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Book Summary: Together – The Healing Power of Human Connection in a Sometimes Lonely World

Together (2020) is a powerful treatise on the impact of loneliness and the benefits of human connection. Drawing on scientific research and personal stories, it explores the high cost of loneliness, and considers how individuals, societies, and governments can tackle the problem by promoting connection.


Psychology, Nutrition, Self-Help, Death and Grief, Coping with Suicide Grief, Sociological Study of Medicine, Popular Social Psychology and Interactions, Mental Health, Science, Relationships, Personal Development

Introduction: Uncover the truth about the loneliness epidemic that’s hidden in plain sight.

Do you sometimes feel lonely? You aren’t the only one. Loneliness is widespread. Many of us feel disconnected, adrift, or not truly understood by those around us. And that’s no surprise.

As these summaries show, it’s part of the human condition to crave connection. It’s our natural state – to be with and connect to other people. But in today’s world, it’s not always straightforward.

While it’s easier than ever to travel to see friends and family, the flip side is that we often live far away from those we love. Technology means we can video-call with our grandparents, but it can also distract us and get in the way of real, face-to-face, human connection.

Loneliness is a serious problem, affecting our health and our happiness. It’s time to take it seriously.

[Book Summary] Together: The Healing Power of Human Connection in a Sometimes Lonely World

In these summaries, you’ll learn

  • why loneliness is a little like hunger, or thirst;
  • how loneliness might be worse for your health than obesity; and
  • why evolution has made it feel good to sing with others.

Loneliness is about more than just being alone, and it’s a larger problem than you might think.

When Vivek Murthy, the author, was appointed the 19th surgeon general of the United States, he had some clear ideas about what he wanted to tackle: mental health , obesity , and the opioid crisis.

But he also wanted to understand people’s own priorities. So after his appointment, he traveled across the United States on a listening tour. And his conversations showed that issues like obesity and the opioid crisis were indeed priorities, but something else came up time and again. From town halls in Alabama to community meetings in North Carolina, the subject of loneliness cropped up almost every time.

It became clear to Murthy that in society today loneliness is a real problem.

The key message here is: Loneliness is about more than just being alone, and it’s a larger problem than you might think.

One cold Oklahoma morning, Murthy was listening to Sam and Sheila, a couple who’d lost their son to opioids. They explained that the pain they felt at his death was made even worse by loneliness. All through their lives they’d been part of a community, but now their neighbors ignored them. Assuming Sam and Sheila would be ashamed of how their son had died, nobody stopped by.

On another day, in Los Angeles, a successful executive admitted that he had just spent his birthday alone. The intensity of his work schedule had led him to lose touch with friends.

Murthy’s findings are anecdotal, but they’re supported by science. Loneliness is widespread. According to a 2018 study by the US organization AARP – which advocates for people as they age – 22 percent of American adults report being socially isolated, either often or always. This is the case all over the world. A quarter of Australian adults report loneliness, while in Japan more than a million adults meet the official definition of hikikomori, or social recluses.

So what exactly is loneliness? Well, it’s not just being alone; it’s the sense that you’re lacking the connections you need.

Researchers have identified three clear strands: Intimate loneliness is the longing for a partner with whom you share a deep bond. Social loneliness is the need for quality friendships. Finally, collective loneliness is the yearning for a community or network of like-minded people.

We need all three types of connection to thrive. And as we’ll see in the next chapter, if you lack one or more, it can be painful – to the extent of seriously harming your health.

Loneliness is a major driver of ill health and even early death.

One day, a patient named James walked into Murthy’s clinic. He had high blood pressure and diabetes, and he wanted help. During his visit, he inadvertently taught Murthy a profound lesson about loneliness and the importance of human connection.

While talking through his physical symptoms, James made a throwaway comment: winning the lottery had ruined his life. Murthy, curious, asked why. James explained that he’d once been a baker. A good one, with lots of customers, and a team. He may have been single, but he was connected to a community.

Then James won the lottery and got rich. He gave up toiling away in a hot kitchen and moved to an affluent, oceanside neighborhood. On paper, he was living the dream. In reality, it was more like a nightmare. Without his community, and surrounded by wealthy neighbors leading private lives, he became withdrawn, put on weight, and eventually developed diabetes.

The key message here is: Loneliness is a major driver of ill health and even early death.

Murthy did his best to treat James’s physical problems. But, in truth, he really had no idea how to treat the true problem: James’s loneliness. At the time, the connection between social isolation and ill health wasn’t well understood. Today, it’s becoming clearer.

At Brigham Young University, psychologist Julianne Holt-Lunstad has been looking at the positive effects of relationships, trying to answer the simple question: Does social connection reduce the risk of premature death?

Holt-Lunstad spent over a year analyzing more than 140 studies, and when the results came in she could barely believe it: according to her findings, people with strong relationships are not just less likely to die early than those with weak relationships; they are a full 50 percent less likely to die early.

To put that into perspective, the impact of weak social connection is pretty much equivalent to smoking 15 cigarettes a day. And it’s a greater risk factor for early death than obesity.

Since Holt-Lunstad’s first paper, countless other studies have found clear links between loneliness and conditions ranging from dementia to coronary heart disease. It’s become apparent that loneliness isn’t just unpleasant. It’s detrimental to human health, and it needs to be taken seriously.

Loneliness is an evolutionary mechanism that tells us something is wrong.

Consider for a moment one of your ancient, tribal ancestors. For him, being connected was essential to leading a moderately safe and secure life. Watching out for wolves with fellow tribe members reduced risk. Hunting, gathering, and then pooling food meant a better chance of survival. Togetherness was essential. Separation from the tribe would have been very dangerous.

For your ancient ancestor isolation would have put his nervous system on red alert. His heart rate would have increased – to help him respond quickly to any threat. His blood sugar levels and blood pressure would have risen – giving him ready energy to burn. And his senses would have heightened to detect even the slightest danger.

With his body and mind in a state of anxious self-preservation, leisurely thoughts were out the window. He’d sleep lightly in case a predator came in the night.

The key message is: Loneliness is an evolutionary mechanism that tells us something is wrong.

According to Dr. John Cacioppo, a cognitive and social neuroscientist known as “Dr. Loneliness,” our experience of social isolation today is the same as that of our earliest ancestors, for whom being alone meant danger.

Loneliness rarely holds such immediate danger now, but, thanks to evolution, our bodies still behave as if we’re alone on the tundra, surrounded by wolves and hostile tribes. So, just like ancient man, when you’re lonely, you may well sleep poorly. In fact, research shows that lonely people sleep less deeply, leaving them tired and irritable.

On top of that, the surges of stress hormones experienced by people with ongoing loneliness cause stress in the cardiovascular system and damage blood vessels.

Loneliness is a bit like hunger or thirst – it’s a sign that something is wrong. But there is a paradox: whereas when we’re hungry, we look for food, when we’re lonely, we don’t look for connection. On the contrary, we shy away from it.

And it makes perfect sense: our isolated ancestors would have been alert to the tiniest threat. Unfortunately, that evolutionary hangover means lonely people today respond counterproductively to even benign social situations. They turn down invitations and stop responding to messages.

So, if you experience loneliness, you can perhaps take some comfort in the knowledge that what you feel is a normal part of human experience.

It is possible to build free societies that are also rooted in connection, if we focus on the right values.

Hutterites are members of a Christian sect, with around 500 colonies scattered across Montana, Western Canada, and the Dakotas. A Hutterite colony is intensely communal. Private property or income is forbidden and every member is looked after. When a woman becomes a mother, for example, she’s joined by a young girl from another family who provides help while, in turn, learning what it means to be a parent.

Hutterite communities are collectivist and starkly different from the individualist societies in the Western world. They are extremely tight-knit, with very low rates of loneliness.

The key message here is: It is possible to build free societies that are also rooted in connection, if we focus on the right values.

There are downsides to traditional, collectivist societies, however. The Hutterites, for example, rely on conformity, and don’t tolerate homosexuality. But individualistic societies with loose social connections are also missing something of value.

What if there were a third way? What if we could form a society with mutual support and freedom for individuals? The case of Anaheim, a city in California, might just prove that such a third way exists.

Anaheim used to have a social-disconnection problem. People lived such private lives that they barely knew their neighbors. But then Tom Tait ran for mayor. The big idea behind his political campaign? Kindness.

Tait’s message certainly tapped into something, because he was elected by a wide margin.

As mayor, Tait began focusing on kindness by getting to know his own neighbors, slipping a note under their doors to suggest meeting so they could better look out for each other. But he wanted to go further. When tackling the opioid crisis, he asked his team to consider what a kind approach to the problem might look like. The result was a program encouraging the police to get opioid users into treatment, instead of arresting them. The message to the community became one of lending a hand, rather than letting them struggle alone. After 15 months, as many as 270 people were in treatment.

Tom Tait offers a lesson for many of us. There is a way to build a community that is both individualistic and collectivist. We just need to show that everyone benefits from being kind to one another.

Our modern, technological world isn’t helping our loneliness problem.

It’s easy nowadays to let human contact slip from daily life. The author, for example, was delighted when online grocery deliveries hit the scene. Just think of all the time savings!

But it turned out that trips to the store had generated a lot of connections. Random meetings with fellow parents in the baby food aisle and chats with friendly clerks may have been small interactions, but they’d kept the author and his family connected to their community.

The key message here is: Our modern, technological world isn’t helping our loneliness problem.

Technology is changing fast, and it’s changing our habits with it. Take the illusion of multitasking. If you have a smartphone, you’re perhaps guilty of quickly checking the weather while also following a friend’s story about his cute baby, or looking at an email while hearing about a neighbor’s vacation.

But research shows that, even when we think we’re multitasking, we’re usually not. We’re actually switching back and forth between tasks really quickly. According to MIT neuroscientist Dr. Earl Miller, tasks involving communication are nearly impossible to focus on simultaneously. So if you steal a look at your phone during a conversation, you might hear what’s being said to you, but you won’t fully process it.

Thanks to the constant presence of technology, we’re losing some of the raw human power of being physically near other people. Only half-concentrating on what someone tells us means we’re not giving them our full attention. And this means we miss out on building understanding and empathy for one another.

The good news is that a reduction in screen time can improve our emotional intelligence . A psychology study involving two groups of 50 children proves this. In the study, one group attended an outdoor camp where technology was banned. The other stayed at school and kept using their smartphones as normal. At the end of a week, both groups were tested for their ability to interpret emotional states in photos and video. The children who’d been without their smartphones were much better at identifying emotion. The reason was clear: after just five days without phones, the campers’ empathy was on the rise, because they’d actually talked to each other.

So try to put down that phone. Technology can certainly bring us closer together, but it will do so only if we use it with care and consideration.

We need the right mix of relationships to lead a happy life.

A Harvard University study into the secrets of a healthy, happy life was started in 1938 and is still going strong today. It tracked the lives of 268 students, and continues to follow their children. One of its key findings has been that close inner-circle friendships are a stronger predictor of happiness and health in life than either wealth or social class.

But while having a tight inner-circle is important, it’s not everything. Sometimes our closest friendships can, paradoxically, lead to a kind of loneliness. In particular, when we prioritize those closest to us – that is to say our romantic partners – we can neglect our wider friendships, and our need for collective connections, as well as intimate ones.

The key message here is: We need the right mix of relationships to lead a happy life.

Our relationships can be thought of in circular groupings. Closest to us is our inner-circle. A little less close are our middle- and outer-circles, made up of friends and casual acquaintances.

When we’re children, we find it easy to establish strong middle-circle friendships like those we make at school. It can be a little harder as adults when we move away from home and face greater demands from work or family.

In fact, if you want a stronger middle-circle, consider joining a group – especially if it involves rhythmic movement or singing. Movement and song are important because evolution has come up with its own special trick to encourage connection, so when we sing in a choir, or dance with people, we get an extra strong boost of endorphins: which are the hormones that make us feel good.

Finally, you shouldn’t forget about your outer-circle – the looser connections you make with people, whether through work or in your neighborhood. In this area, the author has been trying something out: while working in a cafe, he smiles and chats briefly with people at nearby tables. Then, if he needs to use the restroom, rather than take his belongings, he asks one of the strangers to watch them for him.

The first time the author did this, he was surprised to find that it felt good to trust someone else. But the responses have surprised him even more, with one man saying how great it was to be asked, before adding that most people wouldn’t trust a stranger. The interaction took mere minutes but Murthy felt its positive effect for hours. It turns out that even the smallest connections can have a positive impact.

Final Summary

The key message in these summaries:

Humans are social animals but today we are facing a crisis of loneliness. Loneliness threatens our health and happiness, and it’s widespread. To combat it we – as individuals and communities – must work much harder to forge the meaningful, human connection that we all crave.

Actionable advice:

Spend 15 minutes each day with the people you love.

Protect at least a quarter of an hour each day to connect with your loved ones. That’s not just those you live with. Try calling or, better still, video-calling your closest friends or family. A small amount of time each day will help you stay connected.

About the author

Dr. Vivek H. Murthy served as the 19th Surgeon General of the United States appointed by President Barack Obama. As the Vice Admiral of the US Public Health Service Commissioned Corps, he commanded a uniformed service of 6,600 public health officers globally. During his tenure, Dr. Murthy launched the TurnTheTide campaign, catalyzing a movement among health professionals to address the nation’s opioid crisis. He also issued the first Surgeon General’s Report on Alcohol, Drugs, and Health, calling for expanded access to prevention and treatment and for recognizing addiction as a chronic illness, not a character flaw. An internal medicine physician and entrepreneur, Dr. Murthy has co-founded a number of organizations: VISIONS, an HIV/AIDS education program in India; Swasthya, a community health partnership in rural India training women as health providers and educators; software company TrialNetworks; and Doctors for America.

Dr. Murthy received his bachelor’s degree from Harvard and his M.D. and M.B.A. degrees from Yale. He completed his internal medicine residency at Brigham and Women’s Hospital in Boston and later joined Harvard Medical School as faculty in internal medicine. His research focused on vaccine development and later on the participation of women and minorities in clinical trials. Dr. Murthy resides in Washington, D.C. with his wife and two young children.

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