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We've been thinking about loneliness all wrong

Eliza Relman   

We've been thinking about loneliness all wrong

You might call US Surgeon General Vivek Murthy Dr. Loneliness. Since 2017, he has made what he's diagnosed as America's "loneliness epidemic" the center of his public-health agenda, writing several op-eds and a best-selling book and appearing on dozens of news shows and podcasts to issue dire warnings about this deadly scourge.

Last May, Murthy delivered his most urgent cri de coeur to date, an official advisory titled "Our Epidemic of Loneliness and Isolation." Over 80 pages, Murthy unspools the extent of this disease's spread and the need to stop it. "If we fail to do so," he writes, "we will continue to splinter and divide until we can no longer stand as a community or a country."

With the report, a steady trickle of headlines about the epidemic turned into a firehose: "Loneliness is at epidemic levels and it's killing Americans" (USA Today); "This Epidemic of Isolation Is as Harmful as Smoking" (Bloomberg); "America's Loneliness Epidemic Comes for the Restaurant" (The Atlantic). Business Insider published a series of stories last year about "modern loneliness" framed around the epidemic designation, including one I wrote about third places.

In recent months, several high-profile names have branded themselves crusaders against the loneliness outbreak. Hillary Clinton argued that it has made American voters more vulnerable to political extremism and played a role in her loss to Donald Trump. Sen. Chris Murphy of Connecticut introduced a bill to create a "national strategy to combat loneliness." The legendary sex therapist Dr. Ruth, at 95, was appointed New York State's first "loneliness ambassador."

And a cottage industry of venture-capital-backed startups has swooped in to save the day. These apps and experiences range from international group travel for high-achieving millennial women to a Brooklyn-based "2.0 community center" with group meditation and movement exercises.

There's one problem: The loneliness epidemic doesn't exist.

"Epidemic" describes a disease that's spreading, often over a short period of time. It suggests that something is acutely worse today than it was in the past. While it's clear that millions of Americans are lonely and isolated, it's far from clear that the country is lonelier now than it used to be. A 2021 meta-analysis — cited in Murthy's advisory — did find that self-reported rates of loneliness among young adults have steadily ticked up since the 1970s. But how that loneliness has been measured over time has been both inconsistent and mushy. Even the authors caution in their meta-analysis that "the frequently used term 'loneliness epidemic' seems exaggerated." We simply don't know enough about loneliness to call it an epidemic.

For many Americans, loneliness may actually be decreasing. A recent peer-reviewed study found that middle-aged Americans report being less lonely than they were 20 years ago. "Despite media and public dialog portraying loneliness as a worsening problem, little is known about how the prevalence of loneliness has changed over time," the researchers wrote. A 2023 Gallup survey found that rates of loneliness in the US have been steadily declining since the height of the pandemic. A study from the University of Michigan — also released months before Murthy's advisory — similarly found that Americans between 50 and 80 years old are far less likely to report feeling lonely than they were in 2020.

Eric Klinenberg, a professor of sociology at New York University, finds it "baffling" that public-health leaders like Murthy aren't "publicly celebrating the improvement" and studying how and why it happened. "Imagine you're a public leader and you're dealing with the AIDS epidemic and you saw a 20, 25% decline in the prevalence of AIDS in a two-year period," he said "Wouldn't you call attention to the success of the project and try to really explain how we brought numbers down?"

Julianne Holt-Lunstad, a professor of psychology at Brigham Young University who served as the lead science editor of the advisory, says that loneliness is pervasive enough to be a major concern. But even she admits that it's not clear whether loneliness is getting worse. "We can debate what that exact prevalence rate is and whether it's going up or not," she says.

Some of the adverse health outcomes the report warns about are questionable. "The surgeon general has rung an alarm bell that is not as clearly causal as the report shows," says Dave Sbarra, a professor of psychology at the University of Arizona whose research the surgeon general cites in his advisory. "Some of the conclusions go beyond the extant data." In particular, the claim in one chart in the advisory that "lacking social connection is as dangerous as smoking 15 cigarettes a day," he says, is "terribly misleading."

Murthy declined to speak with me for this story. His office said they stand by the advisory, and that it followed the CDC's definition of an epidemic. Still, just four years ago, Murthy himself recognized the uncertainty around health outcomes. He told the Freakonomics podcast that just how loneliness impacts our health is "still in the very early stages of being understood." While we have data that show association, we have fewer studies that prove causation, he added.

The bigger worry is that misdiagnosing loneliness may lead to the wrong treatments.

Most of the solutions proposed by Murthy, politicians, influencers, and startups tend to focus on one person's behavior. "Answer that phone call from a friend," Murthy writes in the report. "Express yourself authentically." But many experts argue that loneliness and social disconnection are symptoms of deep societal problems, including poverty and inadequate healthcare. Calling it a "loneliness epidemic," then, may be a bit like calling COVID a "sneezing pandemic." Holt-Lunstad worries that working to eliminate loneliness is "kind of like getting rid of pain without actually addressing the source of the pain." As we exaggerate or misunderstand loneliness, it will be harder to find solutions that actually help those who are most vulnerable.

Loneliness is a modern condition in human history, and it remains ill-defined and poorly measured.

Before about 1800, "loneliness" was barely used in the English language. It evolved from the word "oneliness," which just meant "alone" and didn't carry the same emotional baggage. Many early Americans embraced being alone as a way to be closer to God.

As Western industrialization and secularism emphasized the individual, society began to view loneliness as distinct from solitude — and as a loathsome experience to be avoided at all costs. Soon marketers began touting technology as a means to alleviate it; a 1912 Bell Telephone ad bragged that the telephone "banishes loneliness." By the mid-20th century, dissecting loneliness was en vogue among everyone from The Beatles to the famed sociologist David Riesman. And in 1978, psychologists at the University of California Los Angeles released a set of survey questions called the Loneliness Scale, which nearly 50 years later remains the closest thing we have to a standardized metric in America.

It's like we have one word for 'snow' and we need to find the Eskimos of loneliness. Eric Klinenberg

Like any subjective experience, loneliness is tricky to measure. And it's often conflated with being socially isolated, which means having few social relationships and interactions and can be measured more objectively. "You can be isolated and not lonely, you can be lonely and not isolated," Holt-Lunstad says. The public uses loneliness as "a catch-all," she says, to describe a slew of other phenomena, including poor-quality relationships. The Chamber of Commerce recently named Washington, DC, the loneliest city in America simply because it has the highest proportion of one-person households, despite research that suggests people who live alone actually socialize more than their married counterparts.

The standard 20-question UCLA Loneliness Scale asks participants to rate their relationships and feelings of connectedness, including "How often do you feel part of a group of friends?" and "How often do you feel that no one really knows you well?" I've answered the survey multiple times. While I've consistently gotten a low score — indicating I'm not particularly lonely — I've noticed that my answers depend somewhat on how I'm feeling that day. I'm more likely to say I feel isolated from others "sometimes" if I've worked long hours from my apartment and not the office that week.

While the scale is intended to measure how people feel in general, not in the moment, there's no universally agreed-upon way to use it. Many surveys, in fact, use an abridged version that asks only three questions. "The problem is that we have different studies that will either be using a different form of the UCLA Loneliness Scale or they will score it differently," Holt-Lunstad says.

The scale determines whether someone has a low, moderate, moderately high, or high degree of loneliness. Some studies count both moderate and severe — resulting in studies that show more than half the population is lonely — while others focus just on severe cases. Other studies — not referenced in the surgeon general's report but widely cited in media — abandon any kind of standard. "There are many, many surveys that are just making up questions about loneliness and are not using the UCLA Loneliness Scale or some other validated loneliness scale," she says.

Another complicating factor: Not all loneliness is bad. Many psychologists see what they call transient loneliness as a healthy type of biological alarm system that, like hunger or thirst, prompts someone to reconnect when they find themselves on the social periphery.

What's actually harmful, researchers believe, is chronic loneliness, which tends to be self-perpetuating and destructive. Regularly feeling lonely is "a form of negative information bias, where people tend to look for confirming evidence that they are on the social periphery, pay attention to negative information, and get stuck in this sort of loop," Sbarra says.

But chronic and transient loneliness also aren't clearly quantified. The surgeon general's report doesn't explain the difference between the two or offer any measure of either. As Klinenberg puts it, "It's like we have one word for 'snow' and we need to find the Eskimos of loneliness."

While the "loneliness epidemic" may be an exaggeration, it's one we're overwhelmingly convinced is real — partly because we're very eager to believe that things have changed for the worse. The social psychologist Adam Mastroianni has found that the belief in moral decline over time is a timeless feature of human psychology. We're both biased toward latching on to the negative news we hear today and more likely to remember happy memories from yesterday. Public intellectuals and politicians perennially argue, baselessly, that Americans are meaner and sadder than ever before.

"They see things that have definitely changed — like people didn't used to have smartphones and now they do — and assume that they know what those changes mean for the human experience," Mastroianni says. "Part of that is underestimating the extent to which people adapt to changes in their environment."

If people believe something has recently gotten worse, they're more likely to believe it can be fixed. So framing loneliness as a modern epidemic makes sense, Mastroianni says, if the goal is to get the public to care about an age-old problem. "Newer problems seem more urgent. There's a very low threshold for people to claim a crisis."

Loneliness is also an attractive, easily understood, widely relatable issue, and it's largely apolitical. Both Republican and Democratic politicians say they care about social disconnection, despite using it to explain different social phenomena and prescribing different solutions. The Biden administration isn't facing the kind of political backlash it has when addressing other public-health issues, such as gun violence or COVID-19.

Beyond semantics, muddying the problem of loneliness and isolation does a disservice to deeper societal issues.

As Jill Lepore has written, Murthy tends to point to loneliness as the root of all mental, physical, and social defects. His "everything-can-be-reduced-to-loneliness argument" suggests that the solution to social disconnection is a fundamental shift in how Americans live, rather than a set of concrete solutions to issues like poverty and discrimination. "That's not a policy agenda. That's an indictment of modern life," she writes.

Though he does outline a few policy fixes for loneliness in his report — investing in social infrastructure like libraries and funding more scientific research on loneliness — Murthy is consumed with changing individual behavior. When he speaks publicly, he advises doing acts of service, calling our friends instead of passively scrolling social media, and leaving voicemails instead of sending texts. He talks about creating a movement to prioritize social connection and a "connection challenge" in which Americans measure their social interactions like steps on a Fitbit.

"Investing in libraries and in accessible parks and gardens and senior centers — that's going to be much more powerful than answering the phone when your friend calls."

Last October, Eric Klinenberg asked Murthy to describe what collective, rather than individual, solutions would alleviate loneliness. But the surgeon general doubled down on his list of intangibles: kindness, generosity, service, and friendship were his primary fixes.

"The movement to rebuild connection is not first and foremost about policies, and it's not even about programs. It's about a fundamental moral choice that we have to make about what kind of society we want to live in," Murthy said.

The surgeon general is right that American life has become far more atomized and asocial, but urging people to put away their phones at dinner isn't the kind of structural fix Americans look to public-health officials for, nor does it address why people are lonely in the first place. "These are great things to do for relationships — they would definitely help people feel more connected to those around them," Klinenberg says. "But this is not 'invest in a better healthcare system so that people know that they're gonna be taken care of if they're sick.'"

Attention and resources in the world of public health are finite, and overstating the pervasiveness of loneliness could distract from more profound political problems — like failures in the healthcare system, student debt, and struggling schools — that feed loneliness and sow distrust in institutions. Unsurprisingly, the most marginalized groups in society — people with low incomes, those who are sick, people of color, and queer people — are the most at risk for being lonely, research shows. Rebuilding the social safety net and expanding access to public centers of community are key solutions to what Klinenberg calls not a loneliness epidemic, but "structural isolation."

"It feels to me like a bit of a political dodge," Klinenberg says. "Really investing in libraries and in accessible parks and gardens and senior centers and athletic facilities and public plazas that work as gathering places — that's going to be much more powerful than answering the phone when your friend calls."

There's also a risk that alarmism or conflating guidance about loneliness will dilute the influence of public-health officials' warnings. In 2020, Jerome Adams, the surgeon general at the time, infamously told Americans to stop buying masks because they weren't effective in stopping the spread of COVID-19. Later, of course, we knew better, but the damage had been done.

For all the attention he's drawn to loneliness and isolation in America, to cure the problem, Dr. Loneliness needs a second opinion.

Eliza Relman is a policy correspondent focused on housing, transportation, and infrastructure on Insider's economy team.

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