Tag Archives: #loneliness

Our New Surgeon General, Vivek Murthy Brings Us Together

Loneliness is like a cold hand resting on your heart. It can tighten your chest, and make you desperate with longing for company and support. I have certainly felt it on many an occasion: while new to a place, recovering from a loss, a death, a fractured friendship. You may have too. It can only be shaken off by the warm hand of a friend, a loved one, or sometimes, even a stranger.

Vivek Murthy’s book Together, The Healing Power of Human Connection in a Sometimes Lonely World was written before the COVID-19 pandemic and was published in April 2020. Many of its observations, however, have a heightened bearing in the pandemic. In an interview published in the LA Review of Books, Murthy defined it eloquently: “Loneliness exists in that gap between the social connection we need, and the social connection we feel is available to us.” In the book, he calls loneliness “the great masquerader” as it can appear in different forms such as “anger, alienation, sadness, and a host of distressing emotional states.”

Vivek Murthy comes across in this book as a gentle soul, deeply understanding of the feelings of loneliness from his own life experiences. This understanding, coupled with his medical training, scientific bent, intellectual curiosity, keen powers of observation, and obvious commitment to public health makes this a very readable, thought-provoking book.

His tone, sincerity, and story-telling skills reminded me of another physician and author, Abraham Verghese, whose book The Tennis Partner is a beautiful account of friendship, addiction, and loneliness.

Murthy starts by laying out the different types of loneliness identified by research: 

  • Intimate, or emotional, loneliness – the longing for a close confidante or intimate partner;
  • Relational, or social, loneliness – the yearning for quality friendships and social companionship and support;
  • Collective loneliness – the hunger for a network or community of people who share your sense of purpose and interests.

All three dimensions are needed for us to thrive; one may have fulfillment in one or two areas but still feel lonely.

Murthy makes the case for how loneliness has evolved, the scientific, neurological underpinnings. Throughout history and evolution over millions of years, humans have depended on community for survival. Together, humans were stronger and better able to withstand dangers, such as attacks by other groups. When one strayed or was separated from the group, one’s very life could be at risk. Hence, the importance of community is practically hardwired into us.

The science underlying loneliness, along with the implications to one’s health, is well researched by Murthy and presented with the requisite references. Dr. John Cacioppo, one of the founders of the field of social neuroscience, first likened loneliness to hunger and thirst, as an important warning signal with biochemical and genetic roots, calling it “a biological and social imperative rooted in thousands of years of human evolution.” The work of Dr. Julianne Holt-Lundstad, a health and social psychologist, showed that weak social connections can be a significant danger to our health.

There are fascinating accounts of research into brain activity during the times we are engaged with others. One of the most striking findings for me was to learn that the same part of the brain that responds to physical pain also responds to emotional pain. Connecting the dots, Murthy makes the connection clear: that people in emotional pain and despair often reach for a numbing drug or drink, as they might for physical pain. This is particularly insightful for the opioid epidemic, from which society is currently reeling.

Murthy’s relates several examples of how people’s lives have been affected by loneliness: children, young, middle-aged, and older adults, both men and women. His account of his own childhood, being bullied for looking and sounding different, will strike a chord with many who have struggled with fitting in and felt they didn’t belong. In a section of friendships among middle school girls, I paused to remember my own daughter’s deep sadness when a close friendship broke off. So many children go through this in middle school, a critical period in their social and emotional development. Support and love are essential to help them tide over such times, until they feel more secure in themselves.

Some of Murthy’s accounts of children subjected to toxic stress (from neglect and or abuse) were heartbreaking. He said studies that have shown, mercifully, that all it takes is one caring adult to prevent and reverse the effects. He gives the example of  Big Brothers and Big Sisters of America,  a non-profit which matches children with supportive adults in one-to-one mentoring relationships.

While the physiological underpinnings of loneliness are the same for all, circumstances may vary, and the effective countermeasure depends on individual inclinations, preferences, and reservations people may have. It’s no big secret or surprise that men are typically less inclined to openly share what is troubling them than are women. Their styles of communicating, and hence their preferred ways of seeking and finding comfort and support, are very different. For example, “Men’s sheds”, local non-profit organizations where men gather around a common activity, build trust, companionship, and community, is an initiative that was started in one locality in Australia and has spread to different parts of the world.

In the second section of the book, he speaks of the different ways we can connect with one another to preempt or assuage loneliness, and with that, be on the path to a healthier life and a healthier society. The circles of connection he describes track with the different types of loneliness; the friendship circles consist of:

  • an inner circle of close friends and confidants,
  • a middle circle of occasional companions, and
  • an outer circle of colleagues and acquaintances.

In a beautiful section on the importance of solitary reflection, Murthy encourages us to tune in to ourselves with an analogy to the heart pumping blood: while the heart pumps blood in systole, it is in diastole that the blood is supplied with oxygen. Hence, “pausing is what sustains the heart.” Art, music, reading, and being in nature are all experiences that can be enjoyed in solitude but make us feel connected with others. One shining example for me is that of Andrea Bocelli on Easter Sunday, singing “Amazing Grace” from the Duomo Cathedral in Italy at the height of the pandemic, bringing the whole world together as we all sat apart in fear and worry. I wrote of this and other ways we have been able to come together during the pandemic.

Murthy describes the three-way relationship between service, loneliness, and addiction. He quotes Rabindranath Tagore, India’s Nobel laureate poet, and from the scriptures of Hinduism, Christianity, Judaism, and Islam, all of which have service written into them. I was reminded of a prominent scientist in the bay area, the late Nagesh Mhatre, who would exhort people “If you are feeling down, find someone who is suffering more and help them. You will both feel better.” The very act of helping someone makes one feel more needed, less lonely, adds a feeling of self-worth.

There are several inspiring examples of individuals, a college freshman named Serena Bian, for one, who surmounted her feelings of loneliness and depression. Even with these inspiring anecdotes and observations, the second section doesn’t hold together as well as the first. There are newer problem statements: connecting kids in the digital age, seeking support from one’s community during parental crises. Parents struggle with childcare. When anything goes awry, a carefully constructed day can fall apart in minutes. While this book was written in pre-pandemic days, parents’ struggles have only become greater. Being responsible for months for children’s schooling from home has stretched many a family to breaking point. Those who must work outside the home have sometimes been forced to make a choice between work and caring for their children. Most of the time, the burden falls on women. The economics are sobering. There have been articles stating that in the workplace, the pandemic will set back women by decades.

While the last two chapters are filled with inspiring anecdotes, I am left wondering how all this can be formalized, how scalable the approaches are without a coordinated nationwide initiative. It requires effort, work, to build community, and it might take more energy than many have when they are burdened by their circumstances or depression.

In America, we live in a deeply individualistic society. Murthy seems optimistic of the ways in which we can build community even with everything that keeps us apart. I find myself less hopeful: since this book was published, we have had the most sobering, divisive period in American history since the struggle to end segregation. Building community seems harder now than ever. On the positive side, we have a new administration, of which Murthy is an important part, and perhaps there will be change for the better.

Towards the end of the book, Murthy’s states surprisingly that “as hard as we may work… the future will depend on our children. It’s up to all of us to teach them how to build a more connected and compassionate world.” Indeed it is, we must strive to be good parents. But are we to just kick the can down the road to our children? I was reminded of Greta Thunberg’s outrage at the 2019 UN climate summit when she exclaimed to the adults who had left things to her generation: “This is all wrong. I shouldn’t be up here. I should be back at school on the other side of the ocean. You come to us young people for hope. How dare you?”

This book presents an important concept that leads to a policy focus on child development. How about assuring social-emotional development at the national level, instead of relying on countless non-profit organizations to pick up where schools and society have dropped the ball? 

In Amanda Gorman’s powerful words, delivered at the inauguration of President Joe Biden.

“…our inaction and inertia will be the inheritance of the next generation.

Our blunders become their burdens.

But one thing is certain:

If we merge mercy with might, and might with right, then love becomes our

legacy and change, our children’s birthright.”

Vivek Murthy has used his pulpit to shine a light on a key contributor to our health and well-being. This book explicitly callout loneliness as a critical contributor to much of what ails us, our physical health as well as the health of our society. If the purpose of the book is to increase awareness and understanding, it has succeeded. If it is to show a clear path forward, it falls short. A diagnosis is the first step. A remedy must follow. In the UK, in 2018, an initiative to combat loneliness was started at the ministerial level. It is not clear what progress has been made. Perhaps the US needs to follow suit.

Dr. Murthy is in a position to chart out the role the government might play, now that he is starting his second stint as Surgeon General, this time in the Biden administration. With his deeply realized perspective on loneliness and health, perhaps we can expect to see more work on this front.

All the best, Dr. Murthy, and Godspeed.

Upcoming Silicon Valley Reads book events are shown here.


Raji Pillai lives in the SF Bay Area and writes at www.rajiwrites.com where this article was originally published. 

Sunset

Pause and Look Back: 2020 Wellness Themes

Sukham Blog – A monthly column focused on health and wellbeing.

As we draw the curtains on a tumultuous year and look forward to better times in 2021, we should pause to take stock.  Let’s reflect on the year we’ve endured; acknowledge and accept the tough, troubling, earthshaking times we’ve lived through – buffeted by the pandemic, and the economic, social, and familial hardships so many of us have endured.  Grieving for the loss of a loved one and for the forfeiture of a way of life, while living through a rising tide of social and racial injustice, intolerance, and hate. Let’s acknowledge these difficult times and accept them. Accept, acknowledge, then look forward.

Let us prepare ourselves for the better times ahead with a new sense of purpose. Determine to look after ourselves and those whom we love better than we did this year. Let’s not make another New Year’s Resolution that is sure to fall by the wayside in two weeks; instead, let’s make an implementable plan we can follow every day.

Each of you knows where you must look to develop your own personal, tailored wellbeing plan – one that addresses Body, Mind, and Spirit.  To get you started, I offer some learnings from the Sukham Blog articles I wrote for India Currents this year for your review and reflection.

Article: Mitigate Chronic Inflammation (Image by Hal Gatewood at Unsplash)

In Love Your Body: Mitigate Chronic Inflammation (February 2020), I described how inflammation is part of our immune system’s defensive mechanism, playing an essential role in healing and controlling infection. However, when this immune response is constantly and repeatedly triggered, this chronic inflammation can cause cumulative damage that could lead to diseases such as type-2 diabetes, heart disease, Alzheimer’s, cancer, and depression. I described what we should do to prevent chronic inflammation or mitigate its effects. Social isolation, psychological stress, disturbed sleep, chronic infections, physical inactivity, poor diet, obesity, and exposure to environmental toxins all contribute to increased chronic inflammation. Review this article, consult your doctor, and create your own 2021 roadmap to combat chronic inflammation and make lifestyle changes for a better tomorrow.

Article: Just Write, It’s Good For You

I discussed writing as therapy in Just Write, It’s Good for You! (July 2020). Research tells us that writing can improve physical wellbeing by boosting immune functioning as well as mood. Writing about your thoughts and feelings for just 15 to 30 minutes a day, three to four days a week can ease stress, grief, and loss. The benefits include better sleep, fewer symptoms of illness, and more happiness among both adults and children.

The following month, in Learning to Embrace Aloneness (August 2020), I described the difference between Loneliness and Aloneness. While loneliness is a manifestation of missing someone or something, aloneness is a state of mind where one takes advantage of being by themselves and uses the opportunity to draw strength, peace, and connectivity with oneself and with nature, to seek our own inner light. Take steps to explore your aloneness!

Article: Lonely In a Crowd (Image by Aziz Acharki at Unsplash)

Loneliness that is left unaddressed, on the other hand, can be harmful. It is an epidemic in our society, as discussed in my second February 2020 article: Lonely in a Crowd. We now understand that loneliness is an emotional state created when we have fewer social contacts and meaningful relationships than we’d like; when we feel no one knows and understands us.  We feel disconnected from people even though they are all around us.  Research shows that it is a risk factor for many illnesses.  Understanding this and learning to watch for signs of loneliness both in ourselves and in those around us should be part of our wellbeing action plan for the coming year, paying special attention to both the young and the elderly in our lives.

An increasing number of us are becoming caregivers for a family member or a friend, as I describe in my May 2020 article The Caregiver Crisis, becoming responsible for his or her physical, psychological, and social needs. While caring for a loved one can be an enriching and rewarding experience that brings out the best in us, long-term care demands sustained attention and is physically exhausting and emotionally draining for both the giver and receiver of care. This leads to increased stress and anxiety and affects relationships.  Understanding this, and planning ways to get respite and avoid burnout is an essential part of any wellbeing roadmap.

Article: Can I Find Happiness? (Image by Zac Durant at Unsplash)

Finally, an upbeat note to round out this brief survey. Earlier this month, in Can I Find Happiness? (December 2020), I talked about my own quest for this elusive state of being. While it is different for each of us, happiness is a combination of frequent positive emotions, plus the sense that your life is good. Each of us can develop that sense by seeking to build a life of meaning and purpose—to move beyond just surviving to flourishing. By building practices into our lives such as cultivating kindness, regular exercise, healthy eating, pursuing goals, discovering spiritual engagement, staying positive, and showing gratitude, we get improved life satisfaction and wellbeing, and learn that the happiness we seek is not out there – it is within ourselves, waiting to be found!

Notice how it’s all interconnected? 

I wish each of you peace, joy, good health, and success in developing and implementing your wellbeing roadmap. See you in 2021!


Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. He is also a columnist for India Currents. 

With sincere thanks to Dawid Zawila at Unsplash for the use of his beautiful photograph.

Lonely in a Crowd

An eight-year-old boy clutches his ball looking forlornly around the schoolyard at the other children playing, talking and calling out in small groups. People moving by a young woman walking along a busy sidewalk are unaware that she hasn’t spoken to anyone in four days. An elderly man watches passersby from a park bench. Since his wife’s death five years ago, he sorely misses a companion to share his daily ups and downs. 

Loneliness manifests in different forms making it an epidemic that impacts nearly half of all Americans, according to a recent article that quotes former U.S. Surgeon General Vivek Murthy as saying “during my years caring for patients, the most common pathology I saw was not heart disease or diabetes, it was loneliness.”  

“I totally agree,” says Dr. Neha Narula, a clinical assistant professor and primary-care physician at Stanford. “Research has shown us that it’s a risk factor for many diseases and has become a huge problem in the last 10 or 20 years.  Even though we are more technologically connected, the rates of loneliness have actually risen.”

Social science researchers define loneliness as the emotional state created when people have fewer social contacts and meaningful relationships than they would like — relationships that make them feel known and understood. “A lot of people think loneliness and social isolation are synonymous,” Dr. Narula says, “however, social isolation is physically not having people around you, whereas loneliness is a subjective feeling of being alone; of being disconnected from people even though they may be around you.  It’s very important to differentiate between the two and realize that it could be hard to recognize that your family and friends can also have these feelings of loneliness.” In short, if you feel lonely, you are lonely.

Dr. Narula frequently sees social isolation and loneliness in her practice. Urban centers like the Bay Area are melting pots that draw transplants from different parts of the world with different cultures, languages and lifestyles who come there for work, many bringing their families. They face many challenges adjusting to a new way of life, including loneliness. A few patients open up and willingly share their feelings; more often, she finds them either shy or nervous, with some unwilling even to acknowledge loneliness because of the huge stigma associated with it. Spouses and family members who do not work are especially susceptible because they lack even the social aspect of the workplace, and sometimes face additional barriers of transportation and language. Regardless of ethnic, social or cultural background, loneliness is more common in adults over 45; however, there’s a higher prevalence in seniors – those over 65. Studies show that nearly one-fifth of seniors live alone and over 40 percent report feeling lonely on a regular basis.  Family physicians increasingly observe it in adolescents and pre-teens as well, who tend to be very active on social media, but have difficulty forming real relationships.

“Evolutionarily we needed social connection to survive,” Dr. Narula points out, “over hundreds of thousands of years, we humans were able to survive as a species among much stronger animals due to the advantage of our brains and our ability to communicate and work as a collective species rather than as individuals. Fast forwarding to 2020, we need to remind ourselves of the importance of finding those people who will help us survive in terms of our health and life span.” 

An abundance of research shows that loneliness is a risk factor for many illnesses, just as smoking is for heart disease and lung cancer. In particular, a Harvard study that followed people for over seven decades established the inverse: one of the clearest indicators of physical health, quality of life and longevity is how happy people are in their relationships. 

Loneliness is an evolutionary phenomenon designed to make humans seek protection in a group for survival by triggering a physiological response: the release of stress hormones like cortisol. In small doses these hormones help solitary humans be more aware of surrounding dangers. However, repeated long-term occurrence results in damage to health leading to high blood pressure, increased inflammation, a weakened immune system, and consequently a reduced life span. Additionally, without the emotional support of family and friends, people who are lonely often stop exercising, overeat and tend towards substance abuse, further compounding impact on health. Research shows that the reduced life span linked to loneliness is similar to smoking 15 cigarettes a day. Poor social relationships were associated with a 29 percent increase in risk of coronary heart disease and a 32 percent rise in the risk of stroke. The impact of higher inflammation on the immune system is particularly severe on the elderly; immunity declines with age, and this serves to accelerate that decline. Isolation can be especially deadly for seniors in the event of an emergency like a bad fall or a heart attack. 

We should take action at individual, community and societal levels to acknowledge and normalize loneliness, and work to remove the stigma that makes it a taboo topic.  “We can be the medicine that each other need,” says Dr. Murthy. Let’s begin with an honest examination of our own condition. Next, let’s pay attention to family and friends, making sure that they feel like they are connected, are able to express their feelings of loneliness and where needed, help them find solutions. Shaping the circumstances and communities we live in can do much more than medicine can. Recognizing that it was a public health challenge, British Prime Minister Theresa May appointed a Minister for Loneliness to her cabinet in 2018 to implement a cross-government strategy to combat it. More societal and governmental action along these lines is needed.

We are an ingenious people. Let’s work together to develop creative solutions to help each other – especially the young and the elderly – develop and lead more connected, healthy and fulfilling lives. No one in our midst should be or feel alone.  

Sukham Blog – This is a monthly column focused on health and wellbeing.  

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. To find out more contact the author at sukhaminfo@gmail.com.  


With sincere thanks to Aziz Acharki at Unsplash for the use of his beautiful photograph.