U.S. Surgeon General Dr. Vivek Murthy’s Final Prescription for America

25:13And then we went into the library and we saw something we've never seen before, which is the kids were actually sitting on the floor and playing board games with each other and having fun and laughing. And wow, isn't that incredible? And you talk to people a couple of generations ago and they're like, well, that was kind of normal as part of childhood. But I think this is where I think we have to just appreciate the extent of what's happened to kids today, which is through no real choice of their own. They have been dropped right in the middle of a profoundly different digital environment that's consumed so much of their attention and focus and fundamentally transformed their relationships with each other.

25:46And I believe contributed to more loneliness and isolation. So, yeah, kids are asking for solutions. And I think that the reason I feel such urgency around this is that, Rich, you know, kids, a year in their life is a lot of time. There's a lot of development happening during that time. And this is why I worry that Congress has not done enough to respond to the urgency of the moment in getting legislation done fast enough. But these steps that schools are taking, the steps parents can take in terms of waiting until after middle school to let their kids start using social media, working with other parents so that they're not alone, drawing tech-free zones in their lives, their kids' lives, to protect sleep and in-person time.

26:26That's why these steps really, really matter and they make a big difference in our kids' lives. Yeah, it's easy to forget that that time is so precious. The plasticity in your brain, is not time to be wasted, right? Like once it kind of gets anchored in, you become who you are and trying to create new neural pathways or rewire yourself becomes a laborious process when you're that age and you're so receptive to learning in a certain way, like that should really be revered and respected. And I guess I'm of two minds when it comes to kids, you know, being at the sort of leading edge of calling for change.

27:04Like on one hand, like that's so encouraging. Like they're raising their hands and saying, do something about this. But at the same time, it's like, where are the adults in the room? Like, you know, they're like, you guys are supposed to be taking care of us. And we're the ones who have to like, you know, call out and say, do something about this. It's well put the way you did. And we should be stepping up to do more for our kids. And this particularly includes our policymakers who I think, you know, obviously have a lot on their plate, but I can't think of a responsibility, Rich, that's more important than making sure our kids are okay.

27:36And that feels like one of our most sacred responsibilities in society to take care of our kids. And by that measure, Congress has really failed to do that over the years. And social media has been around for 20 years. It's not like this just popped up on the scene last year. There have been bills languishing in Congress for years. There was ever a time to step up and get something done, And it would be now when it would be on this issue. And again, there's broad popular support for this. There's broad bipartisan support for it. It's a question of leadership and stepping up to make it happen. Because after you pass a law, you need time to implement it, right?

28:10And that every day that goes by without a safer social media environment is one more day that more kids are being harmed. At the same time that there's bipartisan support for this, you also have to take into consideration, the extent to which Congress is captured by K Street and, you know, the lobbying efforts, which are not insignificant on behalf of Meta and the, you know, the sort of tech conglomerates out there who, you know, I don't know what their lobbying budgets are, but they're gigantic, right? And so that exerts pressure on these bipartisan representatives with respect to, you know, ushering forth the legislation and the regulatory changes that are required to enact that change.

28:51So you're right. And that's a reality of our system right now. Not a reality I like, but that there's a lot of money in politics, right? And that impacts sometimes the decisions that people make. But the one thing that can overcome the power of money in politics are just the voices of overwhelming numbers of people who speak up and demand something different. And I have seen that, you know, like happen in the past. And it's what we need right now, And this is actually why it's so important that parents in particular are being mobilized around this issue and why young people themselves are actually not staying silent.

29:27They're building their own movements, like the Logoff Movement and others, to try to help each other develop a healthier relationship with technology and with social media in particular. But their mobilization, I think, is what we need more of to ultimately drive the kind of change. Because like you said, there are headwinds here. There's the inertia. There's money in politics. There are a lot of reasons not to do this. But the most important reason is that our kids' well-being is at stake. You mentioned parents. Another big initiative relates to parents. You published this New York Times op-ed in August of this year alongside this advisory, general advisory on mental health and well-being of parents.

30:07So maybe explain that and also explain like what inspired you to place your focus on this issue specifically. It's interesting, Rich. You know, I think one of the things I learned from my first term as Surgeon General was that you can come in with your whole list of priorities that you want to accomplish. But at some level, if you really want to do the right thing, you just got to sit down and just take some time to listen to people and ask them what they want. And some of that is just literally just being quiet and just like listening to what you're hearing. What are people saying, but also what are they not saying?

30:42One of the things I heard really clearly when I was on the road, was that parents were really struggling. And this wasn't because parents came to me and said, hey, I wanna talk to you about how I'm struggling. Parents usually would come to me to say, I wanna talk to you about my kids. I'm worried about my children and here's what I'm worried about. But as I dug into it, I started to realize that, wow, parents themselves are under extraordinary stress. They don't know how to manage a lot of these new challenges like around tech for their kids. And they're doing a lot of this alone, right? And so when reason, as I dug into the data, what I found is that parents, contrary to what many people believe, actually struggle with loneliness at higher levels than adults who don't have kids.

31:24And most people think, hey, if you're a parent, you've got kids around you, you're not lonely, you're not struggling. But parents are not only like often raising their kids without family, you know, without a lot of close friends, you know, nearby, but they're also on social media looking at how everyone else is parenting and feeling like they're constantly falling short, right? And that makes them less likely to talk about their struggles because like, I already feel like a terrible parent. I don't want to go out there and admit that I don't know how to do X, Y, and Z for my kids or struggling with how to get them to manage their phone.

31:51And so that makes it even more isolating. The other thing though, I realized about parents as we dug into the data is that 48 % of parents say that on most days, the stress in their lives is completely overwhelming. 48 % of parents, if half the parents are walking around feeling completely overwhelmed, almost paralyzed each day, I mean, that's terrible. That is not normal. And that compares to about a quarter of adults who do not have kids who feel that way. So these two things were really striking and concerning to me. And the third and final thing to know is that, is something that's gonna be obvious to you, Rich, which is that the mental health of parents actually affects the mental health of kids, right?

32:30And vice versa. And so if we're trying to do well by kids and address the youth mental health crisis in this country, which was one of the first issues I started working on, And we actually have to address the mental health challenges that parents are going through as well.

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38:06It is the whole package, really. You said it because it's so much more than just, well, we need to de-stress parents because it's not good for them and it's not good for their kids. It's like, if you are a parent who's under tremendous chronic stress, whether it's financial, emotional, the nature of it matters less than just the fact that you have it, you are inevitably creating an environment for your children in which that is being passed down. And that shows up in all kinds of toxic ways. Sometimes it's unhealed wounds that get unconsciously transmitted to the next generation. and then they have to contend with all of your baggage, right?

38:47And unless they heal it, it gets passed on to the next generation. So in this kind of root cause health hierarchy of needs, it truly is like the fundamental thing. Like if you don't resolve that, you're basically giving birth to a whole new generation of individuals who are gonna have the very same problems. Yeah, that's exactly right. And what is the domino effect of that like across basically everything? Yeah, what you and I are talking about, Rich, is really about making sure that the foundation is strong for health and well-being in our lives. And all this other stuff that we're building on top of that, well-intended as it is, it feels like building on a foundation of sand sometimes.

39:28And it's shaky and it falls apart. And then we ask ourselves, well, hey, we just made that big investment in this health program where we build all these hospitals. How come people aren't happy? How come they're not healthy? Well, there's a foundation that's been at risk and it's been eroding for a while. And that's really, you know, during these last four years and last two terms, really, what I've been trying to just dig deeper into, understanding what are the deeper root issues that are driving our health issues and more broadly our discontent and our despair. And I think if we address those, I think we have a really good shot at not just doing better from a health perspective, but actually enabling ourselves to be really functional as a society, to be able to take on big challenges when they arise, whether that's climate change or a hurricane that comes and affects our community or anything else.

40:15Without that, then even little perturbations, seemingly little perturbations or stresses can knock us over, right? And so I look, there's gonna be at some point in the future, another pandemic. We don't know when it is, right? But just with history and statistics as a guide, like at some point that will happen, right? And one of the things we have to think about as part of pandemic preparedness is not just how quickly can we develop the tests, how quickly can we protect people and treat people and develop diagnostics and vaccines. But we also have to think, how do we build resilience in a community so that whether it's a pandemic or anything else, we can respond to these tragedies.

40:55And that's where mental health, social connection and community, where all of these become really important. They're part of our core of resilience. and without it, again, we're like a house of cards that's easily blown over. Yeah, I mean, not to go down some kind of pandemic rabbit hole here, but my concern is, did we learn the lessons with this past pandemic that are gonna adequately prepare us for the next one? And it seems to me that perhaps we haven't, like there is such an erosion of trust and with this fracture of community and the lack of trust in institutions, even in a best case scenario where the testing and all this sort of science aspect of it that is dialed in, you still have to get buy-in from the public and that requires trust and trust is a product of a cohesive community in which everybody's looking out for each other.

41:44And that's the real piece I think that has to get kind of reconstructed from the ground up on that foundational level. But when you think of parents and stress, even when you're deeply embedded into a loving community and it takes a village and you have that village to help you raise your kid, it's still stressful. Like under any circumstances, like any parent will tell you and you know, and I know, like it's hard, it's really hard. But now we're in a position where we're split apart. We've lost our connection to community. We're experiencing loneliness on an epidemic level. And we just feel like we're on our own, right?

42:22And it's incredibly stressful. There's financial duress. And no matter who you are, you feel like you're not really able to completely show up in the way that you would like to, like because of work demands. And when you're at work, you're thinking about your kids. And when you're with your kids, you're worried about that email. We're never fully present in our lives. And then we go on social media and we see super dads who just look like they're the idealized version of it. And then we feel bad because we're not that or whatever. And so what do we do? Well, we reach for the ice cream or we go to McDonald's or we light up a cigarette.

42:56You know, like then it's sort of like Like the unhealthy lifestyle habits that are contributing to chronic disease are rooted in kind of an emotional discontentedness and sense of not being enough or lack that is fomenting all of that stress and then motivating the need to release that stress in unhealthy ways. Yeah, no, you're exactly right. And I think that the connection between our emotional state and how we eat and how it affects our physical activity is really profound. When we experience stress and distress, that can really feel painful, like literally can feel painful. And as human beings, we will always look to alleviate stress.

43:38And the question is, how do we do that? Right. And we live in an environment where that tells us often that if you're feeling pain, then you either need to optimize yourself more, go achieve more, earn more, get more recognition, etc. Or you need to numb that pain somehow, you know, whether it's with alcohol or with, you know, unhealthy foods or something else. And there's plenty of ads and, you know, around you to tell you that that's the way to just feel better about life. And while there's nothing wrong necessarily with having dessert here and there and doing any of those things, The challenge is when we come to reach for it as a solution to our pain, right?

44:14And that can often begin an unhealthy cycle in our lives that can then contribute to chronic disease. And this is where I think part of what this is about, not just for parents, but all of us, is to understand how do we really address those deeper roots of pain? When it comes to the stress, you're exactly right that you're never going to get rid of all the stress in parenting. Parenting has been stressful forever, right? Ever since, you know, humans began having children. But there is a difference between bearable and unbearable stress. And chronic and acute stress or bad stress and good stress.

44:45Yes. And one of the things that makes a big difference between whether stress hurts you or ultimately is manageable and can in some cases even help you is whether you're managing it alone or not. It's one of several factors that impact that. But when you're dealing with the stress of parenting alone, it's just very different from dealing with it while knowing that there are people who've got your back, you know, and who can support you. Sometimes those people don't even have to do something like for you, like go pick up your child when you can, et cetera. But just knowing that they care about you, that they're not judging you, that they're there to support you makes a difference.

45:16Which is why in the parenting advisory that I issued, in addition to calling for a series of policy solutions to better support parents, like paid sick leave so that parents can be with a sick child and not lose their job or lose income, or solutions like making childcare more affordable, or investing in the child tax credit. In addition to the policy solutions, there are also things that we can do as individuals. As parents, whenever we are able to summon the courage to speak more openly with other parents about what we're going through, what we find nine times out of 10 is that they're often struggling as well.

45:55And then opening up those doors can actually relieve a bit of both of our stress. And the other thing that we found is like, and my wife and I have found this, because we've lived this too. You know, as parents, we've struggled a lot, like many nights, you know, especially when my kids were infants, when I was like, oh, I'm trying to Google things, figuring out what to do for them, what kind of diapers to get, like, why do they have this rash, et cetera. I mean, people think that being trained as a doctor means that somehow you like know how to take care of everything for your child. And that's absolutely not the case.

46:21You're disabusing of that right now. Plenty of moments where my wife and I, both doctors, have felt really lost and stressed, you know, in terms of how to take care of our kids. But what made that look really hard was the fact that we didn't have family here. You know, that at that time, some of our close friends lived around, but many of them did not. And like, we weren't, we felt really isolated. Like we weren't going out to like see people because we felt like we were just having to around the clock manage and figure out things with the kids. And that we just began a really downward cycle. But what helped is help break that cycle.

46:53Because at some point we realized that number one, in addition to just being open with other parents and not trying to put up a front that we've got it all together, we also realized that we just need to spend time with other parents. And we used to say, well, we can't because we don't have childcare and this and that. And we just realized at one point, you know what? It doesn't matter that our house is messy and in total chaos. It doesn't matter that we may not be able to cook a gourmet meal for somebody who comes over. It doesn't matter that a lot of our dishes are chipped, you know, the plates that we might put on the table.

47:23None of that matters. And it doesn't matter that our place is small. What matters is that we just have time with other people. So we would just tell them, you know what? bring your kids over. Our house is total chaos. We don't know what we're going to make, but we'll eat something. Let's just go out and hang out. And then our kids would play with each other. And we would just sit and talk with each other. And what we remember and what our friends remember from those moments are not how chaotic our house was or what they ate. They remember the conversation. They remember how it just felt to be with one another, how nice it felt to just see our kids playing with each other.

47:52And so we've realized that these seemingly small things can make a really big difference. And the small things we also do to help each other, help fellow parents can make a difference too. Like the other day, I was at a kid's school with my wife and it was after school, so kids were playing on the playground. One of the parents needed to step away and just to make a call and said, hey, do you mind watching my kids? Sure, of course. Yeah, we'll watch your kids. Like that didn't take much effort from us, right? We're just saying yes to a request. But one, we felt really good at being able to help, you know, and she also felt really good that there are people who are there to actually help her and watch her child and give her five minutes to go make a phone call.

48:32These seemingly small things help us feel like we're part of something bigger. Yeah. It's so interesting how in so many ways, modern society is just completely orthogonal to like everything that, you know, we know about like what makes us happy and healthy, right? And now we have to issue advisories and create, you know, infrastructure to lead us back to where we naturally always were, you know? And there's something tragic about that, I guess, but also encouraging in that the solution is like, you already know the solution, right? The solution is to invite friends over and like not worry about the small stuff and make sure that you're connecting with people.

49:15And we're just so individuated. Like we're all living our kind of self-obsessed lives. And we've forgotten that, you know, what makes us human is the village. And, you know, we need to get back to some version of, you know, raising our children as part of a, you know, village collective where we're pitching in and helping each other out. Like that's how we We survived over millennia. And now it's all on the individual and oftentimes the single parent to figure it out on a budget where childcare is not affordable. And of course that person is gonna be overly stressed and lonely and despairing because we're not wired for that.

49:55That's not how we survived. And we're communal creatures and we thrive when we're together. And on some level, we need to reconfigure like the tectonic plates of modern society to get us back to that place. We do. And I think given what you just said, I think it's important for people to understand the way we are parenting right now is actually not normal. It's not the way we've parented for thousands of years. And I think this is, it's partly the result of forces around us. I think technology has fractured communities and changed how we dialogue with each other. And we've also come to move around a lot more, right?

50:34So we leave communities behind that we grew up with or we move from job to job and we may leave communities behind that way. And there are benefits to that, but there's a cost, right? That we haven't always figured out how to compensate for. But there's also a cultural piece to this as well, which is that I think over time we have told ourselves somehow that we need to be able to do it all on our own in order to be successful or to be a real man or a real woman or a good parent or whatever it is, right? And that if we can't, if we depend on somebody else and hey, somehow we're weak. And that cultural understanding, I think is at the root of a lot of our pain.

51:09I think a recognition that in fact, we evolved to be interdependent and that that's actually a source of strength and nothing to be ashamed of, has to be at the heart of what we re-embrace here. Because the reality is that like thousands of years ago, when somebody operated with that assumption that strength is going on your own and making it all happen by yourself, like that person got eaten by a predator or starved because they didn't have enough food, right? And the truth is that even though that was thousands of years ago when we were hunters and gatherers, like our nervous systems are very similar to how they were back then.

51:42Our circumstances have evolved a lot, but our brain and our neurological systems are very similar so that when we're separated from our tribe, when we're feeling lonely and isolated, it actually puts us physiologically in a stress state. And when we are stressed chronically, that increases levels of inflammation in our body contributes to heart disease, to other chronic illnesses over time. So whether it's in parenting or other forms, this notion of moving toward interdependence is really vital. And to bring it back to parenting, this is why I think one of the things parents are struggling with is they're caught in a system that tells their kids that success is about individual accomplishment.

52:20How much can I stack on my resume? What kind of school can I get into? What kind of project can I lead? What kind of organization can I found? I was with a friend the other day who was a senior who was applying to college and also has a daughter who's younger and in high school. And they were telling me, you know, it's not good enough anymore just to be well-rounded to get into a really good school. You've got to really spike at something. I said, what does that mean, spike at something? And I said, well, you know, you've got to really dig deep and differentiate yourself in some way. And they gave me some examples of like somebody who would like, one of their kids' classmates would like started like a national organization, you know, focused on a particular issue that they cared about, or somebody who had put together like a global conference, you know, on an issue that they cared about.

53:06And look, props to them. That's wonderful to start an organization or, you know, organize a conference. But the notion that, you know, stacking that kind of increasingly, you know beyond your reach individual achievement is the only path to success and happiness that is driving parents and kids to a place of extreme distress and is I think really detracting from their mental health and well-being so yes this is part of the culture we have to change and one person of their own I understand it's hard to say hey you know what I'm not going to follow that that system anymore because as much as parents and even young people don't like this system that equates success or, you know, with fundamentally wealth and power and followers, even though they don't like that, they don't want to be left behind either.

53:53Yeah, there's no real opting out of it. Yeah, it feels like there's no alternative to them. There's something acutely American about all of it too, this idea or importance or emphasis on personal resilience and self-sufficiency. And it's also an illusion because anyone who's successful is a product of a lot of support in many different ways. Like, you know, this myth of like greatness, you know, sort of emerging out of just one person and their, you know, mission to do something extraordinary is basically a lie anyway. You know, like, so it's all premised on its own foundation of sand, I suppose.

54:33and the pressure on the parents to raise a kid to succeed within this system. And then the pressure that the kid has to shoulder at a very young age to be essentially extraordinary, even have access to education and opportunities is a disease fundamentally, right? Like everything is upside down in that regard. And yet we have parents stressed because it feels like an indulgence for them to put their oxygen mask on first before they put it on the kid because we're so worried about our children and it's an unsafe world and we wanna protect them and we wanna set them up for success and do all the right things.

55:16It's a setup for failure that even for people who have all the resources and do have enough free time to devote the emotional mindshare to raising their children is going to be extraordinarily stressful. Yeah. And even though it seems like a really big problem to change, Rich, because you're talking about shifting an entire culture, right? Here's actually how I think you could start, specifically when it talks about talking about the culture of achievement for kids, what has sadly become, I think, a very toxic culture of achievement. If you had the... top 10 or 15 universities in the country, and the top 10 or 15 workplaces in the country in terms of like number of young people that they recruit, like let's say in a given year.

56:01And if they came to an agreement that they were actually gonna fundamentally change their criteria for admission and hiring, right? Such that rather than prioritizing these elements that we're talking about, are you spiking, quote unquote, spiking at something? Like, are you achieving more and more just for yourself? Instead of that, if they were shifting to thinking about what are you doing in your life to actually serve other people in your community? What are you doing in your life to cultivate healthy relationships and contribute to a sense of connection in your broader community? How are you thinking about your sense of purpose in terms of how you ultimately contribute to the lives of others?

56:41What we know is that those three elements, relationships, purpose, and service, that those are the triad of fulfillment that stand in contrast to this triad of success. And when people are fulfilled, they do better in all dimensions of life, including their health. But until the places that are essentially driving these criteria change, like their admissions and hiring criteria, if they were able to do that, that will send a very strong message to others that this is a direction we need to start shifting in. So universities over time gained a sense of pride over their exclusiveness, right? They would boast about how low their admissions percentage was, as if that was a good thing.

57:25But rather than closing the doors so that the opening is so narrow, universities should be in the business of opening those doors up more. The universities that I have attended, and I've been lucky enough to attend, have massive endowments. Yet their class size hasn't really changed all that much over the years. Why is that? Why aren't we opening the doors wider so more people can study in universities and can actually focus on the elements of life that truly bring fulfillment, like relationships, purpose, and service. So these are choices. Culture flows from the choices we make as individuals, as institutions, and the leading educational institutions and employers in our country have an opportunity to not only shift that criteria for the well-being of students and young people, but that ultimately will help them as well.

58:14because one of the great drains on economic productivity for businesses is actually the mental health strain that so many employees are under. It contributes to absenteeism. People drop out of the workforce. It's a serious, serious issue and costs employers billions overall. So this is an area where it's not only good for society, but good for businesses and universities, but they could help be the tip of the spear when it comes to changing this unhealthy culture of achievement that we're caught in. Universities are essentially luxury brands and their value proposition is exclusivity, right? It's brand recognition.

58:50And what they're selling is like access, like membership to a club that provides you, you know, provides doors to open for your future. And I feel like the pandemic provided an unbelievable opportunity for a seismic shift in that when all of learning went online. That was the moment in which these universities had the opportunity to broaden access to what they were providing. I mean, truly they're public utilities, right? And if they were community-based and oriented around what is in the best interest of the next generation and also our country's best interest, why couldn't they have offered like sort of tiered access to education based upon these digital platforms where they could have taken, I guess, take a prestigious private university and said, well, we usually accept 1500 students or whatever it is a year.

59:49You could make that 50 ,000 or 100 ,000 and price it according to digital access versus like on campus or whatever. And none of that happened. And I thought it was a massive lost opportunity, but they're all about protecting their endowment and maintaining the luxury status of the brand. And so that's certainly something that's upside down. It is. Especially on a state school basis. Yeah. Well, most of these educational institutions are nonprofit organizations that have tax exempt status, right? And that means that fundamentally society is supporting them. And so the question is, are they doing enough to support society?

1:00:30And that's, I think, the fundamental question that we have to ask. There are some places, I was talking a few years ago to President Michael Crow from the Arizona State University, who's actually taken a very different approach than most of his university peers and said, we want to blow the doors as wide open as possible to allow people online, in person, people who have families, people who are single, people who are young, people who are old, to all participate in getting a good education. because that's what a university should be about. And we need more people who are taking that kind of approach more broadly.

1:01:02But look, I think that the bottom line is, this is a moment where we find ourselves at a time of great pain and division and polarization, but also great unhappiness and dealing with fundamental physical and mental health challenges where every institution needs to be asking itself, what can I do to rebuild the fundamentals of community in people's lives, because that is a foundation for health, happiness, and fulfillment. What can I be doing to do that? And if we ask that question, then I think we would operate very differently. Like I think workplaces, for example, would find that being able to structure opportunities for people in the workplace to hear each other's stories and understand each other is good for their health.

1:01:48And it's actually good for the business. People who are engaged and connected at work are more productive, more creative, They have just greater degrees of engagement and they tend to drop out of the workforce less. They would also think about what can we do to bring folks in the workplace together to actually serve our community on a regular basis, recognizing, again, good for them, promotes team bonding, good for the community as well. In our schools, we would think also about how do we build relationships and services as part of the educational experience. If the point is school, and I'm talking about grade school as well, the point of grade school is to give kids a foundation for a healthy and happy life going forward.

1:02:25Then one of the skills that many kids find themselves without is the skills to actually build healthy relationships. Like you and I didn't grow up as digital natives, right? But for a child who's growing up today as a digital native, whose parent, let's say, might be struggling with loneliness as the way a third of adults in America are today, that child may not necessarily automatically come into the world knowing how to build a friendship, how to start a conversation with a stranger, how to deal with conflict when it arises. And this is why when I last year was traveling to universities, I would hear from university administrators that kids didn't know how to have conversations with each other.

1:03:01There were schools that were trying to train students on how to have a conversation with your roommate about things like, I'm messy, you're neat, how do we manage that? I get up early, you get up late, how do we manage that? because there just wasn't comfort in dealing with conflict. And even the students themselves would tell me, hey, how are we supposed to talk to each other when it's not the culture anymore for people to start conversations with each other? And I initially, when the first time they said that at university, I was like, wait, what do you mean? It's not the culture for people to talk to each other.

1:03:27They're like, yeah, it's just, you know, everyone's got their earbuds in, they'll have their devices and like, you know, people just don't talk to each other in person anymore. I even brought this up in my office recently because we were chatting, we were having a conversation about online dating actually and about just dating in general and how challenging it is these days. And one of the women in our office who was in her 30s, she said, I just wish that people would just come up and just have a conversation and approach each other these days. And the folks who are in their office in their 20s actually turn around.

1:03:56They're like, that's just really strange. We don't know anyone who does that. Like that's not how people operate. That's so amazing. And so this is very generational, but I don't actually fault young people for that because the digital environment they're growing up in, it's just fundamentally different. from ours. And so I think we can't assume that those are skills, social skills that people just are born with and they develop automatically. We have to cultivate those in school. And if we don't do that, then what we'll see is what we see today, which is increasing discomfort with in-person social interaction, challenges with developing relationships and managing conflict, and then a widening epidemic of loneliness.

1:04:32But with every such challenge, therein lies the opportunity. And I think it is a unique moment in which we do need to, and perhaps there's receptivity to really looking at how we're educating young people, especially at the grade school level. Because now that we do have these devices, the ones that make it hard for us to talk to each other, they also are repositories of, you know, all facts in the universe, right? Like, so, you know, do we need to be teaching young kids in the same way we always have when we have these super computers in our pocket that can answer every question that we could ever ask it?

1:05:11What we actually need to do is teach young people, not only how to communicate with each other and some basic social skills, but how to operate within, you know, group dynamics and how to, you know, engage in conflict resolution. And perhaps most importantly, how do you develop a relationship, a healthy relationship with your own mind and your interior self? and we've seen some of that, like we have mindfulness or meditation, but I think like just the idea alone that you're responsible for taking care of your interior self and teaching young people how to engage in that conversation with themselves.

1:05:58I mean, imagine the positive domino effect from that, given the fact that your focus is on these kind of foundational elements. But if you can start kids off right with really well dialed in programs and curriculum around like what that looks like at that age, I think would just be seismic. It would be absolutely seismic and like quite literally foundational, right? Because the one thing we know for sure is that at some point in our life, we're going to be on our own, alone, like physically alone without people around us. And the question is, are we comfortable with that or not? You know, when I was growing up, you just had to be comfortable with that because you would figure out how to be because that was just life.

1:06:43There were times where you were just on your own waiting for a friend or waiting for the bus, you know, waiting for, in my case, your parents to pick you up from school. Now, these days, all the white space in our life is filled with our devices, right? Because we can pull them out very easily and just check email, message a friend, check the news. But it's reached a point where I think people have actually become quite uncomfortable with being alone. And there's really important stuff that happens, like when we are alone, like that's when we can reflect. It's when we process stuff that's happened.

1:07:12It's when we may have creative ideas or thoughts. And if we don't have that alone time, if it's squeezed out in our life, then that means we don't have that really important time to reset, reflect, and renew. In many ways, like that's an analogy is to sleep, right? Like we used to think, ah, sleep is expendable, right? It's like, you know, sleep when I'm dead. That was a very popular saying back in the day. But now we've realized in recent decades that actually sleep is vital for your health and wellbeing. And it's so critical for everything from the processing and consolidation of memories to the health of your brain and the rest of your body.

1:07:46Sleep is vital for your health. In that same way, healthy alone time is important. It doesn't mean you necessarily need a lot of it. And we may differ in how much we need depending if we're introverts or extroverts. But I always tell people that the secret to building social connection is often in the small things in life. It's do I take five minutes a day to reach out to somebody I care about just to say, hey, I'm thinking of you? Do I make sure that I'm fully present when I'm talking to somebody else and I'm not distracted by my devices? Do I make sure that I'm doing one thing to like help somebody each day, recognizing service is the most powerful antidote to connection?

1:08:25But the fourth thing actually is around solitude. Am I spending just a few moments in a day by myself. It could be allowing the breeze to just blow against your face and sitting on your front step. It could be walking through nature. It could be a few minutes in meditation or in prayer. It could be a few minutes listening to a song that really inspires you or stills you. Whatever it might be for you, those few moments of solitude, that is when we ground ourselves again. It's when we have the opportunity to let the noise around us settle. And it's all the more important today because there's a lot of noise around us, things coming at us all the time, information, stories, all kinds of things.

1:09:05And without that time to really settle, I actually don't think that we can be our best selves. We need that to just like sleep, to help strengthen our foundation for wellbeing. Yet another something that we have to exert great energy to do that just came naturally as a product of being in a body. It did, but that's one of the things I realized when I was first in medical training, Rich, and as I realized, you know, you're taught in medical training to counsel patients about certain lifestyle changes, right? To improve their health, be around physical activity, changing their diet, whatever it might be.

1:09:41But routinely it would happen that I would see a patient and I would talk to them about that. And the next time they would come back, I'd say, well, how did it go with being able to change your diet or being able to walk, you know, every day after dinner? A lot of times we say, ah, it was really hard. I couldn't actually do it, you know, and we would try and struggle and it'd be tough. But the one big thing I found made a difference was when people did those things in partnership with somebody else. So if they had a friend who they decided they were gonna go to the gym with, or even if they weren't gonna do a gym together, if they both agreed they were gonna get on a gym plan, right, and they helped keep each other accountable, that was very different success rate, much higher, right, than trying to do it on your own.

1:10:17So I think with a lot of these things, whether it's reforming like how we engage with our phones and with social media or making it a priority to reach out and connect with somebody each day or to do one small thing to help somebody, whether it's keeping that five minutes for a solitude each day. If we do these things with someone else, if we make a pact with somebody to do that, it helps a lot. That's what I did in my own life, actually. I was really struggling with a lot of these things and occasionally still do, in fact. But I have two guy friends. We call each other brothers because we've become brothers over time.

1:10:49But we decided that we were all struggling on some of these areas and we needed to help each other. So we make pacts with each other that we're gonna make certain changes. One of them was a couple of years ago, I was actually, I needed to have some surgery on my hand. And they said to me, they said, okay, for the next day and a half after the surgery, you're not gonna be able to type or do very much. So that's a chance to like make a shift in your life. What do you wanna make a shift around? And I said, well, you know, I feel like I've been, I don't know, I check social media too often, just lose time on it.

1:11:20Like I'm busy. I don't have time for anything, but yet somehow I find myself furthering time away on social media. I'd like to maybe re-engineer my relationship with social media, maybe stop checking, you know, my, my, my personal accounts. And they said, okay, okay, well you'll do that. And, uh, and in fact, we'll do that together. And I had tried to do that before, by the way, and failed multiple times, but because of them, this time was actually different. They would text me, periodically, how's it going? I'm like, I don't know. I think I sort of almost went on the thing that they said, delete your app, delete the app from the phone.

1:11:50Just make it increase the barrier to your actually doing that. But they stayed on me, they kept it up and I did that for them too. And I will say that what I realized in the weeks and months afterward is that not only did I have more time that I could put into my family and into work, but I actually found myself reading more, like reading books, right? Which that all the time had like just dissipated in my life because I was always on my device. So all that just to say that there's no shame in leaning on other people and making these sort of packs with others when it comes to changing our behavior.

1:12:22Because it's really the small things that make a big difference. And that five-minute call, that five moments of solitude, when we do that consistently, that can make all the difference in how we feel on a day-to-day basis.

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1:14:19It's so interesting that our uncomfortability around being with ourselves, the idea that it's so difficult to be alone and we don't have to anymore because we have these phones is actually what's driving our loneliness. You know, there's a beautiful irony in that. But yes, like accountability is of course fundamental to any kind of habit change and making it stick. But the real magic there is that it's also a recipe for connection with other people. So it strengthens your bond with your friends, right? And I think there is, you know, amidst this epidemic of loneliness, something that's unique to kind of men of an older age, like I'm older than you, but like when you reach a certain age, like I feel like women are better with their friendships than men are.

1:15:10And just maybe it's a cultural thing or the way we were raised or our notions around masculinity, it becomes very difficult to maintain those friendships that you always had. And even more difficult perhaps to like make new friends, right? And so I'm interested in your thoughts around that and if there's any research or science to kind of support that inclination that I have. So you're absolutely right that loneliness is a huge challenge for men. Women are better at relationships, generally speaking, than men are. Better at staying in touch with people, better at seeking each other out. It doesn't mean that they don't struggle with loneliness, they absolutely do.

1:15:51Interestingly, the surveys show that men and women struggle with loneliness at equal proportions. I actually think that it's probably in reality higher for men, because I do think there's a greater discomfort and even admitting, even on anonymous surveys, even admitting to yourself that you're struggling with loneliness when it comes to guys. So I think what I have found in the lives of men is that there are a few key things that often trigger acute bouts of loneliness, the loss of a spouse, illness, retirement. Those are three big ones among older men. But as men just get older in general, and as they get out of college, for example, and lose a built-in community, sometimes that you have in high school or in college, that can start a very lonely journey in their life, especially if they don't have of a community of friends at work.

1:16:44And I think that's compounded by the cultural expectation that we've placed on men, that somehow being a real man is about not needing anybody else, right? That notion is fundamentally flawed. It's inconsistent with human development and evolution. But also it, I think is sort of premise on this idea that strength is about not needing other people. And I think fundamentally what we have an opportunity to do is to redefine strength, not as the kind of independence that doesn't require others, but as interdependence. And when I think I was telling my team earlier that I've been away from my son and my daughter for a few days, almost a week.

1:17:23They went ahead early with my wife to be with my mother-in-law and father-in-law, my sister-in-law for the Christmas holidays. And I had work and stuff, so I had to stay back. And so I really miss them. And I talk to them every day and we go through all the things we're going to do together when I finally join them at the holiday. But I told my son, I said, you know, one of the things I want to do when we come over, and my son is eight years old, I said, I want to go on a walk with you. And he said, okay, we can go on a walk. And my wife Alice is like, oh, you just want to go with him? I said, no, I'll go on a separate walk with our daughter.

1:17:55I was like, but I want to have a conversation with him about being a man and about what that means. Because he's already getting messages at his age from his classmates and others about what being a guy is all about. But I want him to know that this notion of independence and interdependence, I want him to know that it's okay to depend on other people. It doesn't make him any less of a man. I want him to know it's okay to express what he feels, you know, and to lean into friendship, to take initiative in connecting with other people. And that's not a sign of weakness. When I think about what it means to be a man for me, what my father taught me when I was growing up, he taught me actually what I think has been associated with manhood in different traditions in different cultures for centuries which is that it was fundamentally about honor that it was about upholding values that it was about taking care of people who were vulnerable it was about taking care of your family it was about generosity and it was about kindness these are the things my father taught me that were about being a man.

1:19:04It wasn't that you could get angry if you wanted to. You could hurt somebody if you wanted to, sure. But it was choosing to be kind and generous, choosing to take care of others, choosing to uphold these core values and virtues around love and generosity and kindness. That was a kind of manhood, the concept of being a man that my father taught me about, that I wanna teach my child about. And when I look at men around the country and around the world that I admire, I often find those qualities in them as well. And so I am worried about what's happening with young boys and men in society today. I think many of them feel alienated, cast out, like they don't matter, like people don't care about them.

1:19:45And I think we've got to listen to that feeling. I think it's real. I hear it all the time. But I think some of it also is rooted in this deeper isolation and loneliness that many men are feeling. And I think we have an opportunity to rebuild community for boys and men and to do it around a model of manhood that can not only help them, but can strengthen society more broadly. It's not easy to do, but this is the right moment, I think, to do it. Within that, we have social media and the kind of incessant messaging that is part and parcel of what we've kind of collectively decided is important in terms of what it means to be a man.

1:20:31And that revolves around your accumulation of material goods, power, property, and prestige. Like this is how we grade and calibrate your ability to measure up to some kind of masquerade of masculinity. And I think when you expose that to young men who are lacking an opportunity, it creates a scenario that is gonna lead to kind of toxic outcomes. And that's the thing that concerns me the most. Like how do you remodel masculinity in its healthiest form, which is strength and sort of celebrating the best of what men have to offer, but in the healthiest way. Power exerted for the benefit of others, being devoted to your community and principles and values and your family and all the things that you shared.

1:21:23And I feel like we've sort of gone astray from that. And I think a lot about like how I can model that in the show that I do and sort of set an example for the next generation of young men. But the problem is the social media algorithms favor, you know, the other version of that. And that's what young men are being exposed to, the loneliest of young men. Yes, I think you're right. And that's, I worry about that too. I think what we need, we need to build in-person community for young men. There is no substitute for being in person. And in the absence of in-person community, young men and boys are spending more and more of their time online, where I do think, yes, the algorithms often amplify things that are not necessarily the best about humanity and give them, I think, a distorted version of what being a man is about.

1:22:13I like the way you put it, property, prestige, and power. The challenge, I think, with what has happened today is not only that we've equated that with being a man, we've equated that with self-worth fundamentally, right? And so young men who may not have a lot of money or be famous or powerful feel like they're not worthy. Their life has no value. And what a terrible, terrible way to feel, right? And I think about so many of the young men that I've spent time with over the years who are desperately trying to claw their way back to some sense of meaning or value in society because they don't have those things.

1:22:50And I think what I desperately want them to know is that their value is intrinsic. It's in their ability to give to others, to support others, to be there for others, to care for others. They were born with that. They have the ability to express that at any point. And that is where their value comes from. It's not from what's in their bank account or how many followers they have online, but that is a message that we've got to shift and change. I think you can shift these more easily in person. which is why I think that we need to think, how do we rebuild actual gatherings and moments and experiences for young people that can bond them to each other and help reset the norms and what it means to be a man?

1:23:35Those qualities are naturally emergent, healthy qualities of participating in a healthy community. That's right. In a person community, all of which is kind of leads up to this parting prescription for America, right? That you're like, by the time this comes out, you will have shared publicly sort of your kind of culminating thoughts on, you know, what you want to leave, you know, behind as your final words as you exit office, like this idea, this call towards community. So maybe explain the idea behind this. I mean, we've already touched on a lot of these ideas, but. Yeah, I decided to put this parting prescription together, Rich, because I was reflecting on everything I've learned over these two terms, everything I've been taught by people across our country and really around the world.

1:24:24And it was part of a larger journey to understand what the deeper roots of pain and despair were in our country. And what was really revealed to me through this work, these conversations, the scientific research, conversations with experts so much, was that there are three fundamental components of our lives that fundamentally matter to our well-being and our health. And they've been eroding over time. And those are relationships and purpose and service, those three components. And when we have those, we have a robust sense of community. But the call in this prescription is to now revitalize those three elements, to reground society in them, to build our lives around them, to ask ourselves, how can we connect more deeply with people?

1:25:06How can we do one small thing to help somebody each day? How can we ask ourselves, where do I find meaning in my life? And how can I lean in more there? Whether it's in raising my child or whether it's in, you know, helping take care of people in a hospital or whether it's contributing to the world in some other way. That is our challenge today. It's to rebuild that foundation. Everything else in society is built on a foundation of community and community is anchored in relationships, purpose and service. And I came to this in part, actually, just reflecting on a story that my father shared with me like years ago.

1:25:41He once out of the blue, surprisingly, told me, he said, you know, I never really felt that sense of emptiness or loneliness until I left my village in India. And my father grew up in incredibly poor circumstances. They didn't have enough money to buy shoes or slippers. So he was barefoot most of his childhood. They didn't have running water or electricity. They didn't have enough money for dinner around the table each night. but even though he lacked so much in material terms, in the village, people knew each other, not just their names, but they knew their stories. They chose to spend time with each other.

1:26:15If you were in distress or needed help, people would step up and help you, whether you needed a meal that night or in my dad's case, when he lost his mother to tuberculosis when he was 10, people in the village stepped in. They became surrogate parents. And every day people woke up with a purpose in mind that involved contributing to the village. Some of them were growing crops so that everyone could eat. Some of them were protecting the village in other ways. Some of them were raising the kids in the village or teaching them in the schools. So that actually made his life deeply fulfilling, even though, yes, there was more that he wanted.

1:26:48And that is why I came to see, and I lay out in this prescription, that we have two triads that we have to choose between here. The triad of success, which is grounded in power and fame and wealth, and the triad of fulfillment, which is grounded in relationships, purpose, and service. And there's nothing wrong, by the way, with making money or being famous or being powerful. Nothing wrong with any of that at all. The problem is when we assume that those three are the determinants of our value, when we think that those three are the key to fulfillment, because the truth is they're not. And plenty of people have all three of those and are profoundly unhappy.

1:27:29So I lay out in this prescription a series of steps we can take as individuals as schools and workplaces, as government, as society more broadly, to move the pendulum away from that triad of success, toward that triad of fulfillment, to rebuild community in America. And I would love, Rich, if this could be the example that we set for the world. If America leads in how to rebuild community, how to bring people together to achieve extraordinary goals, do incredible things in the world, that would be one of our greatest exports. It really is at the very core. It's at the base of this pyramid, right?

1:28:07This foundation. Our declining investment in community is really at cross purposes with everything we need to be able to thrive. And so as much as what you're saying is diverting attention from quote unquote success to this idea of fulfillment, to me, it means redefining the word success itself or just understanding the true meaning of success, which isn't power, property, prestige, fame, all these things that we've talked about, but is your investment in your community. because ultimately success is feeling fulfilled. It's feeling purpose-driven. It's having direction in your life. Like all of these things that we want, we've just deluded ourselves into believing that the way to get them is through this traditional idea of success.

1:28:55When all along, we know through millennia of human evolution, that it's a product of our investment in our communities. That's what we've lost sight of. So it's almost like a reclaiming of what we've already, we've always known. That's exactly right. And this is what happens in humanity, right? Like we go, sometimes we fall off the path and we have to get back on the path. This is my life. It's like in the micro of my life too, right? And this is actually gonna happen in all of our lives and we're gonna be clear on what really matters and something is gonna pull us off in some way. We're gonna find ourselves chasing something that actually doesn't truly make us happy, but we thought it was what was valued and by society.

1:29:36But this is our chance to get back on that track and just to recognize that success without fulfillment is not success at all, right? If we're not fulfilled, then we haven't done what we need to do. So this is, as you said, about redefining success and about recognizing what really matters. Look, at the end of the day, I don't know what my kids are gonna do. You know, I think most parents can't predict exactly what their children are gonna do. But I suspect what every parent wants at the end of the day is for their kids to be healthy, happy, and fulfilled. Those three things we want for our children.

1:30:09And now we know the key to how to get that. We know that the key to health and happiness and fulfillment are the relationships they have and service or engagement and their sense of purpose in life. Right now, the majority of young adults, 18 through 25 in America, say that they don't have or have very little sense of purpose or meaning in their life. 58%, right? We have to change that. You know, we want people throughout their lives to feel like they're part of a community, to know that their self-worth is rooted in these intrinsic qualities, their ability to be generous and kind to others. The great thing is when you operate from that perspective, you can actually create so much more in terms of wealth and power and fame and all of these other material pursuits that you may want because you're functioning from a place of strength.

1:31:02And that's really the key here is that community is our great source of strength. It's weakened over time, but we are now called to rebuild it. And that's what we have to dedicate ourselves to. Yeah, on a practical level, just sharing like my own kind of struggles with this. And I'm sure this is like relatable to a lot of people. Like, yes, I understand that. I get that. I agree with you. I know that's correct. But let me just put that aside because I'm climbing this ladder over here. and when I get to the top, then I'll turn my attention to other things because I think they're important. But like, there's only so many hours in a day, I gotta put bread on the table and I'm just shy of getting that promotion and like, I just need to focus on that.

1:31:46Like, this is the reality of it, right? So on some level, the onus is on us. We have to shoulder our own responsibility for community building. And it's difficult because you are kind of having to buck a system where all the incentives are pushing you away from this idea. But we also need, as you point out in the prescription, like we need government, we need the private sector, we need everybody to like kind of contribute to this and fix this alignment problem so that we're establishing incentives that are moving us in the direction of community building rather than away from it. We have to create the ecosystem that makes community more feasible and possible.

1:32:26One of the things I'd love to see, Rich, is a generation of entrepreneurs who see themselves as community builders, who are trying to create the products and services that actually bring us together in person, that help us learn about each other's lives, that bring us together to work in service to our community. Like, how can we do that? You know, how can we use technology and creative ways to do that? Because at the end of the day, I don't think technology in and of itself is evil or bad. I spent seven years in my life building a technology company myself before I was Surgeon General to actually help advance clinical trials.

1:33:02But it's helped me design and use technology that ultimately makes a big difference. But if the idea of building community can be something that inspires our entrepreneurs, that inspires people who are running workplaces now and teaching our kids in schools, then we can start to change that ecosystem around us. Because it does take, we have to make it easier to do the right thing. And again, I think just to be really practical as well, Well, for that person who's got one more rung to climb in the ladder to get their promotion, I think the message of our conversation isn't that that's not important, you know, or that you shouldn't climb that rung and get that promotion.

1:33:36You know, I think if you want to do it, you should go for it. The key, I think, is to recognize that those promotions and what we build onto our resume, they're important, but they don't define who we are or are worth and that the greatest drivers for our fulfillment are in our relationships and service and purpose. And the final thing I need to say about that is that the pathway to building community in our lives does not have to be incredibly onerous. It doesn't have to be, okay, now we've got to quit our job and like move somewhere else and spend 10 hours a day, you know, like talking to our friends on the phone.

1:34:11Like that's very hard to do, those kinds of changes. But to me, what is actually very attractive and what makes me optimistic about building community is that it's in the small small things, small actions we take each day that we can actually really robustly build community. It's like if you laid a brick every day, you know, for a few years, you could build a pretty extraordinary house, right? In an even more powerful way, it's that five minutes reaching out to a friend or five minutes helping somebody each day that can start to build what can be an incredible community for you. It's a decision where you say, you know what?

1:34:46We're gonna have dinner tonight anyway. I'm just gonna tell these friends just come over and bring whatever they're eating over and let's just eat together. Right, these are your connection recipes. Yes, yeah. And in fact, because a lot of people had barriers to connecting in person, we put out this booklet called Recipes for Connection, which was not actual recipes for dishes, but for how to gather, recipes for how to gather. And I did one of these actually recently with a group of friends who are chefs and we gathered around our childhood favorites. That's one of the things we suggest. And so we each brought a dish that we loved when we were kids.

1:35:21And when we came together, not only did we really enjoy the food, but it was also a chance for us to learn stories about each other's lives. Like I brought a dish that was a dessert, an Indian dessert that my mother made called Ras Mala. She made it when I was growing up a lot. And even when I was making it, I was like thinking about my mom. I actually called my mom for the recipe. When I got there, I got to tell them all about my mother. I learned about their families and didn't take much time. Everyone brought something. we fed each other, but what a powerful way to just gather. So it takes some activation energy to do this, but it doesn't have to take a lot of time.

1:35:55And the more we do it, it's like building a muscle. Our social muscle, our community muscle gets weak over time if we don't use it, but it gets stronger over time when we use it, just like any other muscle. And I would just love to see us develop a new generation of what I think of as communitarians, people who recognize the power of community are committed to building it in their own ways in their lives. And that will help us invest in it, you know, as a society, and that will leave us stronger, healthier, and happier, I think, than we've been in a long time. We're craving it. We're starving for it.

1:36:29We all know we need it. And I think we are, like, I'm optimistic about this too. I think we are seeing changes. And there are change makers out there across, you know, all disciplines who are, are taking this to heart. Like, did you see Ev Williams, one of the Twitter founders just launched this new app called Mosey, which is basically like the anti-social media app in that you use it to, like it uploads your contacts. And then if you're going to visit a city or whatever, you can see like, you could tell your friends that live there that you're gonna be there or something. It's like you can kind of pre-plan real life connections to coincide with your travels or you get an alert with somebody that you haven't talked to in a long time because they're gonna be coming through your area like next month or something like that to create those like real world kind of connections and get us off our phone, but using the technology to drive that.

1:37:28That's exactly right. If technology can make our in-person interactions easier, it can be an incredibly powerful tool, right? If it can help us, help clue us in when a friend might be in need or help clue us in when something's greatest happened in a friend's life so we can show up for them or visit them in person. Yeah, it could be incredibly helpful. But what matters here is really the, our goal needs to be very clear, like as we develop these kind of products, right? Which is, I think initially in the world of social media, the goal initially seemed to be building community. And then over time, like it became so driven by a revenue model that was tied to maximizing engagement online, right?

1:38:08Not how much often are you getting together, but maximizing online engagement. And that ended up driving a whole series of changes, which I think has actually led us away from the kind of community that we really need. So this is about being clear about where we want to go. I think all of us want to go fundamentally to the same place, which is that we want to be happy and fulfilled. We don't want to be alone. We want to be with others. But I think that we've been using the wrong map. And we're working really hard, but it's leading us in the wrong direction. there's a chorus to this idea of building community that you keep returning to, which is these three prongs, relationships, purpose, and service.

1:38:47And when I think about that, I can't help but reflect upon a different version of that. Like I think I told you last time, like I'm somebody who's in recovery, I've been in recovery for a long time. And there are three very similar principles to Alcoholics Anonymous, which are unity, recovery, and service, which are only, it's just a twist on exactly what you've been saying, but that's the core foundation of this program, which is an extraordinary community without any kind of organizational structure to it that somehow magically has not only survived for many decades, but has grown and thrived.

1:39:26And at the center of it is this idea that we are a community. We know what our purpose is. Our purpose is to stay sober and to help another alcoholic achieve sobriety. And it's all about service. And these three ideas, which form a triangle surrounded by a circle that draws it all together is basically kind of like the mission statement of this organization and the essence of the energy that infuses the program itself. And it's so similar to like what you're talking about. And it's a template, like it's here and it exists. And it's one of many communities that I'm a member of, but perhaps the most important community, because if I don't have my sobriety, I don't have anything else.

1:40:13That is so powerful, what you just said, and I think helps explain why AA is such an effective force in the lives of so many people. When I think about my friends who regularly attend AA meetings, it's so clear that they draw so much strength from those gatherings, right? And I have one friend in particular who goes to different cities, he travels a lot, but he'll find an AA meeting wherever he is. And even though he may not know the people, you know, because he's in a new city, those three values that you mentioned are anchored into every gathering. And, you know, in that way, I think AA has done a great service, not just to the people who are part of the meetings, but to society more broadly, which is demonstrating that these three core values can be a source of healing in our lives.

1:41:02You don't need expensive technology or tons and tons and tons of time. I'm like, it's building a community around those core values can make all the difference in the world and can give people great strength. So I think the world has a lot to learn from the recovery community and for me in particular on that front. I think within that also is this idea of interdependence. Like you cannot get better until you get over yourself and kind of surrender your self-obsession to a group consciousness. It's like letting go of like your idea of who you are in this like self-sufficiency, you know, myth and letting people in with humility and honesty and vulnerability.

1:41:45And what I've learned over many, many years is, is all of these things that, that we keep bottled up and protected and repressed within us out of fear, because if they really knew who we were, you know, like, which is very much, you know, part and parcel of a toxic version of masculinity that's driven by fear. Like, I need to comport myself a certain way in the world so I'll be accepted and I can achieve these goals. And God forbid, I tell them about my weaknesses. And what you discover in this kind of journey of recovery is that strength is a product of, strength is correlated to the extent to which you're willing to be vulnerable with others.

1:42:26And that vulnerability and that honesty that we so fear is actually the connective tissue that we need that keeps that community so closely aligned. Like it is that honesty that is the stuff of intimacy. And when you kind of get over your ego and your fears and your guilt and your shame, and you let go of all of that and you let people in, that is the place from which true strength emerges and a sense of self that is independent of property, power, and prestige and whatever machinations of the ego have traditionally led you astray. And I think there's real magic in that. And to the extent that someone like yourself, who is in, you know, an extraordinary position of privilege and power has modeled like very gracefully and beautifully, but we need more of it.

1:43:12You know, I try to do my part with this podcast by being an exemplar of that to show an aspirational way, like what that can look like in these conversations that I have. Which I have to tell you on a personal note, you do that really, really well. You know, I've listened to many of your episodes now over the last few years. One of the things that comes out is not only your kindness towards your guests and your thoughtfulness, but it's your honesty. You know, just how open you are about not just the good, but particularly about the hard parts of your life. And one thing I'm curious about maybe to ask you is when you first, it seems clear that you resonate deeply with that aspect of AA and AA, the vulnerability, the openness and honesty.

1:43:56Was it hard to sort of get to a point for you like where you embraced that? Did you initially push any of that away? Oh, of course. And how did you make that transition? Well, mine, like many in that program, is driven by fear. Like when you're backed up against the wall and there's nowhere else to go and you have no other choice, that's usually the kind of thing that can flick that switch. But once you get a taste of it and you realize like, hey, the water's warm over here, then you start to crave it and you realize like, this is what I need in my life. This is what I've wanted all along. And all of the, you know, alcoholism is a disease.

1:44:35The drugs and alcohol are not the problem. It's the emotional discontent. It's a disaffectation of the brain where you feel irritable and discontent and restless. And the solution is a spiritual solution that is delivered in community via intimacy, openness, and honesty. And so once you start to realize that, it becomes easier to kind of give yourself over to it. But yeah, you go into it kicking and screaming because who wants to stop drinking? Well, the alcoholics don't wanna stop drinking. I can tell you that. And I speak from my own experience. So yeah, it's difficult. And I think even for somebody who doesn't struggle with an addiction or has a substance issue, we all have a relationship with the fear of what might happen if we were to let someone in and tell them like, this is how I'm really living or these are the choices that I'm making or I keep struggling with this thing.

1:45:31There's a lot of shame and guilt around that. And we fear that if we open up about that, that we'll be rejected or shunned. And what makes Alcoholics Anonymous such an incredible community is that that's what's embraced. And so you go to these meetings, I apologize to people who are listening or watching because they probably heard me say this before, but it's worth repeating. You go to these meetings and there's a group of people and then someone gets up in front of that group and starts to tell their story warts and all. And they do it with levity and humor while they're telling the most embarrassing stories you can ever imagine that are utterly humiliating in every conceivable way.

1:46:13And instead of the group rejecting that person or sort of thinking poorly of them, everybody's laughing and hugging that person and celebrating them. And you realize like, oh, this is what, because we see ourselves, we all see ourselves. We get strength when we see somebody else who has liberated themselves from the prison that like your fear and your shame and your guilt creates for you. And you realize like, oh, there is a different way and there's a way out of that. And it's just incredibly empowering and also connective, right? And so to the extent that we can all kind of get over our own shame and guilt and open ourselves up to other people on a one-to-one basis.

1:46:56You know, that one-on-one conversation, like AA takes place in the conversation between one alcoholic and another. That is where recovery transpires. And you can scale that up into community, but it begins with you and me talking right now in an honest way where we feel safe enough to share our deepest fears with each other. And I think that that is what we're lacking right now and what we need. And really kind of like the, that's the double helix of community in its healthiest form. That's so powerful. I mean, what a way to help you deal with your fears. Can I ask you, Rich, if you feel comfortable sharing, is there something that you're fearful of now in your life that you're grappling with?

1:47:43I'm riddled with fear. Are you kidding? Anything you want to share? I think I am. It's interesting. I was talking about this with friends of mine who came on the podcast yesterday, who are also in recovery. And one of whom is a very successful person who's gone on this journey with power, property, and prestige and reached the top of the mountain and realized there's no there there, right? And I think I've been in a similar journey where I've gotten overly caught up and preoccupied with like what I do for a living, which has a lot of meaning and purpose. And there's a service piece to it and it's very kind of like nourishing to me in every regard.

1:48:28But there's an ego piece to it too, right? Like how am I measuring up to the other people who do what I do and why is that person getting that? And I'm not getting, like I can be as petty as anybody. Part of that competitiveness and that ambition is fuel to this engine that helps this thing grow and thrive. And that is meaningful for other people out in the world. but the cost of that comes at the intimacy of my relationships with the people that I care about most, right? And it's not like there's anything acute to address there, but there's certainly a low grade kind of chronic piece to it that I've long, you know, that I sort of for too long kind of compartmentalized.

1:49:11And I'm in the process of taking inventory of that and rectifying that. like getting back to what's really important, which is my recovery, my relationship to the recovery community, my marriage, my relationship with my kids. Like I'm a present dad, like I've been married for a long time and I have this incredible relationship with my wife, but I'm also intimacy avoidance. And I can rush off to work and lose myself and what it is that I have to do that day. And I think that's very human and normal. But after being with my wife for 20 plus years and having kids that are now kind of grown, it's an opportunity.

1:49:53How can I deepen my intimacy with my marriage? And how can I have a really enriching relationship with each of my kids? Like, that's what I want. Like I've now reached a certain level of success and prominence and my bills are paid and all of those things are sort of taken care of. I don't need to go all the way to the top to see there's no there there. I can be kind of on my way up and realize like I'm at a point in my life where it's like, what is enough and what's really important? And where have I not shirked, but overlooked a little bit too much things that I shouldn't have. And part of that also the vague is my friendships, that I've let kind of fall by the wayside a little bit, like a lot of men do, because you're focused on your career and whatever free time you have is devoted to your family.

1:50:40and there is a sense of loneliness with that. And I get nourished by having these conversations here, but if my social life outside of my family is relegated to like what happens at this table, like that's not great either, right? So these are things, this is kind of like where I'm at right now and trying to find a healthier, better way forward. And as somebody who's prone to extremes kind of fundamentally, like how can I find balance within that? because I know that my life could be more joyful. And I know that I could experience happiness more consistently and more intimacy with not only my wife and my children, but also my friends.

1:51:24And so I think all of this is available to me and their choices, right? And their choices that are within my grasp. So what is preventing me from making that choice? And where's my ego getting in the way and all of these sorts of things, right? And I think all this brings me to your recent podcast conversation with the fashion designer, Philip Lim. Yeah. Cause he was talking about all these very same things. And I thought it was really, I made some notes. I thought it was like really profound what he had to say because this is a guy, first of all, like kind of an unlikely guest for your podcast, like a fashion designer, you know, on house calls.

1:52:01But what a beautiful choice because here's a guy who had to overcome tremendous obstacles to even be able to make a living, let alone become such a successful creative. And what he talked about was how important creativity and play are. Like, I'm thinking, how can I get back to that state of play? Because that's where not only you're in your most creative place, but it's sort of a natural by-product of being as opposed to like this willful pushing, you know, kind of Western idea. And what was so interesting about him is that he talked about, you know, how he was nurtured and how his parents made space for him to explore, which I thought was really unique as an immigrant story.

1:52:54Like usually it's like, you're going to medical school, you're going, you know, like they wanted him to be upwardly mobile, but they provided that, they didn't laden him or burden him with expectations. And that allowed him to like explore enough so that he could be like who he actually is and express that and turn that into not only a vocation, but really kind of like a gift to the world. Yeah. Well, I'm so glad you listened to that episode. Philip is an extraordinary human. And this piece about play is actually so vital. I was just thinking the other day, So many of the things that we did when we were small kids, we still need to do when we're adults.

1:53:39And play is one of those. I think it allows us to open up our mind and explore and be creative in ways that get closed off too soon. It's one of the things actually I've been reflecting on as my term comes to an end and as I have to think about what life looks like afterward. And people ask me all the time, well, what job are you going to have? Are you doing something you're jumping into, et cetera? And the short answer is no, I don't have something I'm jumping into. I don't think I'll take a single job. I'll probably do a portfolio of things. Who knows? But in thinking about what Philip said, one thing that became clear to me is I need to be able to stretch my mind a little bit.

1:54:14I need to be able to explore, to be creative, to think and reflect without feeling like, oh, I've got to figure this out tomorrow. And I'm trying to take some of the lessons from that and also have that time to confront some of my fears too. I'm grateful to you for sharing some of the fears you're grappling with because I find myself grappling with some very similar ones, you know, and thinking as my time comes to an end and I contemplate a life after government, that part of I realize what I'm scared about, as you were talking, is part of me is worried about losing significance and relevance in the world.

1:54:51And it doesn't make me proud to say that, but, and I know my self-worth is not dependent on that, but that's part of me is like worrying, will I matter to the world anymore when I'm no longer in this job? The other thing I realized on the home front that I'm worried about is I too, even though I feel like I did a much better job this time than the first time I served in terms of managing and caring for my relationships at home, the truth is like a lot has still fallen on my wife to help manage with our kids because the demands of this job. and I find myself at times a bit scared about how to go and renegotiate all of that, like with my wife and think about how do I make up for this lost time and the burden that she's taken on, not a burden per se, but all the extra, you know, that she's done and what she sacrificed.

1:55:41And I know I need to do that, you know, and I need to figure out how to do that and how to do that well. So those are the things I find myself also worried about and fearful about, you know, I was thinking about when you were talking. But this conversation has reminded me that it's probably nothing more important to do than to grapple with those fears and figure out how to build the kind of relationship I really want with my wife and kids. And I have a beautiful relationship with them now, So, but I know that there's another level of depth and quality and intimacy that is there for me to have with them that they are hungry for too, that I now need to make time for and be intentional about.

1:56:33And I don't know exactly how to do all of that, but it is what I want to grapple with. Yeah, that's beautiful. I mean, it is that like tension between like, I need to be relevant. I was like, I plead guilty to that too, but everything that's pushing you towards like what you need to be relevant is moving away, is moving you away from that other thing that you're craving as well, right? And so this is, you're being pulled in these different directions. And I think what Phillip had to say, and in my own experience, this rings true, like the answers come, the more that you are able to like, you know, basically, you know, take your own prescription and, you know, find those moments of silence and reconnect, Like in that space, you're in this liminal space now where you're after many years, you're now like the choice is up to you.

1:57:22And there's probably a lot of people approaching you with interesting things that you could be doing to take that time and like reconnect with your why and what's important to you. And I just know that the more that you do that, like the better position you are in to make the right choice. And you'll know, you know, in that moment. And meanwhile, you can like peel that onion back and go to a deeper level of intimacy with your family and see the magic that emerges from that. Like it's an exciting time for you. It's a time of a different kind of opportunity, I think, for your own kind of like evolution and growth.

1:58:02Yeah, no, I'm grateful for it. And I know that I'll need help doing that. And the two brothers who helped me with changing my habits around social media, I was literally texting with them this morning because they knew what I was going through and texted me to remind me that they were going to be there after January 20th when I begin this journey. So we really do need each other. You have this thing like no one's going to take your call after you get out of the vice admiral outfit? Or just that I'm not going to have anything useful to contribute to the world anymore. It's so insane, right? You know that's insane, right?

1:58:46You know, I know it doesn't sort of make sense, but most of our fears are irrational, you know? Like in my deepest heart of hearts, I feel like what I hopefully contributed during my time on the job were the same kind of instincts and heart that I had even before I was in uniform, and that they will be there when I'm out of uniform as well. So I know that like deep in my heart, but I have these moments where sometimes I'll just wonder, oh, is it gonna be like flipping a switch, you know, and I will no longer have anything valuable to share with the world. And I just have to put those aside. And I realized a lot of those are deep rooted in like, you know, years and years of growing up and worrying about what other people thought and looking for approval from others, right?

1:59:28Like those two elements of growing up, I now realize that those are not how I want to live my life. Every now and then they still creep back into the psyche. And what would it feel like if you no longer were relevant in the kind of traditional sense? Yeah. What would that mean? I think it would... I actually think it could feel really good if as long as I felt like I had great friendships and I was enjoying relationships with my family. And as long as I felt like I was contributing something of real value to the world. Like the thing is, like before having this whole experience, this whole chapter of my life as Surgeon General, I was practicing medicine in Boston and felt deeply fulfilled taking pair of patients and learning about their lives and hopefully making a difference in their lives.

2:00:27I wasn't known, like, you know, I didn't have a reputation. I wasn't even in their academic ranks as assistant professor, associate professor, and full professor. I was below an assistant professor. I wasn't like high up on the totem pole or anything. But I felt a deep sense of satisfaction because I was investing a lot in my friendships. I was super close to my family, my parents, my sister. I was going to see them all the time. And I was doing work that felt really meaningful to me. And so I do think that even if, you know, it comes to pass that I'm no longer sort of irrelevant, quote unquote, to the world or known or whatever it might be, the life could still be deeply fulfilling.

2:01:09And I just, I don't want to lose sight of those like fundamental building blocks. It goes back to community because relevance in its truest sense, isn't like a claim or the validation of strangers across the world. It's the value that you're contributing to a community that you care about. That's what relevance is, right? And that's what you had beforehand. And then you had relevance in this grander sense, but relevance I think has to be calibrated with like your values. And I see you as somebody who's just a deeply empathetic person who's wired to be a healer, like not just a doctor, but truly a healer who feels things deeply.

2:01:55You have such a gentle sense about yourself and soul. And so I believe in you and I trust that you will find a way to continue to serve in the way that feels right for you. And I think we'll be better off for it. Thank you, my friend. That means a lot. That means a lot to me. I wanna thank you for your service to all of us. I appreciate it. I appreciate you coming here today, but come back again sometime when you've made your decision about what you're going to do next. And I just want to say, like, I really value the time that you've spent here. But also, I think as I emailed you, like, I do feel a sense of kinship with you.

2:02:32And I appreciate this sort of burgeoning friendship very much. So thanks, man. It means a lot to me as well. Yeah, and I'd like to stay close. We will. We'll be friends for a long time, Rich. Cheers. Peace. Thank you. Thank you.

2:02:52Thank you.

2:02:59That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest, including links and resources related to everything discussed today, visit the episode page at richroll.com, where you can find the entire podcast archive, my books, Finding Ultra, Voicing Change in the Plant Power Way, as well as the Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube and leave a review and or comment.

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2:04:51Thank you.