Shoshana's Summer Playlist (2/5): What happens to your brain without any social contact? with Dr. Vivek Murthy

0:02Hi, it's Shoshana and welcome to my summer playlist. This summer we're spending time with an idea that I keep coming back to in health. The mind and body are always in conversation. And sometimes that conversation is quiet. Sometimes we notice it right away in our stress, our sleep, our digestion, our attention, or the way that loneliness can settle into the body. So I pulled five talks from the TED Health Archive that helped me think about that connection a little differently. You'll hear from Alexandra Crosswell on deep rest. Dr. Vivek Murthy on loneliness. Dr. Zika Manuel on quality of life.

0:40Megan Rossi on the gut-brain connection. And Dr. Sasha Hamdani on attention. These are conversations that I really loved having and ones that I found myself thinking about long after they ended. And I hope they stay with you too. This is TED Health, a podcast from TED, and I'm your host, Dr. Shoshana Ungerleider. I've been thinking a lot lately about how easy it is to go through an entire day without a real conversation. You know the kind I mean, not just a quick text or a passing like, hey, how are you? I mean an actual moment of connection where someone really sees you. We're recording this episode in January, and I see this trend happen more and more in the wintertime.

1:25Many of us are spending more time indoors as the weather gets colder. And sometimes the holiday season can leave us with amplified feelings of loneliness for those who are far from family or going through a difficult time. If that's you, know that you're not alone. Because according to experts, it turns out many of us are missing this kind of deeper connection a lot more than we'd like to admit. And from a health perspective, social isolation really, really isn't good for us. In this week's episode, I'm excited to bring you a conversation with Dr. Vivek Murthy, the 19th and 21st Surgeon General of the United States.

2:02Dr. Murthy is a physician and public health leader. He's also been sounding the alarm about what he calls the loneliness epidemic in the U.S. for years now. He sees social isolation as a public health crisis that can be just as deadly as heavy tobacco use. And we're going to talk about how we got here. Dr. Murthy and I are going to talk about social media and how our digital lives are reshaping our relationships offline. We'll also explore some small and practical tips we can all take to rebuild connection and strengthen our well-being this new year, starting today. Then after the interview, stick around for a TED-Ed lesson on what happens to your brain without any social contact.

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5:13Dr. Murthy, thank you so much for being here with us on TED Health. Thanks so much for inviting me, Shoshana. So today we are digging into a topic that I know that you know well, social connection and loneliness. We use the word lonely pretty casually now, but from a public health standpoint, what What does loneliness actually mean? And how is it different from simply being alone? Most of us have felt lonely at some point in our lives. Maybe that's when we moved away to college. Maybe it's when we moved to a new job and left old colleagues behind. Remember, maybe it's when we were kids and we moved because of our parents' job and had to just start all over in a new town.

5:54When you think about going beyond that, then we can get into definitions, which is that loneliness itself is a subjective term. It describes the experience of feeling, like the connections I need in life are more than the connections that I actually have. And in that gap, I experience loneliness. But it is distinct from the objective term isolation, which is more a descriptor of the number of people you have around you. And the reason this is important is because it turns out that you can be not isolated at all. You can be surrounded by hundreds or thousands of other people, the way college students are on campuses.

6:26but you can feel very lonely if you don't feel connected to those other people. If you don't feel you can be yourself or don't feel like there's anybody you can reach out to in a crisis. And this turns out is the common experience that people have in the world today. We're surrounded by lots of folks, but often it's the lack of comfort in our connection, the lack of feeling like we can be ourselves, be open, be vulnerable that leads many of us to feel lonely in a crowd. Yeah, I think that framing really helps to ground us. And you've called loneliness an epidemic for people who might hear that and think, how does something emotional turn into a public health issue?

7:03What does the science actually show about its impact on the body, like our heart and our brain and even the immune system? When I was going through medical school, I remember it was a time where we were so much focused on physical health, but there was this growing recognition that, hey, our mind influences our body as well. And now fast forward a number of years and we see that understanding has only grown. And we see now just often very clearly ourselves as clinicians in the hospital that how a patient feels, how they're doing, are they anxious, are they depressed, are they optimistic, sick?

7:36Are they feeling worried? That actually has an impact often on their physical health. We can see that in the form of your heart rate, right? When you get anxious, sometimes your heart rate goes up. Sometimes your blood pressure goes up. So we know there's a connection between body and mind. The challenge with states like loneliness is that they're chronic stress states and stress while in the short term may be beneficial, motivating you to act or to think more sharply or to focus. When you have long-term stress, that can actually start to become detrimental to the body, lead to increased levels of inflammation in our body.

8:09It's why we see actually that people who struggle with a chronic sense of social disconnection, that they actually appear to have a higher risk of poor physical and mental health outcomes. So we see not only a doubling in the risk of depression, increased risk of anxiety and suicide, but we also see a marked increase in their risk of cardiovascular disease and stroke, around 30%, for example. You see a 50 % increase in the risk of dementia among older people and an overall mortality impact associated with social disconnection that's comparable to what we see with obesity and with smoking. And so I say that plainly, but that was quite revelatory to me when I saw this data years ago.

8:51And it helped me understand, especially as somebody who was serving as surgeon general at the time and who was part of an office whose tradition was to work on issues like smoking and obesity, it helped me understand that social disconnection is as important a public health issue and one that we need to pay more attention to. I am certainly heartened by the fact that we're now making these connections, sharing this critically important data. It really certainly hits home for me. Vivek, can you share a story either from your time as Surgeon General or maybe from your own life that changed the way that you think about social connection and health?

9:28Yeah. The stories I encountered on the road during my first term as Surgeon General that made me pay attention to this issue, I didn't actually come into office thinking loneliness was a public health issue or that it was a crisis in any way, shape, or form. I knew that it wasn't a good feeling. I had experienced a lot of loneliness as a kid who struggled in elementary school in particular with making friends because I was very shy and very introverted. I had seen loneliness in my patients as a doctor, even though I never learned about it in medical school. There it was in the stories of the patients that I was admitting to the hospital and seeing in clinic.

10:02But despite all of that, I kept thinking somehow that maybe that was just peculiar to my own experience. But then I began my first term as Surgeon General with a listening tour and started encountering people all across the country who were telling me about loneliness. They, by the way, never used that term. Rarely do they come up to me and say, hi, I'm Shoshana Vivek, I'm lonely. But instead, they would say things like, I feel like I'm carrying all these burdens in life by myself. It'd be really nice if there's somebody to share this with or to lean on. College students would tell me, I'm surrounded by lots of other students, but I don't feel like I can really be myself.

10:36Nobody really knows me. So I feel like I'm just on my own. And I would hear these heartbreaking stories from people of all ages, parents, grandparents, young people who would say, I feel like if I just disappear tomorrow, nobody would even notice. I feel invisible. And to me, these all spoke of a similar thread of loneliness. But then I saw it many times in my life as an adult as well. I remember in particular, the time where I was going through my confirmation process, my first time serving as Surgeon General and ended up being a very difficult, challenging confirmation process because it caught in this swarm of politics around statements that I had made around gun violence.

11:14I had said gun violence was a public health issue for the nation. And I saw that as a truism, not as a controversial statement, but in the political world we live in, it turned out that was a political statement to some people. And I remember those many months of trying to figure this out. I was very new to this whole world of DC and government. I'd never worked in government before. I'd never dealt with the Senate, much less that kind of politics. And I just remember feeling like I had failed my family and my friends because I had run into this problem. The thing about loneliness is it doesn't always make sense to someone on the outside.

11:48But in that time of crisis, I found myself withdrawing more and more. At exactly the time, what I needed to do was actually to reach out more and to lean on other people. So I remember those days were very dark. And thank goodness for my wife, Alice, and for my mother and father, my sister, who really came together around me and lifted me up during some extraordinarily hard, hard moments, and to friends who rallied around me. And you would think that I would have learned my lesson at that point and said, hey, okay, you're in a crisis, you're feeling bad, reach out to other people. But what I've realized since then is that wisdom is not something that we always retain.

12:28It's something we have to be reminded of. And at other points in my life, especially after my first term finished as Surgeon General, once again, in this pit of loneliness and feeling like I had just lost my work community, I had lost my friend community in part because I had failed to stay in touch with people during my first term and consistently had put work ahead of staying in touch with the people I loved, which was a mistake in retrospect. But I had to deal with the consequences of that. And I was up in Boston for something work-related, and I saw an old friend there who I hadn't seen in years.

12:59And I just sort of confessed to her how I was feeling, like pretty lonely and isolated. And she just said to me, your problem is not that you don't have friends. Your problem is you're not experiencing friendship. You have people in your life who would be there for you if you reached out to them. If you swallowed the misgivings or worry or anxiety you have about how they might be mad at you for not staying in touch and just said, hey, I'm here. I need you as a friend. I'm sorry for not being there before, but I'm here. And people will respond. They'll be there for you. And she was right. And it took me reaching out to people proactively to experience that connection again.

13:37So I think all of us in our lives have experiences of loneliness. And the thing I think that I try to remember that I would urge others to perhaps keep in mind as well is that it is very hard to tell who is lonely from the outside. But if you understand the numbers and understand that one in three adults are struggling with loneliness, then you realize many of the people around us are actually lonely. And you never know when you're reaching out to them just to check in and say hello, to offer a kind word, to stop by and offer your company. You never know when that can be a vital lifeline to somebody who's feeling very alone.

14:13I think a lot of people will recognize themselves in that. I certainly see myself. From your perspective, what does a healthy social life really look like in day-to-day life? I think a healthy social life looks like a life where we have a few people around us who we can be real with. That means being honest about how you feel. It's being open about what you're struggling with. It means being able to ask for help. It also means being able to reciprocate that, being able to offer help to others, not waiting for an invitation to help, but stepping up and showing up when there are people who are in need.

14:54You don't need to do that with a lot of people. You don't need hundreds of best friends. You might be two, three, four people in your life. Not all of them may be physically around you, but to know that those people exist in your life, to know you can lean on them and that they can lean on you, that can make all the difference in the world. And I think this is important to underscore because what we have seen in the last 15 to 20 years, particularly with the advent of social media, is that there has been a shift from a focus on quality of relationships to quantity of connections, right? We've replaced friends with followers and confidants with contacts.

15:32The truth is though, that when you have a crisis at three o 'clock in the morning, a random follower or contact on social media is not the one who's showing up for you. It's a friend who knows you, who cares about you, who loves you. And that's why we all have a need for that in our life. I think this concept of social health is an incredibly important one for us to think about in our own lives. And for those of us who have others we care about to think about it in their lives. And for those of us who are in healthcare to think about it in the lives of our patients. Like I was never really taught about how to assess social health when I went through medical training.

16:07But what I do know is that simply by opening up a conversation with the patient and saying, how do you feel about your friendships? Do you have people you can lean on? Or do you have times where you feel lonely in your life? Can you tell me about that? This can be incredibly liberating for many patients, for many individuals who carry the weight of loneliness, often with a sense of shame. And that's a heavy burden to bear. Gosh, that feels especially relevant right now. Social media, right, connects millions and millions of us around the world. And at the same time, it's of course linked to rising loneliness, especially among young people, teenagers, the loneliest generation.

16:51What do you think is happening there? I think social media began with the promise of creating connection and community. And somewhere along the way, it went off the rails. And I think that was driven by a business model that at its heart was about advertising. It's about third-party ad revenue, which meant that engagement became a critical driver of revenue. And if your goal is to keep people on your platform and keep them engaged, then you can employ all kinds of tools and tactics to keep them on, even if it's not good for their mental and physical health and well-being. And I think sadly, that's what we have seen.

17:29And I heard this all the time when I was traveling the country and the world as Surgeon General. So many people have actually said that they have tried to detox or quit social media. A lot of them have not succeeded. But I think it's because we have, think about this, some of the best resource companies in the world with some of the most talented product engineers in the world using cutting edge neuroscience to figure out how to get you to stay on for longer and longer. And especially when you think about young people, a 13-year-old who might be using social media and struggling to limit their usage, and we say to them, hey, you just got to find more willpower, be more disciplined.

18:10In the face of that, that is the definition of an unfair fight. So I don't doubt that many people who built these platforms began many years ago with the desire to create community. But what the data is actually telling us very clearly now, is that for many people, that experience is not translating to community. In fact, it's young people tell me all the time about how social media would make them feel worse about themselves. And there are a number of studies that have backed this up over the years. Some of them I included in my own Surgeon General's advisory on social media and youth mental health.

18:41But young people tell us that using social media makes them feel worse about their body image as well. Many adolescents say they feel addicted to social media. It's impacting their sleep as well. And so you put all of this together and you have to ask yourself the same question, I think, in medicine, we ask ourselves all the time, which is how do you balance risk and benefit? And I think what we're seeing is that the risks of social media have been dramatically underplayed and they're far more significant for young people. And I would say even for adults that we have recognized. And the benefits we hoped for in terms of closer friendships and tighter communities have been dramatically overstated.

19:21It's not to say again that there are no benefits at all to some people, but we've got to ask ourselves, is it a net benefit in our lives? Are we still on social media because we are worried that maybe we'll be left out if we're not? I'll honestly just tell you this. I have encountered many people who have tried to quit social media. Those who have, it's extremely hard for me to think of a single person who has regretted that decision. Again, it's not to say that no one should ever be on social media, but I think especially when it comes to our kids, I think we have to ask ourselves the question, do we really understand the risks and are those risks worth any benefits that we may see?

20:00And I'll tell you that for my kids and what I advise parents across the board to do based on the data that I've examined and more and more data has continued to come out since our report is I don't think that giving your kids access to social media at the age of 13 is a good idea. Until there are safety standards that are put in place that actually ensure that companies are disclosing the full effects and data they have on the health impacts of their platforms on kids. For my kids in particular, they don't feel comfortable with them being on these platforms. We require companies to disclose safety data on a lot of things that kids use, food, toys, et cetera.

20:36Yet on a platform that is relatively ubiquitous among young people with 95 % plus saying they've used social media, somehow our lawmakers have failed to require any type of reasonable safety standards. And to me, that's a red flag. Today's episode is sponsored by Kashi. Say hi to new Kashi Gut Health Granola, a straightforward, delicious way to fuel your gut made with prebiotics, fiber, and cultures. My favorite flavor, blueberry almond, has perfectly crispy clusters, delicious almonds, and bursts of whole blueberries. It's an easy fit for a daily routine, whether that's for breakfast or a snack.

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21:23Hi there, it's Adam Grant from Ted's Rethinking Podcast, and this episode is brought to you by ServiceNow. I get to spend my days studying how people think and what it actually takes to change our minds. It's work I find deeply meaningful. But even in meaningful work, there's still busy work. The admin, the repetitive processes, the invisible load that pulls attention away from what really matters. That's where ServiceNow's AI specialists come in. They don't just tell you what you should do about your busy work. They actually do it. Start to finish. Cases closed. Requests handled. No extra work for you.

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22:03Karen? And because, of course, this isn't just a teen issue, an issue for kids, for someone who feels stuck in the scroll, like so many of us, especially when it feels like everyone else is living their lives completely online, what's a realistic way for us to do a social media reset without feeling totally cut off? So here are a couple of things that I think that we can do. Number one is we can take the first step of trying to create tech-free zones in our life, right? So we could say, for example, that our time at dinner, our time with our family when we're having meals, our time when we're hanging out with friends, that's going to be time that's free of social media.

22:46We're not going to be on it. And that might seem obvious, but the number of people who are, I guarantee you, everybody who is listening to this episode has had an experience in their life where while they've been hanging out with somebody, they've been on social media, they are the other person. The second thing that we can do, we can move to having a particular day of the week that we take as a holiday, if you will, from social media. We might decide, okay, on Saturdays, I'm not going to check or on Fridays, I'm not going to check. But the third thing I would suggest is that we not do this alone, that we find a friend, somebody that we can make a pact with, that we're going to make this commitment to create a tech free zone in our day or take a day off in the week from using social media.

23:27And the reason that's so important is because these platforms are addictive. There's no other way to put it. They're designed to be so. And as a result, it's very easy to backslide. It's very easy to say, let me just open the app. Let me just see quickly if there are any notifications, but I won't really go and scroll, but then 15 minutes in you're scrolling, scrolling. So we need somebody that we're accountable to. And I actually needed this too. Like in my life, I was at a point where I was on it too much. I had this particular moment in 2022 when I was having hand surgery and I needed to recover for a couple of days, which meant I couldn't type as much.

24:01And so two of my very close friends called me and they said, Hey, look, this is going to be a perfect time for you to make some sort of shift in your life. What have you been wanting to do that you haven't been able to do? And I said, you know, honestly, getting off social media is one of those things. So he said, okay, let's do it. Let's make a commitment. I love it. Your friends did an intervention with you. Yeah. And it was so welcome. But because of that, every time I like went to potentially click and check something, you know, I would remember, oh no, I got to check in with them on Friday and tell them how it's going.

24:29Or they're going to just text me out of the blue and ask me how I'm doing. So that actually kept me on it. And I'll tell you that had a real impact on me. You realize how much time you're spending on these platforms. It adds up. the course of the day. But the other thing is the impact it has on your mind, right? Like our attention gets so fractioned and shattered, if you will, by social media, being able to put that aside and sometimes just take a deep breath, read something and focus on it or have a conversation and not be pulled aside. That was an important and a different experience. Look, we didn't get into this challenge overnight of being addicted to social media and seeing all the negative effects it has on us.

25:06And we may not get out of it overnight, but there are small steps we can start to take today. And the important reason to do that is not just for us, but for those of us who have kids or grandkids, it's to role model for them how to have a healthy relationship with technology. Because one of the most common complaints I would get from young people when I would travel was they would say, my parents are always on their phones and always on social media, and I don't know how to get them off. So this problem is a cross-generational problem. It really is. Well, I want to zoom out for a moment here.

25:37You have talked about how public trust in medicine and science has eroded. It's certainly a topic that I am focused a lot on myself. What do you think that we've misunderstood about trust? I think perhaps the most important thing that we have to remember about trust is that fundamentally it's relational. People don't typically just build trust in faceless brands or institutions. We tend to build trust in people or the people we associate with those institutions. And so one thing we saw during COVID is even during the throes of COVID when trust in institutions is declining, it's not like people didn't trust anyone, period.

26:17They still trusted people. Many people still trusted their doctor. They trusted the nurse, so they took care of them and their families, they trusted their friends. If they knew somebody at their local department of public health who had helped them on an issue or come to their community to help, they trusted them. But it came down to who do I actually know? And I think we have to remember that in public health and medicine and use that to rebuild trust on a platform of relationships. For example, that means to me that if we're training nurses, doctors, public health leaders for the future, Part of that training has to be in how do I actually go into a community and listen and understand what people need, talk to them about what we're doing and listen to their reactions to that.

26:59How do I build longer term relationships in a community so that I might be a department of public health, but part of my job is in bringing my information to communities directly, whether that's in church town halls or school gatherings or community town halls, or whether that's making sure that I have an open door policy and people know they can come in at any time and ask questions. we have to figure out how to put a face to health, to public health and medicine. And we have to empower and train and enable public health and medical practitioners to do that. And this is not to be clear about adding one more thing to the long list of things that we ask doctors and medical and public health practitioners to do.

27:43It's more about saying as a system, how can we support them and spending more of their time with the people that they are seeking to serve. There are very few doctors I know who, there are no doctors, I don't know, I mean, put it this way, who got into medicine and were inspired to become a healer so that they could chart more or do more administrative work or spend more time on the phone with an insurance company fighting over a prior authorization. Like people do that because they have to, they're forced to, because they are fighting to get their patients what they need. But this is the kind of administrative burden that we need to increasingly root out of the system.

28:15This is one of the places also where I think AI, if used and designed well, can be helpful in medicine and in public health to reducing some of that administrative burden and helping instead free up some of that time for us to do the human work that needs to be done, not just in our clinics and hospitals, but out in our communities as well. Well, before we wrap up here, I'm curious, I'd love to imagine what could be different. So So from your perspective, what would it look like if schools, if our workplaces, maybe even cities were actually designed with human connection in mind? I think, let me describe a vision that goes even beyond social connection.

28:54I think what we are in desperate need of is a conversation about what kind of world we want to live in, what we want it to be centered around. Do we want it to be centered around traditional models of achievement? Do we want it to be centered around acquisition of wealth and fame? Or do we want it to be centered around people? See, I think that many of the challenges that we're facing in the world today, not just in health, in terms of political polarization, economic challenges we're facing, I think many of these trace themselves in part back to a deeper spiritual crisis that we are going through, not just as a country, but as a global community.

29:33This is a crisis where we have created a model of success rooted in fame, money, and power that is now driving society, that is shaping the world and the path that young people feel they need to not just walk but run down. But the reality is that money, fame, and success in that traditional way, money, fame, and power, if you will, there's nothing wrong with them inherently, but they don't intrinsically make us happy. And so the question is, what has been missing? What is increasingly missing in many of our lives in this modern paradigm of success? What's missing are the factors that drive fulfillment.

30:11And those factors are relationships, service, and purpose. I think of those three as a triad of fulfillment. And all three of those require other people. We need to build relationships with others. We need to serve others. We need to find purpose in lifting each other up and improving each other's lives. It doesn't mean life is easy. It doesn't mean there's no adversity. But it does mean that we find and access a deeper well of peace and fulfillment that we all crave as human beings. And so when I think about the world that I want my children to inherit, the world that I want all of us to claim as our own, I think about a people-centered world where our individual actions in our lives, the choices we make about where we put our time and attention and energy, And the choices we make about how we raise our kids are oriented around how to optimize relationships, service, and purpose in their life.

31:05I think about a world in which our kids, when they go to school, they learn about people who have built their lives around relationships, purpose, and service. They learn the value of those elements. They work together to actually create lives, engage in service projects, do the kind of work that'll help create fulfillment. I think about workplaces that emphasize the same, about policymakers who recognize that the infrastructure for building relationships, social infrastructure, if you will, is something that we've got to invest in. And they put that forward because they realize that's an important part of building the foundation for any healthy community.

31:41So that is my dream of what I hope that we can move toward. And to me, it's more than a single program. It's more than a single issue. And I think at the end of the day, when we think about that moment where we're sitting on our rocking chair, hopefully looking back on a fulfilled life, when we're reflecting about what made that life so fulfilling, what we will likely reflect on is what many of the people who I've cared for over the course of their lives, at the end of their life, reflect on as well, is they reflect on the people. The people they loved, the people they served, the people who gave meaning to their lives.

32:19And my hope is that all of our children don't have to wait until the end of their lives to realize that our purpose is most readily found in each other. Oh, my goodness. I was not expecting to be so moved during this conversation. Thank you. Thank you so much, Vivek. You're amazing. I so appreciate you taking the time to share your perspective and your heart with us. Thank you, Shoshana. Thank you for the chance to have this conversation. And this means, this is very personal for me too, because like a lot of people in the world, like I'm worried about what's happening in the world. I'm worried about the future for my kids.

32:57But I also know that there is a better world we can create. And we have not just the ability, but the instincts to actually do it. Because I think the world we're talking about where we're anchored and rooted in each other, this is actually the kind of world that we have evolved to live in over thousands of years. Like we evolved to be together as social creatures, to collaborate, to help each other, to find purpose in lifting each other up. And so the world I'm talking about is not so much a radical new world that's foreign to the human experience. It's a return to who we always have been at some level.

33:33Beautiful. Thank you.

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34:19It's work I find deeply meaningful. But even in meaningful work, there's still busy work. The admin, the repetitive processes, the invisible load that pulls attention away from what really matters. That's where ServiceNow's AI specialists come in. They don't just tell you what you should do about your busy work. They actually do it. Start to finish. Cases closed. Requests handled. No extra work for you. To learn how to put AI to work for people, visit servicenow.com.

35:07Ever take my job? Get some surprising answers on TED Business wherever you listen to podcasts.

35:23My conversation with Dr. Murthy really puts into perspective how deeply connection shapes our health. Our relationships buffer stress, they support mental well-being, and even influence how our bodies heal and recover. But it also makes me wonder, on the extremes, what happens when connection disappears completely? When being alone isn't a choice you make for a quiet weekend, but something that's forced upon you for days, weeks, or even years? In today's TED-Ed lesson, psychiatrist Dr. Terry Coopers takes us into that reality and unpacks what happens inside the brain and body when isolation goes from peaceful to punishing, and why without human contact, even the healthiest minds can start to unravel.

36:08It's a powerful look at how much we depend on one another and a reminder that caring for our mental and physical health means caring for our connections too. And now, your TED-Ed lesson of the day.

36:24Everyone needs time to themselves, and peaceful solitude has stress-relieving benefits. But being alone takes on an entirely different dimension when it creeps up or is forced upon you. When that's the case, the effects can be surprisingly extensive. And though different people experience distinct effects at different times, symptoms tend to become more severe and persistent the longer one's isolated. When someone is involuntarily confined to one space indefinitely for days, weeks, months, or even years, alone and without productive tasks, their body will likely undergo numerous changes. Let's take a look at what may happen and why.

37:18Early on, stress hormones may spike, and as time passes, that stress can become chronic. Social interactions and meaningful activities are essential for emotional stability. This may be because they provide us with what researchers call social reality testing. A sort of sounding board where we can gauge how rational our perceptions are. So, when someone's deprived of those kinds of communication and tasks, their sense of identity and reality becomes threatened. Their thoughts spiral and their impulses take the reins, setting the stage for depression, obsessions, suicidal ideation, and, for some, delusions and hallucinations.

38:07Over time, this prolonged agitation can cause the brain's limbic system, which regulates fear and stress, to become especially responsive and hyperactive. Meanwhile, the prefrontal cortex, the brain's hub for reasoning and moral judgment, may shrink, impairing one's focus, memory, and cognition. Overall, the balance shifts from rational thinking towards emotionality. And as someone remains in this state, the imbalance becomes ingrained, making them more prone to bouts of anxiety, rage, and irrational actions. Isolation will also affect other parts of the person's health. They may lose sense of time and have difficulties sleeping.

38:57They're more likely to experience heart palpitations, headaches, dizziness, and hypersensitivity. And they may also lose weight because of stress-induced digestive issues and poor appetite. One can attempt to cope by establishing the healthiest routine possible under the extreme circumstances, including robust exercise, reading, and writing. But that can only do so much. The United Nations, many human rights organizations, and experts classify this kind of forced, prolonged isolation as torture. And yet, it's something imprisoned people in many countries endure. Also called solitary confinement or restrictive housing, the practice is most common in the United States.

39:49In 2019, more than 120 ,000 U.S. prisoners lived in solitary confinement, spending 22 to 24 hours a day in mostly windowless cells spanning roughly 6 by 9 feet. Quaker groups introduced solitary confinement to U.S. prisons in the late 1700s as an alternative to corporal punishment, believing it could bring about reflection and penitence, hence penitentiary. But the practice quickly faced criticism, from public figures all the way to the Supreme Court. Charles Dickens, for one, condemned solitary confinement as worse than any torture of the body. Its use dwindled, but then, in the 1980s, alongside more punitive, tough-on-crime laws, U.S.

40:43prison populations skyrocketed. As prisons grew crowded, incidences of protests, rebellions, and violence grew, and prison authorities increasingly used solitary confinement to maintain control. Many people have been placed in solitary confinement for minor, nonviolent infractions, like talking back to prison guards. And solitary confinement is harmful to everyone, but many who've experienced it have pre-existing mental health disorders, which it only exacerbates. Solitary confinement also seems to have lasting effects that make readjusting to life outside of a cell difficult. People who have gone through solitary confinement are three times more likely to show signs of post-traumatic stress disorder, and they commonly report experiencing shifts in their personalities, increased anxiety and paranoia in otherwise ordinary situations, and difficulty concentrating and connecting with others.

41:48Some states have restricted the use of solitary confinement in cases involving serious mental illness, children, or pregnancy. and some have adopted 15 - or 20-day limits for everyone. But laws that regulate solitary confinement aren't always enforced, and prison authorities have created loopholes. Yet solitary confinement does immense damage that is contrary to rehabilitation, while failing to reduce prison violence. Meanwhile, other countries have centered more humane approaches. Norway, for example, imprisons far fewer people per capita than the U.S., while spending five times more per prisoner on accommodations, classes, and work release programs.

42:35Norway also sees far fewer people return to prison after release, with one of the world's lowest rates of recidivism, indicating we tend to get better together.

42:55This TEDx lesson was created by Terry Coopers and directed by Camille Beauvais. Thanks again to Dr. Vivek Murthy for joining us.

43:06And that's it for today's episode. Thank you so much for listening. TEDx Health is a podcast from TED, and I'd love to hear your thoughts about this episode. Send me a message on Instagram at ShoshanaMD. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah DeGrange, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Heilash.

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