Hidden Brain - Relationships 2.0: An Antidote to Loneliness

Episode Date: November 15, 2022

When you go to a medical appointment, your doctor may ask you several questions. Do you smoke? Have you been getting exercise? Are you sleeping? But rarely do they ask: are you lonely? U.S. Surgeon General Vivek Murthy believes we are suffering from an epidemic of loneliness. This week, we revisit our 2020 conversation with Murthy about the importance of human connection to our physical and mental health, and how we can all strengthen our social ties.A note that this week's episode includes a discussion of suicide. If you're experiencing suicidal crisis or emotional distress and are based in the U.S., you can reach the Suicide & Crisis Lifeline by calling 988. Did you catch last week's episode in this series, about the power of tiny interactions? You can find it here. And if you like our work, please consider a financial contribution to help us make many more episodes like this one. 

This is Hidden Brain. I'm Shankar Vedantam. Vivek Murthy was seven years old when his mom walked him up one night long after he'd gone to sleep. She rushed him and his sister into that car. I remember piling back into the back seat and my sister was sleepy sitting next to me. 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, my parents told me that their patient, Gordon, had just died after a long struggle with anesthetic 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 sorry, 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. 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 seven years old. 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. This week on Hidden Brain, we continue our relationships 2.0 series with a look at the hazards of loneliness and how we can all live more connected lives. 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, Connecticut. In 2014, he moved to Washington, D.C. for a new role, Surgeon General of the United States. Based on what he learned, he wrote 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 Muthi, welcome to Hidden Brain. Thanks so much, Shankar. It's good to be with you. When I think of the Office of Surgeon General Vivek, I think about famous reports that have come out of that office about smoking and health or or dealing with the opioid crisis. Shortly after you became Surgeon General, you went on a listening tour of the United States and and the stories you heard prompted you to think of an issue that has received much less attention. In Oklahoma City for example, you wrote that you

met a couple who had just lost a son to an opioid overdose. What did they tell you Vivek? 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 opioid 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 sons 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. So something very similar happened in Flint, Michigan 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?

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, along 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. You were also talking during this time with your fellow doctors and with nurses and other healthcare workers in Boston and Nashville and many people were telling you about the burnout that healthcare workers often experience. But as you listen to their stories, you also picked up an undercurrent of something else. What did you hear? Well, it was so interesting to me

about the experience of colleagues in medicine. Was it so many of us went through medical school and residency training as part of a group, and the group where 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, that they didn't necessarily say that they were struggling with loneliness.

But the words that they used, the phrases that they uttered so often, this phrase was 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 this system. These all convey to me again and again and again, that these doctors felt that they 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. 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, what we're dealing with here is actually really, really big? 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 conversations or even the first five or ten. 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 night's worth of meetings, and I would just take a little time to reflect on what I had heard. And time and time again, what bubble to the top were 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. of Lone Nose was far, far more common than I had realized.

A 2018 survey by the Kaiser Family Foundation found that 22% 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. Lonely people may even live shorter lives.

So studies done by Julianne Holt-Lensdead 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. I think about this often because as a 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 dealt into the research that perhaps loneliness was an equally challenging issue that was a threat to our health that also needed to be addressed.

I was very moved by a personal story you told in the book about a family friend that you call Rajesh, a picture of me of how Rajesh came into your family's life and what happened to him. Rajesh came into your family's life and what happened to him? 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 in a little more space. It was interesting about Rajesh. He was also 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 about the traces that were being put up about the different types of construction that could be used to build a house. And he was only years later when I realized just how lonely Rajesh was, that I thought, hmm, perhaps those conversations

were one of the few that he was having with anyone. 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. 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, 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.

In time, Rajesh came to see that barrier as insurmountable. A note that is next part of the story involves a discussion of suicide. What happened one day is 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 who was my uncle Rajesh's roommate. And Sophia said we're knocking on the door, but he's not opening the door. Sophia, who was my uncle Rajesh's roommate. Sophia said, we're knocking on the door, but he's not opening the door. I figured he must not have heard her because he was extremely hard of hearing. When his hearing aids were out, you could set off a bomb and he wouldn't hear it. He was just incredibly hard of hearing. I was pretty sure that's what it was.

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 ten 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 they 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. 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 Raju had been struggling with the well of sadness. It 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 is architecture and construction. I want to talk for a moment about the general connection between social isolation loneliness and the phenomenon of suicide. The numbers are really staggering Vivek 45,000 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. 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, number one. 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 on 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, our 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 when we are struggling with such high levels of suicide, at a time when 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 have, but they are necessary to have. They're an essential part of the foundation that makes us healthy, well and strong. The COVID-19 pandemic exacerbated the isolation that so many people were already experiencing. Vivek says COVID presented us with unique challenges and with opportunities to renew our relationships with other people. 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. 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 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 live priority list. When we come back, while loneliness often begets loneliness and how we can begin to break the cycle. You're listening to Hidden Brain, I'm Shankar Vedanta.

This is Hidden Brain, I'm Shankar Vedanta. I'm speaking today with physician Vivek Murthy, the 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? Well, the evolutionary theory around loneliness tells us that we were designed to be social creatures that relied on each other for a survival advantage. Thousands of years ago, when we were hunter-gatherers on the tundra, being together interested

relationships increased the chances that we could pull 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 childcare 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 places 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 day 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. 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 pet in your stomach every day when your parents dropped you off at school.

Why was that? 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 they 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 three 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 that how many people suffer in silence with feelings of loneliness, whether they're a child or an adult. 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? 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. 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. 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's often more help out there, more compassionate 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 that's going on in addition to the shame, which is that at a deeper

biological level, because loneliness is a state of threat, and a state of stress, we find that there are a couple of phenomena in the 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 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 likable 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 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 they're 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. In your conversations with people around the country with Aik, 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? 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 manifest 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 frontline issues, 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. If you 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. He says that loneliness is the companion, if you will, of the alcoholics 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. 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? 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. It 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 have shown in my face because he said, oh, you want me to explain why? And I said, I would love for you to have one 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, you know, 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. 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, a negated 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 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. 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, and I felt utterly ill-equipped to address what was clearly the issue that was on his mind.

I could tinker with his by-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. When we come back, how to decrease loneliness and increase social connection? You're listening to Hidden Brain, I'm Shankar Vedanta. This is Hidden Brain, I'm Shankar Vedanta. US 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 Biann, 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 home over the summer after her first year at school, she did a few things that really helped her. What did she do?

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 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 the joyful, happy person that she and her family had always known her to be. 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? 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, but we're not sure that 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 sure that 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 other people.

In Serena's case, one of the things that she had to do was to re-encore 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 to herself,

for example, these were not the signs of somebody who was socially deficient. These are 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. It's a counterintuitive idea to learn how to stay off loneliness, we sometimes may want to practice deliberate solitude, to spend time really understanding and accepting who we are. 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. There's attention 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? What 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 proceeds 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 and just remember three things that we're grateful for can be a very simple but powerful way to again re-engross. 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 allow ourselves to just be. This idea that a little bit can go a long way is often overlooked when we think about self-care and connection with others.

But even small moments of connection can make a difference. I ask Vivek to tell me about a virtual circle that he and his friends have created that's based on ideas from a Japanese tradition. A few years ago, two friends of mine, Sunny and Dave, 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 we're trying to figure out how to balance life. And to some extent we were also all struggling with loneliness and lack of community.

But at the end of that walk we realized 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 a video conference 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. That 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 that if we needed to, we'd get on an ad hoc call, and just, even if it was for five minutes, to 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 what Sunny and Dave gave me. And so we maintain that practice.

We think of ourselves as a MOI, 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 Sunny and Dave have done for me and I'm deeply grateful for it. 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 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 of a wake? 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 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 likable. 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 has 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. And 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? 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. Vivek Muthi is the surgeon general of the United States. He is 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 Break. Thank you so much, Hanker. If you're struggling with isolation and are in crisis, there are people who can help. If

you're in the United States, you can call or text the Suicide and Crisis Lifeline at 988. Hidden Brain is produced by Hidden Brain Media. Our audio production team includes Brigid McCarthy, Annie Murphy-Paul, Christian Wong, Laura Correll, Ryan Katz, Autumn Barnes, and Andrew Chadwick. Tara Boyle is our executive producer. I'm Hidden Brain's executive editor. For today's unsung hero, we turn the mic over to you, our listeners. This segment is brought to you by OnStar. OnStar advisors are now with you everywhere, on the app, in your car, and at home. OnStar.

Be safe out there. Our story comes from Washington Post columnist Carolyn Hacks. When she was 34, Carolyn was living on her own and having a hard time. It was when my mom died of ALS and anybody who knows anything about that knows it's awful. It's just awful watching somebody with their, while their mind stays perfectly clear. And so I was just struggling. But I was still working, actually, through the whole thing, I didn't miss even a week of work. But I was, I think, I probably lost about 20 pounds and was just, I must have looked haunted or something.

But a colleague who wasn't normally in my group of friends who I didn't work with directly, just started checking in on me, just stopping by to say hi. And then every once in a while, just shooting me an email. And sometimes it was chatty stuff. And sometimes it was, hey, how you doing? And it was purely overtures of friendship. There was no angling for professional advantage.

There was no romantic interest. It was just a remarkable act of grace, I think. It was just this person who had an idea of what your normal was and was able to detect that things weren't normal. And that maybe the world needed to be a little bit kinder to you in that moment. Actually, I'm choking up talking about it because it is so...

It is such a profound thing that we can do for each other. I probably didn't put together completely that this person was there to look out for me until after I got better, after I got stronger. And then this person just sort of retreated back into the original place in my life. And remains there. And that was the signal that I got,

that this was sort of the world taking care of itself. And it is a special thing. Carolyn writes a popular advice column for the Washington Post. It appears in more than 200 newspapers. When she hears from readers who are struggling like she was, she offers them this bit of advice. Be sure to notice that there are people in your life

who want to help. I also do think in general our hardest times are what make us the most compassionate. And sometimes the hardest times can also make us the most compassionate. And sometimes the hardest times can also make us bitter, and they can make us angry. But I think having kind people come forward to help you through something difficult will help turn that pain into compassion later. Carolyn Hacks.

She lives near Cape Card, Massachusetts. This segment was brought to you by OnStar. OnStar believes everyone has the right to feel safe everywhere. That's why their emergency advisors are now available to help, not only in the car, but wherever you are, on your phone, in your car, and at home. On-star, be safe out there. If you like this episode and would like us to produce more shows like this, please consider supporting our work. Go to support.hiddenbrain.org. I'm Shankar Vedantam. See you soon. you