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Changes: Dr. Vivek Murthy

The audio version of this episode is available here.

Annie [00:00:05] Hello and welcome to Changes, I am Annie MacManus and in today's episode we are delving into a topic which is at the very heart of the human experience... Loneliness. In July, I wrote an article for The Guardian about my own experiences of loneliness that happened last winter. It's an emotion that all of us have felt at some point, yet its impact on our wellbeing is often hugely underestimated, and I wanted to devote an episode of changes to de-stigmatizing loneliness and learning about ways that we can combat it. And to do that today I've invited an incredible guest, the leading spokesman on public health in the U.S., the 21st Surgeon General of the United States of America, Dr. Vivek Murthy. Nominated as the nation's doctor by Barack Obama and now Joe Biden, Dr. Vivek is responsible for advancing the health and well-being of all Americans and defining and addressing critical public health issues. His bestselling book, Together: The Healing Power of Human Connection in a Sometimes Lonely World, came out in 2020. And earlier this year, in his role as surgeon general, he released a groundbreaking advisory on the loneliness epidemic in America. Dr. Vivek, it's an honour to have you with us on Changes, welcome. 

Dr. Vivek [00:01:18] Well, thank you so much Annie. 

Annie [00:01:19] So first of all, I think some people might be wondering, why am I speaking to a doctor when it comes to loneliness? You know, what is it that loneliness has to do with our physical health? Would you mind answering that question to start? 

Dr. Vivek [00:01:31] Yeah, and it's a fair question to ask because I think for most people, loneliness is a bad feeling but not necessarily something that has implications for your health. And the truth is Annie, that's what I thought for many years too. Even like, when I was in medical school we never learned about loneliness as a health issue. When I was in residency training, it wasn't part of our curricula. But interestingly, I found Annie that everywhere that I went, whether it was seeing patients on my own or when I later became surgeon general, travelling around the country and talking to people around the United States, I found that so many people were struggling with loneliness. And so I dug into it and tried to understand what the science told us about how common this was and about what implications it may have, and that's what really surprised me. I found that not only was loneliness extraordinarily common, but I also found that it had serious consequences for our mental health and our physical health. It turns out that when people struggle with being disconnected, with feeling lonely or being isolated, that increases their risk of depression, anxiety and suicide. It also increases their risk of physical illness. Like so you have a 29% increase in the risk of heart disease, a 31% increase in the risk of stroke, a 50% increase in their risk of dementia among older people and an increase in their risk of premature death. So you put all of this together and these are some pretty surprising effects of loneliness. I often tell people perhaps one of the most striking ones to me, as somebody who works in an office that's focussed for generations on critical public health issues, was recognising that being socially disconnected has a mortality impact on us, a life shortening impact if you will, that's comparable to smoking daily, and it's even greater than obesity. And so that is why I actually have come to believe that addressing loneliness is a public health issue as important as tobacco or obesity. 

Annie [00:03:34] What are the statistics and how bad is it with regards to loneliness and the population of America? 

Dr. Vivek [00:03:40] Well *clears throat* you know, depending on the study you look at there's some variation. But we saw during the height of the pandemic ,1 in 2 adults in America were struggling with a sense of loneliness, and the numbers though were even higher among young people. Now, this is often striking and surprising to people who think, hey, young people, they're really connected by social media, by other forms of technology, why are they lonely? And it comes down to, I think, a really central point. Whether or not we feel lonely is about the quality of our connections, not about the quantity of our connections. And one of the things that has happened in the last 20 years with the advent of social media in particular, is it started shifting more of our relationships from offline, in person, to online behind a screen. But it also created more of a focus on the quantity of connections we had. And over time, you know, we evolved from social media being a place where- that reminded you that it's somebody's birthday so that you went and connected with them offline to celebrate their birthday together, or you called them up on the phone, to now being in a place where, like on a given birthday, I feel like people are just going through their contacts and writing HBD on their feed *Annie laughs*. Like literally we've even shortened Happy Birthday down to three letters. And yeah it's a very different quality of connection. You are much better off having 2 or 3 people who you know well, who know you well, who you can show up for in a crisis, who can show up for you during emergency, people with whom you can truly be yourself, than you are having 300 people who may be connected to you on social media, whose pictures you may see from time to time but aren't necessarily people who you would count as close friends. 

Annie [00:05:23] For anyone listening who thinks they might be suffering from loneliness or they might have, or they might know someone in their lives who is, how would you identify it? And I suppose in your experience of talking to people, do you find that people identify it easily or do they find it hard to get to that word specifically? 

Dr. Vivek [00:05:41] Well, that is a fascinating question because I find that, and I'm saying this from personal experience as somebody who's struggled a lot with loneliness in my own life as a kid and then later on as an adult, that loneliness can be- I think of it as a great masquerader. It can look like different things. I mean, with some people it can look like withdrawal and sadness, and other people it can look like anger. In others, it can manifest as irritability. And in some people it can look like being aloof. One of the things that happens to us is that the lonelier we get, the more we come to believe that it's because of something we did wrong or something we're missing, that we're lonely because we're not likeable or we're not lovable. And you would think that the reaction to that would be to reach out more to other people, but when you steadily have your self-esteem chipped away at, it makes it harder to reach out to others. And we actually enter into this state of hyper vigilance where we become more and more sensitive to signals around us potentially being threats. And so even a well-intentioned offer to have lunch together, we may look at with suspicion. You put this together and you- this can come across as someone who's distant or disinterested in social interaction or aloof, but in reality they may be struggling with a sense of loneliness. So it is a great masquerader but what I've also found is that when you name it, when you ask people 'are you feeling lonely?', so many times people just automatically sense the answer inside, and the answer is yes. 

Annie [00:07:13] Yeah. 

Dr. Vivek [00:07:13] And you know what? I've now talked to probably thousands of people, not just in the United States but in other parts of the world, who have struggled with loneliness and it is extraordinary how when you name it, they say, it took me until that moment to realise that so much of what I was feeling in the preceding months and years were actually manifestations of my loneliness. I just didn't know it. I thought that I needed to just get that promotion at work and I'd feel better. Or I just thought I needed people around me to be more kind and compassionate and then I'd feel better. Or I thought I just needed to get my life together, you know, and I would feel better. But it turned out that the problem was hidden under a different stone. It had to do with the quality of connections that they had or the strength of their relationships in their life. So that's one of the reasons that I've been talking more about loneliness, is I do think that there's great power to naming this, to speaking openly about it, and to recognise that if we are struggling with loneliness, we are not the only ones. This is a common struggle in modern times. 

Annie [00:08:14] So when I wrote this article, I wrote it this year but it was about a period of time last year where I felt lots of different things and it took a while, a few months to to really put that word on it. And when I put out this public article, I could not get over, Vivek, the amount of people who commented on it saying they also felt the same. And it struck me when I was learning about you and your story, something that I'd heard you say with regards to your experiences of school and childhood, where you suffered loneliness as a child and then you spoke to your pupils later on in life. Would you mind talking me through that, please? 

Dr. Vivek [00:08:52] Sure. You know, well as a kid I was pretty shy and I was very introverted. And so it wasn't the easiest thing in the world to make friends but I wanted to. But it was hard. And I also- I could feel how different my background was, you know, from other kids as well. My parents are, you know, from India. And my background, you know, influenced a lot of the foods that we ate at home and the traditions we had. And, you know, on top of being shy and introverted, feeling very different from other kids, made it really quite challenging. And a lot of times growing up, you know, I, I used to fake having a stomach-ache in the mornings when I was in elementary school so- to try, so my mom wouldn't make me go to school. And it wasn't because I was, you know, scared of tests or teachers, I just didn't want to walk into the cafeteria one more time and not have anyone to sit next to, or worry on the playground that I'd be like left out. And so that feeling still feels very visceral to this day, I think when we have these deep experiences as children they stay with us. But the thing that was striking to me in retrospect, Annie, about all of that, is even though I knew that my parents loved me unconditionally, I never told them about these experiences because I was ashamed. And that sense of shame that accompanies our loneliness is what keeps us from sharing that experience. It's what help- makes so many of us who are struggling with this, feel like we're the only ones. Even though all around us people are struggling. And that's what I came to realise, actually years later is when I talked to my classmates from elementary school and told them about what I was experiencing, they looked at me and they'd said 'oh, you too?'. They turned out were- it turns out they were also experiencing loneliness but none of us talked about it. We thought we were the only ones and that is a profound irony in that, our sense that we are the only ones struggling with loneliness makes us even more lonely. 

[00:10:40] *Short musical interlude*

Annie [00:10:50] What would you say is the biggest change you went through in your childhood? 

Dr. Vivek [00:10:54] There is one, you know, experience in particular that, you know, I think about- it was when I was in high school when I had a, an uncle who had actually moved to the United States from India and is married, he had kids in India but he made this sort of midlife change because he wanted to live the American dream. He wanted to come here and build, build a life for himself and ultimately bring his family over. But it was really hard for him. And to make a long story short, after some very difficult couple of years of trying to make it and really struggling, I got a call one day when I was in high school working at the dining table, doing my homework on a Sunday morning, and it was his roommate saying that he wasn't coming out of his room. And, you know, he was very hard of hearing and so I figured his hearing aids weren't in. So I told her, just go bang really loudly on the door, which he did but then he still didn't come out. And then I got worried, so I asked her to call the police to break down the door. And she did and that's when we found out that he had taken his own life. And it was the first time as a high school student, as just a first time in my life where I was confronted with suicide. And I didn't quite know how to process it or what to do about it. But what I do remember in the days ahead was the profound sense of uncertainty and shame that just descended on my family as we started to ask ourselves, was this our fault? Did we miss something? Should we have seen something? Should we have been there more for him? But then in my extended family, I remember people didn't want to talk about it because they thought that it would create a bad name for our family, that other people would look at us as if something was wrong with us, or even that we have like a genetic predisposition to mental illness in our family. These were all of the sources of shame that came with this terrible incident that happened in our family. So that was a first time in my life that I remember sensing just how much deep shame we have around this particular kind of pain that human beings experience, the pain of mental illness. And it stuck with me ever since then, it's informed, you know, how I approach patients, the work I do as Surgeon General. As much as it's important for us to do work on the policy and technical side of making treatment accessible, addressing root causes of mental illness, it serves as a reminder to me that unless we're able to think about each other without the sort of shame and blame and look at each other as human beings and recognise that all of us from time to time will suffer, will hurt, will experience pain, that it's very hard to get through these very difficult moments in life. And that was one such moment when my uncle passed away. 

Annie [00:13:43] Does something like that make loneliness more acute? Can it be a trigger for loneliness? 

Dr. Vivek [00:13:47] Well, suffering in silence is a recipe for loneliness. And that's what happens, I think, to so many families who might have a family member who's struggling either with mental illness or with addiction or with- or who's gone through abuse and feels ashamed to talk about it. Whenever we suffer, but have to suffer in silence, it doubles our pain. But when we're able to reach out and connect with other people, that helps to dilute our pain because it reminds us that we're not alone, that there's somebody who can have our back, that we don't have to carry the entire burden of that pain by ourselves. Human connection is a natural buffer for stress, but when we are alone and isolated every day, average levels of adversity can start to feel utterly overwhelming. And I think that is why so many people today, they feel really overwhelmed and they look at their lives and they're like, hey, shouldn't I be able to manage this? It seems like I'm just working 9 to 5 like everyone else is, I don't have too many huge major issues in my life, like why? Why does it seem like it's so hard? And the reason is because when you are lonely, then again even average levels of adversity, even normal life, can feel overwhelming at times. And we have so little buffer. You know, the time where I really came to feel this up close, Annie, was actually after my first stint as Surgeon General and when I became a civilian again. And that transition happened very abruptly for me, I didn't have the work community that I had, you know, for a few years, but I had also neglected my friends and my family during the time that I served as Surgeon General, which was my mistake. It was perhaps my greatest mistake during my time in government. 

Annie [00:15:32] So this is when you were working with Obama, the first time? Yeah.

Dr. Vivek [00:15:35] That's right. From 2014 to 2017. And the result of that is when that time ended, I felt profoundly alone. It's ironic that even though I understand loneliness, and I was understanding it even at those earlier stages, I didn't fully recognise what was happening to me... That that's what was going on. You know, that I was like, oh, you know, I just need to find something else to engage myself in then I'll feel better. Or I just need to unwind and decompress a little bit from the burnout I've experienced over the last few years and then I'll feel better. You know, these are all the things I told myself. I just need a litte time. I just need to find some direction. I need some professional pursuits to fill in the gap. And it was actually my wife, Alice, who pulled me aside one day and said, I think you've become very lonely and isolated. Like you don't really have a community you're interacting with. And it kind of hit me like a ton of bricks when she said that, because she was right. She's absolutely right. And I realised that even like the day to day things of responding to emails felt overwhelming. Like I was like, ahh I just don't even have the energy to do this. But then I was like berating myself. I was like, gosh, why can't I even just do the basic stuff like respond to emails or return phone calls? Like, why am I feeling like so drained as a result of this? When she said that, it finally made sense to me. I was like, oh yeah, I'm running on fumes. Because those --- relationships were, they were like my fuel. When we are struggling without a sense of connection to other people, then we often lack the basic energy and wherewithal to go about our day to day life and it can feel overwhelming.  

Annie [00:17:11] Yeah. Have you learned about different types of loneliness in your travels and your experiences? Is there different definitive types of loneliness that we can experience? 

Dr. Vivek [00:17:20] There are many actually different ways to slice and dice loneliness, but I'll give you sort of one simple way to think about loneliness in terms of three categories of relationships that we need to not feel lonely in our life. The first category are what I think of as intimate connections. These are, you know, our spouse, our best friends, the people with whom we can totally be ourselves. The second type of relationships are relational connections. So these are our friends, the people we get together with on weekends, we go to their birthday parties, they come over for dinners to our house, we may on vacations with them, go to sporting events or concerts with them. 

Annie [00:17:57] So the friends that you kind of call family, like the friends that you choose as- 

Dr. Vivek [00:18:01] The friends that you choose, yeah.

Annie [00:18:02] Family type thing. Close friends. 

Dr. Vivek [00:18:02] Who you spend time with, you know, maybe a few times a week or a few times a year. 

Annie [00:18:07] Yeah. 

Dr. Vivek [00:18:08] And then the third category, or what I think of as collective connections, so these are our communities. Our faith communities, our volunteer communities, our work communities. And it turns out that we need all three types of connection in our life. Like we need those intimate connections where we can truly have somebody who, you know, shows up for us all the time and vice versa. We need the friends we get together with, but we also need to feel like we're part of a community. That's where we're all connected by something greater than any one of us, whether that's a shared interest, a passion, our faith, our work. And the reason this is really important to understand is, imagine that you're married to someone who is experiencing loneliness. If you don't recognise that there are three categories of relationships that we all need, you might think, gosh, if they're lonely that's got to be a reflection on our marriage. That means that I'm not enough. Something is wrong in this situation. Whereas that may not at all be the case. And I'll give you again, to go back to my own example, when I was struggling with loneliness after my first stint as Surgeon General, I was in a perfectly happy marriage, I was blessed to have this incredible partner, Alice, in my life. That was not the problem. The problem is that I was missing my relational connections and my collective connections. I had lost touch with friends and so I didn't have friends I was getting together with and I wasn't part of a community, I didn't feel like I was, you know, community where we shared interests or had a shared mission, like I didn't have that in my life. So this is one way that you can think about loneliness and as we think about how to build out the connections we want in our life, we can ask ourselves, do we have what we need in each of those three buckets? 

[00:19:49] *Short musical interlude*

Annie [00:19:58] I'm really interested in this idea of feeling part of something bigger than oneself. I've come across it again and again, and I suppose we see it in practice all the time when you go to a football game or a soccer game, you know, any big sporting events, that sense of being a part of something massive. Faith also, music concerts, you know, those things that make you feel like you belong and they make you feel small in a good way, you know, because you're just one part of a big thing. What is that about the human species that needs that? 

Dr. Vivek [00:20:30] Yeah, it's such a good question. You know, whether it's, you know, built in our genes or how we evolved, you know, it could be up for debate but I will say over thousands of years, we have evolved to be a part of something bigger and to be interdependent. Like, if you think about it, when we were hunters and gatherers thousands of years ago, it was the people who came together, who built trusted relationships, who were part of that broader collective, they were actually the ones who survived because they could take turns watching around the fire at night to make sure predators didn't attack. They could pool their food so that they all had a little bit of food each day as opposed to starving, you know, because they ran out of food. They could take turns helping each other with child care and caring for each other's families. These are the things that helped us to survive. Today, in the modern world, like we're so often told that you've got to be independent and independent means you shouldn't need anyone, shouldn't have to depend on another human being. You should be able to figure it out all in your own. The person who did that thousands of years ago when we were hunters and gatherers, they died. They got eaten by a predator *Annie laughs*. They starved because they didn't have enough food. That's just not how we have evolved. We actually evolved to teach us that, to really go far and to really sustain ourselves, we need to go together. We need to recognise our interdependence. One last thing I'll say just about this sense of this power of just being together, is that I think there's something almost at a deeper spiritual level that calls us to want to be a part of something that's bigger than ourselves. And it's the part of us that I think when we go out into nature, feels awe. When we're looking at (Annie: *Whispers* yes!) these incredible landscapes of mountains or rivers or the ocean, when we're just feeling like the energy of the trees, you know, and just breathing in their fresh air. Like, there is something very powerful, you know, about that moment. And the thing about the examples you raised as well, if you've ever been in a football stadium where tens of thousands of voices were chanting in unison, if you ever been in a church or in a synagogue or in a temple where voices were chanting in unison as part of prayer, you felt swept up in that. And the power and the energy kind of rise within you. There is something powerful, and I think at this, really at a spiritual level, in those collective moments. And when I say spiritual, by the way, I'm not talking about religious. I'm talking about a deeper sense of awe and meaning and purpose that we all crave as human beings. And it's one of the reasons why I think we have to broaden a bit of how we think about health, as not just our physical health, as not just our mental health, but we also have to think about spiritual health in that context as well. Again, not as, you know, am I part of a religion per se, but do I have a pathway to experiencing meaning and purpose and a sense of awe. Like whatever it is that brings you into unison and harmony in the way that we're talking about, that's an important part of our health and well-being as well. And it's deeply restorative, which is why I actually think that music is such a powerful force in healing and there are few places that I have found to be as powerful and moving and as renewing and energising as concerts, where you're together with other people, enjoying the deep, profound inspiration of music. 

Annie [00:23:51] I couldn't agree more. I just joined a choir! 

Dr. Vivek [00:23:54] Oh, that's beautiful. 

Annie [00:23:56] And it's been amazing. It's all those things you speak of. It's like this sense of collective communion. And then there's the actual physical act of singing, which is so healing. And then there's also reading the sheet music and having to concentrate on that means it's quite meditative because you cannot think of anything else, so no matter how stressed you are going into it, you come away and your head is empty and you feel spiritually fulfilled. 

Dr. Vivek [00:24:22] That's right. 

Annie [00:24:22] It's really simple and quite remarkable, actually, how much it does for me. 

Dr. Vivek [00:24:28] That's really powerful. Choirs in particular, you know, have been found to be a really powerful sense of connection and community. And I think it has to do in part with the power of music and also in part with the fact that when we are creating something together with other people, that is just such a deeply fulfilling experience. 

[00:24:48] *Short musical interlude*

Annie [00:24:58] You mentioned earlier about social media connections, internet connections, the sense of being connected online and I think a lot of us sometimes mistake, me as well, this sense of being connected online with real connection. Is it enough, would you say, to have lots of friends online, to be talking to people on WhatsApp all day? And when I say talking, I mean typing. 

Dr. Vivek [00:25:18] *Laughs* well, what I'd say is that some online connections can be very helpful supplements to in-person connection, but they're not whole substitutes for in-person connection. We all need some in-person connection in our lives. And it's because, look, over thousands of years, we evolved to process not just the content to somebody's speech, but their facial expressions, their body language, the sound of their voice, the expression in their eyes. All of that matters and not- in us understanding and feeling connected to someone. And you get that best in in-person interaction, and you can supplement that from time to time by having chat groups, you know, with friends where you keep each other up to date on what's happening and maybe share funny stories or share, you know, moments of pain, but you need to hear each other's voice. You need to be able to see each other from time to time as well. So, again, this is a place where I think technology can be a great compliment, but we should never get technology confused with being a substitute for in-person human connection. It is not that. With that said, having in-person connection in your life doesn't have to mean many hours each day of, you know, a deep conversation with somebody face to face. It can be just a few minutes of in-person interaction where we're stopping by, let's say a coworker's cubicle at the end of the day just to see how they're doing and to check in on them, or we're swinging by a friend's place or stopping by a neighbour's house just to say hi for 5 or 10 minutes. It could be even shorter than that. But the point is that we are so hardwired for human connection. We are such magnets for it that when we have even just a little bit in our life of high quality connection, it can make all the difference in the world. When I was a first year medical student, one of my classmates, her father got very ill and needed to have surgery. And as budding doctors, we were all trying to figure out what kind of doctor we wanted to be and so we would ask her a lot about her father's experience in the hospital and we wanted to know who is his favourite doctor. She said it was actually the surgeon who was her favourite. And we said, wow, how is that? We thought surgeons were really busy and they didn't spend a lot of time with their patients outside the operating room. She's like, no, that's true, he only saw him for five minutes at like 5:00 in the morning, but it was what he did during those five minutes. They really counted. He didn't stand at the door. He came inside. He sat next to her father on on the bed. He held his hand while he talked to him. He looked into his eyes. When her father spoke, the surgeon actually paused to really listen to what he was saying and actually answered his questions. And the compassion and kindness and presence with which that surgeon showed up, made that five minutes feel like a half hour. And it was the most meaningful five minutes of her father's day. 

Annie [00:28:17] *Compassionately* Mmmm. 

Dr. Vivek [00:28:17] And that just illustrates the power of our attention, right, we're all trying to figure out how to add that 25th hour to the day. Well, if you want to stretch time, the secret to stretching time is your attention. When you give something more focus, you actually make yourself and the other people feel like you're spending more time with them. So if you have the option of having a half hour call with a friend where you're on your phone doing other things, you're distracted, versus having a 5 or 10 minute conversation with your friend where you're fully focussed, have the 5 or 10 minute conversation and it will actually feel better to you and to them. 

Annie [00:28:58] Let's touch now on some different ways to address loneliness for those who are listening who feel a bit overwhelmed or lost or don't know what to do. So you're mentioning those really high quality interactions don't have to be long. What else can we do on a daily, those small steps can we take to combat a feeling of loneliness? 

Dr. Vivek [00:29:19] So here, here's a few small things I'd recommend. So one we just chatted about, which is when you are engaging with other people, give them the benefit of your full attention. So put your devices away during that time. Focus on them even if the amount of time you have is less than you otherwise would. The second thing I would say, it could just be five minutes a day that you spend reaching out to somebody in your life to tell them, hey, I'm thinking about you. Just wanted to check on you, wanted to know how you're doing. That five minutes is good for you and it's good for them, right? So often we reach out to each other when there's something to do. Hey, I have a question for you. I need to figure this out. When are we coordinating this event together? But sometimes just reaching out to people because we care about them, we're thinking about them, can be one of the most unexpected blessings that we can give someone else. The third thing that we can do is we can pick up the phone when other people call. These days, we don't pick up the phone that often. We let things- people text us or we text them back, etc. 

Annie [00:30:17] Mmmm. 

Dr. Vivek [00:30:17] Or sometimes if we're about to, let's say, going to a busy meeting, we might silence the call and just text them back and be like, hey, I'm tied up right now but I'll try to catch you later. I'll tell you this though, I've realised by trying this out in my own life that when you pick up the phone, and just, even if it's just to say 'hey, I'm about to walk into a meeting, I'm about to have this call with Annie, I can't talk right now but can I bring you back later?', it takes actually the same amount of time or less than taking the time to text back.

Annie [00:30:44] To type the words?

Dr. Vivek [00:30:45] Yes, but it feels so different-

Annie [00:30:47] So true, so true. 

Dr. Vivek [00:30:48] Because they have heard your voice. You've heard their voice. You- they know that you're excited to talk to them. It just makes a world of difference as opposed to texting. And again, keeping- think of it as that, in that evolutionary way that we- because we evolve to take in all of these inputs, the sound of your voice, the pauses, the nuance, what's unsaid is addition to the content of your voice, whenever we get more of that it makes that interaction much more rich. And a corollary to that would be to leave voicemails for people when you can't reach them. There's a great power, again, to short bits of human interaction like that. The last thing I'd share, just as a simple step, is just to look for ways to serve other people, to help one another. I'm talking about small acts of service. Somebody may drop their groceries in the grocery store. We may lean, you know, step over just to help them gather their goods. It could be that we see a co-worker who's having a hard time in the middle of a meeting, and we may just stand back for a- stay back for like a minute or so after the meeting, just to check in on them and say, hey, are you okay? Is there anything I can do to help? These are all small acts of service, and service turns out to be one of the most powerful antidotes to loneliness. Because when we serve somebody else, we not only forge a meaningful connection for them in that moment, whether it's for a minute or for years, but we also remind ourselves that we have great value to bring to the world. And that's one of the things we lose when we feel lonely for a long period of time. We start to feel the way I felt when I was a kid, that I'm lonely because I'm not likeable, something's wrong with me, and it chips away at your self-esteem. So service shortcuts the downward spiral of loneliness. So these sort of simple steps, they can make a world of difference in how connected we feel. 

Annie [00:32:38] You're doing amazing work at the moment on a tour called the We Are Made to Connect tour. You're going around and visiting students all over the country. I wanted to end this conversation with you kind of running us through an exercise that you're doing on that tour with the students. Is there something that you're doing with them that we could then invite our listeners to try and have a go at at home, in order to feel better about their relationships and their social connections in the world? 

Dr. Vivek [00:33:05] Well, absolutely. You know, this college campus tour that we've been doing on loneliness and social connection has been incredibly eye opening and fulfilling. We call it our We Are Made to Connect tour. But one of the exercises that we do with them is, take 60s and think about somebody that they're grateful for. Could be a friend who helped them out the day before. Could be a family member who showed up for them a few years ago during a time of crisis. Could be a teacher who gave them an invaluable life lesson, even though they didn't realise how important it was going to be for them. And then we asked them to take out their phone and compose a text or an email to them in that moment, and to spend that moment writing. It could be a single line or a couple of lines just telling them, hey, I was thinking about you today. I remember what you did for me all that time ago. It meant a lot. Thank you for being in my life. Could be just that simple. And then we ask them to send it. And then a beautiful visual thing that we do is we then, we dim the lights in the auditorium, and we have them turn the flashlights on on their phone and hold that up. And it is such a beautiful scene when you see all of these rays of lights popping up and you realise that each one of those beams of light is going to be received by somebody else. It represents a message that was sent in that moment, and that person is going to open up their email or their text messages and they're going to feel good, feel more connected, even though it was unexpected and perhaps especially because it was. And that serves just as a reminder, not just to those students but to anyone listening here, of the power of what we can do in 60s. That a simple act of gratitude and expressing that gratitude can make us feel so much better, but can also help the people around us feel better. 

Annie [00:34:53] Vivek, last question. For those listening who feel lonely and who are sure that they feel lonely after listening to this, is there a parting message at all? 

Dr. Vivek [00:35:05] Well, in many ways we have become the product of our environment and our circumstances, which have changed dramatically and rapidly around us and fundamentally shifted the nature of our relationships. And that's affected all of us. And so if you are feeling alone, you are not the only one. And it also does not mean that you are broken in some way. Loneliness is part of the human experience. We are all going to go through times in our life where we struggle with loneliness, but if we can talk about that more openly, if we can help one another and support one another, we can build the connections that we truly want. And look, I know that we're living in a world that's constantly demanding more and more of us. There are all of these benchmarks that keep getting pushed forward that make us feel like we're constantly reaching and struggling, striving, but never being enough. But I think it's- this is a moment for us to recognise that investing in our social health, building relationships with one another is just as important as any one of those other pursuits. And so if you're thinking to yourself, gosh, can I really afford the luxury of spending more time or taking that trip to go see my family or investing in more social time, going out with my friends? Can I really afford that? I would tell you that we are living in the consequences of not making those investments, and those have taught us that we can't afford not to invest in the people in our lives. As that old African saying goes, 'if you want to go fast, go alone. But if you want to go far, then go together'. So that's what we're called to do now, build a movement to rebuild social connection in our lives, in our communities and in our world. And if we do that, we build truly people centred lives and we'll be able to have what I want for my kids and for all of our kids and for all of us, which is to lead lives that won't be perfect. They won't be free of adversity but they can be fulfilling. Or we'll know that there are people who have our backs or we'll know that we're not alone, and that, it turns out, matters a great deal. 

Annie [00:37:10] It's such a beautiful way to end this episode. I really appreciate your time, I know you're such a busy man and on behalf of the listeners to Changes, thank you so much. 

Dr. Vivek [00:37:20] Thank you, Annie, and I so appreciate you giving voice to this important issue and helping build more connection in the world. 

Annie [00:37:30] Wow. Vivek Murthy is really something. I can't thank him enough. I felt very zen after that chat and I also made a vow to never, ever, not pick up a phone when someone rings again. Even if it's for 20s to say, 'I'll call you back'. 'Thanks for calling, I'll call you back'. So simple, but those little exchanges can mean so much. If you're up for it, I'd like us to try and do something to do a bit of homework for next week. Why don't we do what Vivek suggested with regards to him being on tour and being with all those students. Why don't we think of one person that we haven't heard from or messaged in a while, someone who we really are thankful for, and why don't we message them and just convey that? Why don't we do that and then we'll discuss it next week? I think we owe it to Vivek for his absolute wisdom and generosity today to try and go and do that one little exercise. Thank you so much for listening. If you know anyone affected by loneliness, if you feel like this conversation has resonated with you, I really hope that it's been helpful for you. And do spread this conversation around, let everyone hear it who you think could benefit from it. And in the episode notes, I'm going to put a list of charities that are really helpful for people who are suffering from loneliness. And also, I'll put a link to the article that I wrote about my own experiences of loneliness last year, and some links to Vivek's books as well. So lots to look at, lots to do. But first things first, who are you thankful for? Text them! Message them! Voice note them! Hey, even call them! Let them know. I'll see you next week.