480 1 MAY 2020 • VOL 368 ISSUE 6490 sciencemag.org SCIENCE
PHOTO: ISTOCK.COM/TOLGARTA
s a fledgling physician, Vivek Mur-
thy considered social issues such as
loneliness to be outside the domain
of doctoring. That all changed when
he met a patient named James,
whose health concerns appeared to
stem from social isolation that started af-
ter winning the lottery. In restructuring his
life to his new economic standing, James
had inadvertently cut himself off from
his existing support network, sending his
health into a downward spiral. In his book
Together, Murthy—who served as the 19th
surgeon general of the United States—
draws from decades of scientific research
and his own experiences with patients like
James to show just how damaging loneli-
ness can be.
The timing of the book’s release coin-
cides with a global public health crisis,
as people around the world adapt to the
ongoing COVID-19 pandemic. Murthy’s ac-
count of the factors driving loneliness and
his suggestions to combat isolation are
particularly poignant now, as many abide
by recommendations to stay home and
avoid social contact with others.
The link between loneliness and health
is rooted in the evolutionary history of hu-
mankind. As a social species, early humans
depended on their communities for food,
shelter, and safety. Survival required build-
ing and maintaining relationships with
others, and exclusion from these relation-
ships was deadly. Given this history, it is
no wonder that the drive to connect with
others—and the pain experienced when
disconnected from others—emerged as a
very important survival instinct.
Just as experiencing physical pain signals
our body to move away from the pain source,
the pain we feel when separated or excluded
from social relationships can serve as a sig-
nal to reconnect with our friends, family, and
community. When forming or maintaining
these important social bonds proves diffi-
cult, our mental and physical health suffers.
Whereas early humans would have lived
in tight-knit communities where social
connections were guaranteed, advances in
mobility and technology in modern society
make sustaining social relationships both
effortful and difficult. Many of us live far
away from our families and friends, and
hectic careers quickly absorb the time
needed to cultivate relationships. Many
of our social interactions now take place
through screens rather than in person, and
increasingly individualistic cultures cause
us to put less priority on our relationships.Murthy describes how many such cul-
tural and technological factors can have
both positive and negative impacts on our
relationships. Social media, for example,
can help us keep in touch with friends and
family across long distances and enable us
to reconnect with loved ones from whom
we have grown apart. At the same time,
technology can prevent us from investing
in our relationships with those closest to
us, leading to greater disconnect.
Collectivistic communities—those that
emphasize the needs of the group over
the needs of individuals—can foster con-
nectedness by providing social institutions
that bind people together. But oppressive
social norms inherent in many such com-
munities can cause undue stress, and those
who do not conform to these norms can
be ostracized and left even more isolated
than those from individualistic communi-
ties. Understanding the profound necessity
of connectedness and how we can protect
ourselves from isolation in modern society
can help us to take deliberate action to cul-
tivate our relationships with others.
For those who are fortunate, the practice
of social distancing during the COVID-19
pandemic may provide valuable opportuni-
ties to reconnect with family and loved ones
quarantined at home. For many others, the
situation will be dire. Those living alone
will experience increased isolation, and
those most at risk, such as the elderly and
ill, may be kept in isolation from their loved
ones. On a societal level, the public health
implications of this widespread disconnect
may be severe.
By showcasing research on the impact of
loneliness and its social and environmental
antecedents, Murthy presents a road map
of the various pathways that lead to con-
nection or isolation. Although the path to
connectedness may be long and arduous,
particularly while social distancing, the di-
rection in which we must head is clear. j10.1126/science.abb3582PSYCHOLOGY
By Joanna Schug
The other public health crisis
Social connection is critical, but many struggle to form and maintain meaningful relationships
Together: The Healing Power
of Human Connection in
a Sometimes Lonely World
Vivek H. Murthy
Harper Wave, 2020. 352 pp.Technology can help us connect with others, but it can also prevent us from investing deeply in relationships.INSIGHTS | BOOKS
The reviewer is at the Department of Psychological Sciences,
College of William and Mary, Williamsburg, VA 23185, USA.
Email: [email protected]