Together Summary

Loneliness is like hunger or thirst; it’s a signal that something is wrong—but unlike hunger, instead of reaching out, we often retreat.

1. Loneliness is not about being alone—it’s about lacking the connections we need.

Loneliness isn’t simply the state of being by yourself. It can happen in a crowded room or within a bustling household. It’s the feeling that there’s a gap between the connection you desire and what you actually receive. Vivek Murthy realized this during his listening tour across America, where community members from various walks of life repeatedly described their deep-seated feelings of disconnection.

Research backs up these anecdotes. A 2018 AARP study found that 22% of adults in the United States frequently or always feel socially isolated. Similarly, one in four Australian adults reports feeling lonely, and Japan has an entire phenomenon, hikikomori, describing over a million social recluses. These statistics highlight how pervasive loneliness has become worldwide.

There are three general kinds of loneliness: intimate loneliness, which reflects a yearning for a partner; social loneliness, which is about the need for close friendships; and collective loneliness, which emerges when we lack belonging to a community or group. Thriving as a human involves satisfying all three forms—just one missing link can leave a person feeling disconnected.

Examples

• A busy executive admitted to Murthy that he spent his birthday completely alone because his work life had eroded his personal connections.
• Sam and Sheila, parents grieving their son’s death, found their community avoided them, magnifying their feelings of isolation.
• Over a quarter of Australians report sustained loneliness, indicating this is a global issue, not just an isolated American experience.

2. Loneliness harms physical health as much as smoking or obesity.

Loneliness isn’t just emotionally painful—it takes a serious toll on the body and mind. During the course of his work, Murthy encountered patients like James, who unknowingly taught him about the connection between loneliness and physical health. James had once been a happy baker, connected to his community, but his isolation after winning the lottery caused his health to spiral into obesity, diabetes, and high blood pressure.

Studies show that weak social connections increase the likelihood of premature death. Research conducted by Brigham Young University psychologist Julianne Holt-Lunstad revealed that having strong relationships can make you 50% less likely to die young. That benefit is greater than combating obesity or avoiding smoking.

The effects of loneliness on health mirror those of physical stress. Chronic loneliness has been linked to cardiovascular issues, weaker immune systems, increased rates of dementia, and even depression. It weakens the bond between mind and body, amplifying risks for an array of ailments.

Examples

• Holt-Lunstad’s research calculates loneliness is as damaging as smoking 15 cigarettes a day.
• James abandoned his social ties after getting rich and found he was poorer in health and happiness as a result.
• Studies tie conditions like coronary heart disease and Alzheimer’s to sustained feelings of isolation.

3. Evolution designed loneliness as a survival alarm, but it can misfire today.

Loneliness is an evolutionary tool. For our ancient ancestors, staying connected to the tribe was crucial for survival. Solitude meant vulnerability to predators and reduced access to food. Therefore, being alone triggered our nervous systems to sound alarms, preparing the body to fight or flee.

This survival mechanism is still with us. When we’re lonely, our bodies react as if under threat—heart rate increases, stress hormones surge, and we sleep poorly. These responses make sense for someone alone in the wild but wreak havoc in the modern world where danger isn’t tied to the lack of tribe-like groups.

Loneliness creates a paradoxical behavior: while it motivates connection in theory, in practice it causes people to retreat further. This self-protective instinct makes lonely individuals interpret neutral situations as hostile, leading them to withdraw even more. It becomes a feedback loop that cements isolation.

Examples

• Dr. John Cacioppo’s research found the nervous system heavily reacts to feelings of social separation.
• Studies show lonely individuals tend to misread social interactions as threatening.
• Modern life triggers evolutionary hangovers that amplify stress in lonely people.

4. Communities grounded in mutual care thrive without sacrificing individuality.

Some societies design themselves to minimize loneliness. Take the Hutterites, a collectivist Christian sect that forgoes personal property and income to emphasize strong communal connections. Mothers, for instance, are paired with younger helpers to forge cross-generational bonds throughout child-rearing.

Yet collectivism often requires conformity, which can clash with individual freedoms. On the other end, ultramodern societies, like many in the Western world, prioritize individualism, which can erode valuable community ties. A middle-ground approach blends both styles—a concept Anaheim, California, embodies.

Under the leadership of Mayor Tom Tait, Anaheim embraced kindness as a citywide value. Tait encouraged neighbors to band together and reimagined programs like opioid interventions with “compassion first.” This fostered a new sense of community while preserving individual liberties.

Examples

• Hutterites maintain minimal loneliness by immersing their lives in togetherness.
• Anaheim rewrote its ordinances to convey support instead of punitive responses.
• Mayor Tait created a culture where connecting locally led to tangible collective benefits.

5. Changes in technology have eroded meaningful connections.

Technology should bring people closer, yet it often creates invisible barriers. Murthy reflects on how online grocery delivery, a convenience he once loved, eliminated his frequent, friendly chats with neighbors and store clerks—small interactions that mattered more than he realized.

The illusion of multitasking through smartphones has also weakened genuine conversations. While it may seem efficient to glance at a phone during a chat, research demonstrates such actions split attention. This reduces empathy and understanding, cutting short the bonds we create when fully present.

Reconnecting in a world saturated with technology begins with reducing screen time. A study with children at an outdoor camp versus kids immersed with smartphones showed that just five days without devices boosted their ability to understand emotions. Technology isn’t inherently bad—it just needs careful use.

Examples

• The author inadvertently lost daily human interaction by switching to online convenience tools.
• MIT neuroscientist Earl Miller’s work proves that multitasking diminishes quality communication.
• Children without smartphones performed better emotionally after living free from screens for five days.

6. Different types of relationships are essential for happiness.

The Harvard Study of Adult Development, one of the longest studies in history, confirms what we often intuitively know: deep relationships contribute far more to happiness and health than wealth or social standing. Yet balancing various types of connections is important.

Intimate relationships are highly valuable, but they aren’t a substitute for broader friendships or community ties. Prioritizing only one type of relationship creates gaps elsewhere, robbing us of varied forms of support. Building robust middle-circle friendships, such as those formed through group activities or hobbies, fulfills our need for camaraderie.

Another overlooked aspect is the importance of outer-circle connections. Small, friendly gestures like asking a stranger for help can increase mutual trust while delivering a surprising boost of well-being. Every circle of connection plays a part.

Examples

• Harvard’s study followed generations, showing how relationships shape lifelong satisfaction.
• Choir groups often deepen bonds faster because singing releases endorphins.
• Murthy experimented by asking strangers for simple favors, noticing benefits in his mood afterward.

Takeaways

1. Protect at least 15 minutes per day to connect deeply with loved ones, whether through a quick video call or an in-person chat.
2. Join a group activity like a choir or fitness class to meet people and enjoy the added benefits of rhythmic bonding.
3. Reduce screen time by setting phone-free hours in your home to focus on real, face-to-face moments.