Dr. Vivek Murthy on why American men are in crisis


One of our obsessions this year at The Ink has been the emotional substrate of our political lives. The multiple threats to democracy we face don’t come out of nowhere, and recently we’ve talked with Senator Chris Murphy about America’s epidemic of loneliness, with author Ruth Whippman on the crisis of identity facing boys and young men in a changing world, and with journalist Paul Waldman about how the right wing has capitalized on many Americans’ stress and anxiety while progressives have been more likely to ignore such things.

A thinker and public leader who realizes that we can’t afford to ignore these multiple crises of feeling if we want to solve the problems of democracy is Dr. Vivek Murthy, the surgeon general of the United States. In our conversation, we dig into why would-be authoritarians are better at connecting to the anxious and fearful and adrift than democratically minded, fact-based leaders, whether capitalism is to blame for the isolation so many Americans experience, how social media drives our societal ills and what we can do to solve it, and why so many American men are in crisis as we’ve failed to help them cope with a more gender-equal society.

We’ve opened this excerpt to all of our readers, and encourage you to read this essential conversation in its entirety.

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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.

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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.

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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.

To go back to the example from medicine, when you understand and recognize and address the emotional needs of a patient, they often more deeply appreciate what you did for their physical needs.

This is something that anyone who has been in conversation or in a relationship with a spouse or with a child can understand. Sometimes, even if you are trying to tell somebody that you’re doing something to serve them, or to help them, and you’re giving them the right tool, if you are emotionally disconnected from them, they feel like you’re not seeing them or understanding them or respecting them or valuing them.

These things are synergistic, but we don’t value these two dimensions of ourselves equally. We don’t train people in institutions to think about how to communicate with the people they’re serving on both levels. We overweight for the cerebral, we underweight for the emotional. And the result is that we fail to connect with people on the issues that matter most.

And this is part of the reason why so many people feel like they’re not seen. One of the things that I found very early on during my first term as surgeon general and was traveling the country on a listening tour is that so many people were telling me that they felt invisible.

They felt that if they disappeared tomorrow, no one would even care. They felt they just weren’t seen. And I was hearing this from college students, I was hearing this from CEOs, I was hearing this from parents, I was hearing this from older Americans. The way we see people, it has to be by connecting again with their deeper emotional and spiritual needs. And I don’t think that’s happening nearly enough right now.

How much of this is downstream from the form of capitalism that America practices today? To be connected to others requires time, which is a function of how much you’re paid, how much you can afford to take off, whether you work 60 hours a week or 40, or 35, or 80. For younger people today, it may be a function of whether you have an apartment big enough to invite four other people over for dinner. 

How do you think about the effect of policy choices around the wages people are paid, the labor protections people have, the bargaining power workers have as an upstream response to loneliness?

Look, I’m certainly a big supporter of innovation. I’m a big supporter of people being able to go out and build businesses and make other people’s lives better by doing so.

But one of the traps we’ve fallen into is that we have come to define productivity almost exclusively in economic terms. Whereas what we have undervalued is the time that people put into their relationships, into raising their children, the time they spend engaging in service to their community, the time they spend reflecting and growing.

That would all be billed as non-productive time from a purely economic perspective in today’s terms. Yet that is the investment that we need to make in order to build not only healthier individual lives, but a stronger society. And this is one of the reasons why so many parents feel like their work in parenting is undervalued.

When you look at the statistics, it’s really striking to me that people are working more — and parents are parenting more, even though they’re also working more. I was really startled recently to see statistics that show that the amount of time that both fathers and mothers are spending with their kids has increased significantly over the last few decades even though parents are working more.

Where is that time coming from, that extra time? You put all this together and that time that is eroding is a time that we spend in person with family and friends, the time we spend for ourselves, and the time we spend for our communities. And that just reflects a fundamental miscalculation about what kind of productivity really matters here.

Any model that pushes us to work more and more and more at the expense of our health and wellbeing and the health and wellbeing of our communities is one that is not sustainable. And that will lead to what we’re seeing now, which is greater levels of unhappiness and isolation that, ultimately, will lead to the weakening and destruction of society.

I had a conversation with Senator Murphy the other day, and one thing we discussed was a masculinity crisis. One that’s connected to, and maybe a subset of, the larger crisis of loneliness and isolation, but has its own special characteristics.

And I don’t think it’s only happening in the United States. Can you talk about how you see a crisis in large numbers of men not being able to figure out a workable model of masculinity in a changing country, a country that’s moving on gender equality. A lot of men can’t quite figure out how to land in the new way of being, even if they’ve moved away from the old way of being.

I think about this first and foremost as a dad myself. I’ve got a son who’s seven years old. I’m like a lot of parents trying to think, “How do I raise him? How do I raise him, and raise my daughter, who’s six, to be healthy, to have a strong sense of identity, to have a sense of purpose and meaning and to build connection in their lives?”

There are a lot of young men and boys who are feeling unmoored and who are feeling lost and who are feeling like the world is shifting under their feet, who are feeling like their place in society is shifting and changing, but who are also feeling potentially that people are increasingly pointing their fingers at them and telling them that they’re the problem.

We have to recognize that the data is actually quite clear that young men and boys are actually falling behind on many metrics, including in education. And addressing that does not mean that we are somehow deprioritizing caring for girls and women: young girls and women have struggled for equality for a long, long time, for generations.

I have noticed that there has been resistance to acknowledging that from people who worry that we’ll take attention away from the continuing effort to ensure that girls and young women also can progress and that we can close the equity gap for them. I would not choose or between my son and my daughter, and I would not accept that as a choice that any of us should make. We’ve got to do both.

But when men feel like they are falling behind, it’s because they don’t have clarity on what their role is in society, and that that is a challenge that constitutes a deeper spiritual crisis. And when people are in crisis, not just boys, but broadly across the board, they become also more vulnerable to the influence of people who would seek to capitalize on or exploit their pain and use it for political or economic gain, to turn them against other people or to get them to support a particular cause.

And that is a danger here. If we do not have positive role models, if we do not have a pathway, we can lay out and guide young men and boys to where they can be of service in their community, where they can feel useful and know that they add value to their communities where they can see a path for progress, then we consign many of them to go down more dangerous paths. And that’s what’s happening now. 

We’ve got to pay attention to that vacuum in role models and leadership for young men. But it’s important to start with acknowledging that young men and boys are actually going through a crisis of their own.

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What you just mentioned is one of my obsessions: the way we’ve failed to manage change overall. I think there’s a basic confusion: if a change that is happening is for the good, then we feel that we don’t need to worry about people coping with that change. We only need to worry about coping with changes that are bad.

So we help you cope with, say, China taking your jobs, but if change falls under the category of progress, then we think you should just get with it. And I think what you’re saying is very important. Good changes are as hard for people to adjust to and cope with as bad changes.

That is so important to underscore: change is hard, whether it’s good or bad. And our failure to acknowledge that speaks to a broader empathy gap that we have in society.

One of the things that I was taught by mentors in medical school who were very patient with me throughout a long process of medical education was that, whether or not you agree with a person’s point of view, whether or not you relate to their way of life, if they’re going through hardship, the right response is empathy.

Empathy doesn’t mean that you agree with everything someone says or believes, but as human beings, we need to be able to recognize when others are in pain. We need to be able to respond to that pain in a way that brings people in, not pushes them out.

And our failure to do that leads to more and more people feeling lonely, isolated, invisible, and resentful. And that’s what we’re experiencing a lot today. People sometimes ask me, “You’re a surgeon general, I thought you’d be spending most of your time on issues like tobacco and obesity and physical activity?”

And I say, “Yes, those are important public health issues. But to me, the deeper crises that we’re dealing with as a country right now that are affecting our health at an individual and societal level is this deeper spiritual crisis that’s marked by loneliness and by a lack of meaning and purpose that many people are experiencing in their lives.”

If we’re not able to address those, if we’re not able to help people find more agency in their lives, find more community in their lives, connect with a sense of purpose that’s rooted in something bigger than themselves, then I think we’re going to have fundamental challenges moving forward as a society.

I mentioned that I was doing this college tour recently, and I’ve had some of the most interesting conversations with young people all across America. I’m talking about high school students in Nebraska, college students in Arizona — all over the country, different settings.

What’s heartening to me is that young people have told me that they want to have a strong sense of purpose. They are very idealistic; they’re mission oriented. They want to do something that’s going to serve something bigger than themselves.

They want to contribute, yet they often talk about the hustle culture that they’re living in that’s constantly telling them that success is about fame, fortune, and power; that it’s about maximizing how many followers you can get.

It’s about building your brand. They literally use that phrase, “building your brand,” but they know or suspect that a lot of the time that may not lead them to happiness or fulfillment. Look, one of my hopes is that even with the turmoil of Covid and how it literally turned our lives upside down, that we can use that as an opportunity to reexamine how we live our lives, to ask ourselves a question: “What really matters in terms of ultimately achieving fulfillment?”

And it’s very clear when you not only look at the data, but when you hear people’s stories. When I think about the stories of patients that I have cared for at the end of their lives when they’re reflecting on what really matters, what drives their happiness and fulfillment fundamentally is our connection to one another and our sense of purpose and meaning in life.

So we need to start speaking to that more. We need to start — that’s a challenge, and if we don’t, this deeper spiritual crisis will consume us as a country and it’s happening in other countries as well.

We did a post a couple of weeks ago, pointing out that millions of Americans are caught between approaches that provide help with no love or love with no help, just getting at this notion of how Democratic politics lacks that affective approach, while the MAGA right has a highly affective approach but no actual solutions.

It is hard, but I think in the same way that in medicine we’d say healing is about bringing together head and heart. I think it’s true for the country more broadly. If you’re seeking to heal a nation in pain, you have to approach that with head and heart. Just doing one without the other leaves people still wanting.

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