A Conversation with U.S. Surgeon General Dr. Vivek Murthy

Ask Lisa Podcast, Ep. 133: A Conversation with U.S. Surgeon General Dr. Vivek Murthy

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional

mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being,

consult a physician or mental health professional.

DR. MURTHY: We can’t stop until everybody who needs mental healthcare can get high-quality care when they need it, that’s culturally appropriate. That’s what we’ve got to be able to do. That’s the benchmark that we should be fighting for.

REENA: Well, I could not be more excited about the guest we’re about to have on Lisa, the US Surgeon General, Dr. Vivek Murthy. You know, I interviewed him at the start of the pandemic, when he wrote this book called “Together: The Healing Power of Human Connection in a Sometimes Lonely World.” And it’s crazy, because literally lockdown had just started when he was out talking about this book. And it’s crazy because he was keying-in and he decided to write a book after leaving his first time as US Surgeon General during the Obama administration. And he’s like, what is the biggest issue facing Americans today? He thought maybe it’s going to be the opioid crisis, which is significant. And he found out no, that people feel isolated, they feel invisible, they feel insignificant. And that’s why he chose to write that book.

LISA: What timing in light of how isolating the pandemic ended up being for so many people.

REENA: So true. And you spoke to him earlier this year in Ohio.

LISA: I did, I had the honor of having an in-person conversation. It was actually recording for his podcast, we did it at the City Club in Cleveland. And it was, it was just wonderful. We had a great time talking.

REENA: He’s got a great podcast too, it’s called “House Calls,” we’re going to tell you more about that at the end of the show. It’s worth subscribing to. But let me, without further ado, introduce our guest, Dr. Murthy is serving in his second term as the US Surgeon General. He works to advance health and well-being for the country. And unlike his predecessors who primarily tackled physical illness, Dr. Murthy is really focused on the connection between mind, heart, and well-being. I just love that. And during his tenure, he’s also called the nation’s attention to the vital need to address the growing mental health crisis in America, particularly around younger people. And he’s shed light on our epidemic of loneliness, and isolation. He’s also the first US Surgeon General to host that podcast you mentioned Lisa, “House Calls with Dr. Vivek Murthy,” where he invites guests and listeners to explore how we can all build a more connected and meaningful life. He also is the father of a 6-year-old boy and a 5-year-old girl. So busy at work and busy at home.

LISA: Welcome Dr. Murthy. We are thrilled to have you here.

DR. MURTHY: Well, thank you both so much. Thank you, Lisa, thank you Reena. I’m just thrilled to be having this conversation with two people who I very much admire. So glad that we’re going to be talking.

LISA: Me too. All right, here we go. Are you ready for some questions?

DR. MURTHY: Yes.

LISA: Okay, so this is your second time around as the US Surgeon General, how has the experience of being a parent yourself changed your perspective on the work you do?

DR. MURTHY: Well, you know, having kids has been probably the most important development in my life. And it has changed so much for me. I had my first child when I was actually in the middle of my first stint as Surgeon General. And I remember even the process of becoming a parent was just, it required negotiating and thinking through a lot. For example, like there had not been, to our recollection, a Surgeon General who had had a child in office for probably a century or more, if ever.

LISA: Wow.

DR. MURTHY: And so all these questions about do you take parental leave, you know, can the Surgeon General take parental leave? Like all of these questions were coming up. But it was a time that really focused me on two things. One is what was happening to parents. And I came to realize that, you know, when you’re blessed with a child, that is indeed a blessing, but it doesn’t mean that it’s an easy journey. And from the get go, there were a lot of very difficult things to negotiate, confusing things to negotiate, not unlike 50-75 years ago. And society, people aren’t growing up in extended families where they’re seeing, you know, younger nieces and nephews and cousins getting raised and having some familiarity with how to raise a baby when they’re a parent themselves. Unlike that, like we had no experience, my wife and I, bringing up a child or figuring out how to handle a baby how to figure out if that cry means your baby’s hungry or they’re tired or they want to snuggle or if it’s none of those things, and something’s like actually going wrong, and they’re sick. So there’s a lot to learn. And it was a pretty steep learning curve, a lot of 3 a.m. waking up in the middle of the night, Googling, like, what is the best diaper, or what do you do?

REENA:I love that. I love that even the US Surgeon General is Googling it at night about what’s happening with their baby.

DR. MURTHY: Oh yeah. It’s just, it’s one of those things. It’s like, my wife, Alice and I are both trained in internal medicine, so not in pediatrics. And, you know, we often used to say like as internists, you know, you know, kids puzzle us. We’re like, well, how do you interpret all these various symptoms that kids are having? So when we became parents, you know, we were mindful about not trying to play doctor to our child, but you know, there’s a lot we didn’t know like, as well. So it was a humbling experience. But lastly, I’ll just say the other way it changed my outlook was, it really gave me a different lens through which to look at, at kids and young adults as they’re growing up and to think about the future, you know, I want the future to be bright for my kids and for all kids. But it’s also I feel a great sense of urgency about so many of the challenges we’re dealing with now, whether it’s violence in our communities, whether it’s political polarization, whether it’s climate change, like the threats to how the world will look for our kids are, they abound, and they’re all around us, we have to attack them with urgency. But we can’t do any of that well if we’re not dealing with the immediate crisis in front of us, which is the mental health crisis in America. And I think about mental health as the fuel that allows us to show up in our lives, for our family, for our friends, at work, in school, in our community. And if we’re sapped of that strength, and then it doesn’t matter how urgent the challenge is in front of us, we’re not able to muster the strength to come together and address and we’re not able to do that together. So this is how having kids for me has really sharpened my focus on what I think is the defining public health challenge of our time, which is a mental health crisis.

REENA: Speaking of the urgency, back in May you issued two advisories: one was talking about the effects of social media on youth and mental health, the other was about the epidemic of loneliness and isolation. And here’s what was written in that advisory that you put out, it says, I’m going to quote directly here, “the mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day, and even greater than associated with obesity and physical inactivity.” You go on to say that the number of close friendships have actually declined over the decade, of the past decade. Wow, why did you choose to issue this advisory? And what do you hope to change?

DR. MURTHY: Reena, I realized that you know what, when you’re in a public health role, as I’ve been privileged to serve in, there’s so many public health issues that you could address, right, and they’re really important issues facing our country, whether it’s cardiovascular disease, cancer, you know, other illnesses. But I found myself really wondering what is the cause behind the cause? What’s the deeper root of what’s driving not only disease and dysfunction in our country, but impairing our ability to address it, as well. And that’s where I found that this issue of loneliness and isolation is actually quite profound. And it’s one of these issues that affects millions of people. But people don’t often know it because it hides in the shadows. We don’t go around talking about our struggles with loneliness, and, and for that reason, it remains, you know, enshrouded in mystery. But what I came to realize, in my first stint as Surgeon General, in talking to people around the country, was that this was extraordinarily common. People of all ages, including college students on campuses, where they were surrounded by thousands of other students were telling me, you know, I feel really alone, I feel really isolated. And so I realized it was incredibly common. But the other thing I realized, Reena, is that it was also consequential, and consequential for our mental health, people who are struggling with that sense of disconnection and loneliness, they are at increased risk for anxiety, depression and suicide. But they’re also at increased risk for physical illness like heart disease, like dementia, and premature death. And that’s where this really stunning finding that the struggling with social disconnection is on par, actually with, in terms of health risk, with smoking daily, and even constitutes even greater risks for mortality than what we see with obesity and physical inactivity. That’s where that really, really hits you. When you realize, hey, this is more than just a bad feeling. Being lonely. This is really bad for our health. But finally, I’ll just say this, if you go beyond health, it turns out loneliness and isolation have profound impacts there too. Communities that are actually more connected with one another tend to be more economically prosperous, they have lower levels of violence, they are more resilient in the face of adversity, like hurricanes or tornadoes. And if you think about all these threats we’re facing today, all these challenges that we have to encounter and deal with for ourselves and for future generations, we’re impaired in our ability to really pull the country together and do that and build a unified response to these threats when people are lonely, isolated, and fragmented. If you’re out there seeking to divide a community, or divide a country, what you would do is you would target communities that are feeling isolated, because it’s easier to turn them against each other. So however you look at it, whether it’s the health of society and democracy, whether it’s the health of workplaces and schools, or the mental and physical health of individuals, it turns out our connection to one another is really essential for our well being.

LISA: Mental health, you know, is my world. And kids and adolescents especially. And, you know, as you are aware, you’ve done such an extraordinary job of getting the word out about, you know, teenagers have suffered massively and mightily pre-pandemic, and then you know, through the pandemic. And now, one of the things that is, that comes up a lot in this is gender. And we have a lot of data showing that, you know, CDC reports indicating the girls have suffered quite a bit. I have my questions about if we are missing the suffering of boys, I think a lot of times our measures are designed to ask questions about what we call internalizing disorders, you know, depression, anxiety, which girls tend to report, they’re not great necessarily picking up the precursors of externalizing disorders. So I have some concerns that boys are flying a bit under the radar in terms of their distress. So I’d love your thoughts on this. And then also, just back to you being a dad, you’ve got a boy, you’ve got a girl, you know, does what you know, as you look at the mental health landscape of young people, is that shaping life at home? What do you think on this?

DR. MURTHY: This is such a good question, Lisa. And I actually think your instincts are right, that I do think we are missing a lot of the suffering that boys are dealing with, that often shows up differently, or flies under the radar. To be clear, this isn’t in any way to minimize the suffering that girls are going through, like young girls are really struggling, we’ve seen rates of suicide and sexual violence all go up among girls, we’ve got to do better for girls. But it turns out that girls and boys are both suffering. But unless we know what to look for, unless we understand that sometimes they may speak about their suffering differently, may exhibit it differently, then I do think you’re right that we’re going to miss part of the picture. And I do think that to some extent is happening with boys. Boys and girls, I think, and obviously we’re stereotyping here, there’s a spectrum within boys and girls of how they may experience or express their suffering, but I think part of the reason that boys are more reluctant to admit, perhaps, to struggling with feelings of anxiety or depression, have to do with culturally how we raise boys. You know, like Niobe Way at Columbia has done a really great job, sorry, at NYU, has done a really interesting job talking about the differences that evolve in boys over time, like, and she’s studied the friendships that boys have, and has found that, you know, at a really young age was boys actually talk about their friends in very similar ways to girls. They might say things like, oh, I really love my friend, I can’t wait to see my friend again. You know, I can’t live without my friend, like, if something great happens, I really want to share that with my friend. They talk about their friends in very similar ways. But then something happens when boys get to middle and later adolescence, which is that we somehow teach them, and by we I mean societal cues around them, teach them that, hey, you know, it’s not okay, as a guy, to talk about your feelings in this way. It’s not okay to talk about needing other people, it’s not okay to say that you love someone unless they’re your romantic partner. So we were essentially telling boys, it’s not okay to feel, right? And as human beings, we all feel, whether we’re boys or girls, whether we’re men or women, like all of us feel. But somehow we’re telling millions and millions of young boys as they grow up that that’s, that’s not the manly thing to do. It’s not masculine. And so I think part of what I believe what we have to do is re-examine how we’re talking about strength and defining strength. Like if you define strength, or if we lead young people that think, that strength is who’s the loudest voice in the room, who can push other people around the most, and exert the most physical strength, you know, over them, and force over them. Who can be the most aggressive, who can demonstrate confidence, whether it’s founded or not. If this is how we’re defining strength, in the superficial optical way, I think we do a disservice to boys. I think we sell them, you know, a story that’s just not true.

REENA: Dr. Murthy, one of the problems is social media, right? You see these stereotypes play out the things, you know, my son’s really into football, you see lots of these macho football videos that he’s watching. How do we protect our children? What do you think the role of government should be in protecting our children from social media?

DR. MURTHY: Two things I’d say here. One, I think on a cultural front, look, I don’t think there’s anything wrong with young boys or girls as seeing people who are demonstrating physical strength or athletic ability, and thinking that that’s desirable, you know, like, it’s good to be strong. I actually think all of us, just from a health perspective should aim to, to do what you know, there’s a wonderful author I like, Naval Ravikand said, which is to have strong bodies, minds at peace, and homes full of love. Right? That’s what we should want for everyone.

LISA: That’s so good.

DR. MURTHY: Credit to him, not to me, but I think we should be encouraging that. The question is how do you use physical strength? Do you use it to harm other people or to protect people? Do you use it to your strength and well-being and to be able to do things in your life for yourself, your family and your community, or do you use it, you know, to, to get compliments, you know, to try to build up your, you know, sort of your ego? Like, I mean, these are different ways of using strength. And so I think cultivating strength is a good thing, how we use it is another thing. But these are cultural forces. And this is a place where I think government doesn’t shape culture in the most powerful ways. It is people, it is us, it is institutions, it is how we tell stories through movies and books. It’s the choices we make as educational institutions and workplaces. And it’s the messages that we get in church and synagogue and our temples and mosques, you know, every weekend like, these are the messages and forces that shape our culture. When it comes though to social media, to your point about government, this is a place where I do think government has an important role to play. It’s not the only player here, you know, we need kids and parents also to think about their role when it comes to social media. But what we’ve done for the last 20 years is we’ve taken the entire responsibility, and I would say burden, of managing new technology, social media, that most parents did not grow up with, that’s rapidly evolving, that’s engineered and designed with some of the best product designers in the world with the intention of maximizing how much time our kids spend on them, and we put the entire burden of managing them on the shoulder of said parents, and we said, good luck.

LISA: Yes.

DR. MURTHY: And in my mind, that is absolutely unacceptable. That is a recipe for disaster and I think it’s why we’re seeing what we’re seeing right now, which is that the kids who are spending, adolescents, on average three hours or more on social media face double the risk of anxiety and depression symptoms, which is concerning, because the average amount of use among adolescents is three and a half hours a day. So I think where government needs to step in, is to number one, establish safety standards for social media, just like we have safety standards for automobiles, which make them safer. Standards that are clear, that are scientifically based, and that are actually enforced by government. But we also need the government to establish requirements around data transparency. Many of the researchers that I’ve spoken to over the last couple of years, who focus their life’s work on social media, have said they think that there’s more there, there is more nuance there. But they can’t get the data from companies to fully understand the extent of impact on our kids. But as a parent, I don’t want to feel like a company is hiding information from me about how a product or platform might be affecting my children. That doesn’t feel right. And it’s not right. And so these requirements should be there, and they should be enforced. So these are places where I think government does have a role, like for the last 20 years, we’ve left it up to companies to police themselves and to do their best. And they’ve taken some measures, don’t get me wrong, to try to make their platforms a bit better. But the proof is in the pudding. And it is telling us right now, the data, that our kids are not doing well, and kids themselves, when I do focus groups with them all around the country, kids themselves say that social media often makes them feel worse about themselves, or worse about their friendships, but they can’t get off of it, because they feel like they’re addicted to these platforms.

LISA: So as we wait, right, I am in agreement with you on the kinds of changes I’d love to be seeing made at the governmental level at the, you know, institutional level. These will take time. What would you want parents to do right now, when it comes to their kids and social media? Like in the meantime, how can we be most useful?

DR. MURTHY: Well, and this is tough, you know, there’s no simple step here. But there are a few things I think we can do. And by the way, typically we think about policy as progress is slow, it takes time to pass laws to debate them, etc. This is a place where I feel a great sense of urgency and I think it’s important for all of us who are parents, who have kids in our lives, who care about kids, regardless of whether we have children ourselves or not, it’s important for all of us to make our voice heard, to make sure we’re talking to policymakers to let them know that this is not a space where we can afford to wait. You know, our kids are living their lives right now, and one year in the life of an adolescent, that is a long time, where a lot of development.

LISA: I’ve always said that teen years are like dog years. You know, like one year, one year for the teenagers, like seven years, you know, for an adult.

DR. MURTHY: Perhaps, yeah. But look, I do think that there are things that parents can do today. So one, I would say that if you have a child who has not started using social media yet, I think delaying their use of social media, as long as you can, ideally until after middle school, is something I would highly recommend. It’s something that we’re going to do for our kids, you know, as they grow up. But the other thing to note is that this is not easy. Obviously there’s a lot of peer pressure for kids to use social media and parents may wonder, hey, if my child is the only one who’s not on social media, are they going to be even more isolated and left out? And that’s a really understandable worry. And this is why I actually think it’s important for parents to partner with each other and support one another in this. Because if you’ve a couple of other parents who are taking similar steps with their child and delaying the age of use, that not only makes it a little easier for you, but your child also has other people that they know then in their lives who are taking a similar path. But I would also second say, if your child’s already on social media, a few things that I’d recommend. One is to make sure you have a conversation and ideally several conversations over time with your child about their use of social media, you want to understand like, what platforms is your child using? What use? Are they using social media primarily to share things they’re doing? If they’re using it to consume content? What are they looking for on social media? And you also want them to understand like what’s appropriate and not appropriate on social media, if they are being harassed or bullied, especially by a stranger, like, you want them to be able to tell you that and to know that that’s not right. So those conversations, starting them is really important. Your child may not say anything to the first one. But knowing that you want to have the conversation, knowing that you’re somebody they can go to if they feel uncomfortable, threatened, where they need help, that is really vital. The last thing I’ll just say for parents is, if your child’s already on social media, making sure that you’re creating tech free zones in your child’s day is also very important. Now, what are tech free zones? These are these times and spaces in your child’s life where they can be without social media, and ideally, without technology. And you want to create these zones in the spaces where your child is engaged in activities that are vital to their development. So think about sleep, think about physical activity, think about in-person interaction. And this could look like, you know, telling your kids that there’s not going to be any technology use for the half hour/hour before they go to bed and then throughout the night. About a third of adolescents are saying that they’re staying up till midnight or later on their devices and a lot of that is social media use. That takes away from sleep, which increases the risk of mental health challenges for kids. But you can also make mealtimes tech-free zones, when kids are going to be potentially with family or each other. You can make physical activity times when they’re out playing sports or when they’re just out with their friends. Also, you know, out with friends, you know, for physical activity, you can make that tech-free time as well. These all require negotiation. Again, this is hard to do alone. But it’s much easier when you’re partnering with other parents to do it. Look, as parents we help each other in a lot of different spaces. Right? I turn to parents all the time, fellow parents, for help. Initially it was on what kind of diapers should we get? What kind of baby formula is okay? Is it normal that my child is not sleeping regularly for the first nine months? Like all these things are things that I turned to other parents for help on. This is one of the areas where as parents we’ve got to support each other, have each other’s backs. And if your kid’s like, no one else’s parents are making me not use my phone, like throughout the night, you can say no, no, no, actually I’ve got a couple other parents who are all working together. And lastly, I’ll leave parents with this too. I have now had the chance to speak to many young people, young adults now, who during early adolescence ended up having parents who said you know what, we’re not going to start social media use for you now. We’re going to wait until you’re in high school and in a few cases, even after high school. And what’s interesting, almost to a tee, is that when I asked those now young adults, how’d you feel about that? Most of them say, you know what, they fought it, like initially. But then within a year or so, they all thank their parents. And I was like really? Well what were you thanking them for? And they said, well they looked around and they saw their classmates like, and how social media was impacting them, and how it was distracting them from other things, how they’re getting embroiled in feuds and struggles, and how they were being bullied online and all of this and they, they didn’t have to deal with that. As one young woman told me, who just graduated from college and actually never used social media throughout grade school, she said, you know, I ended up having a smaller circle of friends, but they were really good friends. And I was really happy. And that’s what I want.

REENA: Oh, that is so good. That is so good. I know. I accidentally, my son has five minutes, he’s in seventh grade, allowed five minutes on Snapchat and that’s it. And it was a negotiation, and I accidentally was going through his Snapchat and hit save on a video which you’re never supposed to do. That is like the most uncool thing. Massive blow up between us over this, and he explained to me why this is uncool. But it’s so stressful. And as you mentioned so lonely for parents. Is there anything, as you are talking about, you know, real people, human beings that you’re interacting with, seeing the reflexive policy, is or one thing in tech policy you feel could be transformative for our kids and social media and for mental health, if that one change were to be made?

DR. MURTHY: Well, I think with social media, the safety standards could be transformative. Like think about our journey with automobiles. There was a time when I was growing up where automobile death rates were incredibly high. And we needed to do something, like as a country, we like literally were losing thousands and thousands of people every year to motor vehicle accidents, including young people. Now the solution wasn’t, you know what, let’s get rid of cars and go back to horses and buggies. The solution was okay, this is technology that has some benefits to our life, but we need to find a way to make it safer. And so automobile safety standards, which helped make sure that cars had seatbelts, which helped make sure that people actually had to use those seatbelts, which put in place airbags, and other safety sort of mechanisms and tools. These played a vital role in dramatically reducing motor vehicle deaths in our country. Those safety standards are what we need to have in place now. If you look at how kids are being harmed by social media, it’s happening in part because they’re being exposed to harmful content, often very violent, very sexual content, even though they may not be able to watch a PG-13 movie, yet they’re somehow on social media seeing this very explicit content. So there’s extreme and harmful content. Many kids are also being exposed to harassment and bullying online, you know, a significant number six out of 10 adolescent girls are saying they have been approached by strangers on social media in ways that have made them feel uncomfortable. That should not happen. But there’s also the effect, what I think of as the sort of crowding out effect, that social media has on other healthy activities. Because kids are spending on-average, three and a half hours a day on social media, in many cases, much more than that, that’s time that’s often taken away from sleep, from in-person interactions, and from healthy physical activity. And what we need in part are safety standards that protect kids against the types of features that would seek to manipulate the minds of children into excessive use. And this is where it is so important, as both of you know well, for people to understand that kids are not just little adults, right their brains, and especially in adolescence, are at a sort of fundamentally different stage of development. And because their brain is at a different phase of development, they are much more prone to being influenced by the social activities and suggestions of other people. They’re more vulnerable when it comes to the effects of social media. So look, all of us growing up, you know, we’ve compared ourselves to others for years and years, for millennia I would say. And so for people who are thinking, eh, you know, kids are comparing themselves to others, haven’t been doing that forever. This is different. It’s different, fundamentally in scale.

LISA: It’s different.

DR. MURTHY: Because maybe I compared myself to a few kids I saw in school, you know, when I was in seventh, eighth, ninth grade, here and there, and I came back felt bad that they had something I didn’t have, or maybe, you know, they had something, you know, in their lives, a vacation they were going on that I didn’t have access to, maybe I felt bad about that. But today, a young person can see thousands of images in a given day on social media and be comparing themselves constantly to those people, which is why kids say all the time, using social media often makes them feel worse about themselves. It’s why so many young people I think are struggling with, you know, with issues with body image, because they’re comparing themselves to unrealistic standards that they’re seeing on social media.

LISA: And that can just flood their feeds. It’s so true. To switch gears a little bit, I was thinking the other day, so I’ve always known I wanted to be a psychologist, I knew as a child that I did. And so when I got to college, the first thing I did was sign up for a developmental psychology course, and it was first semester freshman year. And I still remember the first words out of the professor’s mouth. I remember it just like a movie in my head, he came to the front of the stage and he said, if you want to know how kids are doing, look at how their parents are doing. So if we think about mental health in that lens, you know, that we want to protect the mental health of kids and adolescents, that that involves protecting the mental health of their parents. If you had to say one thing, like one thing that you want the parents who are listening to do to cultivate their own mental health, what would you recommend?

DR. MURTHY: Well, your professor was spot on. And one of the biggest determinants of a child’s mental health and well-being is the mental health of the people at home, and our homes can build us up or they can break us down. And we, I think as parents, I say this not because I want parents to feel guilty, but I actually think we’re living in a time where parents are dealing with more demands, more stressors, and they’re having to navigate more new circumstances than perhaps at any other time in modern history. And so parenting is harder. And parenting is also, it can be a lonely experience. And this is something we actually don’t talk about a lot. But it gets to what I would recommend as a solution here for parents. Like I still remember when when we had our first child, when I was serving as Surgeon General the first time around, and people, you know, on the outside, they’re like, oh my god, what a great time, you’re having this child, what a great time in your life and you must be just thrilled all the time. But the thing is, actually, I remember we were at home. My wife and I were both taking some parental leave. We were like up at crazy hours at 3 a.m. and everyone else is sleeping, people are going to work, they’re doing their thing. We were not living close to family as so many parents unfortunately, aren’t either. And it feels really lonely. You know, and you don’t feel like complaining because at that point, people are like, you were just blessed with this amazing child like, what, are you ungrateful? Like, you know, what’s going on? And so it can be a very lonely experience to be a parent. And not just in those early stages, but later, like one of the things I worry about a lot with parents is that these mental health struggles we’re seeing among kids, parents are beating themselves up and saying is this my fault? Is this evidence that I’m a bad parent? They see their children struggling also with social media, with loneliness, and they say, I guess this is me, I wasn’t able to protect my child. And so I do want parents first and foremost, to know that more is being asked of them today than I think is fair, or in many cases humanly possible to deliver, which is why like, to really do well in parenting, but also to survive and thrive as a parent, yourself, we do need each other. We need connection to one another and support. And this is the most important thing I think a parent could do to support and sustain themselves, is to build healthy, social connection into their life. Now, I know that’s not easy to do. You know, as a parent, one of the things you have in least supply time, right? And so like, when are you going to go out and just hang out with a whole bunch of friends?

LISA: Right.

DR. MURTHY: But this is why I also tell parents, like building social connection is not always about the long stretches of time we have with one another. It’s about the small moments where we make an active decision to text a friend, you know, even if it just takes 10-15 seconds, when we might be having a hard time. Or to text a friend when something good happens, because sharing our joy is a way of also strengthening our connections with one another. It’s also, one thing we can also do, is to just take opportunities to check on one another. You know, one of the things I found to be most powerful, like as a parent early on, like we felt we had no time to go out and do things. But we finally had a friend who said to us, she was a wise parent herself, but she said, you know what? I’m just coming over. And don’t worry about feeding me or anything like that. I’m just coming over and I’m gonna hold your baby, so that you can go literally just sit somewhere and breathe. And I will tell you, that was such a blessing for us to have a friend who did that. But the truth is, we can do that for other people. So just this past weekend, we had a family member who came over with two kids who are really small, they’re under two. And the parents are stressed and they’re tired. And my wife and her enduring wisdom just said to them, you know what, the parent’s job in situations like this is just to eat, to talk, and to have fun. It’s our job to take care of your kids. So let us do that. So you know, we just sat there and hung out with the kids. And the parents had a chance to relax. So these things don’t actually take a lot of time. But these small moments where we reach out and support another parent, where we allow ourselves to receive the support of another parent and not think that means somehow we’re not cutting it, these are the moments that can help strengthen our social connection with one another. So as a parent, give yourself that permission to accept help. Give yourself the permission to ask for help. Because there are often a lot of people on the outside who aren’t sure, should I intrude? Should I check in? Should I just give them space? They may not know that you could use a hand or an ear to listen to you or somebody to just sit, sit there with your child and allow you to just take a shower or get a meal.

LISA: It’s the shower that was always for me, what it came down to.

REENA: What great advice, Because I, you know, like I’ve got two middle schoolers, and one of the things that was transformative for me, for us, under COVID, was four or five people, our friends in the neighborhood would get together at five o’clock and workout, we got these weights, and we’d workout. And now for the month of August our challenge is everyone’s got to reach an average of 10,000 steps a day. So we have a WhatsApp group where we’re all communicating. So it doesn’t matter where they live. Anyone can take part in the challenge, but it’s holding us accountable. But I’m realizing if I don’t take care of my own health, and that means physical health for me, it regulates everything upstairs for me, I’m not a good parent, and I am angry and just don’t like the parent that I become when I don’t work out. So that’s so great to hear about finding that connectivity and helping other parents.

DR. MURTHY: I love what you’re talking about, Reena, because in some ways you’re, you’re helping hold each other accountable, but in kind ways, right? And as parents I think sometimes we need both permission and encouragement to do things for ourselves. You know, I think parents can often feel like, hey, I’m being selfish if I’m taking time for myself, but just as you beautifully said, like, we need to do that to not only be able to sustain ourselves so we can care for our kids, but we role model for our kids all the time. It’s like as one fellow parent said to me when we had our first child, he said, you know, your kids may sometimes listen to what you say. But they’ll more often listen to what you do. And so when we take care of ourselves, whether that’s working out, whether that’s eating well, whether that’s making time here and there to talk to friends, whether that’s managing our own use of social media and drawing boundaries around it, so it doesn’t invade our sleep or time with others, that all helps our kids also see how they can live life in a healthy, balanced, and fulfilling way.

LISA: I’ve often said this on the podcast, my favorite parenting advice I found on the inside of a Dove chocolate wrapper, it said, don’t talk about it, be about it. And I think that’s, it’s what you’re saying, you know, that kids like, they’re watching us. So we can say one thing, but if what we do doesn’t line up, they don’t take it seriously.

REENA: Speaking of the topic of taking it seriously, you know, what do you think it would take to get insurance companies to cover mental health, the way we cover physical health? You know, if you’ve got cancer, you’re going to see your coverage all the way through. But if you have mental health concerns, people are struggling just to get basic healthcare coverage.

DR. MURTHY: They are. And right now, mental healthcare is not nearly as accessible as it needs to be. We need more mental health providers, we need people to be able to be seen in a more timely way, and we need more modes of delivering that care, so that you can get the care where you are, in your home, at school, in your workplace, wherever you are, wherever you want. Now, the good news is that we have made some progress on all three of these fronts. And just recently, in fact, just a few weeks ago, President Biden announced a proposed rule that the Department of Health and Human Services is putting forward to actually strengthen something called the Mental Health Parity Law, which was passed in 2008. That was a long time ago. But despite that passing, and it was a law that sought to do what you’re talking about, Reena, which is to ensure that insurance companies can’t discriminate against mental healthcare, and that they provide the same level of reimbursement and coverage for it as they do for physical health. But despite that, people have still been having problems. They’ve found that insurance companies throw up these requirements, like for prior authorizations that block their access to care. They’ve found that an insurance company may say, sure, sure, we’re covering mental healthcare, but when they look to see who’s in their network, it turns out, they’re very few, if any providers. And so what President Biden announced in this proposed rule was actually a much needed and long awaited effort to strengthen that parity law, to make sure that these loopholes, you know, can’t be there anymore and that insurance companies actually do what people need them to do, which is to provide access to mental healthcare and to cover it, so that people aren’t spending down their life savings just to get their child the mental healthcare that they need. This is something that upsets me, Reena, because you’ve got millions of people across America who are doing their job fulfilling their end of the bargain and paying their premiums every month. And care should be there for them when they need it. And for it not to be, to me, it’s just such a moral transgression.

LISA: And even, you know, you mentioned the economics, right, of communities having good networks, that it actually improves the economics of what goes on around them. I’ve followed the parity laws my whole career. We know that people don’t misuse their mental healthcare coverage, if it’s expanded, that it naturally limits itself. And we also know that money spent on mental healthcare actually reduces costs on physical care. So, you know, even if the moral question aside, right, I mean, there’s just it’s so, so important. And I’m really hopeful that we can keep moving this in the right direction. I

DR. MURTHY: I am, too. And I actually feel optimistic about this. Because, you know, in addition to this parity law, we’ve also, in the last two years, seen more funding going toward expanding the mental health workforce than we’ve seen in a long time. We’ve seen hundreds of millions of dollars go toward building certified community behavioral health clinics, which are clinics which provide trauma based care, and crisis care, but that also is available to people, regardless of insurance status. That’s a big deal. There are now 500 of these clinics, we need many more. But that’s progress. And finally, on the telemedicine front, you know, I talked about the importance of being able to get care to where people are, you know, one of the silver linings of COVID, if there can be one, is that it did accelerate our use of technology to deliver care in a remote sense. And this is a place where we need to make the authorities to do that permanent, we need to be funding the development of telemedicine capabilities, and we need to be adequately reimbursing for that as well. So that you know, especially if you’re a young person and you want to be able to do your session with your counselor on your phone, you should be able to do that. Like there shouldn’t be a requirement that you have to somehow go in-person and drive 30 miles and wait three months to see someone. That is a recipe for disaster. So there has been a lot of progress on this in the last two and a half months, more so than I’ve seen in my entire nearly 30 years in public health. So that’s encouraging to me. But we can’t stop until everybody who needs mental healthcare can get high quality care when they need it. That’s culturally appropriate. That’s what we’ve got to be able to do. That’s the benchmark that we should be fighting for.

LISA: Absolutely.

REENA: It just, the fact that you have focused so much on loneliness, you studied it before you came back into office again. A few years ago, the UK government created a Ministry of Loneliness, and they were made fun of in the tabloids, and now other countries, including Japan, Australia are looking to start the same. Do you think the US government should have a Department of Loneliness to look at this?

DR. MURTHY: I’m glad you brought this up, because I do remember when the UK announced that move to make one of their cabinet ministers essentially in charge of loneliness under their portfolio, and actually later went and met with the minister who is focused on loneliness. And I think it was a brilliant move. And I think it’s necessary, like if you look at government right now, and you say, hey, who’s in charge of addressing loneliness and rebuilding social connection and community? It is not clear who that is. Right? It’s like, in some way, shape or form, many different entities and agencies are working on pieces of that. But I think we would benefit from having an individual and a group that is focused on this issue, because it crosses across departments. I mean, this isn’t just a health issue, right? Our loneliness and disconnection impact us economically, they impact education. So there’s something that we should all be concerned about. And I think having someone in government who is focused on one, ensuring that policies across government, that we understand their impact on connection and community, I think that’s important. Somebody who can also help us develop a detailed strategy, building on the advisory that we have issued on loneliness and isolation, that framework for a strategy. I think that’s important. And finally, that individual can also help to mobilize the broader country behind a common vision, and a strategic plan for where we go. So these are all places where government can help. Again, recognizing that to truly solve the loneliness crisis in America, we’re going to need organizations, individuals, and communities to take a hard look at how we are living our lives and ask ourselves, is this what’s really best for us? Like we are not, what we need to do is to live people-centered lives. Lives that are rooted in relationships. Lives that ultimately support the development of healthy relationships. And right now, I think that we’re living more of a work-centered life. I can tell you this, being brutally honest, that’s what I was doing for many years. And it really was, in the years leading up to the pandemic, and then particularly the pandemic, that made me realize that, sure, if you stopped me on the street at any point and said, what are your top three priorities in life? I would have talked about the people in my life. My mother, my father, my wife, my sister. But if you look at where I was really spending the bulk of my time, effort, attention, and energy, it was really on work. And people fit-in where it was convenient. But I think that we do that to our detriment, and I think that we have under-emphasized and lost sight of how important our relationships really are. And this is a cultural shift that has to take place. Culture is driven by people and institutions. It’s driven by the stories that we tell, through media and entertainment, and through our music. And we have to marshal all of these forces now to tell the story that I believe we need to tell, which is that as a community, as a country, as a planet, we are stronger when we are connected to one another. That there is no shame in investing in our relationships, and that there’s no shame in needing one another, because we evolved to be interdependent. And that’s how we go farther. It’s how we all do better.

REENA: So great. So if you’re hiring a Secretary of Loneliness, I might apply. If that position is open now.

LISA: Reena’s very social, she’d be awesome.

DR. MURTHY: Good to know.

REENA: A little too social. Before we go, Dr. Murthy, I’d love to ask you. What does the US Surgeon General want to ask Lisa,

LISA: Got any questions for me?

DR. MURTHY: Oh gosh, I have too many questions to ask. But I guess one thing that I would wonder about is Lisa, you’ve done such a beautiful job helping parents navigate these last few years, not just the pandemic but, you know, challenges that preceded the pandemic. I’m curious sort of when you talk to parents about the stresses that they are contending with, is there something that has bubbled up to the surface as something that they would find helpful, like a common thread that most parents say, hey, if I had this that would make my life a lot more manageable or enable me to be a better parent to my kids?

LISA: When I talk to parents, who are really feeling strained by the reality of their family life, to me, the theme that seems to recur is, my kid is in distress and I can’t make it go away. Or my kid sometimes has distress, and I can’t prevent it from happening. I worry that parents have somehow gotten the message that you should be able to shield your children from pain. If your kid is in distress, like you said, it’s somehow your fault. And what I would want parents to know, is that, I think sometimes the way we can be most useful to our kids, is to not be frightened of their pain or their worries, to not minimize them, to not try to hurry them away, but to take very seriously, that they have sometimes negative feelings, and to show them with our own steady presence, that they don’t have to be scared of their negative feelings and we’re not scared of our negative feelings. But I worry with so much, appropriate often, headlines about adolescent mental health concern, kid mental health concern, that parents are now feeling frightened of distress on their kids. And so parents need more support around the fact that no matter what they do, there will be times when their kids are really in quite a bit of distress, just in the natural course of life. And that this is not a sign that they have somehow failed or not come through as a parent, and then the support to be there for their kids. Because it’s very hard when your kid’s are in pain.

DR. MURTHY: Yeah, such important points you raised and real wisdom I think that you shared with parents. I mean, if we think about our own upbringing as kids, we all went through distress and moments of loss and anger and misunderstanding and relationships and friendships that were lost and then formed. And I think those ups and downs are normal, but I can appreciate that now, it’s hard for parents to know when those negative emotions are normal, versus when they’re leading to a dangerous place of self harm. And so I really sympathize with parents there. I do think, you know, as much as we often tell, you know, kids, when we’re talking to them and young adults about the power and importance of reaching out to one another, I think that’s so important for parents to do with each other as well. To reach out and to check on one another, recognizing that as perfect as things seem on the outside, I think a lot of parents are actually having a tough time and navigating difficult circumstances, and have a lot of questions about how to manage things, whether it’s how their kid interacts with social media, or how they’re dealing with newer, with AI, or with other tools and sort of shifts in the environment that inevitably come our way. You know, I’ll lastly just say this, Lisa, I think that moments of crisis, and I think we are living in one of those moments now, I think they have the power to not only reveal who we are, but to help us shape who we become. And this is one of those moments where I think, I think it was a moment of identity, where we have to ask ourselves, like who do we choose to be in this moment where so many people are struggling, are feeling invisible and unseen, who are beating themselves up thinking that they’re being bad parents or they’re being bad kids. What I don’t believe is that I don’t believe that we are a nation of bystanders who just sit by and watch others suffer. And just go about our own ways, we may do that. But I don’t think that’s really who we are, deep inside. I think that we are a nation of courageous and kind people who, when given the opportunity, step up to help one another. Not because it benefits us, but because it’s the right thing to do. Because we know that reducing suffering around us is something that we should all do and something that we’d want somebody to do for our kid if they were having a hard time. I think this is a moment to step into that identity as courageous and kind healers, because that is who I think we have the power to be, you know, so often we think about healers is the nurses and doctors in our communities and, and the therapists and others and they are absolutely the healers that we that we need, but we all have the power to help each other heal, because we have the ability to be kind, to be generous, to express our compassion and our love for one another. And we can do that in small brief moments. Simply asking people how they are, pausing to listen, or helping somebody pick up the papers that they just dropped, or giving someone space, you know, to go ahead of us in line if it looks like they’re having a bad day and they really need it. These small acts of kindness, they go a long way to not only helping people feel better, but to reminding us of our identity, of who we really are. Because that, I worry, Lisa is one of the great casualties of crises like this. Is that we may lose sight of who we are. That we may just come to accept the fact that, you know what, the world seems more mean. It seems more lonely and isolated, it feels that people are out for themselves. Maybe that’s just who we are. But I don’t think we should accept that. Because I don’t think it’s the truth of who we are. I don’t think it’s who we are in private moments. And I have a chance to, as I travel the country to meet and encounter so many people who are doing beautiful things for the people around them in their life, like nurses and doctors who are putting themselves at risk at times to help people who are sick, neighbors, who are dropping food off because they know that their neighbor is having a hard time, teachers, who are reaching into their own pockets to buy pencils and art supplies for their kids because they know budgets are tight at home. We don’t read about these in the papers, but these speak to who we really are. And this is our time, I think, to really reclaim that identity as courageous and kind healers.

LISA: Well, thank you. Such an honor to have you with us. So appreciate your messages.

REENA: We’re so grateful for your time. But I just love that you had focused so much on loneliness after leaving office, and you’ve made it such a cornerstone of talking about mental health and how we look at it. It’s been such a game changer. I also want to plug the Surgeon General does have that podcast I mentioned “House Calls with Dr. Vivek Murthy,” where he invites guests and listeners. You definitely want to check it out. You can tune in to “House Calls” on Spotify, Apple Podcasts, YouTube, wherever you get your podcasts. And we’ll put a link to those advisories too. I think it’s well worth a read if you haven’t read it yet. We’ll put that all in our show notes. Dr. Murthy, thank you so much. We hope you’ll come back. And maybe tell us who your new Minister of Loneliness is.

DR. MURTHY: Well, thank you so much, Reena, thank you so much, Lisa. I love this conversation. And most importantly, thank you for all the good energy and wisdom you’re bringing to the world. I really appreciate you both.

REENA: Thank you so much.

LISA: Wonderful. Have a good one.

DR. MURTHY: You too.

REENA: What a conversation. I’m surprised. Often when you get government officials, they find a way to kind of not answer your question. He answered all of our questions.

LISA: And so thoughtfully. I mean, really, it’s very moving to have conversations with him. He thinks about things so deeply and is such a generous spirit.

REENA: Yeah, it really was incredible. So how do you top that? What do you have for us Lisa, for parenting to go?

LISA: Well, I think for parenting to go, I’m just gonna underline something he said. There was a phrase, he had many beautiful, beautiful phrases, but he said, lives that are rooted in relationships. And I think, you know, when I think about what promotes health in any of us, you know how in real estate, they say, location, location, location, I think in our lives, it’s relationships, relationships, relationships. This is true for kids, true for teens, true for us. And I’m going to think long and hard about all of the good advice he gave about what that means, both big and small. You know, how we organize our lives, and also our small gestures in the day. I think we should all try all the time, to be rooted in relationships.

REENA: It’s not something you consciously think about. But after this podcast, I just realized why that is so important for mental health.

LISA: Yep, it’s everything.

REENA: And Lisa, next week, our conversation, we’re going to talk about slurs. How do you get your kids to stop using slurs or if their friends are using slurs, how do you educate them about it.

LISA: Talk about not rooted in relationships.

REENA: You’re absolutely right. Absolutely right. I’ll see you next week.

LISA: I’ll see you next week.