In May of 2023, the US Surgeon General called attention to the most serious public health threat of our time. Something he equated with the most pressing public health threat of the 20th century – tobacco use. He was not talking about fentanyl or opioids, he was not talking about distracted driving or high sugar diets. Dr. Vivek Murthy was worried about loneliness.
According to the CDC, loneliness and it’s close cousin social isolation raise the risk of premature death by almost 30% (https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf#page=8.05), roughly equivalent in risk terms to smoking 15 cigarettes a day. (It hasn’t always been this way though, the American drive to associate was considered remarkable and highly unusual in the 1700’s (de Tocqueville), but for several decades now, the trend has been away from “joining”, with fewer civic and social organizations, with lower memberships. And it’s getting worse. Unlike tobacco use, the trend of loneliness has been accelerating upwards).
Isolation is much different to tobacco though, in several important aspects.
Firstly, the impacts of loneliness are diverse. Risks for individual medical outcomes like heart attack and stroke increase, alongside risks for other stress related illnesses like respiratory ailments, as well as mental health issues like anxiety, depression and dementia. But there are community and economic impacts also. Employees who are lonely are less productive, students who lack connection exhibit lower academic achievement. Perhaps most troubling of all, communities with higher levels of loneliness have lower levels of democratic and civic engagement. The negative impacts of loneliness are obvious, become a self-reinforcing cycle and should raise alarm bells across the spectrum.
So what is driving this epidemic, and what can be done about it? With tobacco, there were a few major factors that contributed to the epidemic and associated outcomes. Socialization of smoking. The addictiveness of nicotine played a major role. Expensive, iconic ad campaigns and cultural cache all contributed. Perhaps the most important was availability. Anyone could get cigarettes anywhere. I remember when cigarette vending machines were a thing.
Each of these factors, other than the addictiveness of nicotine, however was susceptible to intervention, and could be addressed through regulation or other limits. As such, advertising, sale, and portrayals of tobacco were either heavily regulated or taxed, and over time it lost much of its market share and cultural cache. Over time, this combination of regulation, taxation and education meant that use became marginal, and risks were understood. There were several easily identifiable levers, that when pulled, had a very real impact on use rates.
Unlike campaigns that focused on tobacco use, any efforts to solve the problems of loneliness and isolation have to contend with a much more diffuse set of underlying issues, and a much harder set of solutions.
Simply put, the causes of loneliness can not be laid at the feet of a couple of large corporations, or the addictive nature of a single compound. We can’t point an accusatory finger at a specific type of ad campaign, or a particular loophole in our regulations. This crisis has multiple roots, many of which span generations and significant cultural divides.
My point today is not to pinpoint the specific causes of isolation and loneliness. Even if I was smart enough to figure that out, it wouldn’t do a whole lot of good. It’s much more productive to think about what we can do to sidestep the whole problem.
I want to focus on what we can do, in our own small lives, to reduce the epidemic of loneliness and isolation for ourselves and those around us. I want to lay out a super basic, but I think quite poorly understood process that is available to everyone, is achievable by everyone, doesn’t require any significant outlay (other than your time), and as we observe every summer at camp, really works. Making friends. Friendship forming skills are learned skills, and as learned skills they can be practiced and improved, or let atrophy and decline. They can be role modeled, coached, and broken down into parts that aren’t magic. They benefit from practice, and it is worth paying attention to the basic mechanics of these skills, at any time of life.
It should be pointed out from the start that making and keeping friends are two separate but related things. Both require courage, work, empathy, and a willingness to exchange something of value (your time and effort) with no guarantee of reward. This is daunting. Making and keeping friends isn’t just one thing either. It’s a whole tangled set of skills, which are learned and require practice. Not everyone has the best role models to teach them these skills, and an environment to practice them in. But it’s worth making the effort, because we are social individuals, and as the surgeon general points out, having friends keeps us healthy.
For anyone, child, teen or adult, the first (and very obvious) step to making new friends is…meeting new people. It doesn’t have to be someone you’ve never met before, but whether it is someone you met once or twice previously, or someone you are meeting for the first time, they are, potentially, a new friend.
The first rung on the ladder to friendship is acquaintanceship. While it is true that sometimes we’ll meet someone and connect immediately, more often than not we take a little while to warm up to them. We need to get to know their interests, sense of humor and other personality traits, the rhythms of their life. This is the part that takes courage. To get this information, we need to be both curious and vulnerable. There is risk here – of looking foolish or naïve, of saying or doing something insulting, of being laughed at, or even worse, rejected. There is no getting around the fact that the “getting to know” stage is fraught and scary. But every time you do it, every time you meet a new person and take the time to learn more about them…it gets less scary. Because you soon learn that even if it’s not a “good fit”, it’s not the end of the world, and is likely a pleasant, or at least interesting way to spend a few minutes, or hours.
This step of the friend making journey also requires that we build and maintain good conversational skills. Active listening being about the most important. At camp this is probably the number one social skill we try to model and teach. Learning how to not just hear, but listen to what another person is saying, and to respond appropriately, is a surprisingly rare talent. When we encounter people who are good at it, we tend to really like that person). Not far behind listening is being able to carry your side of the conversation, and the two need to be balanced. No one likes being talked at, and no one likes having to do all the talking (well, some people do). Tell a decent story, or be able to say something funny, and you’re most of the way there. I think these two very basic skills - listening, and being an equal conversational partner – account for about 90% of rizz, as the kids call it.
It’s also a bit of a numbers game. Again, this is blindingly obvious, but the people with the most friends tend to be those who meet the most people. I want to emphasize that this is a learned skill. Sure, it can be manufactured by an outside force (icebreakers, anyone?), but think of that as practice for doing it on your own. Recognizing the value in meeting more new people is something one learns through practice. Having a smooth, or even fun, experience meeting them takes practice too. Learning how to help others enjoy the experience of meeting you takes practice. We always like to remind campers that these are all learned skills, and chances are the person you are meeting is just as nervous, and in need of practice as you are.
It does help if there are role models, and “connectors” (people who have gotten really, really good at meeting new people, and enjoy helping others meet new people) around, but it’s not necessary.
Back to the numbers game. It stands to reason that the more people you meet, the better the odds that you’re going to meet someone who shares your interests, sense of humor, background, aspirations, whatever. This is critical, this is the initial motivation. This is what takes an acquaintance-ship, and propels it down the path to a friendship, because this is the excuse for you to start spending time together. For most of us, most of the time, it all comes down to spending enough time.
Some pretty solid research has started to quantify what it takes to make the move from acquaintances to friends, and the biggest thing appears to be time. For kids and teens it can be 40-60 hours spread over as little as 3 weeks, for adults it seems like it’s longer – up to 90 hours, but spread over a couple of months. (https://journals.sagepub.com/doi/10.1177/0265407518761225). Regardless of age, the important thing to recognize is that moving a relationship up to the friendship level requires a significant investment of time.
However, we have limited time available to us. An hour spent is gone forever. If you are embarking on a quest to make a new friendship or two, you want to at least think about being…judicious. We need to invest a lot of our limited hours into an acquaintanceship for it to level up, and the surest way to both enjoy that investment of time, as well as maximize the chances for success, is to share a motivation, an excuse, for hanging out together.
Oftentimes the available pool of potential new friends has been filtered for you (as will be discussed later), and you’ll have a greater chance of success building friendships with anyone there. Other times, it is a more random sampling of individuals, and the chances are lower. (This is why we frequently make great friends at camp, or college, but are less likely to do so at a workplace, or on vacation). Either way, it’s important to be able to figure out if you and your new friend are sympatico, or at least get along well enough to want to continue hanging out for multiple hours a day for weeks at a time. The good news is that the more you practice figuring it out, the better you get, and the more new friends you meet. All it takes is time and a bit of courage.
At this point, leveling up to friendship is all about how you decide to spend your time and attention. There is a cost to a friendship. Spending that time doing stuff or doing nothing with friends means you aren’t doing other things. You are making an investment in yours and your friends future happiness and health. It’s the most worthwhile investment you can make, and it’s fun, and hopefully memorable and rewarding, but its also work. And just like some of our interests and habits can sometimes help level up a friendship, sometimes they can interfere too. We might like playing a particular video game, or reading books, scrolling on a phone, watching a TV show compulsively, working (like employment), exercising, playing a particular sport. We can either find someone who shares this hobby, or if we want to be friends with someone who doesn’t, compromise on how much time we might spend doing our own interests, and instead following a shared interest.
This act of compromise is another of those learned skills that requires lots of practice to get just right. Generally speaking, we find it hard to be friends with those who are not compromising, who expect a friend to conform exactly to their own prior expectations. Similarly, friendship can be hard when the other person has no preferences or interests, and refuses to share any of themselves with their friend. Each friendship is going to be different, with a different balance, and a different set of expectations. Again, a learned skill that requires practice, but is nonetheless eminently achievable.
Once a friendship is formed, it then requires maintenance. We’re all familiar with the terms high- and low-maintenance when it comes to friendships, and every friendship will have different thresholds, but there is no such thing as a no maintenance friendship. Which is not to say a friendship that has lain dormant can not be revived, usually with much less effort than that required to start a new friendship, but if friends aren’t doing the work of communicating, or seeing each other, helping each other out or doing fun stuff together, that relationship is no longer providing the social, mental and physical health benefits. It is no longer reducing isolation and loneliness.
Another way of saying this is that the work of friendship is never done. It’s not a trophy, to be won, inscribed, and put away in a cabinet for display. It’s not an assignment, with a due date. A friendship is an ongoing choice, an agreement entered into by both friends, tethered to past shared experiences, with the promise of more in the future. Usually the maintenance cost is not as high as the initial investment, but often times we choose to spend far more of our time with close friends than we ever could have anticipated. Naturally, many of the strongest friendships, those we invest the most time into, occur in those periods of our lives when we have a little more leisure time to invest – school, college, travel, retirement.
This is one of the patterns we observe frequently at camp, the failure to nurture the new friendship. Campers will come to camp, meet a new friend/s, spend a TON of time together over the span of a fortnight, a month, a summer, and then fail to follow through after camp. Again, learned skills come into play. Taking an in-person, highly available friendship and translating it into the “real world” is hard work. It requires much more synchronizing of schedules, finding ideal means of communication, sharing of disparate experience. But, it is also very possible. We see friendships formed in camp that blossom across years and decades after the summer. The skills required to make the friendship work may require different role modeling – parents instead of counselors, different resources – a weekend visit, or access to tech to communicate, and will impose different expectations, but it’s all possible. And the work put in to a new friendship pays off later.
We like to remind campers that friendships are kind of like trees. When they are very young seedlings and saplings, they must be handled with care and attention, and require more work, more weeding and watering, to thrive. Once they have grown, and the bark is thicker, the trunk is stronger, the tree doesn’t require as much work to thrive. It is also able to withstand much more. A storm won’t kill it, and it can survive periods of drought. Even more aptly, a tree thus cared for into maturity becomes a thing of immense value. It provides shade and shelter, improving the lives of those who have cared for it. A well tended friendship, nurtured past the delicate early phases, will provide myriad benefits for those who tended it well into the future.
At camp, we get to put all this together (including actual trees to help with the ol’ metaphorizing). We pull together a pool of peers who are likely to share at least some interests. We create opportunities to get to know those peers, and take the first step from stranger to acquaintance. We have wonderful role models who understand how to both demonstrate, and coach, the subtle social skills that don’t translate through a screen. We provide a ton of opportunities to practice those skills. And we create endless activities and times for fun, shared memories to be made, so campers can spend the requisite amount of time with their new friends.
Leveling up from acquaintanceship to friendship often happens so quickly at camp that campers question what is happening. Whether they are the type of person who makes friends easily, or has to work a bit harder, almost all are shocked about the depth of friendship that can develop in a relatively short period. We’re talking a few days. When the end of the summer comes rolling around, campers (and staff) often feel they have known their camp friends for most of their lives. Which is not surprising, given how much each of them lives, in the present, during a summer at camp.
We are fortunate at camp to not have to deal with the consequences of loneliness and isolation during the summer. The nature of the community ensures that. What may be even more powerful though is knowing that at the end of the summer there is a whole new group of young people going back to their home communities, with newly refined skills to make, and grow, connections. Now, if we can just get EVERYONE to spend a summer at camp, the surgeon general can worry about something else…