Do you often find yourself feeling lonely, despite the world being more connected than ever? Why do humans crave social connection?
In an age where digital connection has never been easier, an invisible epidemic of isolation threatens our well-being. In Together, former US Surgeon General Vivek Murthy reveals that loneliness is a public health crisis with consequences as deadly as smoking 15 cigarettes daily.
Continue reading for an overview of the book Together.
Overview of Together
In Together (2021), Vivek Murthy argues that loneliness is not an individual problem, but a large-scale public health crisis that needs to be addressed. Through research and personal stories, Murthy shows how our evolutionary need for connection shapes everything from our brain chemistry to our societal structures, and he offers practical solutions for rebuilding meaningful relationships in our increasingly isolated world.
Murthy served as the 19th and 21st Surgeon General of the United States under Presidents Obama and Biden. Harvard-educated with M.D. and M.B.A. degrees from Yale, Murthy co-founded VISIONS Worldwide, an HIV/AIDS education program in India and the US, and Doctors for America, a nonprofit organization focused on health care accessibility. As Surgeon General, he addressed opioid addiction, youth vaping, and the health impacts of social isolation. His work on loneliness as a public health issue has shaped national policy discussions and community health strategies.
In this guide, we’ll begin by examining how Murthy defines loneliness and why it has become so prevalent in modern society, particularly among more vulnerable populations. We’ll then explore the evolutionary importance of human connection. Finally, we’ll discuss the serious physical, mental, and societal consequences of chronic disconnection, before turning to Murthy’s strategies for reconnection at individual, community, and institutional levels.
Throughout this guide, we’ll supplement Murthy’s analysis with commentary exploring neuroplasticity research on social brain development, cultural differences in experiencing loneliness, and innovative models for combatting the loneliness epidemic. We’ll also incorporate insights from experts in other fields including anthropologist Robin Dunbar, Jan Gehl (Cities for People), and Robert Putnam (Bowling Alone).
Part 1: The Loneliness Epidemic
According to Murthy, loneliness is a hidden epidemic affecting millions of people. During his tenure as Surgeon General of the United States, he discovered that behind many of the country’s health crises—addiction, violence, depression, anxiety—loneliness was often an unacknowledged but important underlying factor.
In this section, we’ll discuss Murthy’s definition of loneliness, why loneliness has become so pervasive, and who is most impacted.
Defining Loneliness
Murthy explains that humans require three types of social connection to thrive:
1) Intimate connections are relationships defined by mutual vulnerability, deep understanding, and consistent emotional support. Intimate connections are often romantic partners, close friends, or family members—people who fulfill the universal need to be known and loved.
2) Relational connections constitute the broader network of friends and colleagues with whom you interact regularly, perhaps around shared interests, hobbies, or values. These relationships often provide a sense of belonging and group identity.
3) Collective connections include your relationships to communities, causes, or traditions larger than yourself. These connections offer purpose and meaning through contribution to something that transcends the individual.
According to Murthy, people feel lonely if they are lacking in any one of these types of relationships. So, for example, someone surrounded by casual acquaintances might still feel lonely if they lack intimate connections, just as someone with a closeknit family might feel lonely if they don’t have any meaningful relationships with people in the broader community.
The Loneliness Crisis
Murthy argues that although we have unprecedented opportunities to connect through technology, fundamental shifts in how we live, work, and relate to one another have created the perfect conditions for widespread social disconnection.
First, Murthy argues that shifting cultural values in Western societies have created a perfect storm for loneliness. The growing emphasis on individualism, self-reliance, and personal achievement has steadily eroded our sense of interdependence. This shift manifests in common narratives that celebrate self-made success while subtly (or not so subtly) stigmatizing any form of dependency. Compounding this problem is the increasing conflation of work with self-worth—a mindset that not only glorifies extreme work hours at the expense of relationship-building time, but also promotes the damaging belief that personal sacrifice for career advancement is the primary measure of success and fulfillment.
But Murthy notes that the conflation of work and self-worth is just one part of people’s changing relationship to work. He argues that modern work arrangements (longer hours, frequent relocation, remote work, and job instability) have made it harder to prioritize and maintain connections. American adults, for instance, move an average of 11.7 times during their lifetime, often for new job opportunities, with each relocation requiring people to build new friendships.
Finally, Murthy explains that while, in many ways, technology has allowed us to be more in touch than we were a few decades ago, technological communication, like texting or FaceTime, often fails to replace the satisfaction of in-person interactions. He argues that digital interaction lacks the nonverbal cues and physical proximity that are essential for deep human connection.
Murthy says evidence also suggests that relying too much on digital communication may make us less empathetic. In one study, UCLA researchers found that sixth-graders who spent five days at an outdoor camp without digital devices showed significant improvements in recognizing nonverbal emotional cues compared to a control group that maintained normal device usage, suggesting that reduced screen time could improve people’s social perception skills.
Communities at Higher Risk of Loneliness
Murthy emphasizes that loneliness can affect anyone, regardless of race, age, gender, or nationality. However, he acknowledges that certain populations are more vulnerable than others, including aging adults, adolescents, and people from marginalized communities.
According to Murthy, aging adults are at higher risk of loneliness due to several inevitable life transitions. First, as people retire, they often lose regular contact with colleagues. Furthermore, physical limitations, like reduced mobility or hearing loss, may restrict or discourage them from participating in family gatherings or community events, and the loss of a partner or spouse intensifies feelings of isolation.
Older adults experience loneliness even in group settings like nursing homes, especially when there’s a lack of activities or opportunities to connect meaningfully with staff or other residents. Finally, in countries where ageist attitudes prevail, the contributions of older adults are often belittled and devalued, leading many seniors to internalize these negative perceptions, withdraw from social engagement, and experience deeper feelings of disconnection and loneliness.
Adolescents and young adults also experience high rates of loneliness, and many psychologists blame technology and social media. According to Murthy, social media—with its emphasis on likes and follows—transforms interactions into status markers and encourages users to present an overcurated version of their lives, which discourages vulnerability and honest connections. Murthy adds that packed extracurricular schedules and academic pressure further reduce their opportunities for genuine peer bonding. Finally, Murthy writes, like elders, young people often experience major transitions (like changing schools, leaving home for the first time, starting a job, or going to college), which also disrupt longstanding stable relationships.
Finally, Murthy explains, people from marginalized communities—racial and ethnic minorities, LGBTQ+ individuals, people with disabilities, immigrants, and other minorities—face structural barriers increasing their risk of loneliness. For example, Black Americans encounter workplace microaggressions creating feelings of otherness, while LGBTQ+ youth report higher rates of social isolation in school. Limited media representation further contributes to feelings of invisibility. Murthy argues these barriers create a destructive cycle: Loneliness worsens health outcomes through reduced healthcare access and quality, while economic discrimination limits opportunities for social integration, further entrenching marginalization and isolation.
Part 2: Why Humans Need Connection to Survive
The prevalence of loneliness across such diverse populations suggests that our need for social connection transcends cultural boundaries and demographic differences. This raises a crucial question: Why does social disconnection affect humans so deeply and consistently? According to Murthy, the answer lies in our evolutionary history, where deep connections with others have been essential for survival. In the next section, we’ll explore how our bodies and minds still react to loneliness as if it were a serious threat.
The Role of Social Connection in Human Evolution
Murthy argues that social connection has been key to human evolution. Drawing on the work of neuroscientist John Cacioppo, Murthy explains that humans’ evolutionary advantage was not only due to our physical advantages but also our ability to communicate and collaborate. The study of early human settlements has revealed evidence of sophisticated cooperation. For example, archaeological findings at Göbekli Tepe in Turkey show that hunter-gatherers collaborated to build massive stone monuments around 9,500 BCE that would have required coordinated effort, shared resources, and specialized skills.
This evolutionary advantage continues today: Our ability to collaborate, share knowledge across generations, and build on collective wisdom drives innovation, allowing us to solve complex challenges and fueling technological and cultural progress.
Born to Connect
According to Murthy, our reliance on social cooperation isn’t just historical—it’s embedded in our biology. From birth, humans display innate connection-seeking behaviors that reflect our inherently social nature. Babies cry to signal distress, make eye contact to establish bonds, and become calm when hearing familiar voices—all behaviors that prompt caregivers to stay close and provide protection. Meanwhile, adults instinctively feel powerful protective urges toward infants and young children.
These early bonds shape brain development, creating neural pathways that influence all future relationships: A baby who consistently receives comfort learns that others can be trusted and develops better relationship skills as an adult. Murthy points to the universal pattern of attachment across cultures as evidence that our need for connection is hardwired.
The Physiological Reward of Connection
Murthy writes that our bodies have built-in biological systems that encourage social bonds through pleasurable sensations. When we have positive interactions with others, our brains release oxytocin, dopamine, and serotonin—chemicals that create feelings of pleasure and well-being. This natural reward system makes social connection and cooperation feel good, motivating us to build and maintain relationships.
On the flip side, our brains process social rejection in the same areas that register physical pain. When we feel lonely or excluded, our bodies produce stress hormones and inflammatory responses similar to those triggered by physical threats. This shared neural circuitry creates a powerful drive to reconnect with others, as our biology treats social isolation as a danger to our survival—a mechanism that evolved to protect us by ensuring we maintain the connections necessary for safety and well-being.
Part 3: The Consequences of Loneliness
Our evolutionary hardwiring for connection explains why lacking meaningful relationships profoundly affects our well-being. Murthy explains that when we’re socially disconnected, our bodies and minds respond as though facing a survival threat.
In this section, we’ll examine both the immediate neurobiological effects of disconnection and the long-term consequences of chronic loneliness on physical health, mental well-being, and broader social structures.
The Physiological Response to Loneliness
Loneliness leads to harmful physical changes: Your brain interprets prolonged social isolation as a threat, which triggers the release of cortisol and other stress hormones. These stress hormones are bad for your health in a number of ways—for example, they suppress immune function, increase inflammation, and raise blood pressure.
The Long-Term Health Impacts of Loneliness
According to Murthy, loneliness strongly predicts poor health outcomes and earlier death. Studies show that lonely people experience worse sleep, faster cognitive decline, and reduced stress resilience. Research suggests chronic loneliness is as harmful as smoking 15 cigarettes daily—more dangerous than obesity, alcoholism, or physical inactivity. People who are chronically lonely face a 26-32% higher risk of dying early compared to those with strong social connections, even when accounting for other health factors.
Loneliness also worsens or causes many mental health problems, with studies linking chronic loneliness to higher rates of depression, anxiety, and suicidal thoughts. The relationship works both ways—loneliness can trigger mental health issues, while mental health conditions can further isolate people, creating a harmful cycle.
The Impacts of Loneliness on Social Structures
Murthy says that the collective economic burden of loneliness extends far beyond personal suffering, creating substantial costs for health care systems and workplaces. Research shows that people who are lonely stay 64% longer at hospitals, visit the emergency room 29% more often, and are more likely to be placed in nursing homes when compared to more socially connected peers with similar health conditions. In the workplace, chronic loneliness manifests through higher absenteeism, decreased engagement and productivity, increased disability claims, and earlier retirement.
Part 4: Strategies for Reconnection
According to Murthy, the mental and physical health consequences of chronic loneliness, coupled with its economic implications, make loneliness a public health crisis that requires multiple levels of intervention—from the personal to the institutional. In this section, we’ll discuss strategies to address the crisis of chronic loneliness.
Individual Strategies
To break through loneliness, you need strong connections with others and yourself. Let’s explore some of Murthy’s strategies for building authentic relationships—moving from internal awareness to community engagement.
Get to Know Yourself and Practice Self-Compassion
According to Murthy, understanding yourself helps you connect with others. He recommends asking yourself questions about your values and interests, considering what causes you stress, and reflecting on how you respond to challenges. He also suggests examining where you fall on the introversion-extroversion spectrum to better understand your social interaction preferences. Murthy believes that recognizing these preferences allows you to meet your needs as you maintain meaningful connections with others.
Murthy argues that as you get to know yourself better, you also need to be gentle with yourself because self-criticism can undermine your confidence and ability to connect with others. He offers metta meditation (or loving-kindness meditation) as a strategy to develop self-compassion. Murthy suggests that by treating yourself with the same kindness you would offer a friend, you practice the empathy necessary for developing and sustaining meaningful connections.
Make Time for Solitude and Experience Awe
According to Murthy, self-knowledge and self-compassion require moments of solitude, which can be as simple as a walk, brief meditation, or quiet time before bed. This intentional alone time allows you to process thoughts and emotions without distraction. Murthy also encourages finding opportunities to experience awe, citing psychologist Dacher Keltner’s research. In Awe, Keltner explains how feeling awe when we encounter magnificent works of art, nature, or communal experiences shifts our focus from self-interest to our place within something larger. Both practices enhance your capacity for connection: Solitude helps you understand yourself better, while awe reminds you of your shared humanity with others.
Prioritize Quality Over Quantity
Research shows that when it comes to personal relationships, quality matters more than quantity. Murthy recommends strengthening your inner circle (which usually consists of 5-15 people) through regular face-to-face interactions, vulnerability, and physical activities that release bonding hormones. While these close relationships require the most time, they provide the strongest protection against intimate loneliness.
While you may focus first on your inner circle, don’t neglect your middle circle (casual friends) and outer circle (acquaintances). Murthy says you can strengthen these connections by joining groups centered around shared interests like singing, dancing, or team sports, which create social bonds. In your workplace and community, practice kindness in brief interactions to foster belonging and prevent collective loneliness, whether by greeting neighbors by name or engaging with service workers. Throughout all these relationships, remember personal details, show genuine interest, and participate in the give-and-take of help and support to build reciprocity and trust.
Build Routines That Build Connections
According to Murthy, establishing a routine can help you keep your relationships intact when life gets hectic—so you don’t regress into loneliness just because you’re busy. He recommends technology-free family meals, scheduled check-ins with distant loved ones, and community groups with consistent meetings. These consistent connection points provide stability during difficult times and build the trust that makes asking for support feel natural rather than burdensome.
Community-Based Strategies
While personal relationships are one part of our social health, Murthy emphasizes that broader community connections play an equally vital role in combating loneliness. Now, we’ll outline strategies to weave stronger social fabrics that benefit both individuals and broader communities.
Gather in Community Spaces and Honor Traditions
Murthy encourages people to frequent what sociologist Ray Oldenburg calls “third places”—locations outside home and work where people gather informally, like cafes, libraries, and parks. These venues provide neutral ground for casual interactions that are often the starting point for closer relationships.
Additionally, Murthy highlights the importance of cultural celebrations, seasonal events, and community traditions. These gatherings typically bring together multiple generations, feature shared activities like music and meals, and create opportunities to form shared memories and stories that shape a community’s identity.
Be of Service
Murthy emphasizes that contributing to community well-being through volunteering, neighborhood associations, and civic participation is an antidote to loneliness. He cites research showing that service activities not only benefit recipients but also significantly reduce feelings of isolation among participants by shifting their focus to others and creating opportunities to collaborate on shared goals. Murthy advocates interventions like neighborhood clean-up days, community gardens, and local political engagement that bring people together around common concerns.
According to Murthy, these activities help create what sociologists call “weak ties”—casual acquaintances who contribute significantly to one’s sense of belonging—while building “social capital” (the networks, relationships, and shared values that help communities function effectively). Murthy suggests that the most impactful service opportunities involve regular contact with the same people over time, allowing relationships to develop naturally.
Bridge Demographic Divides
Murthy emphasizes the critical role of programs that bridge age, cultural, and socioeconomic divides. Intergenerational initiatives offer a particularly powerful solution to social isolation. By connecting retirement communities with schools, these programs create mutually beneficial relationships where elders can mentor young people while receiving the vitality and fresh perspectives of youth.
Murthy also discusses how technology can facilitate local, face-to-face connections across demographic divides when used as a bridge to real-world interaction rather than a substitute for it. These bridging programs help address the increasing segregation by age, income, and background that characterizes many modern communities.
Institutional and Policy-Level Strategies
While individual and community efforts are crucial, Murthy argues that addressing the epidemic of loneliness requires coordinated action at institutional and policy levels. Governments, organizations, and institutions can implement evidence-based interventions to create environments where meaningful connections naturally flourish.
Confront the Problem
Murthy advocates comprehensive government strategies to address social isolation, with policy recommendations including funding community organizations that create connection opportunities, supporting public spaces as social infrastructure, and developing campaigns to reduce loneliness stigma—approaches showing promise in the UK, Japan, and Denmark. He points to the UK’s 2018 appointment of a Minister for Loneliness as a pivotal example of institutional recognition.
Additionally, Murthy challenges digital companies to redesign their products to prioritize meaningful connection rather than maximizing engagement through addictive features. While he acknowledges technology’s potential to connect people across distances, he warns that current usage often drives us apart rather than bringing us together, and he suggests tools that facilitate in-person meetups, features that help users monitor screen time, and algorithms that promote quality interactions over endless scrolling.
Treat for Loneliness
Murthy proposes treating social connection as a critical vital sign, transforming healthcare approaches to patient well-being. Drawing on his experience as Surgeon General, he advocates training providers to screen for loneliness during routine visits, establishing referral systems to community resources, and developing support groups for patients with chronic conditions. The UK’s “social prescribing” programs, where physicians prescribe community activities alongside medication, offer a promising model for this approach.
To make these changes sustainable, Murthy recommends restructuring healthcare economics by creating billing codes for loneliness screening, establishing insurance coverage for group medical appointments, and developing financial incentives for preventive social connection interventions. He argues that by integrating social connection into healthcare and aligning medical practice with economic realities, we can address a fundamental but long-overlooked determinant of health.
Design for Connection
Finally, Murthy emphasizes that physical environments and organizational cultures significantly impact our opportunities for social connection. He argues that intentional design across multiple settings can either facilitate or hinder meaningful interaction. By prioritizing connection in the design of shared spaces, institutions can create environments that naturally encourage connection without demanding extraordinary individual effort.
In the Workplace
Murthy argues that organizations must implement structured approaches to foster connection among employees through both physical and cultural means. He emphasizes how redesigning office spaces to include communal areas, establishing formal mentorship programs, and creating policies that prioritize relationship-building can combat workplace isolation. In his research, Murthy found that more progressive companies increasingly recognize that social connection drives innovation, productivity, and retention, leading them to incorporate team-building activities into regular work hours rather than treating them as optional add-ons.
In Schools
According to Murthy, schools and universities can embed connection-building into their core mission through curriculum design, physical spaces, and institutional policies. He points to research showing that implementing social-emotional learning programs from early childhood through higher education helps students develop the foundations for healthy connections. He advocates redesigning classrooms to facilitate collaboration, creating peer mentoring systems across grade levels, and ensuring extracurricular activities are accessible to all students regardless of ability or resources.
In Urban Design
Murthy contends that urban planners, architects, and local governments can intentionally create physical environments that naturally foster social interaction. He cites research showing that developing mixed-use neighborhoods with walkable streets, accessible public spaces, and community gathering spots can counteract isolation in modern urban environments. He references successful examples of communities that have revitalized town centers, created community gardens, and transformed libraries into social hubs with diverse programming to demonstrate how physical infrastructure shapes social behavior.
Hope for the Future
Murthy acknowledges that addressing the loneliness epidemic can feel like a daunting task, but he argues that the future is hopeful. The human drive to connect is fundamentally resilient, deeply ingrained in our nature. Despite the challenges of modern life—technological isolation, changing social structures, and increasingly fragmented communities—our innate capacity for empathy, compassion, and meaningful relationships remains undiminished. According to Murthy, our emerging awareness of loneliness as a critical public health issue is itself a source of optimism. By recognizing social connection as essential to individual and collective well-being, we are taking the first steps toward meaningful change.
Ultimately, says Murthy, combating loneliness is not about returning to an idealized past, but about consciously creating new ways of connecting that reflect our current realities. Each small action—whether reaching out to a neighbor, participating in community service, or simply being more intentional about our social interactions—contributes to a larger movement of reconnection.
Exercise: Map Your Connection Types
According to Murthy, we need three types of connections to thrive: intimate connections, relational connections, and collective connections. Identify strengths and gaps in your social landscape.
- Consider your intimate connections (close relationships characterized by mutual vulnerability and emotional support). List two people with whom you share this type of connection. What qualities make these relationships meaningful to you?
- Now think about your relational connections (the broader network of friends and colleagues with whom you interact regularly around shared interests). Identify an area of your life where these connections could be strengthened. What specific activities or groups might help you develop more of these connections?
- Reflect on your collective connections (relationships to communities, causes, or traditions larger than yourself). What causes or communities currently give you a sense of purpose or belonging? If you feel lacking in this area, what collective endeavors align with your values?
Exercise: Implement Connection Strategies
Murthy outlines various strategies for reconnection on the individual, community, and institutional levels. Develop a plan for strengthening connections in your life.
- Murthy emphasizes that creating routines for connection is crucial for maintaining relationships when life gets busy. Identify one regular activity you could establish to prioritize meaningful social connection (for example, technology-free family meals, scheduled check-ins with loved ones, joining a weekly community group). How will you incorporate this into your schedule?
- According to Murthy, service to others is a powerful antidote to loneliness because it shifts your focus outward and creates opportunities for meaningful collaboration. What volunteering or community service activity aligns with your interests and values? How might participating in this activity benefit both you and others?
- Murthy discusses how public spaces or “third places” provide neutral ground for casual interactions that can develop into deeper relationships. Identify one third place in your community (for example, café, library, park) that you could frequent more regularly. What small steps could you take to engage with others in this space?
- Technology can either facilitate or hinder connection depending on how it’s used. Evaluate your current technology habits—are they primarily helping you connect meaningfully with others, or creating barriers to authentic interaction? Describe one specific change you could make to ensure technology enhances rather than replaces your in-person connections.
