This episode of “Heart of the Matter” is an extended version of Elizabeth Vargas’ conversation with Dr. Vivek Murthy for her news show “Elizabeth Vargas Reports” on NewsNation. They discuss his decision to declare the loneliness epidemic, the importance of rebuilding connections, and how we can make small changes in our daily lives to improve our mental health. Dr. Murthy also talks about his own personal experience with loneliness and shame, and why it’s so important to discuss these struggles openly.

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Episode transcript

Elizabeth Vargas:

For the first time ever, the U.S. Surgeon General today issued a public health advisory warning of an American epidemic of loneliness. More than half of Americans report feeling lonely, and this is having a profound effect on public health. In an 81 page report out today, the Surgeon General warns loneliness poses risks as deadly as smoking to people’s health. People who are lonely are more likely to be depressed, suicidal, and anxious. They are also more likely to suffer from heart disease and stroke. Joining us now to talk about it all is the Surgeon General of the United States, Dr. Vivek Murthy. Good to have you here. It’s really an important subject. I want to start with an editorial you wrote this week in which you said… It’s an extraordinary editorial, and you talked about the fact that you too had struggled with loneliness. You wrote, “I found myself increasingly lonely and isolated, and it felt as if I was the only one who felt that way. Loneliness can chip away your self-esteem and erode your sense of who you are. That’s what happened to me.” Why did you decide to write about the fact that you too have suffered from this?

Dr. Vivek Murthy:

Well, Elizabeth, I think this is a situation so many people find themselves in, being lonely, being isolated, yet we don’t talk about it because there’s a sense of shame that surrounds loneliness, where we worry if we admit to dealing with loneliness that we’re somehow not likable or not lovable or something’s wrong with us, and no one wants to feel that way. For years, I actually as a child, struggled with loneliness and never told anyone because of that shame that surrounds it. As an adult, I knew how important it was though for us to be able to talk about this as a country, and I felt like I couldn’t go and ask other people to speak about their experiences unless I shared my experience as well.

Elizabeth Vargas:

The word ‘lonely’ sounds so small and insignificant. “I feel lonely.” You know what I mean? It’s not like I feel incredibly depressed or I feel incredibly anxious or panicky. Lonely feels ordinary, but this report says it’s not.

Dr. Vivek Murthy:

It’s not. Well, loneliness is a feeling and it’s a feeling that the connections that we have in our life are insufficient and that we need more. More people we can trust, more people who have our back, more people who can support us, more people with whom we can be ourselves, but it’s more than just a bad feeling. We now know that loneliness is associated with serious health risks. The risk of anxiety, depression, and suicide go up when you’re struggling with social disconnection, but also the risk of heart disease and dementia go up as well.

Elizabeth Vargas:

Why is that? I don’t understand the connection.

Dr. Vivek Murthy:

Well, what’s interesting is when we are lonely, we’re actually in a stress state. We’re in a biological stress state, and that’s because over a long time period of time, thousands of years as hunters and gatherers, we evolved to actually be connected to one another. Our safety depended on it such that when we were separated from one another, it actually put our health at risk. We were more at risk for getting attacked by a predator, running out of food. Our nervous systems, believe it or not, our brains and our nerves are very similar to how they were thousands of years ago even though our circumstances are different. So when we are separated from one another, it generates that stress response. When that’s chronic, that chronic stress leads to inflammation and to illness.

Elizabeth Vargas:

What are you supposed to do about it? I mean, the numbers are alarming, more than half the country. By the way, it’s even worse for young adults and teenagers, which we’ve seen from the CDC and the AMA as well, that they’re really, that generation is really struggling. As a whole, what are you supposed to do? What do you recommend that we do if it’s this much of an emergency that you would issue this report?

Dr. Vivek Murthy:

Well, the good news is that there’s a lot we can do. In the advisory, I lay out a number of steps we can take as a country. This is the first time we’ve issued a framework for national strategy to rebuild social connection community in America. While there are steps government can take, while there’s steps community organizations and workplaces and schools can take, let me speak for a moment about what individuals can do because there are small steps we can take that make a big difference in how connected we feel. For example, spending 15 minutes a day reaching out to someone we care about makes a difference, making sure that when we are with others that we are fully present, we’re not distracted by our phones during a dinner conversation when we’re catching up with a friend.

Elizabeth Vargas:

How many times do you see somebody at a party or a dinner, you go to a restaurant and half the people at the tables, they’re all looking at their phones and not at the person across the table.

Dr. Vivek Murthy:

They are. Listen, I understand that because I’ve been in that position too, of checking my phone-

Elizabeth Vargas:

We’ve all done it.

Dr. Vivek Murthy:

… In the middle of a conversation. Here’s the thing I’ve realized is that in the moments where I actually put my devices away and talk to someone, even if I talk to them for less time, I feel so much better. I feel like the connection is much deeper. You know what? They feel it too. These small steps, a little bit of time each day, giving people the gift of our full attention and also looking for small ways to help others in our days, whether that’s neighbors or coworkers or family or friends, this makes a difference because it turns out, and this may surprise people, but service is one of the most powerful antidotes to loneliness. You might think, “Hey, if I’m lonely, aren’t I the one who needs help?”

Elizabeth Vargas:

Mm-hmm.

Dr. Vivek Murthy:

When we help other people, not only do we forge a connection, but we remind ourselves that we have value to bring to the world. As I wrote in my editorial, that is one of the real costs of loneliness is it chips away at our sense of self-worth, at our self-esteem. Over time, we come to believe that we’re lonely because we’re not likable.

Elizabeth Vargas:

Yeah, there’s something wrong with us that we’re feeling this way.

Dr. Vivek Murthy:

That’s right.

Elizabeth Vargas:

How much of this do you lay at the feet of technology and the way our whole lives have been turned around by our phones?

Dr. Vivek Murthy:

I think that’s an important piece of it. I think there’s a whole set of things happening.

Elizabeth Vargas:

Isn’t it most of it, in many ways, honestly?

Dr. Vivek Murthy:

Well, I think for some people it’s a huge chunk of it. I know for me in my own life, the way I was interacting with technology was actually separating me from people. It was diluting the quality of my interactions with others, and it was actually substituting online interactions for what previously had been offline in-person, high quality interactions. I do think that that’s a challenge. I also think that for young people in particular for kids, their use of social media also has some additional challenges, which is that it actually can make them feel worse about themselves as they constantly compare themselves to other people.

Elizabeth Vargas:

Well, we’re seeing that.

Dr. Vivek Murthy:

We are seeing that, and in fact, this is one of the most common things that kids tell me around the country when I travel and do round tables with them. They also tell me that it can make them feel worse about their friendships as they see other people who they thought were good friends of theirs doing all kinds of activities and engagements and going to parties without them, so they feel more left out. Finally, they also say they can’t get off of it because these platforms are-

Elizabeth Vargas:

Highly addictive.

Dr. Vivek Murthy:

… Designed in ways that maximize our attention. Adults feel that too. The bottom line is technology is a big player here, and what we need to do is renegotiate our relationship with technology. We need to, as individuals, make sure we’re creating sacred spaces in our life without tech, whether that’s time at the dinner table, time before we go to sleep, or time when we’re catching up with friends. As a society, we also have to push for technology to be designed in ways that promote healthy relationships, that support our mental health and wellbeing. I’ll tell you, as a doctor, what I care about is not how much time a platform can maximize that’s spent on it. I care about time well spent, and right now, a lot of the time kids are spending on these platforms are hurting them and not helping them.

Elizabeth Vargas:

You’re talking though from a standpoint of, “we,” meaning you, me, every individual listening to this interview right now needs to change our relationship with technology. Does government play a role here, especially when it comes to our kids? I mean, we have them on these apps that have algorithms that are designed to keep you going and going. It’s like pushing the button, pushing the button, pushing the button. We’re seeing more and more, we have a couple of states already that have signed legislation trying to ban certain social media apps for kids under the age of 18.

Dr. Vivek Murthy:

Mm-hmm.

Elizabeth Vargas:

As a government, as a representative of the Biden administration, should something more be done as far as reigning in tech? Is there some sort of government regulation that should be happening around this?

Dr. Vivek Murthy:

Yes, is the short answer. For more than a decade, we have waited for technology platforms to do something. As a father of two small kids, I worry that they are just not moving fast enough. Again, I think the intentions on many of these platforms were built were to build community and bring people together, but we’re not seeing safety standards that we need across these platforms. We’re not even seeing reasonable age measures that are actually enforced. The age at which kids are supposedly allowed to use most social media platforms as 13, yet 40% of kids seven through 12 are using social media. Finally, we need data transparency so that we fully understand which kids are most at risk for bad mental health outcomes with social media and what interventions work to help them. Right now, when I talk to researchers across the country, they tell me that they’re having a hard time getting that data from companies. The bottom line is, this is not going to happen-

Elizabeth Vargas:

From which companies? The social media companies?

Dr. Vivek Murthy:

The social media companies.

Elizabeth Vargas:

Well, of course, they don’t want to be regulated, right?

Dr. Vivek Murthy:

This is exactly why I think policymakers need to step in, require data transparency, set and establish and enforce safety standards. Because without that, I worry that we have asked parents and kids to fight these battles by themself, and it’s high time that we had their back.

Elizabeth Vargas:

We are reading and hearing more and more from both the American Medical Association this week and the CDC several weeks ago talking about this crisis with our young adults and teenagers. The fact that they’re overnighting in emergency rooms, sleeping in emergency rooms because they’re suicidal and there are no beds, that there is a dearth, the complete lack of therapists who are equipped and able to treat teenagers and young adults. There’s this huge gap right now when it comes to mental health in this country. When are we going to fill it?

Dr. Vivek Murthy:

We’ve had a growing mental health crisis in this country for years, and particularly with kids. I’m really worried, and that’s why in December of 2021, I issued a Surgeon General’s advisory on youth mental health to call attention to a crisis and lay out the steps we have to take. What we’ve got to do falls into three buckets. We’ve got to, number one, address the stigma, the shame around mental health so that no child feels embarrassed or bad to ask for help. Number two, we’ve got to make treatment more available. I’m glad to say that in the last two years, we have seen billions of dollars that have been invested in expanding the number of certified community behavioral health clinics that have been invested in expanding the use of telemedicine so we can use technology to bring care to where people are. It’s also now being invested in training more mental health providers. We’ve got to keep on that, but we’ve got to do much more too because there’s still a gap. The third area we’ve got to focus on is prevention. We’ve got to get at the root of what’s driving distress and pain for our children. Certainly social media I think has contributed to the pain and the mental health struggles many kids are facing but I also think there are other factors. Many kids are struggling with online and offline bullying, many are the victims of trauma including violence. Think about the fact that gun violence has now become the number one cause of death among children. Number one cause of death. The trauma that gun violence insights in communities, in children is really quite profound. We’ve got to look at this collectively and say that kids are going through far more than what typical generations go through in terms of the hardships of growing up, something unique happening to this generation of children. I’m glad there’s more focus, more investment, more attention in this issue in the last two years than I’ve seen in almost 30 years in public health. We’ve got to keep pushing on that accelerator because too many children are struggling today and we can’t rest until every child has the care that they need.

Elizabeth Vargas:

Finally, just bringing it back to the loneliness thing. The one thing that’s striking in this report, doesn’t matter who you are or where you live, rich, poor, urban, rural, young, old, it spans the spectrum. It’s everywhere.

Dr. Vivek Murthy:

That’s true, and that is why it’s so important we recognize that this is a universal struggle, one that we shouldn’t be ashamed to talk about. In fact, when we do share our story, we find that many other people nod and say, “Yes, okay. I’m not the only one.” That’s what happened to me when I wrote this editorial. I heard from so many people who said, “I’m struggling as well.” We’ve got to recognize that. We also have to recognize one more thing, which is that success does not insulate you against loneliness. I worry that so many young people tell me that they feel like they’re being asked to chase money, chase power, chase fame as the markers of success. I’ll tell you one thing I learned from years of doctoring and from holding patients’ hands in the last moments of their lives and hearing their stories, is what they talked about when they reflected on a meaningful life are none of those things. It wasn’t how big their office was or how much money they had in their bank account. It was the relationships they had, the people they loved, the people who loved them. That’s what brought them joy and fulfillment, and that is what we have to focus on once more. It’s why I talk about in this advisory, the importance of building a culture of connection, where we recognize that kindness and generosity, service and love, these are the bedrocks of strong relationships, strong lives and strong families.

Elizabeth Vargas:

Dr. Vivek Murthy, thanks so much for being here to talk about this report. I hope it makes a difference.

Dr. Vivek Murthy:

Thank you so much.