborhood on the water in a gated community where everyone had big houses and large properties and big fences in between their properties. And he started to realize that having, quote-unquote, "made it," he now felt quite lonely. He didn't have those relationships that he realized had been so important to him, far more important than he had thought, with his customers and colleagues and neighbors.

And as he became lonelier, he became angrier as well. He found himself angry at his neighbors because they had big fences and didn't seem to care about him or anyone else. He found himself angry at old friends from the bakery who he felt weren't keeping in touch with him. He became angry, and he was alone. And it was shortly after that that he developed obesity and diabetes and high blood pressure, and that's what brought him in to see me.

And it was a powerful reminder for me of two things. One, it was a humbling reminder that all of the things that I had studied in medical school had not really prepared me for this moment because I had never really studied anything about loneliness or understood it to be a problem. You know, I'll tell you, Shankar, that was a hard moment for me also because I felt helpless. I didn't know what to offer him. It was - I felt utterly ill-equipped to address what was clearly the issue that was on his mind. I could tinker with his blood pressure medicines. I could adjust his insulin. And I did do those things, but I left with this feeling of dissatisfaction knowing that I was not equipped in that moment to provide him what he needed.

(SOUNDBITE OF MUSIC)

VEDANTAM: When we come back - how to decrease loneliness and increase social connection. You're listening to HIDDEN BRAIN. I'm Shankar Vedantam. This is NPR.

(SOUNDBITE OF MUSIC)

VEDANTAM: Former Surgeon General Vivek Murthy believes that social isolation and loneliness are major public health problems in the United States. We've looked at the scope of the problem and the signs of loneliness. Now we turn to solutions. Vivek, I'm wondering if you can tell me the story of a young woman, Serena Bian (ph). When she first got to college at the University of Pennsylvania, she was terribly lonely, and like you in elementary school, she felt like she was the only one with the problem. But when she got back home over the summer after her first year at school, she did a few things that really helped her. What did she do?

V MURTHY: Well, Serena, after her very lonely first year in college, came home, and she reengaged in some of the activities that had given her joy. She loved beekeeping, and so she started taking care of bees again. She joined a yoga group and not only enjoyed the physical practice of yoga and the relaxation that it brought her, but she bonded with the other people who had come together to take classes that summer. She also spent time with her parents and with good friends from high school that she had come to know over the years and who knew her authentically for who she was. And those experiences together were a reminder to her of who she could be and who she actually really was when she was joyful and happy and connected. That summer was like taking a cloth and wiping down this mirror that had become so frosted that she had lost sight of who she was, and now she could finally see that joyful, happy person that she and her family had always known her to be.

VEDANTAM: So you say that one of the things that Serena learned to do was to connect with herself. You just talked about some of the ways in which she learned to do that. Why is connecting with yourself important to being able to connect with others?

V MURTHY: Connection to self, it turns out, is the foundation that we need to connect to other people. When we're connected to ourselves, we understand that we have self-worth. We understand that we have value to bring to the world. And the truth is that many of us walk around not necessarily believing that or having moments of doubt where we're not sure that we're - if we're good enough. It's not surprising that that's the case because so much around us emphasizes that we aren't enough, that we're not thin enough or good looking enough or rich enough or funny enough or famous enough. But the truth is that that erosion of confidence in ourselves, of comfort with who we are, that can impair our ability to reach out to and connect to other people.

In Serena's case, one of the things that she had to do was to re-anchor herself and get comfortable with who she was at a time where her world was turned upside down after she went to college. And it turns out that there are really two components to connection to self, two components, if you will, to self-acceptance. And those are self-knowledge and self-compassion. For Serena, it was the chance to recapture solitude in a place of comfort that allowed her to reflect more deeply on her experiences. It was a chance to talk to people about her experiences who knew her and trusted her that helped her start to see that the tendency she had to want to have more time for herself, for example, these were not the signs of somebody who was socially deficient. These were the signs of somebody who tended to be introverted by nature, and that was just who she was. So as she gained knowledge of who she was and what she needed, she also realized that she needed to be compassionate and forgiving toward herself, that it wasn't enough to know what she needed and what her traits were, but she had to be able to accept herself for who she was.

VEDANTAM: I'm wondering, during a time like we're going through right now, where many of us are quarantining ourselves because of the coronavirus pandemic, do you think that these practices involving sort of deliberate solitude could be a tool to learn something about ourselves and learn how to stave off loneliness?

V MURTHY: I do think solitude is really important right now. You know, what's powerful about solitude is it gives us both the time to quieten the noise around us, but it also gives us the opportunity to reflect and to simply be. You know, there is a tension in our modern world between being and doing. We're built, as a culture, around action. If there's a problem, the way we address it is through action. What do we do? Who do we call? What action do we take? What plan do we execute? It's all about action. But one of the things that I have come to understand more deeply in the process of talking to people and researching this topic of loneliness is that being precedes action. And we all know this in our own lives. We know that when we spend time getting into the right frame of mind, then often we can be much more effective in the action that we take.

And so solitude is extraordinarily powerful because it allows us to focus again on being. And solitude can be experienced in different ways. Simply spending five minutes sitting outside and feeling the wind against your face or spending time just listening to the birds chirping or to the conversation around you or to the ambient noise and just experiencing your breath as it goes in or out, that experience of solitude, however it comes, can be extraordinarily powerful and calming. One of my favorite ways to experience solitude is through gratitude practice as well, to take five minutes to just remember three things that we're grateful for. It can be a very simple but powerful way to again reanchor us.

So in this time of great upheaval, I think it's more important than ever that we find time for that solitude. And the key here is that a little bit of time can go a long way. It's not about spending an hour in mindfulness practice. This is about spending a few high-quality minutes allowing ourselves to just be.

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VEDANTAM: There have been scholars who have pointed out that the term social distancing is actually a bad phrase because what you need to combat a pandemic is physical distancing, not social distancing. Can you talk a little bit about how you and your friends have created, you know, virtual circles for yourselves based on the ideas from a Japanese tradition?

V MURTHY: So I agree that the term social distancing is a misnomer. What we're seeking to do is to physically distance people, but what happens to our social connection is up to us. Whether it weakens as a result of reduced physical contact or whether we intentionally find ways to strengthen it is a decision that is in our hands to make.

A few years ago, two friends of mine, Sonny (ph) and Dave (ph), were at a retreat in Colorado Springs. And these are two dear friends of mine who I love seeing, but I don't get to see them nearly as often as I want. And as we were walking around the lake, we said, gosh, wouldn't it be great if we could see each other more often? We were all three at inflection points in our life. We were struggling with career decisions. We were all recently married and were trying to figure out how to balance life. And to some extent, we were also all struggling with loneliness and a lack of community. But at the end of that walk, we realized that unless we did something differently, that we simply just couldn't wish that more opportunities for meeting up would come about.

So we made a pact at the end of that walk. We said, once a month, we are going to videoconference for two hours. And during those two hours, we're going to be honest and open with each other about what we're going through. Sure, we're going to have fun. We're going to catch up, but we're also going to talk about the hard things that friends don't talk to each other about often enough. We're going to talk about our health, about our relationships, about our finances. And we also made a commitment that in between those calls, that if we needed support or we were confused about a big decision that we had to make or we were just feeling lost, that we'd reach out, that we would text each other. And if we needed to, we'd get on an ad hoc call and just, even if it was for five minutes, just talk to each other and hear each other's voices.

Over the next few months, those calls became my lifeline. They became the backbone, you know, of my journey from disconnection back to connection. Now, I had felt always deeply loved and connected to my wife Alice and to our two small children. But what I realized I was missing, even though I had these beautiful, intimate connections, you know, with my parents, my sister and Alice and the kids, is I was missing those relational connections and those collective connections. And that was a big part of what Sonny and Dave gave me.

And so we maintain that practice. We think of ourselves as a moai, which is an ancient Japanese tradition for bringing people together in the old times from a very, very early age where they would be connected and committed to each other, and they would see each other through difficult times, whatever came. And that's what Sonny and Dave have done for me, and I'm deeply grateful for it.

VEDANTAM: One of the ideas you talk about is how, if you want to feel more connected to others, the best thing to do might not be to ask why others are not reaching out to you but ask how you can be of service to others. And there certainly have been, you know, leaders like Martin Luther King Jr. and Mahatma Gandhi who've talked about this idea, that service in some ways can be an antidote to loneliness. Can you talk about this idea, Vivek?

V MURTHY: Absolutely. This was one of the most powerful lessons that I learned, which is that service is one of the most powerful solutions when it comes to loneliness. It is a natural and highly effective way of connecting with other people. And to understand that, you have to understand that the biology of loneliness makes us turn our focus inward. And it also leads to a general chipping away of our self-esteem over time as we come to believe that we're lonely because we're not likeable. But what service does which is so powerful is it shifts the focus from us to someone else in the context of a positive experience. And it also reaffirms for us that we have value to bring to the world and to somebody else's life. And that can be extraordinarily powerful in breaking that downward spiral of loneliness, which is so dangerous.

If we look around us, we'll find that there are many ways in which we can serve. Serving isn't always volunteering at a soup kitchen or volunteering to build homes with Habitat for Humanity, as powerful as those methods of serving are. But service can also be calling a friend who you know may be struggling to balance work and kids and could use a pick-me-up or could just use the knowledge that somebody is looking out for them. Service can be checking on a neighbor who might be elderly and struggling. Service can be helping a colleague at work who might be having a tough day, just bringing them a coffee or stopping to say, hey I want to know how you're doing and then actually pausing to listen to what they have to say.

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V MURTHY: You know, one of the greatest gifts that we can give another person is the gift of our full attention. And often when we think about serving, we think, what can I tell somebody to help them fix something? And what can I do to change a problem in their life? But we often forget that simply showing up and listening can be an extraordinarily powerful experience. If you've ever felt deeply listened to by somebody else, you know that that experience helps you feel seen and appreciated and understood. And that is a very, very powerful antidote to loneliness and to disconnection. So as we think about how to serve, I suspect that if we look around us that we'll find many opportunities to do so. And we'll recognize that all we need to bring to those opportunities to serve are an open mind, a full heart and a desire to truly honestly and openly connect with another human being.

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VEDANTAM: Vivek Murthy served as the 19th surgeon general of the United States. He's the author of the book "Together: The Healing Power Of Human Connection In A Sometimes Lonely World." Vivek, thank you for joining me today on HIDDEN BRAIN.

V MURTHY: Thank you so much, Shankar.

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VEDANTAM: This week's show was produced by Parth Shah and edited by Tara Boyle and Rhaina Cohen; technical support from Andy Huether. Our team includes Jenny Schmidt, Thomas Lu, Laura Kwerel, Cat Schuknecht and Lushik Wahba. If you want to hear more about the topic of loneliness, be sure to check out an earlier episode of HIDDEN BRAIN titled "The Lonely American Man." One challenge in producing our show from home is trying to replicate the sound of NPR's studios. This can be challenging because our guests are also often at home. Often the burden of creating a quiet recording space falls on their families. That's why this week's unsung hero is Vivek's sister, Dr. Rashmi Murthy. She facilitated our interview by keeping the Vivek's kids occupied while he chatted with me.

RASHMI MURTHY: Booboo (ph), come. We have to go. Come here. Come here. Come here.

UNIDENTIFIED CHILD: Why?

R MURTHY: Papa's recording. Even I can't be upstairs.

VEDANTAM: Thank you, Rashmi, for allowing us to turn your home into a temporary recording studio. We really appreciate it.

R MURTHY: Come. Let's do - let's do pee-pee and then I'll give you some ice cream. Come. Vivek, is the podcast over?

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VEDANTAM: For more HIDDEN BRAIN, you can follow us on Facebook and Twitter. If this episode spoke to you, please be sure to share it with a friend. I'm Shankar Vedantam, and this is NPR.

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