Dedication To my wife, Alice, the best friend I could have ever hoped to have To our children, Teyjas and Shanthi, who remind me each day of how good it feels to love To my mother, father, and Rashmi, who gave me everything and to whom I owe everything Contents Cover Title Page Dedication Author’s Note Preface Section I: Making Sense of Loneliness Chapter 1: Under Our Noses Chapter 2: The Evolution of Loneliness Chapter 3: Cultures of Connection Chapter 4: Why Now? Chapter 5: Unmasking Loneliness Section II: Building a More Connected Life Chapter 6: Relating Inside Out Chapter 7: Circles of Connection Chapter 8: A Family of Families Conclusion Acknowledgments Notes Index About the Author Praise Copyright About the Publisher Author’s Note This is a book about the importance of human connection, the hidden impact of loneliness on our health, and the social power of community. As a physician, I felt compelled to address these issues because of the rising physical and emotional toll of social disconnection that I’ve watched throughout society over the past few decades. What I could not anticipate, however, was the unprecedented test that our global community would face just as this book was going to press. In the first weeks of 2020, the COVID-19 pandemic turned physical human contact into a potentially mortal threat. The novel coronavirus was on the loose, like an invisible stalker, and any of our fellow human beings could have been its carrier. Almost overnight, it seemed, getting close enough to breathe on another person became synonymous with danger. The public health imperative was clear: to save lives, we’d need to radically increase the space between us. As I write these words, we are still in the middle of this pandemic. With health workers at risk, hospital equipment in short supply, and death rates from the coronavirus spiking by the day, governments the world over have mandated “social distancing,” closed schools and most businesses, and ordered everyone but essential service workers to stay home. Those first responders, health-care and food-supply workers, and others who must stay on the job to protect us are now putting their lives on the line. They remind us just how much we depend on each other. In response, parents like my wife, Alice, and I have canceled our children’s playdates; nursing homes have banned visits to the elderly, who are among those most at risk from this virus; and engaged couples must postpone their long-planned wedding celebrations. So much of the socializing that we all took for granted—concerts, ball games, movies and meals with friends, office banter, and congregational worship—suddenly is on hold. It seemed at first that this crisis must inevitably lead to social as well as physical isolation. If we could not meet, how could we connect? If we could not share the same space, how could we help each other? If we could not touch, how could we love? Even that term, social distancing, seemed to condemn us to loneliness. And then there was the issue of trust. Fear of infection and panic over the potential economic fallout drove some to ignore the official mandates and hoard emergency supplies. Alongside the looming specter of a global financial recession rose an equally disturbing prospect of a social recession —a fraying of communal bonds that deepens in severity the longer we go without human interaction. As the pandemic continues, however, it becomes ever clearer that social distancing is a misnomer. To be sure, we must practice physical distancing to stop the spread of COVID-19, but socially, we may emerge from this crisis feeling closer to friends and family members than ever before. Each day brings new examples of our communal ingenuity as we meet this crisis together. In Italy, one of the hardest hit countries, neighbors isolated in their homes have found shared comfort by singing from their windows in unison. In China, patients in quarantine units have turned to square dancing to lift their spirits as they recuperate. And all over the world, families, friends, and strangers have been performing acts of generosity— bringing groceries to the ill and elderly, calling to check on vulnerable neighbors, and sharing local updates on everything from grocery store hours to the availability of toilet paper. (Who knew that toilet paper would be such a hot commodity in a pandemic!) We are fortunate today that technology offers us ready opportunities to strengthen our connections remotely. The pandemic is inspiring creativity online as artists dance and sing together through videos from home. Families celebrate birthdays through FaceTime. Audiences enjoy live opera performances streamed over the internet, and students, from kindergartners to doctoral candidates, meet in classes online. As we learn to play, work, and collaborate virtually, we are helping each other fend off loneliness and reminding each other just how vital we are to our mutual resiliency. I’m struck by how many of the lessons I learned while writing this book now have immediate relevance. By strengthening our social connections, we can fortify our communities and protect each other. Four key strategies will help us not only to weather this crisis but also to heal our social world far into the future: 1. Spend time each day with those you love. This is not limited to the people in your immediate household. Reach out also to the other members of your lifeline via phone or, better yet, videoconference, so you can hear their voices and see their faces. Devote at least fifteen minutes each day to connecting with those you most care about. 2. Focus on each other. Try to eliminate distractions when interacting with others. Forget about multitasking and give the other person the gift of your full attention, making eye contact, if possible, and genuinely listening. 3. Embrace solitude. The first step toward building stronger connections with others is to build a stronger connection with oneself. Solitude helps us do that by allowing us to check in with our own feelings and thoughts, to explore our creativity, to connect with nature. Meditation, prayer, art, music, and time spent outdoors can all be sources of solitary comfort and joy. 4. Help and be helped. Service is a form of human connection that reminds us of our value and purpose in life. Giving and receiving, both, strengthen our social bonds—checking on a neighbor, seeking advice, even just offering a smile to a stranger six feet away, all can make us stronger. I once had a physician mentor who would pause and take a deep breath before he entered a patient’s room, using those few seconds to remind himself how grateful he was for the chance to help someone heal. Today, we all share this opportunity. Healthy relationships are as essential as vaccines and ventilators for our global recovery. This pandemic isn’t the first and won’t be the last time our social connections are tested, but it is rare for the whole world to face such a grave challenge simultaneously. For all our differences, our shared experience is itself a bond. We will have this memory in common for the rest of our lives. And if we learn from this moment to be better together, we won’t just endure this crisis. We will thrive. March 2020 Preface On December 15, 2014, I began my tenure as the Nineteenth Surgeon General of the United States. I expected that my focus as the “nation’s doctor” would encompass issues like obesity, tobacco-related disease, mental health, and vaccine-preventable illness. That’s what I’d told the US Senate at my confirmation hearings some ten months earlier, and there was plenty of data to support these as important focus areas. But the surgeon general’s position, which oversees more than six thousand uniformed Commissioned Corps officers working throughout the federal government to protect, promote, and advance the health of the nation, comes with high expectations. For more than a century, the physicians holding this office have addressed national health crises ranging from yellow fever and influenza outbreaks to the aftermath of hurricanes and tornados to the terrorist attacks on 9/11. Over the past few decades, the nation’s doctor also has become America’s most trusted voice on public health issues such as smoking and HIV/AIDS. It mattered to me that the issues I selected as focus areas also mattered most to the people I served. I hadn’t grown up in the public eye or as a creature of politics. I was a child of medicine. Much of my youth was spent in my father and mother’s medical office, where my father practiced medicine and my mother managed everything else. My sister and I spent many afternoons after school helping out with paperwork, filing charts, cleaning the office, and greeting patients as they came and went. It was there that I found my inspiration to go into medicine. I saw the way people arrived looking anxious and left more peaceful and reassured, with my parents as partners in their healing. Medicine for my parents was all about relationship, and they built those connections by listening. Insurance companies would protest their spending more than the approved fifteen minutes with their patients, but my parents understood that to truly listen, you have to meet people where they are, emotionally and physically, however long that takes. That was the kind of medicine I strived to practice. That was the kind of leader I wanted to be. And so, as I began my tenure, I decided to listen before setting my agenda and laying out my plans.