The Invisible Famine

Humans evolved for millions of years to live surrounded by dozens of people. In fact the way apes currently live is a lot closer to what our bodies evolved to expect than how humans are living today. For millions of years from cradle to grave we lived like apes in tribes of 30-50 people. You didn't have to "make time for connection" or "self care", those things were baked into the world we lived in. The ambient social environment was richly connected and the constant social signal and response was like air; it was the fabric of your reality every moment of your life.

In our modern world we see rich social connection as a nice to have. But in 2023 the U.S. Surgeon General put out an advisory saying social connection is "a fundamental human need, [and is] as essential to survival as food [and] water." The advisory went on to say that the impact on death risk "of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day, and even greater than that associated with obesity and physical inactivity", and calling loneliness and isolation a public health crisis.

A meta analysis that same year published in Nature, one of the most prestigious journals in medicine, looked across 90 studies including over 2 million people, and what they found was that social isolation and loneliness increased overall death rates, and specifically heart disease and cancer related death rates. The effect size rivaling that of smoking.

A Harvard neuroscientist took this idea a step further and actually studied loneliness and social need to find out where it lives in our brains, to see if calling it a basic need was true. Was it closer to an emotion like sadness? Or more akin to something like our need for food or sleep? And what she found was that it does not reside in the part of the brain that controls emotion, but that it was in fact located in the hypothalamus, which is the part of the brain that controls our basic biological human needs like hunger and thirst. It uses the exact same neural architecture. The way she framed it was to think of it like a bean counter. Your brain tracks your social input the same way it tracks your caloric input. When social input drops below threshold, the need neurons fire and drive social seeking behavior. When social input reaches satiety, the satiety neurons fire and inhibit the need neurons. The same way it does for hunger or thirst.

We did not evolve to live in a house alone or with maybe a spouse and two kids where we were expected to teach our children what it means to be human with educational materials and toys. Where they had to be taught to be responsible and help out through regimented chores and instruction. Where the parents were in charge of play and discipline and teaching skills and teaching socializing and coregulation all in an isolated structure while also being expected to do a million other things.

In ancient tribes kids grew up surrounded by dozens of adults, running around with other kids of all ages. No one person was in charge of any one kid - it was a network where the children had jobs, and endless companions, and dozens of adult nervous systems showing them through experience how to behave and what they needed to learn. Adults had dozens of other adults around to socialize with, to help with jobs, to watch over things when they are injured or sick, to attune to them too. No calling in sick to work and inconveniencing people, no finding childcare, you just rest when you need to and rejoin when you're ready. Some people go out to forage for food, or hunt, they come back in the evenings, people socialize, eat, connect. This was the social world our bodies evolved for.

In the 1960s, researchers studied a small Italian-American town called Roseto, Pennsylvania. The residents fried everything in lard, smoked cigars, drank wine regularly, and worked in hazardous slate quarries. By every metric medicine uses to predict heart disease, they should have been dropping dead. But what they found was that they had virtually no heart attacks in men aged 55-64, normally the highest risk group. The only thing that was different about Roseto was its social structure. The town had been settled by immigrants from a single Italian village, and they had recreated that village's tight-knit multigenerational social world almost exactly; three generations in one house, elderly central to daily life, dense interconnected relationships as the background fabric of existence.

So knowing this, imagine if you had a community of let's say apes, who were functioning just fine, but then all of a sudden there was a food shortage. And not just for a day or two, but an ongoing food shortage for years on end. What would you expect to see?

This has been studied across decades of research on animal populations under resource scarcity and what has been documented is consistent. They see aggression increasing as everyone starts to compete for what's available. They see hoarding with animals stashing more food than they need. They see some animals become frantic and desperate, taking risks they normally wouldn't, and others giving up and withdrawing, becoming passive and lethargic. They see the social bonds start to fray as sharing decreases and competition increases. They see parents struggling to care for their young because they're depleted themselves, and they see the whole group getting sicker, with elevated stress hormones, weakened immune systems, and more overall disease.

Now replace food with social connection, and look at the behavior of the humans around you. This is what we're living in. Think about the social and behavioral dysfunction that we see: political tribalism, social media addiction, workaholism, consumerism, relationship dysfunction, and chronic illness. These are all what you would expect to see in an animal experiencing the social equivalent of a famine.

And this isn't just behavioral; the chemistry matches too. Across a multitude of research programs over decades and hundreds of people, it has been clearly shown that social starvation produces the exact same chemical state as pathostasis. Elevated cortisol levels, elevated inflammation, glucocorticoid resistance, immune dysfunction, and slower wound healing. Social deficits produce the pathostatic chemical environment. In the Pennsylvania town Roseto mentioned above, researchers went back 30 years later and found that as the population Americanized and the village structure broke up, heart disease rates rose to match national averages.

Social starvation response

In 1975 a researcher named Tronick at UMass in Boston studied what happens when a mother who is normally very responsive to her baby emotionally stays in front of them but goes completely expressionless for 3 minutes. What they saw was that there was a predictable cascade of behaviors that the infants in the study would enact. First, they would solicit reconnection, they would smile, coo, reach, point, anything they could think of to get their mother to reengage with them. When that didn't work they would escalate; they would start being louder, more insistent, exaggerate their expressions etc. When that didn't work they would show distress, they would frown, flail their limbs, show confusion or agitation, and eventually they would start crying. When all of this failed to work they would then withdraw. The baby would go still, start sucking on their fingers or thumbs to self sooth. Their facial expression would look withdrawn and hopeless. And this study has been replicated hundreds of times across many different cultures. And even more telling, they have measured cortisol levels and have seen a distinct elevation starting at phase three. This happens in just three minutes of social withdrawal. Three minutes to go through this entire cycle of distress. And they see these same behavioral patterns in infants of depressed mothers. Those mothers are the still face experiment all the time, and so they see them cycling through these patterns over and over again. The effects of adults looking down at their phones while caring for their infants are likely staggering.

If we next look at a more extreme version of social isolation, children raised in orphanages from birth where they were fed and changed but otherwise ignored, they also have a very clear pattern of dysfunction. These children show stunted brain development, physical growth delays, behavioral problems, autism-like behaviors like rocking, stimming, and hand flapping, and psychological issues like depression, anxiety, disruptive behavior, and adhd. The longer they were in the institution before adoption, the more these patterns stayed stuck throughout their lives. Which of course makes sense through this lens, as they are both practicing the stuck behaviors longer, and getting far less corrective wiring on top of that.

And finally there is a study where they created a ball tossing game where there were three players, two computer players and one person, the subject of the study, where the human subject knew the other two players were computer players. How it worked was they had the three players playing ball toss, and then they would at some point have the computer players spontaneously stop participating. And despite knowing it was a computer, they found that the players showed immediate emotional pain on brain scans. Which shows that this pattern is so automatic and so innate that even with cognitive awareness that the other players were just a computer program, their emotional response wasn’t inhibited. And the subsequent behaviors of the human subjects after this perceived social disruption were consistently one of three things: they either tried really hard to get the players to re-engage, showed aggression toward the game, or withdrew emotionally. This happened within minutes of disengagement by the computer players. And for human players that reported social anxiety before the test, the study showed they hadn't fully emotionally recovered even 45 minutes after experiencing this loss. If a virtual ball toss partner is triggering the same neural architecture as a human relationship does, imagine what a human seeming conversational AI can do. And yet no one is evaluating it through that lens.

And in addition to showing that not getting what we need socially triggers Pathostatic chemicals, they’ve also shown the opposite: that having attuned social presence can inhibit the threat response. There was a study where they put people in an fMRI and measured their brain's threat response while they anticipated an electric shock. Some were alone, some were holding a stranger's hand, and some were holding the hand of someone close to them. And what they found was that the threat response was inhibited on a spectrum, the better the relationship you had with the person you were holding hands with the more your threat response was inhibited. Being alone produced the most threat activation. A stranger's hand helped a little. And the hand of someone close to them reduced the threat response significantly, but they found this only worked if the relationship was a good one. And they found the best relationships almost completely suppressed it.

What these four studies show is that across the lifespan from infant to child to adult, social withdrawal or isolation produces very clear mobilizing and immobilizing PAG responses, which are the threat response in action. And the presence of social connection inhibits it.

Our bodies, our ancient mammalian nervous systems, expect a world of constant, unscheduled, multigenerational, bidirectional social signaling happening all day every day as the background condition of existence. And that just doesn't exist anymore. In our modern world, even considering those with the "best" lives, nobody is getting fed socially the way our mammalian brain is expecting. Which means that even the people you do have access to are also starving, and in chronic threat chemistry. Which means that they can't attune to each other the way the human body requires. Which means more social isolation and more deprivation generation after generation.

Optimizing our way to illness

And this is why we see chronic illness rates on the rise. 60% of US adults have at least one chronic condition and 40% have multiple, with 90% of the annual healthcare spending going to chronic disease. And those numbers are only including the diseases that medicine considers "real". If you included the whole swath of diseases, the actual full picture of chronic suffering, adding things like fibromyalgia and chronic fatigue and IBS, that number gets closer to 80 or 90%. Even in children the rate of chronic disease has nearly doubled from 23% in 1999 to more than 40% today. We see the rates of chronic disease rising across all age groups, and nobody seems to know why.

The cognitive revolution gave us the ability to think differently than any other animal before us, and we used this ability to optimize for food security, and shelter, and water. For comfort, and entertainment, and ease of life. We have objectively never been more safe, more secure, and more comfortable. And we have never been more chronically ill. Each innovation has stripped away more ambient social fabric, replacing it with longer commutes, smaller households, more screens, less unstructured time with other humans. And each generation raised with less social infrastructure raises the next generation with even less capacity to provide it.

And hearing all of this it can be really easy to think to yourself, I wouldn't WANT to be surrounded by people all the time; who among us wishes they were living with their parents and their aunts and uncles and cousins? Likely no one. But that's not because living around people is inherently bad, it's because our bodies understand intuitively that it would feel awful in our current world given the pathostatic state of most people's systems. Everyone developed on a spectrum of social starvation, so everyone is running patterns that feel threatening. Being around lots of people doesn't feel good to most of us. So it's important to understand that the environment we were living in back in hunter gatherer times was not the same as what it would feel like now if we tried to reenact it. It would feel safe and nourishing, not stressful and overwhelming.

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Remember the ACEs survey from earlier in the book? With its ten questions that predict disease better than anything medicine routinely measures? Let’s look at those questions again. Every single one is measuring social environment failure. With a dose response curve showing the severity of social starvation during development predicts how deeply pathostatic wiring gets laid down. And the cognitive loops we described in the last chapter, rumination and suppression, are how we try to manage this constant threat state internally. If you think about the content of rumination and suppression, it is always based around safety needs, and most of the time, in our modern world, that need is social.

Our cognition allowed us to optimize our environment for safety, and to become the most powerful animal on the planet. And in so doing we created a world wide famine. But it turns out, one field has been circling the answer for addressing this deficit for over a century. Let's look at how close they got next.