Hello everybody welcome to live i work with process bringing authors you love bentonite go to the website currently offering reduced sales for the physical are closed for you and get your Online Purchases when everybodys here tonight and thank you so much for that. Tonight we click on fast the question of the bottom of your screen you can vote for what answers you and hear the most. Reminded unlike that in person author prose the author cannot see you through the screen. Onto the event doctor vivek murthy see former u. S. Journal general surgeon he is been busy with president ial counsel joe biden uncovered 19. Im so sorry heres the interpreter is breaking up because youre speaking so quickly. Thank you and please start again with vivek murthy bio. Served as a 19th Surgeon General of the United States from 2014 to 2017 is the author of tonights book together. He has canceled president ial candidate joe biden uncovered 19 and what citizens should do to eliminate the spread. Hes a writer for president obama and for head speech writer for head lady michele obama. Interpreting surfaces tonight are provided by mary. [inaudible] lets welcome sarah. Thank you so much beth i am so glad to beer with my dear friend and someone who i admire greatly. To joy to talk about this book which is by far one of the most important books ive read in a very long time, totally change my understanding of loneliness was personally meaningful as well as really enlightening. Im thrilled to be here today. Thank you sarah for being here and im glad to be your friend. [laughter] see when you are the Surgeon General of the United States of america. After the Obama Administration ended you could have written a memoir, tellall, leadership book that would have been sold and airports everywhere. Instead you decide to write a book about loneliness arguing its really serious problem here in america and around the world. Why did you decide to write this book . And what makes it such a serious problem . First develop me say how wonderful it is to be here, to be finally sharing this book with the world and talking with different i admire anyone is going to be a tallow would be much more likely to be used sarah then meet your much more likely to share than i would. This is not the book i thought i would write. I did have ideas about books i wanted to write about sort of a new view of Public Health i had had in trying to rebuild our Public Health infrastructure, its my time in office and what he learned about government. But then what happened is sometimes you can have the best plans and you go in different direction thats what happened to may bring 2017 i wrote this article for Harvard Business review for loneliness in the workplace but i wrote because the editor asked me to it and i wasnt really sure how interested Business Leaders would be in this. What i found in the days and weeks that followed the publication of that article, is i was getting so many messages from around the world. Some of them were from media from folks who said hey we think this is a real problem in our country and those messages come from all over the United States, india, japan, south korea places him latin america and then i got a whole bunch of Text Messages from individuals it said you know ive been struggling with loneliness for a long time or my spouses been. Did not realize it was so common i didnt realize and it was really striking to me. Long story short after that would end up happening as it became clear through that experience and the suggestions in a good friend and confidant said this is actually an issue that is not only important to write about, i realize the more i talked about the more it was important to me and was a resignation with my own experience so thats what led me to it ultimately focus on this topic i talked about in the early stages of the book when i traveled around the country Surgeon General and met people saw big cities everywhere i heard stories that were not surprising, stories about peoples struggles with addiction, about parents who lost their own children to overdoses experience known should ever have to go through but so many were. I heard about parents who were worried about the depression and anxiety seem to be rising among kids and children their generation. I started to see behind these stories this is how it presented wasnt someone coming up and saying hi my name is jack him struggling with loneliness, people would say things like that i feel i could have to deal with all of these problems that have to do it on my own. They would say i feel absolutely invisible. And time after time hearing that it started to register for me there is something bigger going on here. It reminded me of my experiences in the hospital were in the earliest days of doctoring i remember seeing so many patients who would come in and had no wood with them. Sometimes that a really important diagnosis we had made, we had to make a really huge decision about treatment, i would ask them who can i call . And these are really tough issues to deal with by oneself. And so often i would get answer there is nobody to call. Even at the last stages of life in those final days and hours where i was privileged to sit with people and to be witness to the final moments, a lot of times it was just me and my colleagues at the hospital who were those witnesses. There is no one else who is there. I was reminded of those experiences when i was traveling the country and the more i looked into it i realized loneliness is both more common and more consequentials terms of its impact on our health. Host that sounds like you were seeing willingness in many populations we couldnt think of just the elderly as being lonely but is actually know it was affecting people of all ages and backgrounds is that the case . Speaking absolutely sarah when people traveled abroad and talk to people in england and other countries when i found is most people have the notion the elderly who were troubled the reason they believe that is the case is we get lonely as we get older sometimes were more limited in our ability to both illness or disability, maybe we have the experience of losing family and friends as we get olders and other get ill. We are unable to connect with people as well. And all of that is true, but i found that really interestingly was loneliness is affecting people across the age span is a big spike in fact with young people folks with the millennial generation buried what i also found interestingly was seem to be the great equalizer in a sentence like i found where the you are richer or poorer i was hearing stories of loneliness. If people lived in urban or rural areas where i traveled the phishing villages i heard about loneliness members of congress in washington d. C. In hushed tones buying close doors they were started with loneliness and many of their peers or two. Moms and dads, people rich and poor, everybody seemed to have an experience to share whether they need someone in their life had loneliness. It made me realize or Something Different going on here. Theres both parties come to agree on and you know that, but i found interestingly enough is poor of an environment is reliving and topping that the subject of loneliness and social connection for like it resignation with everybody. I say theres no topic that i touched on during my tenure that seemed to be court within people is deeply. Host terms of the effects of it seems our Mental Health effects struck in your book about how loneliness has actual physical health effects. At one point you said its the equivalent of smoky certain number of cigarettes a day forget statistic it was really shocking. Guest this is something that surprising to me as well put i learned to the conversations of people i had in the research i did after words, that loneliness is more has it deep concept has major consequences outside of her health as well how we perform in the workplace i wish up at School Common reason with the conversation i think has serious contribution to the polarization we are experiencing today in our politics and or difficulty having dialogue and society we come back to the health piece for moment, what its showing us his theres a Strong Association between loneliness and the risk of Heart Disease and dementia and depression and anxiety. People who struggle with loneliness have more fragmented sleep quality and rest and fullness of that sleep. Now given everything we are learning about the importance of sleep on her Overall Health we are realizing important and the impact of loneliness on her sleep is effective. And what you reference is the study done from Young University association of loneliness and lung chevy is quite interesting. That mortality impact or the degrees and which ones life is shortened when you struggle with loneliness seems to be similar to loneliness of smoking 15 pets of cigarettes a day thats greater than the mortality impact of obesity and sedentary living. I see this as someone who served as Surgeon General and an office that spent decades working on smoking, obesity, physical activity, havent really focused on the issue of loneliness and social connection because we never fully appreciated the powerful impact it had on her health. Guest that is extraordinary. Just stepping back very quickly, we say loneliness i just want to quickly define what you mean . In your book you distinguish between loneliness and solitude is there more to it than that . At the great question. Loneliness is a subjective term is determined by how we feel about the quality of our connections. I would say if you had to define it further youd say it loneliness is a gap between the social connections we feel we need, and the ones we have. Not some experience loneliness a couple of things that i disable this though is that loneliness has really unfortunate stigma around it. Many people feel because there lonely admit youre not likable or youre broken in some way. I say that not just as a theoretical point, i say that for practical experience from personal experience because of my own troubles tell myself thats why i never talk to my family about loneliness i felt deeply loved why was home i was blessed and am blessed i have a mother, father, sister who deeply love me and i knew that i always felt secure and loved at home. But that sense of belonging evaporated when i walked into school in the morning and i felt a sinking pit in my stomach each day when we were in school to drop me off i was scared about those moments on the playground whenever to be picked for team a word about being the last one picked even though i had pretty good athletic ability. I worried about most of all about lunchtime, walking into the cafeteria and not knowing if there be someone to sit next if someone would make room for me. I just cannot wait until 3 00 p. M. When the bell rang in Elementary School to find my parents to go back home to an environment why felt secure. So i know from personal experience the shame that comes with loneliness and it comes from not only admitting to ourselves its happening but it makes us feel we are alone we never know those around us were hiding their loneliness the reason i bring this up is because i think there is an important reason for us to understand loneliness is actually not shameful but its a natural signal that our mind just like we experience hunger or thirst we lack social connection something we actually do for survival that evolution has led us to, we feel a similar signal in that signal is loneliness. If we respond to that signal by a seeking out meaningful connection in our lives, by calling a parent or dear friend by going to visit somebody whose company you enjoy, assumes a loneliness may subside. If that loneliness persist for long periods of time, that we can start to see and run into the Health Consequences we are talking about. Very interesting thing happens when loneliness is chronic and we start to develop these patterns which can take us even deeper will we experience loneliness whats happening from the evolution experience we are wired to actually feel we are in a state of threat and danger we are lonely. And how we do it over the years will be involved. Safety really depend on numbers and the tundra. If we werent together in terms of relationships theres a greater chance who take turns walking after predators to share the food supply make sure he didnt starve we became separated from our tribe the chance of survival automatically dropped. That became baked into our nervous system so we could perceive separation and loneliness as a stress and we experience it from ever elevated threat levels with an increased focus on herself because were worried about safety. Doesnt make sense that evolutionary concept to think about what happened in the modern world where feeling chronically lonely thats accompanied with more suspicion of people and developments around you you can start to see how you can actually make it harder to connect with people when youre in that mindset, when you combine that with the fact it chips away at our selfesteem start to convince us we are may be lonely and it makes it even harder for people to venture out. So the paradox in that sense, you find when youre chronically lonely you can withdraw further and further into your shell, just when you need to be reaching out. One of the reasons its persistent unless you understand how to approach it. Student that is heartbreaking to think about the spiral leads to deeper loneliness which leads to deeper loneliness that seems like a very painful place to be. Stepping back for minute what are some of the historical trends in the societal trends that have led to the rise in loneliness and particularly interested in the role of the internet and social media not just causing loneliness but possibly alleviating loneliness which is it . Is it responsible for loneliness to people left lonely whats the role of that with the trends were seen . Guest good question on me just say from the outset when you hear the topic of loneliness thats a real downer. I will tell you that my experience talking to people about the subject and study and over the last three years has actually led me to it feel deeply inspired and helpful because the story about loneliness is partly about loneliness extraordinary power of Human Connection sunlight here body and minds but the society in which we live we have stories that come from those that made me realize we have at our fingertips, the ability to build the kind of world that cannot only sustain us and a deeper and more fulfilling way but can also support our children and the ways we hope they can live. I know we will talk more about that but i want to mention that because its really important to recognize out of the challenge of loneliness comes this governing the deeper resource we have that can be deeply, deeply sustaining. But where did this all come from . It turns out loneliness is not new. It did not just happen when the internet started. But people have been lonely for generations and generations. We hadnt written about it for the longest of times, it seems that shakespeare was one of the early figures it started writing about it. Whats striking at several factors. There certainly a mobility factor or we are more mobile than ever were and its amazing at the opportunities it creates for us we also move away from communities that we have come to know over time the other challenge is the cultural challenge i think its one of the most insidious and difficult to attract which is even though i went out on a Street Corner and ask ten people what is your number one priority in life . I would almost guarantee they would say a person or group of people their kids or spouse et cetera. Even though they would say that, i would say that if you look at how we actually live our lives as judged by where we put our time, our attention, and our energy. For many of us and certainly has been the case for me over the last many years, focus is not actually on those people. Its more so on work or other priorities. Importantly we dont do it because were bad people or we dont value human relationships. We do this in part because we live in a culture that tells us that success is defined in a particular way its defined not by your ability to build on the relationships and nurture them over time defined by your ability to power or reputation to make five lots and lots of followers of a hat people are mailed time people your name for my severe that time the position of power in the ceo mike Company Manager my organization, principal of my school. People say while hes really made it if you achieve a position of power. The thing is, when you talk to people who have achieved in all three of these areas or any one of them, they will almost always uniformly say is that the pursuit of that goal contrasted with after they felt once they achieved it. It did not on the lasting fulfillment that they wish they had had. And so the culture that leads us to prioritize and define success in a way that is different and i think separate from human relationships is one i think ultimately needs us to focus on things that separate us and ultimately lead us to deep prioritize human relationships. And finally when you have tech when you brought that up it is the single most question i get asked about loneliness. Parents in particular who seek kids on devices often alone in the room on the weekends and evenings as its hurting my child . Is it making my child more lonely . Is a really important questions to ask for it i will say my belief of our technology and everything ive seen, read, understood now is technology itself is a tool. The question is how do we use it . We use technology in ways it strengthens our connection for example if we live far away from a relative and we cant go in travel and see them often but we can face time with them on a regular basis, that can actually be a social experience if we also use technology to connect with people offline, that can be powerful too. If im coming to Miami Florida for example in a posting on facebook pay them to miami at you my friend free to hang out or catch lunch or dinner, we actually meet up. We say connect with friends. Find yourself as a member of the community, not many people like you around you find y