Together: The Healing Power of Human Connection in a Sometimes Lonely World

Nonfiction | Book | Adult | Published in 2020

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Summary

Background

Chapter Summaries & Analyses

Author’s Note-Preface

Part 1, Chapters 1-2

Part 1, Chapters 3-5

Part 2, Chapters 6-7

Part 2, Chapter 8-Conclusion

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Tools

Beta

Discussion Questions

Themes

The Impact of Loneliness on Physical and Mental Health

Content Warning: This section of the Study Guide discusses depression, anxiety, suicide, self-harm, addiction, violence, and other public health concerns.

While loneliness is often associated with one’s mental state, the negative impact of loneliness on both physical and mental health is the core theme of Murthy’s book.

In his Preface, Murthy writes that his time as the 19th surgeon general of the United States brought the country’s loneliness problem into sharper focus. In December 2014, at the start of his tenure, Murthy and his team embarked on a listening tour of America, traveling across the country to speak to people about their health. Their primary question was, “How can we help?” (12). Responses ranged from concerns about addiction to health conditions like diabetes and heart disease. As recurring topic, however, was not a health ailment per se, but loneliness: “Loneliness ran like a dark thread through many of the more obvious issues that people brought to my attention, like addiction, violence, anxiety, and depression” (12). Murthy spoke to teachers and school administrators concerned about their students’ social isolation. In Oklahoma City, he spoke to parents who were experiencing loneliness after their son died of an opioid overdose. Their experiences were not unique. Murthy encountered lonely people across the country, including people with addictions: “I listened to men and women who told me that the hardest part of addiction […] was the profound loneliness they experienced when they felt like their family and friends had given up on them” (13). What Murthy learned during his listening tour dovetailed with his experiences at Boston’s Brigham and Women’s Hospital, where many of his patient suffered from loneliness: “I began to notice other aspects of the people I was caring for, including their social lives—or lack thereof” (21).

By connecting the feeling of loneliness to specific biological processes—such as hypervigilance, which activates a chain of hormonal and physical responses—Murthy demonstrates how loneliness underlies many health problems, including stress, depression, diabetes, high blood pressure, and heart disease. Loneliness also increases the risk of addiction and early death. Thus, loneliness is not just a personal problem, but also an issue with a deep societal impact: “the combination of loneliness and stigma creates a cascade of consequences that affect not only our personal health and productivity, but also the health of society” (26-27). Shame and fear prevent lonely people from seeking help, sparking a self-perpetuating cycle of pain that often results in destructive behaviors.

Although researchers have long recognized the health hazards of loneliness, Murthy brings its specific health risks to the fore, allowing readers to “more deeply appreciate the relationship between loneliness, social connection, and physical and emotional health” (27).

Social Connection as an Antidote to Loneliness

Murthy argues that the need for connection is universal and that strong social bonds combat loneliness. He compares the feeling of being socially connected to being at home: “To be at home is to be known. It is to be loved for who you are. It is to share a sense of common ground, common interests, pursuit, and values with others who truly care about you” (15). Throughout Together, Murthy emphasizes the importance of making and maintaining social connections, but he emphasizes that quality matters: “What often matters is not the quantity or frequency of social contact but the quality of our connections and how we feel about them” (25).

Murthy describes three circles of connection—intimate, relational, and collective—all three of which are necessary to ward off loneliness. Intimate connections include romantic partners and close confidants. According to Murthy, having a circle of close friends and confidantes protects against intimate loneliness. The relational circle is larger than the intimate circle, comprising casual friends with common interests, such as members of a sports club. These connections protect against relational loneliness by repairing emotional damage, reducing stress, and fostering a sense of purpose and joy. The collective circle, the largest of the three, consists of colleagues and other acquaintances. Having strong collective connections creates a sense of belonging and makes people feel more secure in their communal identity. It also nurtures a feeling of shared purpose, while staving off collective loneliness. The three circles reflect the full range of high-quality connections people need to thrive. The lack of connections in any of these circles can make people lonely, which helps explain why people in supportive marriages can still feel lonely for friends and community.

Murthy argues that people who are skilled at making and keeping friends experience less loneliness than those who struggle with friendship and offers several tools for building one’s connection skills. People can connect in many ways, including gathering for meals (intimate connections), playing sports together (relational connections), and exchanging pleasantries at work (collective connections). However, friendship is a two-way street. At a dinner, for example, a host might introduce guests who don’t know each other, while guests might offer to refill glasses, serve drinks, and clear the table after the meal. Studies show that the healthiest friendships are mutually supportive. This includes sharing, listening, helping, and reciprocating feelings. To flourish, friendships require kindness, openheartedness, honesty, understanding, and empathy. Gratitude is a side effect of friendship. People with friends are grateful for the opportunity to be vulnerable and imperfect, but still be loved. As Murthy notes, “we all need to know that we matter and that we are loved” (36).

Social Connections in the Digital Era

The impact of technology on social connections runs as a throughline in Murthy’s book, particularly when it comes to social connections among youth and teenagers. Murthy acknowledges that screens are a central part of people’s lives, including children. Young and old alike use technology to connect, relax, and amuse themselves. Children rely on technology to do their homework. Many adults spend their days working at their computers. Technology also allows people in distant locations to keep in touch, notably, families living in different places.

While some experts believe that the internet and video games are detrimental to children’s social development, Murthy takes a more nuanced view, recognizing the value of online connections for certain populations. Citing researchers at the National Programs and Outreach for the Child Mind Institute, Murthy argues that different children respond to technology differently: “Many kids say social media actually increases their opportunities for connection and allows them to find communities of belonging” (229). At the same time, however, technology can harm children who have behavioral and mental health concerns, as well as children struggling to meet developmental benchmarks. Children who benefit the most from online connections are generally nonconformists or members of marginalized groups, such as LGBTQ+ youth: “If no one in your school community is like you […], it can be vitally reassuring to find kindred spirits through an online community” (231). Murthy emphasizes that each child has different needs, however: “not all screens have the same effects on all children. Each child is different in their needs and underlying susceptibility to social media’s harms” (229). He suggests that parents take these differences into account when setting limits around screen time.

Murthy cites numerous studies to support his claims about technology and social connections. In 2019, for example, researchers at the University of Oxford found that screen time negatively impacts teenagers, but only in a small way. The study also showed that bullying and smoking marijuana were far more damaging to adolescents’ social connections than digital technology.

However, Murthy acknowledges that technology has some drawbacks when it comes to social connection. Technology creates distance between people, which reduces empathy. Social media promotes comparison, which can fuel anxiety, low self-esteem, and depression. In addition, technology diminishes the capacity for solitude, which Murthy argues is necessary for developing a strong sense of self. The less time friends spend together, the more likely they are to slip from the intimate circle of connection to the outer circles. Although technology can facilitate connections, it can also take time away from more meaningful, in-person interactions.

As Murthy notes, technology holds mixed blessings, allowing people to make meaningful connections, but also enabling bullying, amplifying comparison, and substituting lower quality relationships for higher ones. He therefore prescribes a balanced approach to connecting via screens, and for children, a supervised and guided experience.