Speak up
Illustration: Jeong Suh, Bryan Christie Design
It's a simple greeting, but its power is profound: Science reveals that social interaction can help us live healthier, happier, and longer lives. Yet too many of us are missing out on chances for connection. Sanjay Gupta, MD, reports on an epidemic quietly sweeping society—and why we should all speak up.
Her loneliness was worst at night. As soon as her head hit the pillow and darkness surrounded her, she'd be engulfed in a longing she couldn't shake. Morning wasn't much better: another day, another forced smile as she tried to mask the emptiness she felt inside.

Over the past year as I've investigated the human impact of loneliness, the stories I've uncovered have stopped me cold. In part because I never expected to hear them from the people in front of me, people with no outward hint of a problem. But mostly because the descriptions of their sense of isolation were so heartbreaking: "It's unceasing, toxic, brutal." "I feel invisible." "It's like living with a hole smack in the center of your chest—a hollow feeling." "My loneliness magnifies every pain in my body."

According to estimates by University of Chicago psychology professor John T. Cacioppo, PhD, coauthor of Loneliness: Human Nature and the Need for Social Connection, at any given time at least one in five people, or roughly 60 million Americans, suffers from loneliness. By this I mean both the acute bouts of melancholy we all feel from time to time, as well as a chronic lack of intimacy—a yearning for someone to truly know you, get you, see you—that can leave people feeling seriously unmoored.

As researchers have discovered, loneliness is hardly just a social issue; its physical impacts are among the most profound in modern medicine. Air pollution, obesity, and excessive alcohol use have been found to increase a person's mortality risk by 6, 23, and 37 percent, respectively. Loneliness may increase your risk by a shocking 45 percent. And it's not just the body that suffers: A study published in 2012 found that older lonely people are 64 percent more likely to develop dementia than their more connected counterparts are.

How can your social life have such a dramatic impact on your health? The oft-repeated theory is that friends encourage us to take care of ourselves and they step in when we're not feeling well; however, research shows that the dynamic may play out on a deeper level: Cacioppo was part of a team that discovered loneliness may actually alter genetic activity in the body. In people who felt as though they had few social connections, the researchers found that certain genes linked to inflammation were overexpressed, while other genes involved in antiviral responses were suppressed. Being lonely, it turns out, can literally make you sick.

But what has captured my attention in particular is the literal pain of loneliness. A remarkable study led by Naomi Eisenberger, PhD, an associate professor of social psychology at UCLA, found that being excluded—which can push you to the social perimeter and, as a result, cause feelings of loneliness—triggered activity in some of the same regions of the brain that register physical pain. From an evolutionary perspective, this makes sense; our prehistoric ancestors relied on social groups not just for companionship, but for survival. Staying close to the tribe brought access to shelter, food, and protection. Separation from the group, on the other hand, meant danger. Today when we feel left out, our bodies may sense a threat to survival, and some of the same pain signals that would engage if we were in real physical danger are flipped on. In the chronically lonely, levels of the stress hormone cortisol shoot up higher in the morning than in more socially connected people and never fully subside at night. As a result, a person can be left feeling fatigued, edgy, and irritable.

Next: The gap between us may be growing
Yet for all we're learning about how much harm isolation can cause, we seem to be growing more detached. According to data from the General Social Survey, people reported having one fewer close friend in 2004—down from three friends to two—than those asked the same question in 1985. And nearly 20 percent of people said they had only one confidant with whom they felt comfortable sharing important matters.

What's changed? "No one picks up the phone anymore," says Frances Reimers, a 34-year-old marketing executive in Alexandria, Virginia. "Sure, I have friends who like or comment on something I've posted on social media, but that's not really friendship." Indeed, while social media has given us more ways to communicate, many experts believe it may also leave us more alienated. It's the deteriorating quality of our relationships that concerns researchers like Harry Reis, PhD, a professor of psychology at the University of Rochester. "We need to interact with other people on a fairly deep level, and that's what many of us are missing," says Reis. Are texting, tweeting, posting, and liking solely to blame? Of course not, but for those who tend to hide behind screens instead of going out and socializing, online networks provide an illusion of interaction that is a poor substitute for real connection.

It also doesn't help that as a society, we continue to wall ourselves off from family and friends largely by choice. "I live far from my family, but I don't complain about how isolating that feels, because I've told myself it's just part of being independent," says Tiffany Congilosi, 25, whose husband is in the military. In fact, these days living alone or separated from our extended families is seen as a marker of maturity and financial success. When we do find ourselves surrounded by others, we often look for ways to keep our distance: In one Pew poll, 13 percent of cell phone owners admitted to pretending to use their phones to avoid interacting with those around them. And with the rise in automation—self-checkout kiosks, online banking, Siri—it's now easier to avoid communicating with whole swaths of people in ways we simply couldn't have imagined only a few generations ago. A certain solitariness has gradually become the norm. "I know there are people who love me, but it seems as though no one really wants to take time to reach out to talk and just be together anymore," says Kim Wood, 53, who spends her days caring for her elderly mother.

Despite how common loneliness is, it seems destined to be one of the last great emotional taboos. "I see patients who say they're depressed, but when they explain what's really bothering them, in many cases they're not depressed at all," says psychiatrist Richard Schwartz, MD, coauthor of The Lonely American: Drifting Apart in the Twenty-First Century. "They're lonely, but haven't labeled it that way. We've destigmatized depression to a point where people are more comfortable saying 'I'm depressed' than 'I'm lonely.'" It's as if "lonely" were synonymous with "loser." "My girlfriends asked why on earth I would admit in a national magazine to being lonely," Reimers says. "But it's important to be honest. Generally, my life is A-plus, but 15 percent of the time it's not, and I need a little help. It's not always easy to articulate to friends that you need them to step up."

To be sure, there's nothing loserish or even unique about feeling lonely. But experts warned me that it's impossible to paint a portrait of a lonely person with broad strokes. Loneliness doesn't discriminate—it can affect the single and the attached, the city dweller and the suburbanite. And what's missing can be different for everyone. For Rebecca Staples, a 46-year-old single mother of three, it's the lack of a romantic partner and a sense of fulfillment that brings on overwhelming emptiness each night. Emily White, on the other hand, says her feelings of isolation first stemmed from not having a like-minded community when she was in law school. "I didn't share the goals of the people around me, so it was hard to fit in," says White, who chronicled her experience in Lonely: Learning to Live with Solitude. "I knew I didn't want to practice law, but I stuck it out for a few years. There's this notion that someone successful or attractive can't be lonely. But it's not your looks that matter. If you feel like no one sees you for who you really are, you're going to feel alone."

At the heart of all of this is a basic need to be acknowledged. In fact, a Purdue University study found that people who made eye contact with strangers reported feeling less disconnected than those who felt as if people looked right through them. Reaching out, even in the smallest ways, can inch us closer to more meaningful relationships, which research shows can prevent much of the damage social isolation causes. People with larger social networks are less likely to get sick, and their memories are sharper. Social support can even reduce physical pain. In a study coauthored by Eisenberger, when women in long-term romantic relationships were asked to rate the pain from heat applied to their arms, they reported lower levels of discomfort when looking at pictures of their partners.

Perhaps most shockingly, research has found that friends may be an essential key to longevity: Over a given period, people who have strong ties to family, friends, or coworkers have a 50 percent greater chance of outliving those with fewer social connections. If our relationships can have such an effect on our overall health, why don't we prioritize spending time with the people around us as much as we do exercising and eating right? We may assume everyone else is either too uninterested or busy for conversation, but what if, as a society, we began to challenge that assumption? What if we made the first move, setting off the potential for a deeper connection? All it takes is a willingness to reach out. And it begins with a simple hello.

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