In 2023, the United States Surgeon General Vivek Murthy, MD, issued an advisory pinpointing loneliness, isolation, and lack of personal connections as an “underappreciated public health crisis.” Approximately 50 percent of American adults experience measurable levels of loneliness, he said, increasing their risk for poor health and premature death, a risk equal to that of smoking daily.
If you have poor or insufficient personal connections, you also have a
29 percent increased risk of heart disease, 32 percent increased risk of stroke, 50 percent increased risk of dementia, 60 percent increased risk of premature death, and 100 percent increased risk of depression.
Loneliness is bad for your health even if you don’t generally think of yourself as lonely or typically experience loneliness, say researchers from the Penn State College for Health and Human Development. In a 2024 study of more than 1,500 people ages 35 to 64, the researchers found that those with temporary feelings of loneliness were more likely to have daily health issues like fatigue, headaches, and nausea.
How loneliness hurts health
How does friendship protect health? A study from researchers at the University of Virginia provides a possible answer.
Sixteen people underwent a functional MRI, which displays brain activity in real time. Low-level electrical shocks were randomly administered, equivalent to the “shock” of mild, ongoing stress, like being caught in stalled traffic, responding to a barrage of emails, or dealing with your angry teenager. During the MRI, individuals held the hand of either someone close to them or a stranger. When holding the hand of someone to whom they felt close, they registered only one-third the level of activity in the parts of the brain that register feelings of threat, compared with holding the hand of a stranger.
The support and connection of friendship helps you absorb the impact of stress, which causes or complicates nearly every condition and illness. Friends provide you with a chance to rest, recover, and revitalize.
Loneliness is not a defect
The first step on your journey to building friendship is to reframe your concept of loneliness. There is a stereotype that sees a lonely person as someone who has something wrong with them: a person who isn’t likable, who has poor social skills, or who is isolated. But loneliness isn’t a fault or defect.
Loneliness comes from a human need, like hunger for food. Hunger is not a problem: Not getting your need met for food is the problem. Similarly, there is a natural human need for connection with other people. If you don’t admit you have this need, you’re less likely to get your need met.
If you’re hungry, you ask yourself what you’re hungry for. If you’re lonely, ask yourself, “What kind of connection do I need? What kind of support am I looking for?” This recognition of loneliness as a common and normal need—just like hunger and thirst—helps you feel motivated to do something about your loneliness, without shaming yourself.
Three foundations of friendship
There is a big difference between feeling friendly and building a friendship. There are many times when you feel friendly with other people. But building a friendship—an authentic connection where both people feel seen and known in a safe and satisfying way—requires three factors: positivity, consistency, and vulnerability.
Positivity. Positivity is not about being upbeat in a relationship. Positivity is how you feel when you leave an interaction with a friend. If it’s positive, you feel supported, hopeful, more confident, or prouder. To foster positivity, ask yourself this question: “What am I doing to ensure that the friend I’m interacting with feels better about themselves and their life for having been with me?” And do it!
Another way to implement positivity: After a friend has been vulnerable with you, make sure you express your gratitude by saying something like, “Thank you for sharing that with me.”
Consistency. You may have met a lot of people who could have become your friend, but the relationship lacked the consistency that is a must for building friendship. Consistency describes your pattern of interaction with another person: how long you’ve known each other, how much access you have to each other, and the frequency and duration you spend time together.
Friendship was easy in school because consistency was automatic. We spent time with the same people every day. But when we’re older, we need to initiate and schedule interactions. We’re not lonely because we’re not meeting people. We’re lonely because we don’t figure out how to consistently spend time with the people we meet. Unless we spend time with another person, we won’t feel supported, close, or familiar with them.
To build consistency, ask yourself, “How do I build friendships in a place that is already consistent, like a religious organization or a bowling league?” Or, “What am I willing to participate in that is consistent, so I can see people regularly and build friendships?”
If you don’t have a plan to be consistent with a friend, you won’t create a pattern that leads to friendship. It’s like physical health—you don’t go to a gym one time and conclude that it didn’t work to foster health. But we tend to think that way about social health, meeting people once and wondering why we didn’t become friends. If you keep sharing time with the same people over and over, and demonstrate vulnerability and positivity, they will bond with you.
Vulnerability. The essence of friendship is the feeling of being seen and known. In friendship, you feel that your friend is interested in you, that you can open up and reveal yourself, that you can be authentic, that your opinions matter, that the stories you tell matter.
However, being vulnerable doesn’t mean you pour out your life story the first time you meet someone. Rather, you get to know a person in incremental, appropriate ways. As you increase consistency, you increase vulnerability.
An effective way to increase vulnerability is to ask your friend open-ended questions that allow the other person to tell a story. An example: “What’s one thing that’s going really well in your life, and one area that’s keeping you up at night?”
A year to deeper friendships
Most people are happiest with three to five close friends. Here’s one way to build three to five deeper friendships over the next year. Write down the names of three to five people you want to feel closer to 12 months from now. Ask yourself two questions about each person: How strong is this relationship? How healthy is it?
Answer each question with a one to 10 rating.Ask yourself, “Which of the three requirements of friendship would make the biggest difference in these relationships?”
You might say to yourself, “This relationship is strong in consistency and vulnerability, but not positivity. I’m kind of exhausted by the relationship. I’m dreading the phone calls, after which I feel drained and weary. For the relationship to be healthy for me, I need to add more positivity.”
Or, you might have plenty of consistency—you see your friend nearly every weekend for a round of golf—but very little vulnerability.
Bottom line: For each of the three to five people, be strategic about the friendship you have, the friendship you want, and what you have to do to build that friendship.
Bottom Line Health interviewed Shasta Nelson, MDiv, author of The Business of Friendship: Making the Most of Our Relationships Where We Spend Most of Our Time; Frientimacy: How to Deepen Friendships for Lifelong Health and Happiness; and Friendships Don’t Just Happen: The Guide to Creating a Meaningful Circle of Girlfriends. She is a two-time featured TEDx speaker, with her first TED talk receiving over 800,000 views, and she has delivered more than 500 keynote speeches for over 20 different industries.
