The Epidemic of Loneliness with Dr. Abdul El-Sayed and Jes Tom

Transcript

ANNOUNCER
Please welcome to the stage Charles Blow.

[applause]

[Charles Blow, a Black man with a gray beard wearing a blue suit, Host]

CHARLES BLOW: Hello. Welcome to “Ideas at Ford with Charles Blow,” where we bring together some of the world’s best and most innovative thinkers who are offering ideas for how to solve some of the world’s biggest problems. Tonight, we are tackling something that has become an epidemic in this country, which is the epidemic of loneliness. Here to discuss, we have county public health director, host of the America Dissected podcast and author of Healing Politics and Medicare for All, Dr. Abdul El-Sayed. And, a comedian, writer, and actor you may know from their specials, Less Lonely and Hannah Gadsby’s Gender Agenda on Netflix, Jes Tom.

CHARLES BLOW: So I’m going to start with you, Abdul. When people talk about a epidemic of loneliness and this being a public health crisis, what are they talking about?

[Abdul El-Sayed, an Arab American man with black hair, a beard and mustache wearing a white shirt and a blue jacket with a floral pocket square, Physician, Epidemiologist, and Public Servant] 

DR. ABDUL EL-SAYED: I think when we talk about human phenomena, it’s one thing to talk about one’s own experience, it’s another to talk about the emergent phenomena of all of us experiencing this thing at the same time. And what that points to is actually all of the circumstance within which we are not interacting, because like, there’s more people on this earth than there ever have been. The idea that we are more lonely from a just basic logical standpoint is kind of crazy. And we have all of this stuff that in theory is supposed to connect us. 

So what is it, right, about the anti-social media that we’re all a part of? What is it about the way that we’ve organized our society that means that we are literally “water, water everywhere without a drop to drink?” And I think that that experience of it is really what I think people are, are frustrated about, sad about, and increasingly anxious about.

CHARLES BLOW: But the effects of this are profound. The Surgeon General issued an advisory in May calling this a public health emergency. And, you know, he said that there’s a connection between this loneliness and worse mental health outcomes, but also that the levels of premature death rival those of smokers.

DR. ABDUL EL-SAYED: Right. Right.

CHARLES BLOW: How do we engage with data like that to change how we think about loneliness, that it’s not just a sad thing that someone doesn’t have a connection, but that it is a threat to your health?

DR. ABDUL EL-SAYED: Yeah, I applaud and appreciate Dr. Murthy for taking this on and bringing it to the valence of our public conversation. In public health, I think we’ve gotten a bit of a bad rap, if I may, during the pandemic, because we kind of forgot what we are supposed to do. I think in public health, we tried to be kind of a lukewarm version of medicine where we give you advice, and then you follow our advice. And if you don’t follow our advice, then we “tsk tsk” you and shame you, which is not really what public health was ever really about. Public health was really about trying to identify those phenomena that exist outside of us, but ultimately end up shaping us in some really big ways. So when you think about smoking, what did we do about smoking? Yes, we told people you shouldn’t smoke, but we also pursued a set of public policies that made smoking the kind of thing that people didn’t really want to do that much anymore. And that was a big victory. Similarly, when we think about loneliness, right, I think to ask the question of what is the public health intervention now? I really think that, you know, it’s one thing to tell somebody who’s lonely, “You should be less lonely, right?”

CHARLES BLOW: Their response is like, “Tell me about it.”

DR. ABDUL EL-SAYED: “Yeah, I agree.” But then why? What is it about the way we’ve built our lives? What is it about the fact that you have, you know, trillion dollar industries that exist to monetize our time, our eardrums, and our eyeballs? What is it about the infrastructure that tells us that we should stare at a screen when we wake up to check our email, go stare at a screen to talk to the people who emailed us, and then stare at a screen to watch somebody entertain us after we’ve gotten out of all of our screen meetings? Right. 

What is it about that system that needs to be deconstructed? What are the tools of subsidies? What are the tools of regulation that ought to be there to empower us and enable us? And I think taking this data and breaking out of the individual choices we make and asking the meta questions about why we’re all making them. That’s where I hope we end up. 

CHARLES BLOW: Jes, in your most recent…

[laughter] 

JES TOM: He’s a doctor. I’m a comedian.

[laughter] 

CHARLES BLOW: Balance, Jes. Balance. So your most recent off-Broadway show, Less Lonely, you grappled with a lot that I think boils down to the idea of connection, which is connection to self and how you identify yourself, connection in in terms of relationship, that you were transitioning as COVID pushed all of us into lockdown, and that that experience that all of us experience some level of isolation. You were experiencing a transformation and an isolation all at once. What has been your experience of loneliness in your journey?

[Jes Tom, an East Asian trans masculine person with tan skin and red hair wearing a brown over shirt over a white undershirt and blue jeans, Comedian, Writer, and Actor] 

JES TOM: Well, like you said, my show Less Lonely kind of meets me at the crux of these three different narratives, all pertaining to loneliness. One being my obsession with finding romantic love, like the love of my life, one being my, my gender transition, and then the last being that I was transitioning just as the COVID-19 pandemic hit. Which effectively means I was going through puberty for the second time in total isolation, which is actually a cool way to go through puberty as we’ve figured out. 

[laugher] 

And I actually had a pretty interesting experience of the pandemic with regards to loneliness and community, because before the pandemic, I was always so busy, and I lived far away from all of my friends. I lived in Queens, which is another country to people in Brooklyn. They will never come to visit you, they’ll lie. So, whereas before the pandemic, I was literally seeing, like, some of my best friends twice, three times a year. In the pandemic when everybody went online, it meant, like, all of my friends were suddenly in the same place. So actually, I weirdly became, like, very connected to people in isolation. And then once we all kind of went back into the world again, I sort of was like, “Now, where did my friends go?”

CHARLES BLOW: Wow. Abdul, talk to us about that idea of the online experience—what it has done to connect us, but also what has it done to isolate us from in-person, intimate, interpersonal reactions? There’s clearly a desire to be in connection with people in person. How did these things live together?

DR. ABDUL EL-SAYED: Yeah, I mean, so think about that feeling that you have after a really good night of conversation with folks that you can look in the eye, whose bodies and faces you can read. That feeling, I think, is the essence of what it means not to be lonely. Like that, that is the thing we’re all kind of talking about. And the hard part is that all of us, on our hips or in our pockets, on our chest, wherever you keep that little phone, have this simulacrum of a social experience that parses that social experience into small bits and pieces that never get to the whole of that feeling. And I think this does a couple of different things that are pretty dangerous.

The first is it cheapens real social interaction by making you think you can have it all the time. The second is that because it glows and makes lights and colors, it pops dopamine into our brains all the time, which make us reach for that thing rather than climbing the overhead cost of real social interactions. Like, “I got to get out of my house and put on some clothes and go to a place and sit with my friends.”

And then it also de-risks relationships, which I actually think is the biggest cost. So you think on the other side of that amazing dinner experience you just had? There’s a lot that could have gone wrong. And, you know, there’s a definition of beauty, which is “marveling at the unlikelihood of being.” And I think being with other people is its own form of social beauty. The unlikelihood of being. You and I found each other and we got to have this amazing experience. But I actually think having those things have some cost—and some risk—gives them real value. And I think between those three things we have given over that amazing piece of what it means to be together to a bunch of companies who spend trillions of dollars to make sure that our social experiences get interspersed with ads for things we really probably shouldn’t buy. Right? But that’s the business here.
CHARLES BLOW: But I want that sweater! 

DR. ABDUL EL-SAYED: But you would look really good in that sweater! I probably wouldn’t.

JES TOM: You don’t know what it’s going to look like in real life. You don’t know what they’re going to send you.

[laughter]

DR. ABDUL EL-SAYED: We need to be looking for harder, riskier kinds of interactions. The problem with it, though, is that that’s a long-term benefit and a short-term cost. And humans are really bad at making decisions whose long-term benefits are large, right? But whose short-term costs are large. And that’s the, I think, the tough part.

CHARLES BLOW: I’ve heard you talk about the idea of needing more social infrastructure that, that the way we build our cities, the way we build our communities can actually either contribute to loneliness or contribute to more social cohesion and people being forced together, not like forcing us in a bad way, but in a positive way. What does that look like? Why have we abandoned it, first of all? And how do we get it back?

DR. ABDUL EL-SAYED: Yeah, I really appreciate the question. My daughter, who’s nearly seven years old, every time we come to New York, she cannot wait to get on the subway. And you ask her, “Why?” And she’s like, “Well, because I get to see everybody.” And I think if, obviously, if it’s your primary mode of transportation, you take the upside for granted. And sometimes that upside can be some real downside. I admit that. 

But there is something about seeing and being in space with people who are going about their day to remind you that you live in a society. Now, you can imagine what it means to bring your kids out to a town square or a playground where your kids are now interacting with other kids. Or if you own a dog, a dog park, right? Everybody knows that. Yes. The dog park is a place where the dog has to do what the dog has to do. But it’s also a place where you get to meet other dog owners, people who share experiences with you.

And I think the point that I’m making here is that there has to be a pull aspect to it. And when you build really good social infrastructure, it pulls you out. You want to be there. And part of what makes it so great is the other people who are there. And, you know, I think about when I was a little kid, my grandparents—we used to spend the summers with them—had this amazing pool in their neighborhood. But what made the pool great wasn’t that it was just a body of water where I could swim. It was all of the other kids who were there and all the games that we would play. And I think we forget. Right? That play is a very human thing. And although play starts to look a little bit different as an adult, we all kind of need it and want it.

And when you build spaces that people come together looking to engage with each other, it is those other people that make that experience worth having. And so it has to be aspirational. It has to pull you. It doesn’t you know, it’s got to be something that you want to be a part of. And the problem with it is we stopped building that a long time ago.

CHARLES BLOW: But, but even after we’ve seen experiments where, even though New York City has plenty of parks, you build the High Line. People want it. Commerce shows up. New housing shows up. Aren’t cities learning from these newer experiments that what people want more than anything is public space? 

DR. ABDUL EL-SAYED: I think we’re actually in the situation where there are several visions of what we actually want out of each other at play. And folks who choose to opt into urban communities opt into them because they understand that what makes this place is the sum of everybody here. There’s some brilliant economics that’s demonstrated the value of having a lot of folks in one place together, exchanging ideas and all the amazing things that come out of that. But there’s also a vision of America where I get my own, you get your own, and I would rather not have to share with you, right? And I actually think that there’s still a lot more work that needs to be done about getting to the foundational questions at the bottom of what happens when the people you’re sharing space with don’t look like you, don’t love like you, don’t pray like you, may not pray at all?

And is it still valuable to share space with them? And folks here have said, “Absolutely, I learn so much about myself and other folks.” But there are a lot of folks who say, “No, that’s scary and I don’t want to do that.” I think we actually have to start asking a lot bigger questions of the cultural experience underneath that and what people select into.

CHARLES BLOW: But one of the things that was in one of your podcasts, you talked about, well, we in the aggregate may be shying away from building public space. Wealthy people are not. In their own isolated communities, they are building plenty of public space that only they in that community can access. So it is an imbalance of public space and a use of public space that does not cross boundaries that is what we’re seeing.

DR. ABDUL EL-SAYED: It is the new segregation. And I worry, right, because those public spaces are really nice. And the same forces tell us that not only can we not build public spaces in those spaces, but the idea that maybe all of us would have to select into that one public space is not something we want to engage with. The other problem here is, to be clear, we are dealing with a challenge in this country where actually a lot of people don’t have private space. Right? What is the epidemic of the unhoused except for a lot of people just don’t have their own private space? And what happens when a lot of folks don’t have their own private space is you end up getting disorder in the public space, which then opts a lot of people out of the public space. Right. And if we’re not serious about asking that question of how do you build private spaces for everybody, I worry about the continued segregation of public spaces for some folks, right? And the assumption that public spaces for most of us, right, are not worth building.

CHARLES BLOW: I want to switch gears a little bit and talk about how loneliness and isolation has a disproportionate impact on men. I ask both of you about this, but Jes, I want to start with you because I saw an Instagram post or maybe it was some other social media site posts recently, and it was a trans man, and he was in tears, and he was saying no one told him that being a man would be so lonely. That when he lived his life as a woman, women would hug, they would embrace, they would empathize, they would create community, and that all of that had vanished when he became a man. And not only was he lonely, he was feared. So people would cross the street when they saw him coming. I’m curious about how you have experienced this, what you have heard about this from other people who have transitioned, and how they experience this difference between living life identified as a female and then identified as a man?

JES TOM: Totally. Totally. I mean, something interesting about transition is that it really—like the way that a trans person gets treated almost depends entirely on, like, literally what that individual looks like. For example, nobody is afraid of me. 

[laughter] 

Nobody is scared of me. I’m not exactly giving the picture of like threatening masculinity, but, you know, I haven’t seen that clip, but I would strongly suspect that the person who made that video is probably somebody who, quote unquote, “passes very well,” so it can move through society without people noticing that they’re trans, and probably somebody who wants to culturally engage with, like, men and like, straight men in their culture. I am having a kind of different experience. My sort of lore is that testosterone turned me from a lesbian into a gay man, because god forbid I become a functioning member of society. 

[laughter]

So what happened with me is that after living literally 17 years as like, a lesbian or a lesbian adjacent, non-binary person—choosing to be in lesbian spaces, choosing to be surrounded by women and socializing with women all the time. Now I’ve moved into the gay space and I’m socializing almost only with men. And gay men, while they do operate differently from straight men, there’s also, I would say, a real epidemic of loneliness among gay men as well. It’s very common for me to know gay men who have, you know, never had a boyfriend in their life, never had a serious relationship. But they’ve been out as gay for a really long time.

I think that because I am trans and because I am queer, I already have had to break the mold of expectations of like the way somebody’s life is lived. So I already am critical. I’m already looking at everything with a critical eye, so I’m not as susceptible to, like, falling into like, “Oh, this is how a man should be. You know, a man is very serious and doesn’t show his emotions and never hugs his friends.” I don’t really have to be like that. But it’s a matter of kind of everybody realizing that none of us has to be like that.

CHARLES BLOW: Abdul, how do we get to this point where so many men disproportionately are experiencing loneliness and isolation in this way? And what does it mean for us as a society to have that many men living that experience?

DR. ABDUL EL-SAYED: I think we need to have an answer to toxic masculinity. If all masculinity is just toxic, then you’re going to have a lot of folks out there who are like, “Okay, I guess I’m just toxic.” And then you get the most toxic version. So my question is, like, “What’s the benevolent masculinity?” What does that look like? Are we willing to engage with this question of like, alright, so what is it that is unique and interesting about you being a guy, right? And look, I say that and I’m sure everybody’s like, “It’s the patriarchy.” Yes, it is the patriarchy. I get it. 

But if you tell a person, “Hey, listen, there is nothing unique or redeeming about what you are,” then they’re going to look for the person who says, “There is something unique and redeeming about what you are.” And then you end up in this situation where you have this most, this stew of folks performing the most toxic version of masculinity because they think that’s what this is supposed to be.

And I think the way that we start to engage with this problem, right, is to start to create spaces where folks can come together. And then we, we sort of ask you to kind of experiment with it. It’s like, “Do I like being this tough guy all the time?” Does that make me feel good? Does that give me this feeling of like, ‘I can be and do in the world and people like me and I like them and I’m being productive in the way that I want to be productive?’” And I think most of the time the answer is no. There’s no space where you can go and say, “What is that version of this that is pro-social, that’s thoughtful, that’s engaged, that can cry and hug my friends?” Right?

So I can feel like a tough guy, but I actually kind of feel very fragile and sad inside. Right. And I think we got here in large part because you’ve got a group of people who’ve realized that they can prey on a group of young, vulnerable people. Right. That has been the truth forever. It happens. It’s just, it’s way easier to do when people are isolated from the relationships that nurtured them because of their phones, where this stuff is fed to them because they fall into a particular algorithm and then they can’t really find a way out. And then what happens is folks just lean in. I just don’t think we’ve created the off-ramps that we need to. And let’s just be clear. Right. We can keep doing it this way, but I don’t think any of us like the outcomes. And these men in particular don’t like the outcomes. So we’re going to have to find some rational, thoughtful, engaged, pro-social way of trying to get folks to feel like they can inhabit who they are.

JES TOM: There’s also a phenomenon of transmasculine people who have, you know, undergone medical transition, who for all intents and purposes move through the world appearing to be men who very strongly don’t want to identify as men because of this kind of negative attachment to being a man, to the idea of toxic masculinity or the idea that like once you quote unquote “become a man,” once you give over to identifying as a man, then you do have to give up these things, being intimate with your friends, like being soft, being sensitive. And I also have felt that way, like for a long, long time because of the negative connotation to like being a man.

CHARLES BLOW: So how then, would you weigh in on Abdul’s proposition of, “What does a benevolent masculinity look like?”

JES TOM: Yeah, there’s I mean, there’s a lot of discourse in this, especially among trans men, because a lot of us think of ourselves as being, like, uniquely positioned, you know, to embody a benevolent masculinity just by virtue of, of having lived some period of time understanding, you know, to a certain extent, like what it’s like to move through the world as a woman or as somebody that the world thinks is a woman. Yeah, we’re in the unique position to grow into new types of men. Um, you know, men who are caring, caring without being patriarchal, um, you know, gathering, gathering community and, and taking care of people. Like, I feel like things that you could call, like if you called it nurturing, you would think it was feminine. But men can do that exact same thing, too. 

CHARLES BLOW: Abdul, I want to ask you a question about boundaries of definitions, which is, when does solitude—which can be healthy and reflective—tip over into loneliness, which can be corrosive? Because I think a lot of people crave some solitude, some distance from the noise of the world, especially today, and the screens and whatever, but also from, a break from people around them. But how do we prevent that from becoming loneliness?

DR. ABDUL EL-SAYED: That’s a really good question, because different people have, from what we understand, different people like and have capacity for different levels of socialization. And that’s perfectly fine, and that doesn’t mean that everybody who’s introverted or doesn’t need to be around people all the time is lonely. And the hard part about loneliness is that it’s not a momentary experience. It’s an emergent experience. The question is, are you getting the amount of nurturing that you might like? The other part of it is, you could spend your whole day with people and none of those relationships are fortifying or, or invested in by either of you. Right. And so it’s not just a function of like, “Am I around people?” It’s a function of “Am I building meaningful relationships to the level that I need, such that my need for social investment, interaction, engagement, and love is sated by the coterie of people I have in my life?”

And, right, there are a lot of people who have, from what on the outside would look like a great family relation—set of relationships who feel lonely for a different kind of interaction in their lives. And so, I think what we, we have to separate from is like the number of people in your life that you see regularly versus whether or not those relationships are deep, meaningful, and offering you what you need to feel sated and to feel together.

CHARLES BLOW: Jes, I want to ask you about how we disguise loneliness in society, because if you open Instagram, nobody’s lonely. Everybody’s around friends and they have the same fake smile in every picture—

JES TOM: You want to ask a comedian about how we’re disguising our mental illness, I—okay.

[laugher]

CHARLES BLOW: I think that the public facing image of a lot of communities is that people are actively engaged in very deep, communal activities. And so people see pride parades and they see people collecting at gay bars or whatever, or drag shows or whatever. And they think that the image that they have is that these are deeply connected people. Clearly, none of them are lonely. And I think that that exists across the spectrum, that we kind of disguise the fact that we are alone or lonely, because we only show the pictures to the world of when we’re happy and smiling and we’re surrounded by people. 

JES TOM: Totally. I mean, thinking about, you know, what you were saying earlier about, like, Instagram and social media. I think that especially Instagram has created this sort of social hierarchy economy where you want to appear, right, exactly like you were saying, like you’re hanging out with a ton of people. You’re surrounded by friends at all times or like, maybe, you know, maybe you have a famous friend and you’re like, hanging out with that person and that makes you look really cool.

And then, so, what it does is it kind of turns what is like a real human interaction—like you’re really there, like at your friend’s birthday party—into a kind of like, chip that you can use, that you can like throw out into the world. “Look at whose birthday party I was at,” like, “Look where I was and look at who I was with.” And it’s when you start focusing on like, “Ooh, this is going to make a really good picture,” or “This is going to look really good to other people who are looking at my Instagram,” then you’re thinking of the people who are in the phone rather than the people who are literally around you in real life. And all of us, I think, are in this. I know I definitely am, of really trying to like, learn how to, like, be present, learn how to like, come back to my real human self and be in the room and be with everyone instead of being like, “Oh my God, like, who do I need to get a picture with next?” The token of the photo is more important to me than the fact that I, like, spent time with that person.

DR. ABDUL EL-SAYED: Can I pick up on that because it’s a really important point. I’m a certain age. We got internet in 1996, I was 13. And then I have a brother who’s eight years younger than me and a sister who’s 15 years younger than me. But the degree to which these kinds of online-mediated social interactions perform this, like, vacuum suck back into them for younger generations, for whom so much of social interaction has to be mediated in these spaces that are online—to me is really profound. Like I feel like I’m still of the age that I can opt out. But I know for a lot of my siblings, particularly my youngest sibling, there’s not an opting out, because that’s the space in which all of these folks interact. So if you want to interact with folks in your age and stage, you’re going to have to do it, in part, in this online mediated environment. Which means you’re always torn, right? Because currency is that you got the picture and put it on Instagram, right? “Pics or it didn’t happen.” And when that’s the case, you can’t just say, “Listen, you know what? Like, I know it’s corrosive and I know it’s a problem. I’m gonna opt out.” And then you’re the only one who’s not actually involved and you’re missing the group chat.

CHARLES BLOW: So it’s another kind of loneliness.

DR. ABDUL EL-SAYED: Exactly. And, and so it creates is almost impossible situation where you’re torn. Like, “Do I actually engage with the real life person in front of me or the online-mediated simulacrum of all my other friends? And I can’t actually choose. I have to do them both.” Which is an impossible thing to be. We talk about being present. That is by definition the opposite of being present.

CHARLES BLOW: So I’m going to give you the last word on this and just see if you can—that’s depressing. And we’re going to see if you have any—

JES TOM: I came to the Epidemic of Loneliness to be cheered up so…

[laughter]

 I’m feeling confused.

CHARLES BLOW: Are you optimistic about how we will be able to dig ourselves out of this?

DR. ABDUL EL-SAYED: I’m not. I’ll be honest with you. Let me, let me offer you where this small shred of optimism sits. I think that there are a lot of young folks who are so frustrated by this existence that they’re thinking about new ways of opting out. So one—there’s this interesting thing that happened in terms of social media use over the last five years. The sort of monofeed Internet started to fall away. So like, that’s like Instagram, where you’re connected to friends, people, you know, on this one feed that is now feeding you highlight reels of everybody else’s life. And I think it started to bifurcate into two things. One side of it is TikTok, which is people I don’t know, doing things that are like, of the moment, and I just watch them do their thing. And then the other side of it is group chat, right? And you see a lot more group chat, which is, “I’m actually only interacting with a small group of people.” It’s far less performative than Instagram was. And I think that that is a movement or an opting out of some of the most caustic forms of social media. So that gives me hope. 

JES TOM: I want to say something about this. I want to say something about this as a comedian. I’ve spoken a lot as kind of a queer person and a trans person, but as a comedian, I feel very strongly about, like, the gathering of real people in real life. I find comedy—not to overstate the importance of standup comedy in our society—but comedy is one of the few places where you can gather and have, like, a real, live experience with all live people or all—any live performance, poetry, music, anything like that.

But comedy, especially because it’s, like, conversational, because it’s like a back and forth directly between the audience and the person on stage, and with the audience all together. It’s a place where you can get together and everybody can laugh together about something. And I could write essays on essays about the way social media is kind of decimating the way we do standup comedy. But I bring it up to say, like, real life still exists. Real life still exists. We’re all in this room together, having a shared experience together, which is not dissimilar to, like, the shared experience that you have, say, on the subway, or walking on the street and seeing other people. Again, like you said, fully asymmetrical, and we’re in for a long and crazy fight ahead of us. But real life exists, like, we’re here right now. We’re not inside of Instagram.

CHARLES BLOW: I want to thank both of you for being here tonight. I think this is a conversation that needs to happen, needs to happen more often. The more we talk about it, acknowledge what is happening with our isolation, with our lack of connection, at least we move closer to the idea that somebody has better solutions for how to solve it. So I just want to thank both of you and give them another round of applause.

[applause]

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