A surgeon general’s urgent warnings

Dr. Vivek Murthy talks to us about the crisis of American masculinity, why pro-democracy leaders struggle to speak to the emotions, and whether social media should be banned for minors

Dr. Vivek Murthy, the surgeon general of the United States, is an unusual doctor, but unusual in a way that is on the rise. He is a doctor whose primary interests are problems not often thought of as medical. He has the authority to prescribe medicine, but the remedies he is interested in can’t be bought at a pharmacy.

He is part of a wave of public health doctors and thinkers who in recent years have sought to make us look at health more holistically. These doctors want us to see more of our health challenges as connected to the larger choices and problems of the society — and to see more of our social problems as matters of health.

Murthy, who is now in his second term as surgeon general, has made loneliness in particular his big focus. You’ve felt it. I’ve felt it. We’ve all felt it. But Murthy thinks it’s a shared social — and, yes, health — problem as much as is, say, cancer or diabetes. I wish this had been a widespread doctrine when I was in middle school.

Today we bring you this really special conversation with the United States’ surgeon general that touches on so many themes we have been pursuing at The Ink: Why are would-be authoritarians better at connecting to the anxious and fearful and adrift than democratically minded, fact-based leaders, and does it have to be that way? Is capitalism ultimately to blame for the isolation so many Americans now experience? Why are so many American men in crisis? And is it possible to hold simultaneously in one’s mind the thoughts that (a) men have been fussed over too long already and (b) if we don’t help men cope with the transition to a more gender-equal society, everyone will suffer? Is social media for minors more like tobacco or like opioids — and, therefore, should it be banned outright for young people or just better regulated?

This is a really special conversation. You won’t want to miss it.

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I've seen you discuss the crisis of loneliness not just as something we see happening to individuals, but as having to do with the bigger political and institutional crises in the country.

Heading into an election year, how do you make the connection between loneliness and isolation and the rise of authoritarian movements, fascist movements, the kind of interest in violence that’s made its way into the mainstream from the corners of political life?  

Well, our relationships with one another are a critical part of how we root ourselves in the world and how we buffer stress and adversity in our lives. And when we don't have that connection, we are more deeply impacted by uncertainty and adversity around us, and also we feel more threatened.

In that state, we are more likely to be impacted by forces that would divide us, that would polarize society, that would try to compel us to take extreme action in the face of that threat. 

I'll just give you an example: If someone told me that my child was in imminent danger and they convinced me that they are the only ones that could help, I would overlook a lot of shortcomings, a lot of fundamental moral disagreements I had with that person. I’d put aside a lot of concerns about the impact that they might have on other parts of my life or the world if I thought they could save what was most important to me.

And that is one of the reasons why I'm concerned about this loneliness epidemic that we're experiencing not just in the United States but around the world. It has profound impacts for individual health, physical, and mental, but it also has a profound impact on the health of society. And I don't think it's a coincidence that we're seeing increasing polarization and division at a time where our connections to one another have deeply frayed.

With the exception of you making this case publicly and often, it seems to me that often the very purveyors of division you mention are much better at diagnosing what's going on than the people you’re allied with have been. Demagogues are better at understanding the status anxiety felt by white folks in a changing country than people who actually want progress; Jordan Peterson is better at responding to the fact of a masculinity crisis than people who are talking to men in good ways.

Can you talk about why a lot of the people in the administration you work for, the people aligned with you, are not really thinking at the level of affect and why the bad guys in many cases are much smarter about that?

One of the challenges that we've seen recently is that sometimes we forget that human beings are both cerebral and emotional creatures. We are all that way. We have the capacity to feel; we have the capacity to think.

But one of the things I learned early on in medical school is you have to recognize and treat both parts of a human being. If somebody comes in with, let's say, congestive heart failure, and they're in the hospital because the swelling in their legs is worsening, if all you do is give them a diuretic, a water pill to help remove some of that water and reduce the swelling, but you fail to recognize that because they were unable to walk because of that swelling in their legs, they just missed their daughter's wedding, they've been missing out on many important family moments, then you miss a really important part of how their illness has affected them.

And this is one of the reasons you sometimes find in medicine that patients will go to a doctor and though, even by the book they'll get the right treatment, the right antibiotic, the right medication, they'll come away feeling that they weren't seen and heard and understood. So you have to treat the whole patient. And that's more than just getting the cerebral part right.

So what we have to recognize is that, yes, there are material concerns that people have in their lives around the economy, around safety, around other challenges like a housing crisis, but there is also a deeper spiritual crisis that's taking place in many of our communities, in our country and in the world more broadly, a crisis that's marked by people feeling a greater sense of disconnection from one another, feeling unmoored or disconnected from sources of meaning and purpose in their lives.

So this is a place where policy matters, but policy alone is not enough to address the deeper pain in people's lives. We've got to listen, we've got to understand and address both the pragmatic and the deeper emotional spiritual crisis that people are going through right now. Otherwise we leave people feeling like we're not seeing them, we're not hearing them, we're not understanding what's really going on in their lives.

This makes me think we have a lot of well-meaning leaders who are much more comfortable talking about the cerebral aspect — building bridges, or the price of a drug, or expanding Medicaid, these kinds of hard but fundamentally policy things — than they are comfortable talking about the things you're talking about.  

Well, it is a really good point you bring up, and I think it reflects a broader cultural trend over the last several decades, where we've decided that certain skills and topics are hard skills and others are soft. And we put things like intellectual analysis, details of policy, numeric-based assessments in this category of hard skills. If I can talk about numbers, if I can talk about concrete deliverables, if I talk about moving the needle on a metric, then okay, that has real value. But the other stuff, the soft stuff is seen as less valuable, or as stuff that you don't need to have a skill to do.

That couldn't be farther from the truth, and it betrays a fundamental misunderstanding of human beings.