Book Summary: Together by Vivek H. Murthy

A book summary of the key ideas from Together: Loneliness, Health and What Happens When We Find Connection by Vivek Murthy, along with the view from the blog.

The Book in a Nutshell

As the Nineteenth Surgeon General of the United States, Vivek Murthy found that one of the most common underlying themes of ill health was loneliness, without exemption by wealth, education or accomplishments.

The book seeks to explain why building a more connected world holds the key to solving many medical and societal issues. And as Murthy argues throughout, we are already equipped with the antidote: our universal condition for human connection.

Book Summary: The Key Ideas

#1: The types and dangers of loneliness: Loneliness can be divided into the three layers of intimate, relational and collective loneliness. A range of research suggests low social connections can lead to adverse physical health impacts.

#2: The evolution of loneliness: Our biological response to loneliness is a consequence of our evolutionary need for social connection. Over the long run, this response can have a destructive health impact.

#3: The trend towards individualism: Changes in cultures and technologies are increasingly leading us to individualism over collectivism. We need to rebalance.

#4: The three circles of connection: A solution for policymakers and individuals requires three levels of social connection to be addressed, which mirror the types of loneliness.

#5: Addressing loneliness, inside-out and outside-in: To address loneliness, we first need to get reacquainted with our authentic selves. Meanwhile, parents, educators and policymakers must lead the way in fostering social connections.

Book Summary: The Key Ideas in Detail

Key Idea #1: The types and dangers of loneliness

Murthy defines loneliness as “the subjective feeling that you’re lacking the social connections you need.”

According to researchers, there are three types of loneliness:

  1. Intimate (or emotional) loneliness: Longing for a close confidante or intimate partner, sharing a mutual bond and trust.
  2. Relational (or social) loneliness: Longing for quality friendships and social support.
  3. Collective loneliness: Hunger for a network or community of people who share your sense of purpose and interests.

The perspective of these three types of loneliness varies by person, but ultimately both introverts and extroverts need strong relationships to feel a sense of belonging. And importantly, it is the quality of these relationships, not the quantity, that matters the most.

Loneliness is also distinct from solitude. This is voluntary isolation, and the evidence suggests it has a range of benefits. In fact, getting comfortable with solitude can paradoxically improve our ability to connect with others.

One of the big challenges with the loneliness epidemic is the cycle it creates. The shame and fear of loneliness make it self-perpetuating, discouraging us from joining clubs and meeting others. Many then turn to self-destructive behaviours to cope.

The first step to overcoming this cycle is to accept that human connection is as important as food and water. Accumulating research is driving home this importance. One significant study by Julianne Holt-Lunstad found that people with strong social relationships were 50% less likely to die prematurely than people with weak social relationships.

As a consequence of the growing evidence, the medical profession is increasingly moving to more “social prescribing”, but there is much more to do.

Key Idea #2: The evolution of loneliness

Social connection is a biological imperative rooted in our evolution as a species.

Our ancestors quickly learned that we were more likely to be attacked or starve if we became separated from our groups. But social groups also provided the numbers for mating, communal teaching and protection. In short, our survival depended on social connection and we’ve carried forward this instinct in the modern world.

Our instinctive need for socialisation also appears to show up in our brain activity. Functional MRI studies of the brain show how social brain pathways are active in our default state. In other words, without realising it, social thinking seems to turn on like a reflex.

A similar conclusion can be drawn at a chemical level. Social contact releases endorphins, while dopamine acts as a social motivator. Meanwhile, our evolution seems designed such that we perceive isolation as an emergency. When faced with loneliness, our bodies release cortisol and raise our blood pressure and blood sugar levels so we have energy available.

Over the long run, this biological reaction to loneliness no longer serves a short-term benefit. Instead, it produces long-term destruction through stress and inflammation, as well as undermining our sleep as we experience more “micro-awakenings”. This is why loneliness so often surfaces with confounders like depression and anxiety, which can make it difficult to isolate root causes.

Key Idea #3: The trends towards individualism

Loneliness is influenced by social norms and individual needs, which is why the balance shifts dramatically between different cultures.

Murthy draws the comparison between Southern Europe, where family and community ties are strong and less people live alone, and Northern Europe, where this is less true. Our experience of loneliness is relative. In other words, someone who lives alone in Greece or Italy may feel lonelier than in Sweden or Norway.

Murthy argues for cultures to find the right balance between individualism and collectivism, recognising that extreme collectivism has its own unique set of dangers. We have moved too far towards individualism and must focus on communities and groups to foster social connections once more, without undermining individual liberties.

But several other trends are potentially running counter.

With technological advances, we can enjoy the conveniences of community without interacting with others. Some technologies, like social media, have been linked with higher rates of loneliness. New technologies can also create distractions, encouraging the false idea of multitasking, harming communication and empathy, and fostering a comparison culture. Ironically, social media’s constant presence can even undermine our capacity for solitude.

Murthy accepts there are positives, but our use of technology must be shaped to optimise connections:

“The point is that the more our lifestyle evolves to maximise efficiency at the expense of human interaction, the more focused we must become in directing our use of technology to facilitate deeper personal connections.”

Displacement and migration can also create a unique sense of loneliness, through language barriers, loss of identify and status, and cultural differences. Meanwhile, the reality of longer life and deep socio-political divides are further exacerbating the loneliness epidemic.

Key Idea #4: The three of circles of connection

The most beneficial relationships for our health are reciprocal and mutually beneficial. The fundamental characteristic of such relationships is reciprocal feeling. These are relationships that mirror each other’s values and create a positive feedback loop, teaching us to love ourselves as we love our friends.

Paradoxically, loneliness can impede this mutuality:

“… when we’re lonely, the urgency of our social need can make it difficult to honor and respond to the concerns of others – even if they are our friends.”

Murthy highlights three circles of connection, which correspond to the three types of loneliness (see Key Idea #1).

#1: Inner Circle: Close Friends and Confidantes

A well-known longitudinal study from Harvard that has run for more than 80 years found that inner-circle relationships were better predictors of health and happiness than IQ, wealth or social class. Murthy suggests that one contributory factor here may be the release of oxytocin and endorphins benefitting our health. But these shouldn’t come at the expense of outer circles. Healthy outer circles strengthen our emotional core.

#2: Middle Circle: Occasional Companions

Middle-circle friends protect against relational loneliness. According to anthropologist Robin Dunbar, our middle circle may expand our friendships to around 150. Murthy suggests that we can redevelop our middle circles by gathering for common interests. Laughter and synchronised sounds seem to produce more satisfying social bonds than group activities like creative writing.

#3: Outer Circle: Colleagues and Acquaintances

Shared purpose and interests help to stave off collective loneliness. Dunbar suggests this circle can expand our networks up to 500 people in total. The role of social connection in work has important performance implications. Friends at work increase our “relational energy”, first having a positive emotional effect and then firing up cognitive engagement.

Key Idea #5: Addressing loneliness, inside-out and outside-in

When lonely, we are more likely to beat ourselves up about it, magnifying our weaknesses, discounting our strengths, and distrusting our internal compass:

“Once we lose our internal compass, our emotional sense of grounding and identity can begin to slip. On a rational level, we may know we have worth, that we have light to bring to the lives of others, yet it’s hard to ignore the messaging that insists we ought to be someone we’re not.”

To stop this pattern, we first need to make our “self-talk” more constructive. This means treating ourselves as we would treat loved ones. One of the key points here is to know ourselves. Because of clouded objectivity, this can actually be harder than knowing others.

To do this, we need to take a step back and think about the questions that reveal what we value and how our personalities differ from others.

But focusing on rebuilding from the inside-out is just the start. In the final chapter, Murthy turns his attention to the external influencers in our lives.

While children thrive on social connection, significant changes are altering the landscape. A barrage of cultural messages “prioritise fame, wealth and status ahead of kindness, honesty and character.”

Research shows that students consider moral character to be important, but achievement is ranked above caring for others more often. Ironically, research also shows that social isolation can actually undermine academic performance.

Parenting plays a key role. Surveys have found that kids in close families with supportive parents consider themselves more socially adept and have higher self-esteem and fewer academic problems.

Technology, of course, is also playing a role. Przybylski and Weinstein’s “Goldilocks hypothesis” posits that higher screen time may be linked to low well-being, but so is low screen time. In other words, kids may want to be off social media platforms, but communication is now so limited to these channels that it risks undermining well-being.

Parents have a key role to play in balancing screen time and social nourishment. Educators also have a role in developing programmes focused on managing emotions and building social connections.

You can buy the book here or you can find more of our book notes here. For further related reading, try Quiet by Susan Cain, Grit by Angela Duckworth and Digital Minimalism by Cal Newport.

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