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Loneliness, Vitality, and the Six Domains of Health with Dr. Alan Rozanski · Friendship IRL: Real Talk About Friendship, Community, and What It Actually Takes

• 0:00
  Podcast Intro/Outro: All right, gang. Here's to nights that turn into mornings and friends that turn into family. Cheers. Hello, hello, and welcome to the Friendship IRL podcast. I'm your host, Alex Alexander. Each week we talk about what is working(and what is not) in our friendships, community and connections. Have you ever wished you could sit down and have a conversation about what is really going on in your friendships? Well, you found your people. Join us as we dive into real life stories and explore new ways to approach these connections. Together, we're reimagining the rules of friendship
• 0:57
  Alex Alexander [Narration]: There is this one stat that gets brought up, I swear. Almost any time we're talking about friendship, community, connection, it's that loneliness is as deadly as smoking 15 cigarettes a day. And every time I hear this stat, I think to myself, "Okay, but what does that actually mean? What is happening inside the body? What is loneliness doing to us? Our heart, our lungs, our brains...
• 1:33
  Alex Alexander [Narration]: like somebody tell me." So when Dr. Alan Rozanski and I connected, I asked him if he could answer that question, and he said, "Yeah, but in a way." And it turned out I was asking the wrong question. This episode turned out to be so much more profound and thought-provoking than just talking about the physical implications of loneliness. You see, I was thinking of health as the absence of disease, but that also meant that I was asking a much smaller question than the one we ended up talking about.
• 2:11
  Alex Alexander [Narration]: Dr. Rozanski has spent decades studying the question, "What is health?" Not health as the absence of disease, not health as the number on your labs or how many miles you logged this week, health as vitality-that inner sense of feeling alive, energetic, like possibility is still open to you. Dr. Alan Rozanski is a cardiologist, researcher, and professor of medicine at the Icahn School of Medicine at Mount Sinai, where he serves as chief academic officer and director of nuclear cardiology. He trained at Yale, Tufts, and Mount Sinai, founded a large preventive cardiology program at Cedars-Sinai, and received a sabbatical fellowship from the MacArthur Foundation to study the science of health-promoting and health-damaging behaviors, alongside leading 300 peer-reviewed articles. And his work sits at the place where cardiology, health psychology, and behavioral medicine meet.
• 3:21
  Alex Alexander [Narration]: Over more than four decades of research, he developed the Six Domains of Health and vitality, a map of everything that actually creates health: physical activity, mental vitality, emotional well-being, purposeful living, stress, and social connectivity. Now that last one-that's obviously why he's here today. In this episode, we get into what loneliness actually does to the body, why the absence of disease, like I was thinking in the beginning is really not the same as being healthy. We have to go further than that. How the Six Domains of Health pull each other up or drag each other down, and why the question might not be how do I fix my loneliness. It might be where do I put my energy first? This episode is a lot in the best way possible, so let's dive in.
• 4:28
  Alex Alexander: Dr. Rozanski, thank you so much for being here today and taking time out of your busy schedule. Every time we go to hop on a call, I think to myself, like, well, I don't know if he doesn't show up, it's probably because he's saving someone's life. I'm just like so grateful that you could be here and take the time today.
• 4:44
  Dr. Alan Rozanski: My pleasure.
• 4:44
  Dr. Alan Rozanski: It's a pleasure to be here.
• 4:47
  Alex Alexander: Well, since you and I have chatted before, I have a little bit of your backstory, but there are not as many doctors that I know that I have found who are focused on social connection. And the Six Domains of Health, like you've created that framework, but you kind of accidentally walked into this work. Can you tell me a little bit about your origin story and how you got here?
• 5:10
  Dr. Alan Rozanski: Sure, for sure, it was an accident in terms of pre-planning in college. I knew I wanted to be a doctor. I actually wanted to be a psychiatrist and went to medical school with that intention, but after I took my cardiology rotation, that was in my third year of medical school.
• 5:26
  Dr. Alan Rozanski: I just fell in love in terms of taking a history of patients with chest pain and helping them. So I just thought about cardiology from then on, and became a cardiologist, intending to go into private practice. But at the end of my training, this new field of cardiac imaging, it opened up called nuclear cardiology, and it's the application of nuclear medicine techniques, but applied to patients while they bicycle exercise or do treadmill exercise, and we can look at the blood flow of the heart or the wall motion of the heart while people are under maximal exercise stress, so I thought that was super fascinating, and I went out to Los Angeles to get training. I thought I'd be there for a couple months, and it turned out to be 10 years. But that was, let's say, the first thing unintended. But in my third year there, there was data that had come out which was stunning at that time in the cardiology world, we had this new opportunity to look at people's electrocardiogram, not while they were in the hospitals, you know, lying down, but actually while they were engaged in a daily life activity. It was called ambulatory electrocardiography, and this new data was showing to Gene that it was patients who were having these abnormalities on electrocardiogram, which signified lack of blood supply to the heart, occurring transiently while they were driving the car, while they were doing household activities, and and other things that did not appear to be at least physically stressful to patients. So, I got this idea. Sometimes, you know, this is as fortuitous. Let's just say it's that. That gee we could study this a bit in the laboratory instead of just having patients exercise. Why don't we also have them do some model stresses? And these were all mental in nature. We set them up to look at the subtraction of serial sevens from a four-digit number as fast as they could, and this other test called the Word Stroop test, which is a standard psychological stress, and putting them under a cognitive load. And the other thing we had the patients do was just simply ask them to speak for five minutes about the personal stress in their lives. We told the patients we're not trying to test your head; we're trying to test your heart, but you have to make these stories personally relevant, and honestly, I didn't know what to expect. I was skeptical that we see abnormalities on cardiac function. And just for your audience, what we're looking for is that let's say you have someone on a bicycle, and you're having them exercise on a bicycle, and you have the walls of the heart moving in and out like a balloon in and out, if there's a blockage, one of the coronaries, that wall during exercise will start to slow down and may even stop moving. So we wanted to see if this would occur during mental stress. So the second patient we did was a man about to lose his job, and he's talking about this stress, and it's getting very personal.
• 8:18
  Dr. Alan Rozanski: And as he's doing this, lo and behold, he has decrease in wall motion in part of his heart, about 30% of his heart, and actually stopped moving during the peak of that. Just speaking about his stress, so that was just very stunning to us. We were able to reproduce similar findings in about 20 of our 40 patients with heart disease that we studied, again for your audience, this is not a phenomenon you see in in people without heart disease, and these were people with quite advanced heart disease. But it was this aha moment. Gee, there is this understanding between the mind and the body. It's real. It can be measured, and from there I went on. I got a sabbatical fellowship from the MacArthur Foundation to study this in more depth for two years. That allowed me to be on different campuses around the country, working with the biobehavioral scientists. This was back in the 1980s when this whole field of looking at factors such as depression and stress and loneliness and its relationship to heart disease was just beginning. In those days, there was a lot of skepticism that any of this was true, and I was exposed to these very careful investigators, and lo and behold, I got exposed to all the aspects of the mind-body relationship, and I haven't stopped studying it for the last 40 years since.
• 9:40
  Alex Alexander [Narration]: So, as somebody who isn't an MD, right? I have no medical degree.
• 9:43
  Alex Alexander [Narration]: What I am hearing is that this was proof that there is a mind-body connection, and when we are feeling psychological impacts, it is actually impacting our, I guess, physical health.
• 9:59
  Dr. Alan Rozanski: Yes, there.
• 9:59
  Dr. Alan Rozanski: It is a relationship that impacts your physical health, but it's not dramatic. In this study, we were looking at something acute in patients with severe heart disease, and for two or three years, I just focused on the effects of acute stress, if you will, on heart disease. But once I did the sabbatical, I transitioned to the normative kind of things people experience in their daily life, those quotidian stresses, and how they may affect the heart and other you know parts of the body over the course of years. So that became my focus.
• 10:29
  Dr. Alan Rozanski: Let me add that for, and this is key. I mean, I mean, I think we'll just set the table in terms of discussion. I and everybody else in the medical field were focused in those days looking at negative factors, which affect health negatively, like depression, like social isolation, and so forth. But about 25 years ago, I transitioned, if you will, to looking at the flip side, which is wait, what's the impact of positive social factors of feeling happy, of having a strong sense of meaning on your health in the positive sense, and the relationship there is very profound as well. So it's not a negative thing. It's it's just looking at the full spectrum of the relationship between the body and the soul and the head and physique and all of those things are interrelated.
• 11:24
  Alex Alexander [Narration]: Well, to me, that should seem hopeful because, as I mentioned to you before, there is this stat in the connection, friendship, community space that just I see it everywhere to the point where, like, I don't even want to repeat it here, but I'm going to repeat it, which is that loneliness is as deadly as smoking 15 cigarettes a day, so I love what you just said because you're pointing out that social connection also has a huge impact, right? We have like this scare tactic stat that I'm always like, well, what does that even mean to people? What is happening inside people's bodies? But then you are also saying, well, if we do have social connection, that also is impactful. We don't need this just like scary stat all the time.
• 12:08
  Dr. Alan Rozanski: Yeah, that that is absolutely the most important thing we can emphasize here because the nature of news is to you know emphasize the negative, the risks, and so forth. We as human beings are also built in with a certain negativity bias, which is well documented. If you go to a house which is beautifully decorated and you see one rip on the curtain, your eyes will gravitate to that right away.
• 12:35
  Dr. Alan Rozanski: You know, and you'll be focused on it. That's the nature of things. But the fact is that the positive aspects of it, and also the other part of this is we as physicians are trained appropriately to detect disease and cure disease. That's our main function, right? A curative nature, and that's the overwhelming reason why patients go to doctors, and it's the overwhelming mission of hospital systems. So the positive side often gets drowned out upon that, and often that part isn't really in doesn't really occur in the hospital so much, right?
• 13:08
  Dr. Alan Rozanski: It's building up your sense of flourishment, but you're not, you know, depending on a hospital to get the advice to do so. So the positive stuff gets de-emphasized, unfortunately, for many reasons.
• 13:21
  Alex Alexander [Narration]: Well, one of my favorite things that you've said, and I have seen in your other podcast interviews, and your work, and your blog, is this idea that like the absence of disease does not equal health, and I love that so much because it really does make you stop and think for a second.
• 13:37
  Alex Alexander [Narration]: Like so many of us are out here in our day to day, just almost chasing the absence of disease, and I say that as someone with like chronic health issues. So when I hear you talk about it as like, you know, you you said in our call, if someone's not depressed, does that mean they're happy? Can you unpack that a little bit because I think it's such a mindset shift for people.
• 13:59
  Dr. Alan Rozanski: 100% it really is, and as you just said, you know, if you're not depressed, it doesn't mean you're happy. It just means you're not depressed. But happiness is at the other end of the spectrum. But not being depressed doesn't define it. In the same sense, the mindset is so intrinsically there by default that if you don't have disease, therefore you're healthy. You went to the doctor.
• 14:22
  Dr. Alan Rozanski: You were complaining of some shortness of breath. The doctor detects. Voila, nothing showed up negative. He says, "Oh, you got a good bill of health." Certainly didn't address the patient's issues. You know. So the problem is that if we're going to talk about health, we need to define it. And I actually have gone around for years asking doctors, residents, colleagues, and other people how do you define health? And the answer I get usually is something that's just thought out intellectually. Well, it's some kind of physical and social and mental well-being, and in fact, the World Health Organization has a definition in their opening charter. You know, they opened up in 1948. They said that health is complete physical, mental, or social well-being, and not merely the absence of disease. So, first of all, they didn't need the second part of that phrase. Why did they put it in, and not merely the absence of disease? Because they recognized all the way back then that's how people thought about health. Okay, but then they said complete physical, mental, and social well-being.
• 15:27
  Dr. Alan Rozanski: Well, well, what do you do with that? First of all, what do you mean by complete? How do you measure it? But if you don't have a definition of health, then it's all vague and so forth. So this is something I've worked on in terms of many years, and I came to realize that the nature of health is this inner pleasurable sense of feeling energetic and alive. In other words, it's not just the absence; it's something that's very positive. That someone who's really healthy they feel a sense of vitality. Vitality is, I think, a very good definition of health. I have grandchildren, and they come and visit, and they're three and four, and it's crazy because they don't walk.
• 16:07
  Dr. Alan Rozanski: Everywhere they go, they run.
• 16:07
  Dr. Alan Rozanski: You know, full of vitality. But you know, in the course of our lives, there's times when we feel very energetic, and at times when we're not. So if we understand what are the things that promote feeling energetic and alive; those are the same very things that promote actually being healthy.
• 16:25
  Dr. Alan Rozanski: Interestingly enough, so that's I'm summarizing something that took me 40 years to understand.
• 16:32
  Dr. Alan Rozanski: But if we live with that definition of health, then we have a North Pole. You know, if you're feeling somewhat blessed and energetic, why are you not feeling that? Is it because you're sluggish? You haven't been exercising. You haven't been getting enough sleep. Maybe it's because you know you have a poor diet. But it could be any of many other things. It could be loneliness. It could be the fact that you don't have a sense of strong purpose. It could be that you are a bit depressed. It could be that you're ruminating a lot and full of negative, you know, mindsets that are weighing you down. All of those things that depress vitality also over the long term can damage your health. So they're very interrelated.
• 17:14
  Alex Alexander: Well, when I hear you talk about vitality and your grandkids, what comes to mind for me when I hear you describe it as like possibility?
• 17:18
  Alex Alexander: Like I wake up every day with a sense of if I wanted to go hike that trail, I would have the physical health to do it, and if I wanted to go socialize, I would have people that I felt like I could go to and have a good time with, and if I wanted to write a book and release it into the world, like I know it's going to be a challenge, but I feel like there's the sense of purpose, and like mentally, I feel strong enough to go after that goal.
• 17:49
  Dr. Alan Rozanski: Yeah, I love that distinction. You know, when they measure happiness over the life cycle, they find that there's kind of a high level in early adulthood. Then in midlife, it kind of dips, and then often it actually increases again in older age, but for different reasons. But the happiness of youth is that sense of possibility that everything's open to me, and when you don't feel it's open to you, because for many reasons that weighs you down.
• 18:18
  Alex Alexander [Narration]: Well, and you get to you know the middle years of your your life.
• 18:21
  Alex Alexander [Narration]: I'm 36 almost 37 and so I would assume that for a lot of people, the maybe lack of possibility, lack of vitality is just almost the stressors we have accumulated, the the backpacks we are carrying, the things we want to achieve that now is the time in life to do it, and maybe that all weighs down on you simultaneously. So it's a lot of things at one time. I feel like thinking in my life now.
• 18:49
  Dr. Alan Rozanski: That is the essence of I think the middle years. But the good news is that if we acknowledge that, and if we see that it's affecting our sense of vitality, well, we have different pathways we can take to combat that and to improve that and to feel to have more possibility and to have more vitality. There's very many things you can do.
• 19:10
  Alex Alexander: I have a question that relates to your Six Domains of Health, but it means we have to tell people about the Six Domains of Health.
• 19:16
  Dr. Alan Rozanski: Sure.
• 19:17
  Alex Alexander [Narration]: So can we talk about what those are? Because I got a question up here that just came up, but it's gonna be hard to ask if they don't know what these are.
• 19:25
  Dr. Alan Rozanski: Sure. So, in a nutshell, one of the things I came to realize near the onset was that because I'm trained as a scientist, I didn't want to come up with some theory and whatever, and I was exposed to these bio behavioral scientists who were, you know, very scientifically oriented, and I came to realize the body itself testifies as to what's healthy.
• 19:48
  Dr. Alan Rozanski: No one will argue with this.
• 19:48
  Dr. Alan Rozanski: Anything that promotes longevity, anything that decreases your risk of disease, anything that protects your physiology, and especially when it does all three of those things. It's healthy. So, if you're physically active, if you're moving a lot, if you're doing resistance training, if you're getting good sleep, if you have a good diet, all those things are healthy. They all do all of those things. They promote longevity, decrease the risk of disease, protect your physiology. Things that you know
• 20:18
  on the opposite: not getting sufficient sleep, having a poor diet, smoking cigarettes-unhealthy because they do the opposite. They shorten longevity. They increase the disease of risk. But that's just the physical domain. That's one domain. So I said six domains. The second is the area of your cognitions, your very mindsets, the quality of your thinking. So we know now from data that's about 30 years old that optimists live longer and they have less risk of heart disease than pessimists. And pessimists is the opposite of the scale. There's people who somewhere neutral in the middle, but optimists you'll you'll live longer, you'll have better cardiovascular function.
• 20:58
  on the opposite: Pessimists the opposite. Same is true with gratitude, for example, and we could think of other mindsets. So that's your cognitive area. Then you get into the emotional area. You know, looking from depression to happiness. So what happens is that when people are depressed, the body's whole physiology goes haywire, and it's not just one of the most difficult things to deal with, you know, in terms of a person's soul, to feel depressed in life, but it affects your very biology. So that people are depressed have higher levels of insulin, more inflammation. They develop physical fat. They have inflammation in the lining of the arteries, which makes them at risk for heart disease. The amygdala, the fear center of the brain enlarges actually. So all of this is going on, and explains that depression is a major risk factor for heart disease and other illnesses. But happiness, the opposite. So people who are generally happy, actually, it's a health protective area. So that's the third area. The fourth area we touched upon lightly, which is the sense of our social life?
• 22:00
  on the opposite: You know, when people feel connected with others, when they feel supported, when they feel to have meaningful relationships, that's health promotive. But when people are lonely, that that emotional sense of not having significant relationships that is health toxic. There's much data, reproducible studies, many studies, many analyzes, which have shown that. So that's the fourth domain. Fifth domain actually is our sense of purposeful living. People have a strong sense of purpose in life.
• 22:31
  on the opposite: These data are newer. Actually, it's one of the more new areas studied in the behavioral field.
• 22:34
  on the opposite: But the data has been highly reproducible. That a strong sense of life purpose also is health protective, also a longevity factor. Lack of purpose and boredom is the opposite. And the sixth area is stress. So here, this harkens to the beginning of our conversation because there's so much news about the negative effects of stress. Well, there's a form of stress what we call toxic stress, which can be health damaging, that stress that is ongoing that you can't control, it's stress that's meaningless, like someone who was subjected to trauma, or it could be stress that causes a lot of negativity on an ongoing basis. That's not healthy, but stress in general, the type of stress we pursue in the form of challenges in terms of pursuing our sense of meaning-that actually is health-promoting, actually, because it increases your sense of being, optimism, meaning, self-esteem. So those are your Six Domains of Health.
• 23:35
  Alex Alexander [Narration]: Before we go any further, I want to repeat the Six Domains of Health because I feel like there was a lot there, and I want these to stick. So we have physical health, mental vitality, purposeful living, emotional mastery, stress management, and social connectivity. Now, Dr.
• 23:53
  Alex Alexander [Narration]: Rozanski's website is in the show notes. He has done a ton of other podcast episodes where he goes deep on these different domains, and if you find this as fascinating as I do, it is worth the rabbit hole. Now, this podcast that you're listening to is about friendship, community, and connection. So, social connectivity is obviously what I brought him on here to talk about, and I want to read you something directly from the page on his website where he talks about social connectivity, he says social connectivity is the capacity to connect to and feel connected with other people.
• 24:29
  Alex Alexander [Narration]: These connections shape far more than happiness. Strong relationships build strength and resilience. They reinforce healthy behaviors, broaden perspective, and protect both mental and physical health. The quality of our relationships may be one of the most important influences on long-term health and longevity. Yet, genuine connection has become increasingly easy to defer. We stay in touch digitally while drifting apart in practice, and the demands of modern life quietly crowd out the time and presence that meaningful relationships require. Now, I want to take this one step further because I think a lot of us defer because we don't feel like it's worth our energy. If we invest, what will the return on our investment be? I think a lot of us have just accepted where we are, not because we're happy with it, but because social connection feels like something that happens to us, not something we can actually impact. So we take what we can get. We tell ourselves it's fine, and for a lot of people, it is fine. Technically, you're not at rock bottom. You're not desperate. You're just running on maybe 10 or 20% enough to get by, but not enough to feel like this area of your life is truly where you want it to be. What I want you to hear from this conversation, from every podcast episode in the Friendship IRL catalog, and from everything Dr.
• 26:18
  Alex Alexander [Narration]: Rozanski just laid out, is that you can impact this area of your life more than you think, and the moment you start to believe that, you might realize that what you have is actually a starting point, not a ceiling, and it's okay to want more than fine.
• 26:41
  Alex Alexander: And I would assume, looking at these and just thinking about my own life experience, there's a lot of interconnectedness. Like I'm looking at social connection, and I'm thinking, right? I spend so much time on this podcast, quality of thought being on there. I don't know if you saw me smiling at you, but I was smiling really big because I spend a lot of time in certain episodes, talking to people about just like, hey, you can assume that you walk into a room and nobody likes you, or you can assume that you walk into a room and people find you interesting and they want to know who you are and they are curious about you, and for a while, I think you almost have to just kind of pretend until you start to see the evidence that changes that quality of thought. But that, if you don't have that, if it's always a negative quality of thought related to social connection, that's going to impact your social connection.
• 27:34
  Alex Alexander: Similarly, I have talked about in the podcast so many times that I got diagnosed with a trio, a lovely little trio of chronic illnesses, a couple years ago, and I have been navigating that. Right, that definitely has an impact on my social connections because sometimes I don't feel up for much of anything. Like I'm taking migraine meds and I'm just curled up in bed hoping this passes. You know, stress management. If you are so overwhelmed by life, what's an example of this?
• 28:08
  Alex Alexander: If you are have become a caregiver for a parent recently who is ill, and that is all consuming, you are bringing that stress to every social connection. And I hope that your friends are open to helping navigate that and listening to you, but that's not everyone's experience, and then that feels like a negative place, and you don't want to keep going to hang out with your friends because they aren't being supportive. So
• 28:34
  this is all to say: as I'm listening, it feels like a web to me, and they're all so interconnected.
• 28:42
  Dr. Alan Rozanski: I just love your observations. This is so spot on. It is so so fundamental. This is exactly true. One of these domains will affect the other domains, either positive or negative. The thing that they all impact actually is that sense of vitality. When you're exercising regularly, when you have a sense of meaning, when you feel socially connected, when you're happy, all of these things produce that inner sense of feeling alive and energetic. And when you're feeling pessimistic, when you're feeling lonely, it's going to affect your sleep. It's going to affect you know your desire to go out and exercise. So they all are interrelated, just as you say, but the positive, very positive aspect of this is to understand that you can get into a vicious cycle if you're down in one area, and everybody's experienced this in their lives, right? Where you know that maybe there was a sudden loss of a job, and all of a sudden they feel down, and their diet's going to pop. But the opposite is true. You can set up a virtuous cycle where you say,"Wait a second, I'm not where I want to be, and I've got a map.
• 29:47
  Dr. Alan Rozanski: It's any one of these six domains. What can I do in any one of these domains to speak to me to start to improve, and that starts to generalize to other areas, and that's a very positive."
• 31:07
  Alex Alexander [Narration]: So that brings me to the question I was going to ask you before we talked through the Six Domains of Health. It would have been hard to ask this question, which is, do you feel like the goal is to get them all to some sort of equal place? Is it to have some sort of like if I'm thinking of them as a ranking system of one to 10 to get an average, is it to just not have certain ones be rock bottom because then they're causing that vicious cycle potentially? You know, I look at this and I'm thinking to... I'll use myself as an example, right?
• 31:42
  Alex Alexander [Narration]: I've been dealing with this chronic health stuff, so if I had to rank my health one through 10, I mean, I'm probably sitting at like a four or a five. My quality of thought that's like middle of the road.
• 31:51
  Alex Alexander [Narration]: Same with emotional health, but my social connections high. Like I would give those like a nine to a 10, and I'm lucky for that.
• 31:58
  Alex Alexander [Narration]: Same with sense of life purpose, and then stress is kind of in the middle. So I feel like I have a mix of like really really high ones, ones that kind of live in the middle, and then a couple that to me feel like I really don't want my physical health to be a four. Working hard on that every day.
• 32:16
  Dr. Alan Rozanski: Right, right.
• 32:16
  Dr. Alan Rozanski: Well, that is a great question, and I think we can unpack that.
• 32:20
  Dr. Alan Rozanski: Nobody's going to be a 10 in all of these areas. You know, we're all built with different personalities. Where there's some things we do really great and other things we don't do as well, and the goal is not to be gee I got to fix all of these up to a nine or 10. That's not the goal. The goal is life is always a balancing act. You know we're like the jugglers in life where we have so many things that we have to do, so many roles, so many ambitions. You know, and the goal is to be on our sense of mission, but having said that, you do need minimum standards in each of these areas. You know, you're not you're not looking for the top necessarily in all of them, but you need to have a minimum standard in all of them. You have to have a minimum amount of sleep. You have to have minimum standards about your diet. You know, you should be watching your weight with a certain standard. You need standards around, you know how you use your time. You need standards on how much you're going to navigate in your social relationships. So that very importantly, this would be a great example. We can completely sublimate our need to be connected to other people, and and very often people do that. I see it all the time because we get really involved in our jobs and our sense of meaning and whatever, and so you you know you lose touch with certain of your friends and so forth. But if you do that for a long period of time, you're just going to lose those friendships. And then what happens is you can end up doing that not for a year or two, but a decade or two, and all of a sudden, you know, you're reaching whether it's retirement age or a time when your job didn't mean as much to you, and you want to have that sense of social connectedness.
• 33:56
  Dr. Alan Rozanski: And those high school friends you had, those college friends, well, you didn't nurture them, and then after a while, it's just gone. It's just gone. So you have to have these minimum standards in all of these six areas?
• 34:10
  Alex Alexander [Narration]: Well, and something else I'm thinking about as we're talking about this, especially like we'll use social connection because that's what I talk about here on the podcast. Is I would wonder how much of it is people's own definition of what is meeting minimum standard, so the reason I ask that is I get a number of people who contact me, especially men, who have maybe put their entire focus into their career, and they wake up at let's say 40 years old, they find my podcast, they send me these messages, and they say, I don't think I have a single friend because all I've done is work, and so I think that person would rank their social connections at like a zero. But, but the conversation I generally have with them is, okay, do you have any other connections that are meaningful in your life? You may not have a lot of close present friends right now, and maybe you've let some of your old friendships go. But do you have coworkers that you really enjoy? Do you have a community, whether it's maybe it's a professional community, like a networking community, where you actually have a lot of people who know you and you enjoy spending time with them. Do you have family that you connect with regularly? Sometimes I think that we actually have more than we realize, but we have this like limited definition of what counts, if that makes sense. And it takes somebody else to see what we have to appreciate it because we're so focused on what we don't have, especially if like societally the definition is that everybody should have friends. And believe me, I want everybody to have friends. I'm here to help them figure that out. But sometimes when you realize like, oh, I'm actually starting from a three instead of a zero, it feels way more possible, as we all know.
• 36:08
  Dr. Alan Rozanski: Right. Well, I think you're a born psychologist. I think what you said to this man was perfect.
• 36:15
  Dr. Alan Rozanski: You know, because people tend to focus on what they don't have, and now they they can be negative. And you know, the first step in optimism is learning how to examine how we explain things to ourselves, and people need help with that to see, you know, the positive. So that was very good that you did that, and then to understand that that's changeable. That's changeable. You may have had no friends till you're 40, but you can go out and make a friend, and that then becomes enormous, right? I went from nothing to I got a friend now, you know, and then you built from there.
• 36:53
  Alex Alexander [Narration]: Yeah, or I went from nothing, and now I'm part of a community that I feel so welcome in, and that's like a space where maybe you are going to make somebody who feels more like a friend. Yeah, yeah.
• 37:04
  Alex Alexander [Narration]: I just talk about all the time.
• 37:07
  Alex Alexander [Narration]: There's so much possibility.
• 37:08
  Dr. Alan Rozanski: Yes, yes,
• 37:09
  Alex Alexander: out there.
• 37:10
  Dr. Alan Rozanski: Exactly.
• 37:13
  Alex Alexander [Narration]: If this is you, if you are looking at your ranking for your social connection, and you wish that it was a different number, I am so glad you are here. And I want to be really specific about what I mean by you have your ranking, but you wish that you were somewhere else. Because I think most people will jump to think of people who are ranking themselves like a zero or a one or a three. But what about if you're a five, but you don't want to be a five anymore. Maybe you have friends, you talk to them, you love them, but they live across the country, or you became a stay-at-home parent, and none of your friends are in that same season with you, and you get to the end of your days just feeling so profoundly lonely, or everyone in your life is great, but nobody quite fits in your actual day to day anymore. You've had so many big, profound life changes in the last couple years. You have people, but you still feel like something is off, and then you feel guilty for feeling that way because you have people. That's what I mean by a five. And if that is you, you are allowed to be here. You are allowed to want more. Admitting that a piece is missing, even if a large chunk of your friendships and relationships look great, if there is one area that just feels like it is really dragging you down, that it is causing you real stress and friction, that's okay. It's okay to be honest that you want more. Friendship IRL exists for the zero and the five, or the seven, it exists for anyone who wishes something was different in their friendships, community, or connections. It gives you a way to see possibility where things feel stuck, and wanting more is actually the first step. I'm really, really glad that you found this episode.
• 39:28
  Alex Alexander: So now that we've covered how everything is kind of a web in my mind, I love a web analogy, and it's connected. Everything has the positives and the negatives, and we can kind of slide the scales everywhere. I think hopefully people are catching on when we're talking about that stat I don't love about how loneliness is the same as smoking 15 cigarettes a day on your health.
• 39:51
  Alex Alexander: I guess to me it would start to make sense that if you are lonely, if your social connection is at a zero or a one or a two, and it's really low, that is going to start to have an impact on the other five domains of health. Can you talk a little bit more about that and like some of the mechanisms that we know happen in the body when loneliness starts to drag down those other domains of health?
• 40:22
  Dr. Alan Rozanski: Yeah, there's really about you can almost break down the two main pathways, but I think three would be more appropriate. One of them is just as you're
• 40:30
  alluding: when people are lonely, they're less likely to pursue positive health behaviors. By the way, that's true for all of these psychological factors. When people don't have a sense of meaning, when people, you know, are unhappy or depressed, when people don't feel like you handle the stress. Health behaviors go south. That's empiric data that has been shown over the course of decades. We know, for example, pessimists have poor health behaviors, and optimists have the opposite.
• 40:57
  alluding: Part of that is that sense of well-being gives you energy to do things. It gives you that sense of being energetic. People are more energetic. People are more optimistic, have more pro-social behaviors, they have more pro-health behaviors. So that's one key mechanism. But it turns out that when you have ongoing negative social or psychological, psychosocial factors, it actually starts to affect the body directly. It can result in increase in stress hormones such as cortisol. You can see increase in insulin resistance and inflammation.
• 41:33
  alluding: These have all been shown in people who are lonely, and these things can be synergistic over time. So you have this behavioral factor as well. Also, there is something interesting about our sense of connectedness and our sense of need for purpose-it's actually been termed this by many theorists, if you will, called basic psychological needs. So, what's a basic psychological need? It's a-it's a need, just like we have physical needs. We have a need to sleep, and we need to drink.
• 42:05
  alluding: And if we don't, our body will let us know. Well, we have basic psychological needs too. That when they're met, such as our need for purpose and our need to be connected, it increases our sense of vitality. And when it doesn't, and here's the but part of it, it affects us, but it affects us in a way that's not clear. There's not alarm bells going off. There's nothing that's you know if you're sitting there day after day engrossed in your work. There's no alarm bell going off that gee I'm not connecting to people, right? You know it's just something that over time. But one you wake up to it, and then that need does not feel expressed. It affects us. We feel frustrated. We feel something's not right. Our vitality is down, but often people don't know where to put it. Maybe they think they're hungry. Maybe they feel they need a vacation. So it's very easy to misplace this needs for you know to be connected or to be you know to pursue you know our sense of meaning. And so we have to be attuned to that.
• 43:06
  alluding: These are these basic needs, and the answer is these minimum standards in all of these important domains.
• 43:13
  Alex Alexander [Narration]: Yeah, I often talk about loneliness as a cue, similar to a hunger cue, and how we can all train ourselves. You know, if you really want, or if you're really busy, or if you're a neurodivergent mind, like you can ignore your hunger cues.
• 43:26
  Alex Alexander [Narration]: Your stomach can be grumbling, and you're just so focused on your work in like tunnel vision that you don't even notice you're hungry until hours later, or that you have to go to the restroom, or that you're thirsty, or that you're hot.
• 43:40
  Alex Alexander [Narration]: Right? We have all these places where we can ignore a cue, and so I obviously, obviously, I often talk about loneliness as a cue, but I think so many of us aren't used to noticing it. That it is a very easy to ignore cue for many people.
• 44:02
  Dr. Alan Rozanski: So what comes to mind as you say that is that the biological needs are obvious ones. I think what you're saying is that the cue here isn't obvious until you start to make the connection. I'm feeling frustrated. Why do I feel frustrated? Then you got to stop and think about it. And the problem is we're just so fast today, right? I mean we're just so busy. And then when we're free, we're involved in social media, looking at our cell phone, and we don't take the time to reflect on what might be those cues and paying attention to them.
• 44:34
  Alex Alexander: Well, or it could just be that you're so used to ignoring the cue and you don't even know what to do about it. You know, if you're somebody who feels like you haven't had friends for really a long time, and maybe you have a therapist.
• 44:45
  Alex Alexander: This is a great way in my mind to describe it. It's like you have a therapist. You see them every Thursday, and you are used to just ignoring or minimizing that loneliness cue until Thursday, until you can talk about your life, and you get that like small dose of relief on Thursday at therapy, and then the next week, by like Tuesday, it's creeping up again, and so what you may not realize is you think like, well, I don't know, maybe I need to go to therapy twice a week, maybe I have more things I need to work on. But in reality, you might just need more people around you who see you and see what you're going through and can talk about their own lives, and you know, just feel more connected.
• 45:31
  Dr. Alan Rozanski: Absolutely, I think you're spot on with that.
• 45:33
  Dr. Alan Rozanski: I really do.
• 45:34
  Alex Alexander [Narration]: I think another thing that people are going to wonder then is, do you think cues, and I don't know if you have science and data for this or not, are different for people who maybe identify as an extrovert versus an introvert.
• 45:49
  Alex Alexander [Narration]: Like, do you think there's some sort of spectrum of social need?
• 45:52
  Dr. Alan Rozanski: Oh, absolutely. That's the interesting part about that. You know, I mean, we know for sure people know introverts and extroverts, and extroverts have a need to be around more people.
• 46:03
  Dr. Alan Rozanski: Introverts can be satisfied.
• 46:07
  Dr. Alan Rozanski: With one friend, and you know, just actually having someone in the room, and I think there's people who even derive their sense of social connectedness by their sense of giving to humanity. I think that's also possible. So there's there's a whole range of variety to that, you know. But it's important not to misread what your needs may be,
• 46:29
  Alex Alexander [Narration]: yeah, and to pay attention, it makes me think. I have this really interesting podcast episode with a woman who came on to talk about how she moved a lot. She was nomadic, well, you know, like moved every three, four months, and how she always felt really bad about that because she never developed. Like she had some close friends from college and childhood and things that she kept in touch with, but because she was moving every three months, she didn't have these really really close friends, and she felt really guilty. But also, she kind of didn't feel like she needed them. And by the end of the episode, we determined that she actually really loves like more of a community feel. She gets a lot of social connection from going to like the same restaurant to sit on the patio and getting to kind of be a regular for a little while. It was just a really interesting.
• 47:19
  Alex Alexander [Narration]: By the end, she kind of was like, "Wow, I'm gonna stop being so mean to myself about not making close friends. I actually realized I feel great.
• 47:27
  Dr. Alan Rozanski: Yeah, it
• 47:28
  Alex Alexander: was an interesting episode. That was definitely not how either of us thought it was going to play out.
• 47:35
  Alex Alexander [Narration]: A few episodes that you might want to cue up after this one. The story I just mentioned about the woman who realized she was getting her social connection met through community rather than close friendships. That is Episode 58, titled "You're Not Doing It Wrong: Why Friendship Looks Different for Everyone." It's a really good episode. And when Dr. Rozanski and I were talking about purpose earlier in this conversation, you might have been like, "What does purpose have to do with connections, Alex? With my health, what are you talking about?" Well, I have two
• 48:10
  episodes for you: Episode 62, Finding Your Purpose Through Friendship with Mark Delaney, and Episode 125 Super Psyched: The Four Types of Connection We All Need with Dr. Adam Dorsay.
• 48:24
  episodes for you: Both of these episodes go deep on our personal connection to purpose and something bigger than ourselves. I have had so many listeners message me about these two episodes specifically, telling me that they have listened to them two or three times just to sit with them.
• 48:39
  episodes for you: They are that kind of episode.
• 48:44
  episodes for you: All three are linked in the show notes.
• 48:47
  Alex Alexander: So the other interesting thing then is that you know in the modern times, like you said, you've been studying this for 40 years now.
• 48:54
  Alex Alexander: The last 10-15, maybe even 20 years are a very different like social landscape that we live in right one that is full of virtual connection. That is full of people working from home. A lot of them getting social connection from screens. Do you think that is having any sort of an impact on our social connection and our health?
• 49:24
  Dr. Alan Rozanski: Undoubtedly, undoubtedly. Anything whether you talk about electricity, nuclear power, whatever, want something that's a power can be used for the good or can be used for the bad. So social media is something that we have in our own domain that we can use for our good or for bad. It can be a lot of good that comes out of it. Certainly, an older person who's a bit frail and is homebound-it's invaluable to you know be able to be socially connected to other people in a world where we have our relatives maybe living on the other coast, invaluable for staying connected. That's all to the good, but-and this is the but-if you use it just for your, let's say, fast food of social connectedness, so that you are not spending time with some close friends, some people where there's quality face time, where you're learning to open up to each other, sharing your vulnerabilities, reading the nonverbal cues that are available when you are present, you know, and making that time to be confidants for each other, then that's a loss of a deep friendship, and you end up with just superficial friendships. So when you are very busy in life, as we are today, it's so easy to just say, you know, I'll just pick up the phone and say hello.
• 50:46
  Dr. Alan Rozanski: And what I see a lot of, you know, because I'm involved with trainees and younger people and people in general, is a tendency. Often, I think, in the younger generation, for people to rely on texting and emails rather than picking up a phone and talking to people, not realizing, hey, wait, the more it's important. The more the higher level, whether it's a phone call or getting together in person, is so. This is part of the minimum standards I talk about. There has to be time spent, I believe, most weeks, if not all weeks, where you're getting together with at least one or two close friends, even if it's for a short period of time. You got to set that standard of not letting it just be social media,
• 51:31
  Alex Alexander [Narration]: and I'm really grateful. I do want to say for your answer about virtual connection, because I think often we can all think it's just all bad. But as you pointed out, there are so many places where it actually is doing good or enabling someone who otherwise would have no connection.
• 51:49
  Dr. Alan Rozanski: Sure.
• 51:49
  Alex Alexander [Narration]: Like I know I have a listener who messages me all the time who has a very specific illness, and it's really hard to get out of the house. And virtual connection is really their only way to stay connected. Yes. And so we can't totally villainize something.
• 52:05
  Dr. Alan Rozanski: Not at all.
• 52:05
  Dr. Alan Rozanski: Not at all. I don't.
• 52:09
  Alex Alexander: No, no. Aren't we all grateful to be able to?
• 52:11
  Alex Alexander: I'm grateful to like pick up the phone and be able to FaceTime my nieces in Italy and see how they're doing today. What a magical thing that is! Sure,
• 52:19
  Dr. Alan Rozanski: absolutely, it really is, and we should be grateful for that.
• 52:23
  Alex Alexander [Narration]: So, if anybody has been listening to this episode today and they, you know, are just really considering maybe some areas of their health they hadn't considered before. The impact that social connection, because we all know my audience in particular is always interested in social connection. If this is kind of their first time thinking about their health in this cumulative, overarching way, not just well, like my physical health is good, so I'm fine. I could go out and run a half marathon today. Do you have any advice or like first places to examine for somebody who's thinking about their health in a new way?
• 53:02
  Dr. Alan Rozanski: Yeah, great question, and I do actually. I would say two things. One is you have to understand, and I think this has been part of our message at least subliminally, the power of the first step. You have to appreciate that. G, if I will just take a first step in any one of these domains, and I do it consistently, that will make a difference. The secret source of success in behavioral change is consistency. It's not about the magnitude of what you do, but it's about staying consistent in whatever you decide to do. So that's number one. And then number two is to where to start. Of course, it's variable for a given person. You know, if you're feeling truly lonely, that may be the first place to address. However, in general, where I like to point out to people, and often people are surprised, is the importance of being physically active. It is like the gateway to all of these other areas. When we're physically active, when we're moving, when we're walking, life itself is about movement.
• 54:03
  Dr. Alan Rozanski: Depression is lack of motion.
• 54:07
  Dr. Alan Rozanski: That's what depression is. So when you start to be more physically active, like if I'm dealing with someone who has a weight issue, first place I start is trying to get them more physically active. Why? Because when we get more physically active, it's not just physical but spiritual. The data is very clear that people who are physically active have a lower risk of depression. It's actually a mood elevator, and it puts you on a positive track for all of these other areas. So that's where I would apply the first step. If you're listening to this and you're sedentary, start walking five minutes a day. Do it consistently, and you'll start to see changes.
• 54:42
  Alex Alexander [Narration]: Well, and I would add, you know, if you're out there moving in the world, you have to go out into the world often. There is virtual connection. You have to go out into the world to meet people and make those connections and smile at someone and get that peace too. So
• 54:57
  Dr. Alan Rozanski: yes,
• 54:57
  Alex Alexander [Narration]: like movement.
• 54:58
  Dr. Alan Rozanski: Yeah,
• 54:59
  Alex Alexander [Narration]: get moving.
• 55:00
  Dr. Alan Rozanski: Yeah, one smile a day. Do one more smile a day than you do now.
• 55:04
  Alex Alexander [Narration]: Oh, I love that one. Well, thank you so much for being here, Dr.
• 55:06
  Alex Alexander [Narration]: Rozanski, I really appreciate it.
• 55:10
  Alex Alexander [Narration]: Stick with me here as I close out this episode because I have some of my own lingering thoughts and takeaways, things that I'm really truly going to be thinking about for the next couple weeks, probably. I've been thinking about how often so many of us are just chasing the absence of disease. How my life, my friends' lives, our schedules, what I see on social media-it's making sure I get in every lift, taking every supplement, optimizing every workout, eating exactly as I should, and calling that health, protecting our health, looking out for our long-term health, and I say that as someone who has also been hyper-focused on these things, but what Dr.
• 56:00
  Alex Alexander [Narration]: Rozanski is pointing to is something different: the absence of disease. Is not the presence of health, vitality is, and vitality is not just physical.
• 56:12
  Alex Alexander [Narration]: It is all six of these domains working together, pulling each other up or dragging each other down. So here's what I keep coming back to: Am I putting all of my energy into taking one domain that maybe I'm already doing really well at, like I would rank it as a nine, and trying to get it to a 10, when maybe I should be looking at a domain that I feel like is a six and trying to get it to a seven or an eight, because I wonder how much we all try to perfect the areas we are already good at, while leaving other areas completely untouched, and what that is costing us in the long run, and what we're looking at versus not looking at. Right?
• 57:04
  Alex Alexander [Narration]: Like if we're all so hyper focused on our physical health, when's the last time we actually checked in on the numbers in those other areas? I don't know about you, but that is something I will be sitting with for a while. If this episode opened something up for you, I really want you to go spend some time on Dr. Rozanski's website. It is linked in the show notes. He has a blog, more podcast interviews, and a lot more. I mean, 300 plus peer-reviewed studies, more on the Six Domains of Health. It is worth the time. And if you are sitting somewhere on that social connection spectrum and you want to make a shift, whether you're at a one, a two, a five, a seven, if you want something different, I would say my book"Are We Friends Yet?" is also linked in the show notes. It has guided reflection questions that will help you figure out exactly where to put your energy to make the biggest impact in your connections to move you towards what will make you feel like that area really got a bump, and with that, I'll see you next week.
• 58:15
  Podcast Intro/Outro: Thank you for listening to this episode of Friendship IRL. I am so honored to have these conversations with you. But don't let the chat die here. Send me a voice message. I created a special website just to chat with you. You can find it at alexalex.chat. You can also find me on Instagram. My handle, @itsalexalexander. Or go ahead and leave a review wherever you prefer to listen to podcasts. Now if you want to take this conversation a step further, send this episode to a friend. Tell them you found it interesting. And use what we just talked about as a conversation starter the next time you and your friend hang out. No need for a teary goodbye. I'll be back with a new episode next week.