The Loneliness Epidemic — with Dr. Vivek Murthy

23:37In fact, the majority of people when surveyed say that their relationships are among the most important sources of meaning. So when we don't have that, it makes it harder for us to engage, including engaging on our health, which brings up finally the actual practices and behaviors in our life. Like I know from taking care of patients over the years that a patient's ability to actually take their medications, go to their follow-up appointments, especially if they have really complicated chronic illnesses, that a lot of that is dependent on what kind of support they have around them. And if they're not supported, it's not only harder to do those things, but think about how much easier it is to fall off the wagon with your diet or with your physical exercise routine when you don't have buddies that you're accountable to or people who are encouraging you every day.

24:21So you put all these things together and you see at a biological, psychological, and behavioral level, loneliness has a profound impact on our health. I read your op-ed. You're what I call a really measured, balanced person. And I think one of the reasons you're so effective is you don't come across as political. I don't think people rear up and feel threatened or that in any way there's any malice. You're just seen as your aim is true. I immediately go to, okay, someone's at fault here. And I immediately go to social media that there's some studies recently showing that where we saw a real spike, especially in teen depression, is when social went on mobile.

25:00And I saw some recent research that absolutely blew me away. Two things, one from Jonathan Haidt and one from, oh gosh, I'm forgetting her name. She just did some, really some great research. And the first is the cohort effect, that the kind of the solution to loneliness with kids who are on too much social media was just take snap away. You negligent parent, it's your fault. And what they found is that when the kid is off of social media, he too or she too becomes depressed because they're isolated and ostracized from all their friends who are on social media. And that also social distancing, the ultimate social distancing through the pandemic was caused by social media.

25:36That mental health is actually more a function of social distancing from social media than from the pandemic. So I find that the culprit here, I know there's a variety of factors here, but as always, and this is my go-to, that social media firms who have an economic incentive in delaying and obfuscating anything around the externalities or the harms here are playing an enormous role in this depression and loneliness epidemic. Your thoughts? Yeah, so I'm glad you raised it. And, you know, when I mentioned that, I think technology has helped us in some ways or harmed us in other ways. This is one of the areas where that I'm deeply concerned about, which is the impact of social media on our connection to one another.

26:16Look, now, I think many of the people who built social media platforms built them thinking that they would foster greater community and connection. And while I admire the intention, I think we have to look at the reality of what's going on right now, which is that when I talk to kids around the country, as I do very often when I hold roundtables when I travel, you know, kids tell me three things very consistently about social media. They say it makes them feel worse about themselves as they're constantly comparing themselves to other people online. It makes them feel worse about their friendships as they see their friends constantly doing things without them.

26:49But it also is something that they can't get off of. And that is the part that worries me too, that these platforms have often been designed to maximize the amount of time that people spend on them, not the quality of time that they're spending or the quality of relationships that they're building. And that has real impacts on us. It's not just the direct psychological impacts on how we see ourselves and others, but it's also the opportunity cost here. The time I'm spending online is time I'm not spending in person with other people. It's time that I'm not spending, you know, doing activities that support my health and well-being like sleep.

27:25Like it turns out a disturbing portion of young people stay up till midnight or later on weekday nights using social media. These are and I'm talking about kids in school. Right. So and it's robbing them of their sleep, which increases the risk of mental health concerns. So what we don't have, Scott, with social media is what we have for many other products that kids use, which are actual safety standards. and data transparency so that we understand the full impact of these platforms and that we hold them to account. Because I just think that we are going to look back on this time, you know, in five years, 10 years, and ask ourselves, if we don't take action now, what were we doing at a time where our kids were struggling with their mental health and where social media has likely had a significant effect here?

28:12We've got to take action and safety standards have to be a key part of that. But what does that mean? Because I think that there's general consensus and even the PR people at the social media companies will claim that we need something. You know, they publicly say we need regulation and then they deploy an army of capital and lobbyists to get in the way of all regulation. Do we need an SEC? Do we need criminal and civil penalties? Like when you talk to other branches of the government, because if we don't create the right incentives and deterrence, quite frankly, and penalties and regulation, I don't think any amount of third places or parks or new leagues is going to compensate for the damage of when your kid goes into his or her room and goes down a rabbit hole and starts getting more reaffirmation they should be depressed or getting shamed, whatever it might be, you know, on and on and on.

29:03But what do you think we need to do specifically? Do we need a regulatory agency? Do we need more punishment here? What would be your advice? Yeah, so I think the thing is we need several things. Number one, we need clear rules, right? And it rules around what age is appropriate, what safety standards have to be met. And let me be clear about what I mean by safety standards. Right now, kids are exposed to a lot of harmful content online, whether that's violence, whether that's hate speech, whether it's pornography, and it's happening to young kids too, right? And we've got to ensure that the kind of safety standards we put in place are ones that demand and require platforms to create environments where kids are not exposed to these kind of harmful, you know, content where they aren't designed features that are pushing them to maximize the amount of time spent, particularly during sleeping hours.

29:58We've got to make sure also that there aren't features that are actually having a negative impact directly on the mental health and well-being of kids and that aren't also driving content to them, algorithms that are driving content that's harmful. Like I talk to parents often who tell me that their child wasn't doing well from a psychological perspective and they happen to type in the word suicide, you know, into a search when they, you know, consumed a video that had content related to suicide. Suddenly they pushed all kinds of content that was not helpful to them. One mom told me that she was having a very difficult time because her kid was getting all of these videos suggested, you know, teaching him how to actually take his own life.

30:39And in some cases, encouraging him to do so as a way of taking control of his life. And she was, as any parent would be, was absolutely just incensed that this was happening and in disbelief that such content would be pushed to her child. But safety standards need to prevent these from happening. But the other thing that's important, in addition to having rules, Scott, is that they're actually enforced, right? Right now, in theory, platforms have a rule that 13-year-olds and above are allowed to use their platforms. Yet why do we have 40 % of kids 7 through 12 who are on social media? That doesn't make sense, right?

31:18If we're actually going to be enforcing rules. So they've got to be enforced. And I just don't think we're in a place where we can rely on the industry itself or individual companies to self-regulate and to figure this out by themselves because it's been more than a decade and we've not seen, I think, the kind of changes and the extent of changes that we need to truly protect our kids. And one of the reasons, you know, I've spoken publicly about this as well, about my concerns about the age at which kids start using these products, the lack of enforcement, about the need for, not only for safety standards, but also for data transparency because researchers are telling us, independent researchers who are trying to understand the full impact on mental health of kids, they're telling us they can't get access to the full data from the companies.

31:59So you're proposing a national framework to rebuild social connection in the United States. What does that look like? So what it looks like is six pillars that we have laid out that actually will help guide us in how we rebuild the social fabric of our country. And I'll sort of quickly take you through a couple of those. But one of the key pillars that we talk about in the advisory is about rebuilding our social infrastructure in our communities. What is social infrastructure? Well, these are the programs and the structures that actually support the development of healthy relationships. These are the opportunities for people to gather, you know, sponsored by the YMCA.

32:39These are the church and synagogue gatherings. These are the school programs that teach kids about emotions and about building healthy relationships. But these are also the workplace cultures that bosses and managers can help cultivate that help people build relationships with one another. And finally, there's an infrastructure component here, too. Think about the fact that our infrastructure in our cities affects how easy it is for us to walk and come and see one another and interact with people in our community. All of this is part of the social infrastructure that we need to rebuild. But the second pillar that we lay out in this infrastructure has to do with policies.

33:14With the fact that in the government, we always think about the financial impact of our policies. What I worry about is that we don't often enough think about the social impact of our policies. Sometimes well-intended education or transportation policies may actually have the untoward effect of creating more separation or physical barriers in communities for it to make it harder for people to see one another. But the third thing we've got to do, the third pillar is around the healthcare sector. We've got to mobilize our healthcare sector to get involved here. That means training doctors and nurses to be able to identify loneliness and isolation.

33:47It means insurance companies actually supporting and paying for services that will help people build greater connection in their life, particularly elderly patients. So this is part of the health sector involvement. And then the last three that I'll mention briefly is, you know, we have a call here to reform digital environments. You and I have been talking about that because we've got to make technology something that supports healthy connection. And we've got to our fifth pillar is around research and knowledge. You know, there's a lot we know now about the impact of loneliness, but this is not an area that we have prioritized in research as a country.

34:19You think about the stat you mentioned at the beginning, Scott, one in two adults who are reporting measurable levels of loneliness. This is more than the number of adults who have diabetes in the country. It's more than the number of adults who smoke in the country. We should be devoting more resources to this. But there's one last pillar, a sixth pillar, which reminds me actually of conversations you and I have had in the past, which has to do with how we build a culture of connection. You can't legislate culture. You can't pass some rule that creates the culture. Culture is built by you and me and all of us in our communities, by what we think, what we believe, what we feel, and how we treat each other.

34:55And what I worry about, Scott, is that it now feels, so I encounter so many people around the country who say it feels like we've become somehow mean-spirited. It feels like we don't care about one another, that we're, everyone's just out there for themselves. But to me, like the foundation of a truly connected society is a core set of values centered around kindness, generosity, service, and connection to one another. and we've got to bring those values to life. We've got to put them center stage and we bring them to life by acting on them, by having leaders who actually model those values, by selecting and choosing leaders who speak to and live up to those values and by designing workplaces and schools that also teach kids at a young age about these values and live out these values in practice.

35:41So to me, this is a critical part of how we build a culture of connection and what we need to do to ultimately create a more connected America. that. When I look back at my childhood and I think about the opportunities for socialization, I played sports after school. I was a member of a Boy Scout troop. On weekends, I'd go see my dad and his second, third, or fourth wife, and most of them would take me to church. My Boy Scout troop, 42 has gone away in Culver City. I don't know if it's because of demographics. I don't know if it's because of the bad reputation that Boy Scouts got. I don't know what it is.

36:12I know that economics have led public schools to cancel a lot of after-school programs. Is there some sort of economic program where we could offer subsidies or additional tax breaks to nonprofits that are in the business of getting large groups of people together? Like how do we, what type of programs lift, get everyone thinking about opening parks and leagues and in places of worship again? Well, it's a really good point, Scott. And I do think that we need a couple of things here if we want to truly resurrect those community institutions and build new ones, which is we've got to make it clear to the public and to the country that this has to be a priority.

36:50Right now, it's not clear to people that we need to rebuild our social infrastructure. Many people don't even remember the days when folks used to get together in the ways that you're describing. But the second thing we've got to do is we've got to lay out a series of, as I think of it, guidelines, frameworks, a pathway for how people can go about doing that in their communities so that we can empower local organizations, workplaces, and individuals to come together and to create these types of gatherings. And the third thing we've got to do is support them with material funding and resources.

37:21And right now, look, there's a lot of money that governments at all levels, local, state, and federal, put toward addressing health and building infrastructure. To me, this is an important area for us to invest in a place where I'd like to see government overall invest more and to see the private sector work together with the public sector to fund these kinds of initiatives locally, because these matter. And look, I'll just tell you one quick story I think about that speaks to the power of what individuals can do. Some years ago, I was introduced to this incredibly inspiring woman named Sarah Harmeyer, who had just moved to Dallas, Texas.

37:59She got there, didn't know anybody. She was single. She wasn't in a relationship, so she didn't have a built-in network of somebody at home. and she felt lonely. And she wasn't quite sure what to do, but she wasn't finding organizations, associations that were bringing people together. So she one day just had this idea of inviting people over for a meal. And it seemed actually quite risky at the time because she thought, well, what if they don't want to come? What if they're already busy with their own families? What if I look like a loser because I don't have anyone around me? All of these worries were going through her head.

38:29But her, and she also had a small place and she thought, well, my place is small. I can't really entertain people. But her father actually came in and said, I'll help you build a table, a big wooden table that you can put outside in the yard. You can just have people over for a potluck. So that's what she decided to do. And she sent an invitation out to all of the neighbors. And the response, Scott, utterly overwhelmed her. Everyone wanted to come to this party. And they showed up. They brought food. They bought drinks. They had an incredible time together. What she did is she would just go around and say, hey, this is Vivek.

39:03He's a doctor. This is, you know, Brian, he's a lawyer. This is John, he's a plumber. Here's what he does. You know, have a good time, chat. She invited people to pour drinks and do dishes and just make it their home. And this became a lifeline for not just for her, but for so many people in the community. And she realized that those neighbors, even a lot who had been there for a long time, they were feeling lonely and isolated too. So Sarah Harmeyer's neighbor's table, you know, as we came to call it, became a gathering point for people in her community. This is what individuals can do. in addition to the organizations that we need to step up.

39:36Yeah, I love that. And just a couple, I think about this a lot because I'm naturally an introvert. And as I get older, it's weird. I think all of us at certain points in our life feel a sense of loneliness and people, and it's embarrassing to say because you're worried that it outs you as someone who's not as successful or as masculine as you'd like to think. And there's two hacks I would suggest to almost everybody. The first is just say yes more. It's, you know, Netflix and your dogs are always calling to stay home and just try and push the limits of your comfort zone and say yes to more invitations.

40:12And the second thing, and this has been more liberating and I think an easier hack, is to separate the person from the politics because it doubles the opportunity for relationships. And I live in Florida and I'm surrounded by people who do not share my political views. And I found myself getting a tighter and tighter and narrower set of social circles because I was turned off by someone's political views. And the reality is 40 years ago, people didn't know what their neighbor's political views are. And quite frankly, they didn't care. They just knew that, oh, Bob seems like a nice guy. You know what I mean?

40:42Why wouldn't I have a beer with him, right? Now I immediately go to, well, he's a Trumper. I want nothing to do with this guy. And you immediately shut off 50 % of potential relationships. Anyways, Vivek, how old are your kids? They're five and six. Based on your research and what you're seeing here, how has your approach to fathering changed or going to change? I guess, do you have, well, I'll start. When my kids were younger, I was very much the ambition dad. Have you done your homework? I always felt it was my role to teach them lessons, to coach them. This is what you did wrong here. This is how you do better.

41:20And then as I've gotten older and I've become much more aware of these mental health issues that are just really are a crisis among our kids. You know, you have your world of work, you have your world of fun, something comes off the tracks when you're a kid, your whole world shinks to that. And I've kind of, I won't say I've gotten 180, but I'm no longer the ambition dad. I'm like, how do I build that in my kids? How do I build that sense of mental and emotional well-being and ease and confidence? And if they don't end up at college, I'll be disappointed. That's meaningful. It's not profound. And I try to do, every day I try to coach less, if you will, or reprimand less or discipline less and find something they're doing and just say, wow, you're great at that.

42:03Or, God, I just think, you know, I told my kid the other day, I'm like, God, I just can't get over how handsome you are. I don't know where you got that. You know, just every day trying to build them up and make them like themselves more. Anyways, I'm done with my virtue signaling. What do you do each day to try and give your sense of self, your kids that sense of self and confidence? Well, first, I just love that we're talking about this because this is a stuff I think parents need opportunities to talk about more with each other so they can learn from each other. And I'm learning from you as you're talking.

42:33But I think dads in particular, it's not something we tend to talk about a lot with each other. What I do is, first of all, make sure that my kids know that I love them. I tell them often. You know, I'm very physically affectionate with them. and they're in the age where they let me. So I'm going to take full advantage of that and keep hugging them as long as I can. But I want them to know that they're loved because we know that secure attachments are one of the greatest predictors for kids of happiness, fulfillment, health, and economic success. The other thing that we do with our kids also is we do try to make sure we are always pointing out the things that they are doing well, right?

43:10So whether that's, you know, doing a good job practicing the piano that day or whether it's being good about, you know, taking the initiative to like, you know, say hi to somebody that they were shy around. Like it could be small, it could be big, but we try to highlight that for them. I want to be clear though, because if many people think that what you and I are talking about, you know, is perhaps too soft or it could be construed as too weak. It's not at all. You know, like we can both be disciplined with our kids and encourage them and push them to do more and support them in times of adversity and not shield them entirely from adversity, while we're also making sure our kids know that they are loved, that they are supported, that they remember what they have going for them and all the beauty they have inside them.

43:53Those two things are not incompatible, but earlier generations thought they were. Like I remember many parents in my parents' generation feel like if you complimented your kids too much or told them that they were good, that that would make them unmotivated and that it was the lack of something, the lack of compliments, compliments, the lack of approval from their parents that would become a driver for success. And I just I think that just leads to pathology, you know, down, down the line. And I think we need to affirm our kids. We need to encourage our kids and we need to support them in the adversity that they take on, because kids also grow through adversity, but they grow the most when they know that they have support, that they've got people who love them, whether they succeed or whether they fail.

44:36Is this, so assuming the president gets reelected, you're with Obama, you might be in Washington another six years or longer. Is this your, is loneliness your thing? Is this your thing that you're, if of all the health issues, whether it's pandemics or preparing for another pandemic or vaccine research or obesity, there's just so many issues. And my sense is to be effective, of it's not what to do, it's what you don't do. What's your focus? Is loneliness going to be your thing? So this is, to me, I'd say that my most important focus is going to remain on mental health and well-being. And within that, the issue of rebuilding social connection and community is my top priority area.

45:21I'm most interested in, but also most concerned about. Because I think, Scott, that if we want to, if we want what I suspect you and I want and what parents all over the country want for our kids, which is to be healthy, to be happy, to be fulfilled, to be productive members of society and to inherit a world that is welcoming and open and that's full of opportunity. I don't see how we can do that when we're increasingly fragmented, when we're more and more distant from one another. Like I think about the future pandemics all the time. There's something we have to prepare for. How are we gonna manage the next pandemic when it comes through if we aren't invested in one another, if we don't know one another, if we feel connected to each other, if we're all out there by ourselves.

46:03You know, the data is really interesting that when you look at communities that have a high degree of social connection, they have lower rates of violence, they have higher economic prosperity, they're more resilient in the face of natural disasters like hurricanes or tornadoes, because they pull together, they help each other more. And so this is the issue that for me is the central focus of my tenure as Surgeon General, because I just think it's foundational, Scott. We just can't do the things we need to do. We can't overcome adversity and build the future we want for our kids when we're fragmented and separated.

46:36Dr. Vivek Murthy serves as the 21st Surgeon General of the United States and the Vice Admiral of the U.S. Public Health Service Commission Corps. While serving as Surgeon General, Dr. Murthy is focused on drawing attention to a number of critical public issues, including the growing proliferation of health misinformation, the ongoing youth mental health crisis, well-being, and burnout in the health worker community and social isolation and loneliness. She joins us from New York City. Vivek, I think you are doing such important work and you bring such grace, this unique combination of grace and intellect.

47:11I really think you're making a big difference and really appreciate your public service. Well, that's so kind of you to say. It means a lot coming from someone whose work I've admired over the years. And so thank you, Scott, for this conversation, for your friendship and for all the good work that you're doing to help lift up the mental health challenges that our kids are facing. I appreciate you. We'll be right back.

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49:36Algebra of Happiness. I'm about to finish my book called The Algebra of Wealth, Strategies for Economic Security. And one of the things that I'm doing to try and stay mentally fit, in addition to physically fit, is writing books. It's the hardest thing I do. Every time I started a new book, I'm angry that I agreed to do another book. But it keeps me, it's hard and I think it keeps me mentally youthful, if you will. Anyway, I'm thinking my next book is going to be on masculinity. And this is, I apologize, a little bit redundant from the Pivot podcast where I talked about the same thing. But I've been spending a lot of time finding videos and interesting examples of men who I think demonstrate a dimension of masculinity.

50:19And first, you'd have to define it, which I'm still in the midst of doing. But what we have is, I would argue, not only a crisis in loneliness, but a crisis in masculinity in that we decided that masculinity was toxic. and because we didn't want to address the issues around addiction, incarceration, loneliness, mating inequality, suicide, very real issues, and because people saw it as politically incorrect to in any way show compassion for men into that void, jumped on people like Andrew Tate who basically used it as a means of promoting misogyny and just a weird fucked up sense of masculinity where, you know, buy a McLaren and treat women like property and, oh, that's how you regain masculinity.

51:03And nothing could be further from the truth. Anyways, I found three examples of what I would like to believe demonstrate this new form of masculinity. And we need to take this, we need to take masculinity back and redefine it. And rather than trying to define it, I just want to play these videos and give a brief description of what I found was so important and inspiring. The first is a video from Michael J. Fox. My life is set up so I can pack Parkinson's along with me if I have to. You've not squandered any of your capacity, but at some point, Parkinson's going to make the call for you, isn't it?

51:41Yeah, it's back in the door. I won't lie, it's getting harder. It's getting tougher. Every day gets tougher. but that's the way it is I mean, you don't really see about that Here Michael is showing his vulnerability This is someone who's known for his comedic acting You know, he's probably not going to go down as one of the greatest actors in history but he's having a really meaningful impact on the world because most men are afraid to show their vulnerability and what you do when you show your vulnerability is you say to the rest of the world I'm struggling and if I'm someone famous or someone strong the temptation would be not to show that side.

52:21Nobody wants to, or I think few people have the courage to reveal that kind of vulnerability. And there's no doubt about it. This video is rattling when you see this guy who, if like me, kind of grew up with him to see just how much he's suffering visibly. But he and his family have made the conscious decision to say that this type of leadership, this type of vulnerability will make it easier for other people suffering from Parkinson's. And there was a time when if someone had Down syndrome, you hid them from the public. There was a time where we didn't talk about our mother's breast cancer. We didn't talk about our prostate cancer.

52:58We didn't talk about our kid engaging in self-harm. And until you start talking about those things, it's difficult to address them because people can't relate to them and don't think they happen to them or the people they know. And they do. The second video is from Joe Rogan. We should be taking care of our own. This should be a primary thing like this to strengthen our community to strengthen our civilization One of the primary things is we should be taking care of each other physically. It should be like Above all right education. You shouldn't have to fucking be in debt a quarter million dollars if you get a fucking education Don't we want less losers?

53:35I think this is an important video because I think joe rogan is someone that a lot of young men look up to He's an amazing physical shape. I watch videos on him and his fitness routine, and I appreciate and admire just how fucking strong he is at his age. The guy is jacked and works out very seriously every day, and I admire that, and I think that is an expression of masculinity. I think we're meant to be strong. I've said several times that any man under the age of 30 should be able to walk into any room and know if shit got real. They could kill and eat everybody or outrun them. you're going to look back if you're a young man and wish you'd gotten as strong as possible because you'll marvel at what is the human male form under the age of 30.

54:13It's okay as you get older, but there's something about that form that is in that strength, in that bone structure, in that double twitch muscle that is just remarkable at that age. Anyways, enough about me slobbering off Joseph Ezeke. In addition, he communicates in a way that young people, especially young men, really, really appreciate. And he just kind of burst into this moment of empathy talking about how important education and healthcare is. And more specifically, that a lot of people don't appreciate what it's like to be unfortunate, that a lot of our blessings are just a function of our luck.

54:49And when guys like that who are seen as tough and truth tellers in their own kind of, I don't know, aggressive, robust, masculine way demonstrate that type of empathy, I think we move the world forward. And then finally, the last video is from Michael Keaton. And he's someone I just think is a fantastic actor, whether it was Night Shift, I think he's a great comedic actor, Beetlejuice. Kind of went through a desert, a little bit of a desert of a career. 10 or 15 years, wasn't in a lot. And then came back just so strong. It was a Birdman that he got best actor for. And then I thought Dope Sick was one of the better miniseries I've ever seen.

55:30I thought it was so moving, so accurate, so well done, kind of a crowning achievement for him. And he just simply says, you know, spend more time with your kids. You know, I was having this conversation with Bill Hader the other day, and he was going through something. I said, dude, trust me, hang out with your kids as much as you can, as long as you can. You will never regret it. You'll look back. You're going to lose some jobs. It's okay. In the long run, that's the thing. And I find that a decent definition or a decent dimension of masculinity would be that you always, regardless of what a baller you are, attempt to find or allocate a lot of your spare time to just being with your kids, not necessarily doing anything.

56:12I think the whole notion of quality time is bullshit. I think there is no such thing as quality time because the thing about the randomness of children means that you never know when quality moments of time are going to happen. They can happen in the car. They can happen over dinner. And the only way you get that quality time is through one thing, and that is time. And that's a lot of it. But we need to take back this space of masculinity and redefine more positive dimensions around it. that says that being a man, and I recognize that it's a continuum and that we need to respect everyone along that continuum, but for the 95 % or the 47 % of men who do identify with some sort of masculine attributes, we need to redefine what those are such that we can help our young men exhibit a more productive, a more modern, a more thoughtful, a more empathetic, and a more productive means of masculinity.

57:03That's all I have. This episode was produced by Caroline Shagrin. Jennifer Sanchez is our associate producer and Drew Burrows is our technical director. Thank you for listening to the Prop G pod from the Vox Media Podcast Network. We will catch you on Saturday for No Mercy, No Malice, as read by George Hahn, and on Monday with our weekly markets show.

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