Vivek Murthy Returns (US Surgeon General)

Vivek Murthy, is a physician and a Vice Admiral in the United States Public Health Service Commissioned Corps, who has served as the 19th and 21st Surgeon General of the United States. He has a beautiful book out right now called Together, The Healing Power of Human Connection in a Sometimes Lonely World. Additionally, he has a great podcast called House Calls. So please check out House Calls and the book together. Now, very importantly, we have the new Armchair Anonymous prompts.

These will also be on the website. Some people are confused where you find them, www.armchairexpertpod.com, and they are as follows. Tell us a time something crazy happened on Halloween.

She can talk about other people's kids.

Exactly. No patrons. Nope. Although you can have been a patron, but you have to be a bartender.

So quickly, crazy thing on Halloween, crazy babysitting, crazy bartending, crazy piercing tattooing. Please go to the website and submit. Please enjoy Dr. Vivek Morthy. We are supported by Squarespace.

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I want to start with an apology.

He wanted Papa off the computer. Ha ha, ha, ha, ha ha. That's right. And you had this beautiful scenery behind you, this yard, which you later told us had been decorated or horticultured to resemble India. There was jackfruit trees.

It's like, no, it's just a peacock.

It's pretty amazing. That's exciting.

I would presume. you're home based now in DC?

also. We lost 10 family members to COVID. There was a lot of pain, a lot of challenge, but one thing that helped-.

And the interesting thing is I remember telling my wife, I was like, you know, COVID's really made me realize how important it is to be close to family, to be together. And I was like, I can't think of a single job that I would feel would be worth it to leave this setting, except if there was, I don't know, like an emergency, and the president asked us to come help. Right.

And then all of a sudden, no one can help themselves. They're kind of making jokes. And sure, there's a sick dying person right here, but we're gonna still keep it light. And it's very counterintuitive how fun those things can be. And I guess it's really just a testament to how much we get out of it.

I don't know if you've had this experience, but my parents sort of still think of me the way they did when I lived at home.

And it shouldn't, I'm just who. I was to my parents back in the day, which is part of what I love. But during the pandemic, it was interesting. I had this experience of, I was doing these daily briefing calls with President Biden at that time. This was before he was president, but it was about COVID.

Helping him understand what was happening in the world with COVID and understanding kind of what his thoughts and questions were. So, anyway, having these intense daily calls and I'm doing them at the same table that I did my high school homework at.

my life wasn't matching up to that. And there was this gap and it was growing. Friends would call and I just wasn't calling back. I'm like, I'll wait till I have more time and then weeks would go by. I wasn't proactively staying in touch with people.

And, like you were saying, when I was, even with my family and friends, I was constantly checking email, I was on my phone. There were reasons for all of this that I would tell myself and say, well, there's a lot of work, I need to stay up as often as I can, make sure I'm not getting behind. This is a once in a lifetime opportunity to serve and kind of do as much as I can during this short time. I'll catch up later with friends. These are the stories I told myself.

I think they're similar to stories and perhaps many of us tell ourselves when we defer things that are critical for our wellbeing. And what happened actually? when President Biden asked me to come serve again as Surgeon General is, I had this conversation with my wife and I said, he's asked if we would be open to coming back. And my wife paused and she said, Vivek, what's gonna be different this time?

You know, I realized a lot of times we make mistakes in life and we don't have a second chance. I was blessed to have another opportunity to get it right. And so, while it's not perfect, what I do, I think better now, I really do try to prioritize family and friends in a few ways. One, I work hard whenever I'm in town to make it home for dinner and to be there for dinner, for bedtime with my kids and to be present. The second thing that I do is I try to make sure that I'm there for the critical things that are happening in our kids' school.

So whether that's being the mystery reader in class, which I do from time to time, or whether that's making sure I'm there for the parent-teacher conferences.

Masked singer. Yeah, yeah, it was like masked reader. They wore like sushi rolls.

So the kids all think that I'm a pilot or a police officer.

So, but with the mystery reader, it's actually fun, because that's when parents get to go and read a book. But then one of my secret pleasures is I love to tell stories to my kids, but to make up the stories, right? So every night I'll gather them in my arms and I'll make up a story for them. And at this point, doing this for a few years, we've created this whole mythical universe of characters and everything. And so when I go to their school, I'll make up a story for their classmates.

Yeah, very much, an artist that is medical.

it'll peel out. So you'll go and you'll do that off the dump. It's not my place to do this, but I similarly make up stories for the kids. Oh, wow. But I think, because I come from an improv background, to start my story, they each get to pick a word.

So it'll be like unicorn and toothbrush. So somehow I've got to incorporate these in a non-thrown away manner. You know, they gotta be instrumental for the story. The unicorn and toothbrush, or whatever two words they throw out. I don't know.

I just feel like maybe it could- I love that. Amp up your-.

I thought I would fail.

It's exceedingly fun.

And I think the more inviting and the more fun the things are, the more appealing they are.

These are a lot of the games that we played when we were kids, but people just wanted to have fun. We would do dance parties at our home and we were all terrible dancers, but we just wanted to have fun and it brought us together. So I couldn't agree with you more. I think fun is underrated, is an antidote to loneliness and as a way to rebuild a fabric of society, but we need more of it, not less of it. And I think, particularly when we think about our kids and I actually, I'm coming to you guys from sitting down with a group of university chaplains who I was meeting with.

These are individuals who kind of look out for the spiritual health and wellbeing of the student body. And they're deeply concerned about the mental health crisis that's happening among young people. And something that I've been working on for the last few years, so we were meeting to discuss it. But one of the things that comes out so often, it came out of this conversation with them, but also my round tables, with young people everywhere is that we have, I think, forced such an overly structured, overly regimented way of being instead of expectations on young people today, that the fun in their life, the white space for creativity, for exploration, for making mistakes and learning from them, I worry a lot of that has been squeezed out. Kids are so over-scheduled today.

They always talk to me about being caught up in hustle culture. They say, hey, I'm hustling after fancy job, fancy internship. I'm supposed to be famous and get all these followers and build my brand, do all these things. It's just exhausting. But I'm told that that's what I gotta do to make it.

If you don't get better, who gives a shit? And then you become an adult. It's supposed to flip like a light switch and you're supposed to enjoy process. And we know intellectually that that is the route to happiness is enjoying the process, not the results. Yeah, you gotta undo 24 years of methodical brainwash that everything's about results.

Maybe it's, I'm gonna play this game. Maybe it's, I'm gonna watch that thing. It's gonna make me laugh, whatever it is. But joy is a renewable resource that we have within us. And it's like electricity can power us in doing different things in our life.

It can give us energy. It can give us perspective, but we don't really cultivate joy. We try to cultivate skills and we tell ourselves, hey, those skills are the key to success. But all the skills in the world without the joy is like having the most powerful car in the world, with no electricity or gas in it. It's not going anywhere.

Well, let's talk about, globally, your different approach to previous surgeon generals, which is they have historically focused on physical ailments. Now let's just for a minute, put quotes over physical, because your mental health is part of your, yeah. But let's just say they have been far more targeted on physical maladies. And your approach is kind of a departure. And so, even though we did it in the first interview, let's go through some of the dark statistics associated with loneliness and lack of social connection.

The headline which people are now hearing with some regularity is the smoking analogy. Will you tell us the effects of loneliness?

I was asked, hey, what are your priorities? This was not one of the ones that I listed because it wasn't on my radar.

One is that loneliness is incredibly common. And the recent surgeon general's advisory we issued a few months ago on the epidemic of loneliness and isolation actually pegs this number at around 50% of adults who are reporting measurable levels of loneliness. But the numbers are actually even higher among young people, who are experiencing the highest levels of loneliness across the age spectrum. So I realized, number one, it's incredibly common. But the second thing I realized, to your point, Dax, was how consequential it was for our health and wellbeing.

So we find that when people are struggling with loneliness and with isolation, their risk of anxiety and depression and suicide go up, but their risk of physical illness goes up too. So they have a approximately 30% increase in their risk of heart disease and stroke. Their risk of dementia among older people goes up by 50%. Their risk of premature death goes up as well. And people have done studies looking at this and they find that the mortality impact overall of loneliness and isolation is comparable to what we see with smoking.

I say that as somebody who holds an office that is focused for more than half a century on smoking, on tobacco-related disease, but I have now come to believe that addressing loneliness is just as important a public health priority as addressing tobacco-related illness. They're both critically important.

And then, when you're all alone and miserable, how do you self-medicate? There's different options. Doritos are a great one. Cigarettes are a great one. Jack Daniels is a great one.

It's hard to pinpoint where the momentum starts rolling in the wrong direction, but there's so many factors and someone has to synthesize all these things, right?

And you spoke about trauma, trauma that may happen from abuse or from other experiences, especially early in life, can have so many myriad consequences downstream, in terms of not just mental health, but physical health outcomes too. The interesting thing about trauma is, in addition to counseling and professional help, being incredibly useful for many people in overcoming the adverse effects of trauma, one of the biggest sources of healing for people who've gone through trauma are healthy relationships.

Sometimes it's in depression and anxiety. It comes out in different ways. But one of the things they found in this Kauai study was that when they looked at kids who had gone through high degrees of trauma, they found that what made the difference between the kids who ended up doing well later in life and those who didn't were actually their presence of healthy, trusted relationships. And that could be a parent. It could be a close friend.

It could be a teacher or a mentor, but we all need these relationships to thrive. And this is, I think, so important to underscore, because I think there is a thread in our culture that tells us that, hey, to be successful, we've got to be independent. And what does independent means? It means we shouldn't need other people. We should be able to do everything.

And look, there's nothing. that's wrong with striving for getting better and better. We should do that. We should strive to be our best selves, to develop better and better skills, to be stronger, to be more resilient. But that is not incompatible with needing and relying on other people, because we evolved to be interdependent species.

Thousands of years ago, if we said and modeled our lives after that notion of independence, that we don't need anyone else, I'll tell you what happened to us. The person who left the group, so to speak, and said, don't need anyone else. I'm out there on my own. That person got eaten by a predator. Oh, they did.

Yeah. They starved from insufficient food supply. It was the people who stuck together and said, yeah, we got to get better on our own, but we'll share food. We'll take turns watching around the fire at night to protect the group from predators. Those are the people who lived longer.

We learn to trust one another. The problem with trauma is it warps your worldview. Well, you could say it warps it, or it anchors it in reality, which is, there are predators. There are bad guys. And the only thing that can counteract that narrative is to be kind of submerged in good guys, to have the active data in front of you at all times.

No, no, this person is not one of those people. This person loves me and is committed to me and has sacrifices for me. That's the antidote to the worldview that you have to take on as a result of trauma.

We were meant to see each other and get each other through all of it and still are best friends. I was with him last weekend.

So I think it's really remarkable that you did.

I love this song. It's awesome. Oh my God, I'm so glad you said that. My sister got the tape for her birthday two weeks ago and I stole the tape and have been listening to it over and over again. We just had this moment like, okay, great.

It's okay for us to like this song.

What a shirt for you to pick out.

We are supported by BetterHelp. It's easy to look at someone else and think, gosh, I wish I had their life. But you know, comparing your life to others never ends. well. The truth is, their life probably isn't nearly as glamorous or put together as you think.

So stop focusing on them and focus on you. If you need a little help with that, I recommend therapy. I'm a big fan of the saying, I don't compare myself to other people, I only compare myself to earlier versions of myself.

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I've talked to many people in the executive branch about this. And everyone has a story, either about their own life or about somebody in their life who they're concerned about. And when you pair your personal story with this really powerful data that talks about the health impact of loneliness, it's hard not to accept that this is a profound public health challenge that we've got to address. And it's hard also not to accept that there's something foundational about this, that if we were to build stronger connections in our lives and in our community, it would make us healthier on a variety of grounds, right? It would help us address a number of other illnesses in terms of reducing the incidence of those illnesses, but it's bigger than health, because we see that when communities are connected, when they're more connected, they tend to be more economically prosperous.

They tend to have lower levels of violence. They tend to be more resilient in the face of adversity, like a hurricane or a tornado. And this makes sense intuitively, right? It's like, if we're all connected to one another and we're gonna help one another, and if we help one another, we're more likely to stay after a disaster or help each other through difficult times. But there's also this issue around polarization, right?

Like right now, there are few people I meet in the country who aren't worried about the polarization that they read about and hear on the airwaves. A country that is isolated and disconnected from one another is much more easier to exploit and to divide.

He was very concerned about how common it was and how it was impacting the country. So he has, for a variety of reasons, I think, a deep appreciation for mental health more broadly as an important topic. But I think he and other government leaders now recognize that loneliness is a key part of that as well. And that if we're not actively stitching together the social fabric of our country, we will continue to watch it fray. And that means that we're gonna continue to watch increases in polarization, increases in health conditions.

And when I was talking to a group of university chaplains this morning, one of the things that they were telling me is that they have noticed this profound sense of loneliness among their students that has been growing over the years. And, right alongside that, they have felt that the joy that students used to come to campus with has diminished. And there's a direct correlation between those two.

So it's like, one is, is it on the increase? And then two, do we know what's causing it? And is that even relevant? If really the solution is, we know what the solution is. It maybe doesn't matter what the causality is.

We're also seeing, for example, that isolation in populations has been increasing as well. And if you think about it, it makes sense. When we moved from a society where people were living, let's say, in extended families, where they tended not to travel as much, where you worked in the same place that you tended to grow up, people had a sense of communities. roots developed over time and they kept those roots. Part of modernity has involved moving around a lot more and has also involved families not necessarily living in extended family environments.

We just sort of took it for granted that, yeah, you know, we've always had people in our life. We'll always have people in our life. That stuff will continue. But I think what the last 20, 30 years has shown us is that we can't take it for granted that there have been real costs to our connection to one another, as we've embraced a lot of modernity, including modern technology. That doesn't mean that we need to go back to the 1950s or chuck all the progress that we've made or the opportunities that we have.

What it does mean is that we have to proactively develop strategies for strengthening connection in our individual lives and as a society more broadly, which is why one of the things that I've called for, in addition to a number of individual steps that we can take, is also, on a societal level, the rebuilding of social infrastructure, which, you know, we're used to thinking about bridges and highways as traditional infrastructure, but social infrastructure are the programs and policies that support the development of healthy relationships. Those might be community service organizations that bring people together. They could be faith organizations that give people opportunities to learn about one another across differences. They may be recreational leagues or youth leagues, but participation in all of these has decreased significantly over the last half century. And we have to rebuild this infrastructure if we want to rebuild connection.

I'm doing that even though I have stuff to do, which feels hard because, as someone who's like, wants to achieve and wants to-.

If I had a family, I think I would be like, well, of course I have to have dinner with my family or I have to put them to bed or something. Or drive them to school. Exactly. There are markers that the world appreciates for connection, but if you're single, there isn't that. So you yourself have to just say like, I'm doing this for myself.

That's not outrageous. And yesterday was the first Wednesday of the month. We had dinner, and every time I leave I'm like, I'm so delighted I finally cracked how to see him, which is, it has to be scheduled.

And so this isn't about transforming ourselves into something that's totally different, this is about coming back to who we are. But the other thing is, it's actually the small moments of connection that can make a big difference in how ultimately connected we feel. So, to your point, if you schedule time with a friend, even if it's like a half hour to have a meal or an hour, they catch up once a month, once every couple months, that can make a big difference. But even if it's smaller than that, I'll tell you something my wife does, which I love, she uses the time that we spend dropping our kids off to school when the four of us are in the car together, she uses that time to just ask the kids about something nice that happened to them. And that's a chance for us just to talk as a family for those few minutes that we're in the car.

So we're repurposing time to connect more deeply. The third thing that I've realized also is time is scarce, right? But there is one way to stretch time, and that's actually to give our full attention to someone else. So if the three of us are having dinner together and we said, okay, we're gonna catch up for half an hour, but the three of us are actually also kind of on our phones and check an email here and there, that half hour will go by quickly and we'll be like, oh, we didn't get to talk about that much, what happened? But if you try putting your devices away, not in your pocket, where you're like waiting for them to vibrate, but put them out of view, just devote your attention for half an hour to somebody else, that can be really powerful.

It can make a half hour feel like an hour or a couple of hours. And so it's not always about how much time we have, sometimes it's about how much attention we're bringing to a situation that allows us to really enjoy and appreciate the connection there. And to me, these small shifts are cultural shifts that are achievable, but they start with us believing that it's important to prioritize connection. And for me, part of the reason to have a national conversation about this and a global conversation is that if more and more people believe that this is an important priority, then it actually makes it easier for us to carve out time for this. Like, because I know my wife, Alice, really knows about how important social connection is, it's easier for me to say, okay, I can take an hour on Sunday and talk to my buddies, because Alice knows that that's really important for my health and wellbeing, it's not just an indulgence.

Keep in mind, we all, at least I hope all of us, do get up every morning and brush our teeth, right?

That's what we just talked about. And seek out opportunities to serve others. This last one has so many different benefits. There's a tenant of AA, right? You fully acknowledge the selfishness of the selfless act, which is.

while I'm helping you, it's hard for me to ruminate on the many things that could make Dax happier. And the freedom from that rumination and self-obsession is a gift. It's so pleasing to stop thinking about myself for some extended period of time.

It's not just building a house with Habitat for Humanity. Those are powerful ways to serve. But service can be seeing someone who's in need and offering a kind word, checking on them, seeing somebody who spilled their coffee in the coffee store and helping them clean it up or get a new cup. I mean, there are small ways to serve that make a really big difference in how connected we are. And especially when we do this with strangers, this is something that many of us realized during the pandemic, when we couldn't see strangers in particular.

A lot of people told me, you know, I expected to miss my family, my friends, the people I couldn't see, my work colleagues, perhaps, but I didn't expect to miss those strangers at the coffee shop, or to miss seeing people in the grocery store, but it's really nice to see them again. So those small moments of connection where we're kind to someone else, those are all acts of service that help bond us to one another.

This is just data of marriage rates. in New York City in the 70s versus now. People are more and more and more alone. In my opinion, we're just living in the opposite way we were designed to live, and then we're shocked when we have kind of pandemic level mental health issues. This is not what we were supposed to be doing.

Friendship is one of the greatest buffers for stress. They helped us make sense of confusing times. When we were in times of despair and confusion, it was friends who often hold up a mirror to us and help us see who we really are and what matters to us. Those are the profound values of friendship and of social connection. And I worry that unless we recognize that value, unless we make a conscious decision to move from what has become a work-centered life to a people-centered life, that we will continue to struggle, I think, with the rates of depression and anxiety and unhappiness and lack of joy that we are seeing so commonly around us, especially among young people.

If you think about these three buckets, the first one we're starting on, that's part of the purpose of conversations like this that we're having is to give people permission to say, yes, this is important. I can make this a priority in my life. I want to choose a life of connection. That doesn't make me weak. It doesn't make me irresponsible.

It doesn't mean I'm not committed to being successful. It means I understand what's important for my health and wellbeing. So I think that movement is starting. We need to accelerate it, and we need to have more conversations in schools, workplaces, faith organizations, communities, around this. But on the individual front, the second bucket, these were some of the steps we were talking about earlier, I think, are very powerful.

Just spending a few minutes each day connecting with someone you care about, making sure that when you're talking to family and friends, that you're giving them your full attention, looking for ways to serve as well, in small ways and big ways. These can help us foster greater connection in our life. If we think about the third bucket and the community bucket, this is about, again, mobilizing our institutions. So if you run a workplace, for example, workplaces can be really powerful in creating opportunities for people to get to know one another. I'll give you an example of what we do in our office.

Once a week, when we have our all-hands meetings, we have something we call our Humans of OSG exercise. This is OSG stands for Office of the Search. in General. This is a simple 10 to 15 minutes where we have one team member interview another, and it could be about anything in their life, as long as it's not about their current job. It could be about what excited them when they were younger.

What did they dream about doing? What worries them? What's their family like? What music do they love? And those 10 to 15 minutes often lead us feeling like we know the person better and feel closer to them than we had perhaps in the prior year of working with them, because we've come to understand them as a whole person.

And that's 10 minutes in an all-staff meeting. It's not putting aside a few hours to have a company picnic on weekends when you can't be with your family. It's not come to happy hour after work where you had to take time away from family. It's very simple, but it's powerful. In schools as well.

I think schools do a great job in recognizing the importance of things like math and science and history, but I think one of the most important life skills that we can give to kids is a skill to build healthy relationships and manage healthy relationships, because a lot of people don't know how to do that. And when I talk to folks today, teachers at all levels, grade school level, college level, many of them are worried that young people today, in part, not because anything of their own fault, but because they're rapidly changing social media environment and technology environment, that many young people are not feeling comfortable reaching out to strangers, building new friendships, initiating conversations. That's a skill set we can't assume everyone is born with. That's something we have to cultivate. So this is what schools can do.

So if we focus on these three buckets, I think we can make a big difference. And I lay a lot of this out in our advisory in terms of a national strategy that we need to have to rebuild social connection and community in America, but it starts with what we do in our individual lives. And that's why I think, for anyone who's listening here today, who's feeling perhaps the pinch of loneliness, who's worried about somebody in their own lives, some of these simple individual steps that we've talked about, that's where it starts. And when you start making those changes in your life, it affects your friends. They're starting to feel more connected.

They're starting to ask you what you're doing. One quick anecdote, something I did in my own life, which made a big difference. When I was feeling profoundly lonely. in 2017, 2018, my first stint as a surgeon general had ended. I didn't quite know what to do with my life.

I was in part feeling like I had failed, because I hadn't been able to do everything I had wanted to do in the role. And I had allowed my identity to get really wrapped up in the job. And so, when I was no longer in the job, I'm like, well, who am I? What is my worth to society? Why would anyone want me to do something with them or work with them or hang out with them?

I was having all of these thoughts.

A friend years ago once told me, we were having one of these late night philosophical conversations in college, and I said to him, how would you define a friend? And he just kind of thought about it. He said, you know, a friend is someone who reminds you of who you are when you forget.

And we actually realized we were all feeling a bit lonely and a bit lost during that time. And at the end, we were like, you know, it'd be great if we saw each other again. We should try to make it a point to see each other, knowing we lived in different cities, knowing in the back of our heads, it probably wasn't gonna happen as often as we wanted. But then finally, I was like, you know what? We gotta do something to make this different.

So we made a commitment to each other. at the end of that walk. We said, we are going to call each other on video conference once a month and talk for two hours. We're not gonna be distracted by other devices and stuff. when we do that.

Number two, we're gonna talk about the things that really matter to us, that we don't often talk about enough with other friends. And those include our health, our finances, our family, our fears. And the third thing we said is that, in between those calls, if things come up that make us really worried or scared or anxious, or things that bring us a lot of joy, we're actually gonna text each other and let the other two know and respond. And if we need to have an emergency call, we'll do it. We formed something called a Moai, which is an old Okinawan tradition where kids would come together early in life and commit to one another and be there for one another.

And I'll tell you that that Moai really saved me. Huge decisions that I had to make in my life about family, about work, about all kinds of things, about my health. I called my Moai brothers, Sonny and Dave. I was like, I'm feeling like I'm spending on this. I don't know what to do here, or I'm feeling like I'm gonna do this, but I'm gonna do it for the wrong reasons.

I'm feeling really angry about this situation. I'm not sure how to break out of it. And we would help talk each other through it. There was no expense to that. There was no major prep or training we had to go through, but there was an explicit commitment that we made to one another.

And I think a lot of times we tiptoe around our friendships in life thinking, hey, I don't wanna intrude on my friend's privacy. I don't wanna impose on their time. I don't wanna make their lives harder by asking them for things. And meanwhile, they're thinking the same thing as well. And so if we can take the implicit affection and love and commitment we have to one another and make it explicit, such that we can ask each other for help, so we can actually be present with one another, we can have regular time with one another, as you did with your friends scheduling these monthly dinners, we can strengthen the relationships we have in our life.

And I tell you, my life feels a lot less lonely because I have my Moai with Sonny and Dave.

I said, I think I need your advice. I think you've been through stuff that I'm now going through and I'd like to get your advice. And the response was so immediate, like, yeah, name the time, dude. And in that moment, I recognized like, yeah, people love to give advice. They love it.

Again, I always thought, I don't wanna be a pain in anyone's ass. I just wanna be value additive to everyone. But asking someone for advice is value additive. It makes that person feel like they have something to pass on. They like it.

I have a couple of questions that are just more surgeon generally questions.

Oh, really? And we don't want to take 10,, 20,, 30, 40 years to build 988 into everything it can and needs to be. And so there's a lot of emphasis being put now on making the right investments, building out those networks so that you can get the help that you need it whenever you need it.

I keep getting whiffs of hot dogs, as if someone's cooking them right next to the air conditioner.

Okay, obviously this surge in general, I imagine you're asked about drug policy. That's a health issue. Increasingly we're recognizing that as a health issue. It used to be a criminal issue, but now, thank God, it's more and more a health issue. And you were on record in 2021 saying that there was no value, quote, to incarcerating people for cannabis use, which I couldn't agree with more.

But let's get into the harder ones. So Oregon now famously has decriminalized most drugs or put very small fines on things. There's been a couple articles I've read recently that says this is not going very well for them. And I wonder what your thoughts are on kind of a global drug policy for America, and how do we figure... I mean, I feel qualified.

I've done every single drug and I've been addicted to many of them. I think I could come up with the list of what we should decriminalize and what we shouldn't. But I'm very curious how you approach it, given your job, when you're thinking about what a drug policy should be for the country.

That doesn't mean that you overlook any adverse consequences to their addiction, not at all. What it does mean is that if we are taking people and putting them in prison instead of getting them help and treatment, we are not serving them, but we actually are not serving society, right? Because then what happens to them? They serve their time in prison. They are suffering.

They come out and they are still addicted. So it is better for all of us to take people who may run into trouble with the criminal justice system and try to get them into treatment. It's also important that for folks who are in jail, perhaps for other issues, but who also have a concurrent addiction issue in their life, that they also have access to treatment, right? In prisons. And this has been a place where we have not had enough readily available treatment, like in our prison system, for folks struggling with substance use disorders.

So to me, that has to be a first principle, is that when we identify people struggling with addiction, we get them help, we divert them into the health system. And that's where drug courts actually were focused on, right? And that's where there were a lot of successes that came from drug courts. And you know, the people who I think really appreciate this kind of shift are law enforcement themselves. I've talked to many law enforcement officers over the years about the drug addiction crisis we've got in America.

Many of them say, look, we didn't train. as healthcare providers. We can respond to an issue, but we need to know where to get them, where they can get help. Historically, folks have landed up in emergency rooms, which is not the ideal location to provide somebody with long-term care. So that's why, again, the move toward one, investing more in drug courts, but two, building stronger partnerships between public health and law enforcement so you can get people in to substance use treatment, that is what we have to do.

And the third thing I'll just mention is related to what you brought up earlier, Dax, which was on AA, which is communities of support that help people who are dealing with the substance use disorder. These were invaluable. You know, as much as I'm a believer in certain medications, you know, their ability to help, I think without community, it's very difficult. But I think that's where we also have to support community organizations that provide that kind of ongoing support, friendship, partnership for folks who are dealing with substance use disorders. All of these are critical parts of the operation here.

And look, a lot of this is about the execution as well. Sometimes you have a policy that's well-intended and isn't executed well, and then people will say, oh, that was the wrong idea. But sometimes it's not the idea, it's the execution. So we've got to get this right.

And this is particularly important for people with substance use disorders who needed medication, assisted treatment, access to counseling. How are they gonna get those? Well, it turned out. getting them virtually was extraordinarily helpful. It was literally a lifeline.

Part of the debate battle that's happening right now is whether those telemedicine authorities should be extended, whether they should be made permanent. I'm a believer that this is the direction that we need to go in, of making them part of the long-term apparatus of how we deliver care. When I was visiting Alaska in 2016,, I went to visit a small fishing village called Naposkiak, which is so small, it's 150 people. There are no roads to Naposkiak. You can only get there by boat or by plane.

And in this small fishing village, in this small little building, it wasn't even a building, it was almost like a hut, where they had provided first aid, they had a small screen set up on the wall. And I asked them, I said, what is that screen there for? And they said, oh, that's where people can come and sit and get counseling for their substance use disorders from healthcare providers in the lower 48.. And what a beautiful way to use technology to bring care to where people are. So, in my mind, that's part of what we've gotta do to make sure care is accessible.

They have counselors available to help them process the experience and guide them through it, because it can be a great experience. for some people. It can be a traumatic experience. for other people. It depends on their particular brain, their particular life history, and set of experiences and trauma.

It's done in a controlled setting, and it's done with professionals who can give counseling and care. And if that's what I'm talking about, why research is so important, it's like understanding the right way to deliver this so that most Denver people can have the most amount of benefit is what's really important here. What I'm worried about is, one, that we haven't done enough to make that research easy and fast. Given the scale of the crisis, we should be pulling out the stops. We should be doing, in a sense, like what we did with the vaccines during COVID, right?

Which is, we developed vaccines in a remarkably short timeframe without skipping the safety and efficacy and quality steps. Those were done, but the global community cooperated on an unprecedented scale to get this done, because we were in a crisis. The mental health may be a more slow-moving crisis. It might be more under the surface, but it's just as much a crisis. And so there are, I think, administrative steps and legal steps that need to be taken to make that research easier and to accelerate it.

The thing I worry about is that people will accelerate moves to distribute psilocybin on a widespread basis without any guidance to help their providers about who it helps, who it may hurt, how to administer it. If you went to a primary care doctor now and said, I have treatment-resistant depression. Can you prescribe me psilocybin?

And I think psilocybin is an area where the initial research, I think, is intriguing, and we've got to do much more quickly there.

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But you look at some lifestyle tools, right? You look at sleep, physical exercise, even to some extent, diet and relationships. These all have impacts on our mental health and wellbeing. When we sleep better, that improves our mental health. When we exercise, that lifts our mood and can have a powerful impact on our mental health, which is why, whenever I'm cranky and I'm in a bad mood, my wife just tells me, go downstairs and lift something heavy in the gym and you'll feel better.

And she's always right. Similarly with friendships, we've talked a lot about social connection here. I really believe that this is a moment coming through COVID when people's lives have been dramatically changed, when people are actually reflecting on what the future looks like and what perhaps they want from their lives. This is a moment for us to take a hard look at what life should and could look like, and to say, what would it look like if we truly built a people-centered life? What would it look like if we invested that five minutes, a day in reaching out to other people in our lives?

What would it look like if we really did look for ways to serve? We put our side, our phone, and actually focus on the person in front of us. How would we feel? You can do that? experiment in your own life, and I think the results will be clear.

But the bottom line is, if we use this moment to build a movement in our country and around the world, to create greater connection, to strengthen the social fabric of society, then I think that will lift all boats. It will improve our physical and mental health. It'll improve how our kids do in school. It'll improve how people perform in the workplace, and there's good data on all of this. But that's a conscious decision that we have to make right now, because the forces that are telling us to just keep pursuing more followers online, thinking that somehow that constitutes friendship, or that are forcing us to pursue fancier jobs or titles, thinking that that's the social currency that we need to feel worthy and meaningful, I'll tell you that those, in my mind, don't work.

There are so many people, the three of us all know, who are wealthy, who are powerful, who are famous, and who feel profoundly unhappy and profoundly alone. But the contrast, when I think about patients I've cared for over the years, there are many of them who were not famous, who were not rich, who didn't have powerful, fancy jobs, but you know, they were really happy, and the common denominator in their lives was that they had fulfilling relationships. One of the earliest patients I took care of was a man who came to see me for his diabetes and high blood pressure. And when I sat down with him, I said, I'm so glad to meet you. Tell me a little bit about your life.

And the first thing I remember him saying to me was, you know, doc, I won the lottery, and it was the worst thing that ever happened to me. And I was stunned when he said that. And I said, well, what do you mean? And it turned out he had this amazing life. He worked in the food industry.

He had customers who loved him, and he had coworkers who he really enjoyed. He lived in a modest home, but he knew his neighbors. They liked each other, felt he had a community there. But then he won the lottery, and he was like, I don't need to do any of this anymore. I'm gonna quit my job.

I'm gonna move to a fancy community by a big home on the water. And that's what he did. He moved into this gated community. He was living, quote, unquote, the life. But then, soon after that, he realized he really missed the people he worked with.

He missed the feedback he got from his customers and being able to bring joy into their lives. He didn't know his neighbors because everyone had these big walls up around their houses. And he became lonelier and lonelier and lonelier. I've seen anecdotally among men, especially older men, that their loneliness tends to manifest as anger and irritability. That's exactly how he became.

And shortly after that, he developed high blood pressure and diabetes, and that's what brought him to Come See Me. And that's why he said that winning the lottery was the worst thing that ever happened to him. So some of these things that we perhaps chase after or are told are the keys to success.

But if you think that achieving those credentials or getting that diploma alone is what's gonna make you happy, then you're set up for disappointment. And look, the thing is, if we all look back at our lives, we all probably can remember things that we aimed for. And as soon as we got them, we started to feel unhappy.

Now this is a counterintuitive because you think, great, solitude, isn't that being alone? Why is that gonna help me be connected to other people? The difference between solitude and loneliness is that solitude is actually a welcome state of being alone. It's a time where you connect more deeply with yourself, where you reflect, where you have a chance to just be in a world that seems like it's moving faster and faster and faster. And for some people that could be sitting on your front porch for five minutes and just feeling the wind against your face.

It could be taking a walk in your neighborhood. It could be just lying down and putting on some music that helps you feel inspired or calm. It could be any one of those things. It could be meditation, it could be prayer. But these moments of solitude are important because when we allow the noise around us to settle, that's when we start to get more and more comfortable with who we are, with recognizing who we are.

And one of the things that's happening increasingly right now, not just to young people, but to all of us, is, I think, that we have become less and less comfortable being on our own, being alone, right? And not being lonely, that's a separate thing, but being physically alone and having that time. Like. I've felt that in my own life. Sometimes I feel like, gosh, if I have the five minutes, I should be doing something.

I should be either doing some work, or I should be listening to a podcast, or I should be doing this or doing that, or whatever, being productive. But the truth is sometimes that five minutes, which seems wasteful, is really an investment in re-grounding ourselves, in the same way that, like if we were working out, we don't work out continuously. We work out and then we give ourselves a break so that our muscles can build and our body can recover. And that's what time and solitude is good for as well. And so, whether that's two minutes a day or five minutes a day, we all need those moments of solitude.

And it's something that we're trying to teach our kids too right now is how to not always look for something that can occupy them, but how to just take a few minutes, even if it's just two minutes, and just breathe. Sometimes I do this with our kids together is we'll just all breathe together for a minute, take a deep breath in and deep breath out. Box breaths. And practice just being, yeah.

What I like about doing it first thing in the morning is you can feel yourself join in the chaos after it. You can feel your adrenaline and cortisol. You can feel your heart rate change. I think it's really important to observe the trick, because when you wake up, if you grab the phone, you're there and there's no break from it. So you're just there.

You're in that hyper state and then it never ends. So you go to bed and then you repeat in the morning. But if you can do it first thing in the morning and actually get that, whatever it is for you, 10, 20 minutes of nothingness, it makes you more conscious of how distracting and how not great the other stuff is for you. It's like sobering up enough. Some people don't even know if they're high because they haven't been sober long.

I like doing it. I love that.

That's why they're there. But yeah, I just believe these men who were telling me it was nice for them. And then I learned TM. and yeah, I think it's incredible. And the rare occasion I can't start my day that way, the whole thing's very altered.

And days. I don't do that, if something happens, I'm up late and I wake up late, or if I just somehow slip and like dip into my phone, it just fundamentally is different. My mind's turning already. You feel frayed all day, right? Yeah, I feel frayed and distracted all day.

We often talk about time as one of our greatest resources, and it absolutely is. Our attention is also one of our great resources. It's how we make our time count for even more. And our attention is really frayed right now. And a lot of people I talk to say they feel like they can't even read a book anymore because they just don't have the attention to do it.

They can't read a full-length article anymore, because they just get distracted by X, Y, and Z. I think it's a struggle for a lot of people.

And there just aren't that many other venues. We were just talking about it actually with folks in my office who were saying that groups of existing friends tend to get together, but circles where you actually introduce new friends to each other, where circles integrate or overlap, that just doesn't happen as much anymore. People aren't going to parties anymore in the same way. So I actually think that matchmaking is even more important now than it was when we last spoke. And I still have the same love for doing it that I did before, because I just think there are a few things that are, for me, as joyous as being able to bring someone together with somebody else in a relationship that's meaningful to them, whether that lasts for a short time or that lasts forever, it's really meaningful.

But I find that a lot of people say they want to be set up by their friends, but it's not happening for a bunch of reasons. It's not because their friends don't care about them, but sometimes their friends aren't sure if it would be awkward if it didn't work out or they aren't sure if it would be intrusive if they suggested it. But it's a meta statement, but it's a matchmaking matchmaking problem, which is that there are friends out there who want to be matchmade. There are friends who have a network and they can do the matchmaking, but you actually have to bring these folks together. But this is actually something I find myself thinking about how to work on, especially after my time as Surgeon General, because I just think, if more people find love in their life, that makes the world better.

And you need three people in your life. I said that to him. It's like, he's already declared he wants that advice and he wants to have more meaning in his life. And then I offered that, as what was my experience and what I'd argue was Obama's. And I had a lot of people who were like, stop single-shaming people and stop childless.

And I know that, because there are plenty of relationships I see in my life that are lonely. They're together and they're lonely. Sure. And that's many, not just like, oh, I know, one person. That's a lot.

So I don't think that the antidote is a romantic partnership. I think finding love in some way and genuine connection is the answer. And it doesn't have to come in that form.

Because both people are going like, yeah, it's been a long time since you had a glass of water, Mary. Yeah.

So they can be physically around one another more, because some of my dearest friends live nowhere near me. If I have a need or something like that, there's more steps to take to actually flag that for them, for them to respond, than somebody who's actually living next to me or with me. So you're right, the numbers are the numbers. But what they tell us most importantly is that when you have somebody in your life who is an intimate connection, meaning you love each other deeply, you can trust one another, you can rely on one another, you can be there for one another, that that does make a difference in your health, your wellbeing, and your longevity. And there are people who don't necessarily have that in a romantic or platonic relationship.

There are people who are in marriages who may not experience that right now. But, by and large, having those kinds of relationships is what we need to be aiming for. And look, I know these are hard to have without people feeling like you are perhaps blaming them for the life that they're living. I think that we need to be able to talk about the data and what it shows us. But to say that, look, at the end of the day, the sort of active factor here, if you will, is having loving relationships in your life.

And you have to ask yourself what those really are, because those aren't transactional relationships. And I think sometimes we think about transactional relationships we have in our life, or somebody that we happen to be friends with on social media, like, well, yeah, yeah, we're friends. But really, when I think about real close friends, is this somebody who you love deeply? Is this somebody who you can be open with and truly be yourself with? Is this somebody who would be there for you in a crisis?

And is this somebody who would be honest with you when you're falling short, when you need the feedback, when you need someone to keep you accountable? Those are the kind of really close, intimate connections that we need a few of in our life. We don't need 50, we don't need 100, we don't need 10.. We just need a handful. If we have them, then we tend to be healthier, happier, and live longer.

On a broader level, though, I love what we're doing now, which is just having dialogue about certain things that we may have slightly different views on, but we're all concerned about the same thing. I do think part of what we've gotta do as a society is figure out how can we talk about stuff that we may not necessarily see eye to eye on or agree totally on, but how can we respect people's intention and not just judge them based on the words that are coming out of their mouth, right? We do this with our closest friends, right? They might say something like, huh, that sounded funny, but I know that they're not a mean-spirited person.

Definitely. And the absence of that just means that people don't talk about the questions they have, they resent each other more, and we have less conversation and we become more divided.

And I feel there's a lot of fear in the world right now. that's manifesting as anger and resentment, and jealousy, and rage and insecurity, and it's tearing us apart and it's hurting us and it's damaging our health. A world that's grounded in love, I think, is more consistent with who we are intrinsically. That's where people are kind and generous to one another, where they look out for each other, where they have each other's backs. And so when my kid falls down, I want someone to be there to extend a hand and say, it's okay, get up, you can try again.

I want my kids to do that for someone else as well, to be big enough to recognize that we are more than our worst moments and our worst mistakes, and to give other people grace in that way. To me, that's fundamentally what all this work is about, is trying to see how can we together create a world that's fueled by love, a world that our kids will thrive in, and a world that I think we all want.

Ah, just catching my breath.