Background

A recent trip to Kolkata, India during festival season taught me many lessons. I spent most of my childhood summers in Kolkata and developed very close relationships with grandparents, aunts, uncles, and cousins. My last trip was 8 years ago, so reconnecting after all that time was truly meaningful. Since my last visit, loneliness and mental health issues were already escalating worldwide, and this intensified during the pandemic. Social distancing and isolation for health reasons led to the emergence of convenient technologies that enabled us to work, learn, shop, and entertain ourselves, within the confines of our home.

For extroverts, the change was dramatic and unbearable, so when things returned to a slightly more normal state, they continued to connect live with live people. Many introverts actually thrived during the pandemic since there was no social pressure to turn outward. Many introverts already had individual practices, habits, and lifestyles that in many ways were conducive to living in isolation. For many ambiverts like myself who fall somewhere in between, we shifted a little or a lot more towards the introvert side, and felt like we did fine. Zoom work and meet-ups felt like a reasonable substitute, with occasional live interactions sprinkled in here and there.

My trip to India and the subsequent return to the US made me realize something. I had significantly reduced my dosage of live people exposure, which was compounded by my wife and I becoming recent empty nesters. Don’t get me wrong. I absolutely love time to myself and would still tip my own scale more towards the introversion side, but I still realized I was underdosing on people. Let me share how I break things down after giving it some thought.

3 Forms of People Exposure

I think of there being 3 major forms of people exposure which I define as follows:

1. Active people exposure (APE) is when you interact live with other people, such as meeting family, or meeting colleagues or a friend for coffee, a hike, etc. 

2. Passive people exposure (PPE) is non-interactive or very light interactive live exposure to people you mostly don’t know. For example, going to a farmer’s market where you have brief interactions with different vendors. Working at a coffee shop or library where you are surrounded by other human beings and may briefly interact with a barista or librarian or some other service staff. Walking on a street with a steady stream of people around you where you may smile at someone, say things like “hello,” “excuse me,” or “cute dog.” 

3. Digital people exposure (DPE) is interaction with people through screens. Now DPE can be active if you are interacting with known people (family, work colleagues, etc.) or passive (scrolling through social media profiles of people you don’t know personally). I’m not going to subcategorize here, so let’s just leave it at DPE for all screen-facing human interactions. 

In my everyday life in the US, my DPE dosage is high since I spend many of my days in Zoom meetings. I do see patients which I would say partially counts as APE. Although I enjoy connecting with patients live in my clinic, the time pressure and electronic administrative work associated with patient interactions in the current state make this form of APE highly stressful for many physicians and is a major cause of physician burnout. I try my best to get more PPE by working or hanging out in public spaces, especially with my dog, but would say even that has gone down. The APE has definitely taken a hit over the years. It seems nowadays people have gotten so extraordinarily busy that the mere act of trying to align calendars for even a simple dinner has gotten so challenging that we often take the path of least resistance, which is staying home and watching Netflix or some other form of home entertainment.

The India Effect

In India, the relative doses of people exposure took a dramatic turn. For the 10 days I was there, I was flooded with APE given all of the different family members I was meeting on a daily basis during festival season. The PPE dosage skyrocketed as well given the number of cars and people on the streets at any given time, in addition to meeting shopkeepers and street vendors with whom I enjoyed dusting off my rusty Bengali speaking skills. This might sound stifling to some of you, but even as someone who skews on the introvert side, I absolutely loved the energy of having so many people around me during a festive part of the year.

The loud din of people talking, yelling, babies screaming, horns blaring, etc. was such a refreshing change from the often pindrop silence of my suburban neighborhood. There was very little DPE as I interacted with some family through WhatsApp and had only 1 work webinar that was a must attend event scheduled months in advance. My overall dosage of people exposure on a daily basis over those 10 days felt like it surpassed the past few years, and what I didn’t realize was that I truly needed it. It filled my heart and soul in a way that even the best zoom gathering or Facetime call could never come close to.

A Balanced Perspective on Loneliness

There has been quite a bit written and spoken about our loneliness epidemic. I’m going to be a bit contrarian by saying that I think the topic requires far more nuance. Some of us genuinely thrive on lower doses of people than others. Falsely labeling these individuals as lonely and repeatedly pointing out the adverse health effects can create unnecessary stigma. Many individuals who might be perceived as being “lonely” have deeply meaningful spiritual practices or enjoy creative and other individual pursuits that provide joy and purpose.

I fall into this category, but I also realized from the India trip that I’ve slipped into a comfort zone where I’ve gradually lowered my people dosage over time and need to re-engage with more APE and PPE.

There is plenty of research out there highlighting how live people exposure can facilitate the release of hormones and brain chemicals that improve emotional health and wellbeing. When I work in bustling coffee shops or even a quiet library with people around me, there is no doubt I get better quality work done than when I’m in the confines of my home office. When I go into the office or clinic to work and have the incidental chats with colleagues in nearby spaces, especially after a few days of work from home, there’s no doubt I feel better. I’ve noticed my patients who are working in more of a hybrid environment appear to do better than those who are almost exclusively working from home. I realize this continues to be a controversial topic, but as your non-employer who is focused soley on your health and wellbeing, and not your workplace productivity, I do suggest most individuals consider increasing their overall dosage of APE and PPE and see how it feels. 

The Future of Work and Socialization

I watched a portion of the Youtube interview between Mark Zuckerberg and Lex Fridman in the metaverse here that gave a peek into what the future of work and personal interactions might look like. I encourage you to watch even a few minutes of this interview. From a purely technology standpoint, I can’t deny that it’s an impressive interface. However from an emotional and gut-feeling perspective, as a human being and someone who spends a large part of his life thinking about human health, I found the metaverse interaction to be more haunting and disturbing than exciting.

Just like social media was falsely sold to us as a way to help us feel more socially connected, now a similar cast of characters are selling us another even more addictive technology with little thought about the overall impact on human health at all ages. Yes, I understand how this current technology can improve the state of the current workplace and upgrade remote meetings, and how interacting in the metaverse with my aunt in India could be so much more lifelike than just a 2-dimensional WhatsApp call, but what’s the price we are going to pay for this?

How would I classify this type of more lifelike 3-dimensional digital human interaction. Is this DPE moving a bit more towards APE? I’ll give you my gut feeling answer, especially after being fresh off my India trip. Absolutely not. I don’t think this more advanced version of the DPE drug is a replacement for live human exposure, which has been wired into us from the birth of humanity. I don’t think you will produce the identical sensation and release of hormones and neurochemicals in the metaverse that you get from interacting in the live universe.

Like all new technologies, there will be a an initial period of excitement with a “wow factor.” Remember how it felt to receive or send that first e-mail, or engage in that first video call on your smartphone, for those of you old enough to have gone through those transitions?

Once novel technologies become as routine and mundane as every other technology we now take for granted, the excitement factor dissipates and we are left spending more time indoors with an even lower dose of our already abysmal time spent in APE or PPE.

How much more convenience do we humans truly need? If the metaverse is truly so immersive, interactive, and lifelike, especially to youth, then the incentive to step outside our homes and engage in live people exposure will likely take a further hit. I think it might be the final nail in the coffin that encloses existing and newer generations of humans into indoor spaces to work and socialize. For those of us who grew up before DPE technologies became mainstream, we felt the true benefits of live people exposure, so we retain a stronger native urge to interact with live people.

We are willing to go through the effort of scheduling gatherings and family or friend’s trips. We are willing to step outside our comfort zone. However imagine today’s child or tomorrow’s child being raised in a world that is increasingly more digital than live. Will the primal need to connect live with others be suppressed? What will be the health impacts of this type of suppression?

I don’t have an answer, but based on the current mental health crisis in adults and youth, in spite of living in the most convenient and technologically advanced time of our civilization, I am not optimistic. The same tech czars are repeatedly creating a neverending cycle of problems which they then turnaround and offer solutions for. They disguise it as convenience, efficiency, and entertainment, however it’s just a newer generation digital drug that is exponentially more addictive than prior versions.

What Can You Do?

If I reflect on the social media experiment where I weigh the pros and cons of having products like Instagram and TikTok, knowing that there are people who make a living off these platforms, but also seeing the impact on emotional health on youth and adults, I would call that experiment a failure. I’m not saying that there should be no social media, but that there were endless opportunities to identify red flags and put mechanisms in place to reduce the addictiveness of these technologies and the impact especially on our vulnerable youth. At the very least, I strongly believe age restrictions should be placed on all social media platforms.

The developing brain of youth should not be exposed to a form of technology that is repeatedly being shown to have an adverse effect on emotional health. So many parents and employers complain about Gen Z’s inability to successfully interact with humans in live situations. How dare they cast criticism towards Gen Z when it’s many of their peers, aka millenials, who created those hyperaddictive technologies that prevented that generation from developing the social and emotional skills so many of us older adults take for granted.

Many of these millenial parents raised their own children in this virtual world, bragging about how their 5 year old could operate an iPhone or iPad, and leaving their kids in the hands of these digital caretakers for hours on end. Yes, many of these parents may have been unaware of the future health impact of immersing children in these technologies, but turning around and criticizing Gen Z’s lack of social skills is an unfair accusation.

If I think of my own childhood and what it would have been like if all these technologies existed, I can tell you that I would have likely immersed myself in gaming and possibly social media as well. Instead, I had the benefit of being raised on all APE and PPE, with zero DPE. As a result, interacting in live social situations and speaking in public feel natural to me.

However if I had a DPE-dominant childhood like so many of today’s youth, I know I would have had far more social anxiety and far less skill as a public speaker. Even the relatively brief period of the pandemic shutdown in the span of many of our much longer human adult lives, created an unfamiliar sense of social anxiety for many of us.

What can we do now as parents and employers? Be empathetic to youth and instead of criticizing them, put systems in place at home and in the workplace to encourage significantly more APE and PPE. Regardless of how lifelike the metaverse and avatar interactions in immersive environments might appear, I would absolutely err on the side of counting these as DPEs. Kids still need to meet their friends live as often as possible. Let them game together in their bedroom, side by side, and then ask them to come to the dining room for lunch or a snack. Aside from jobs that are clearly remote where meeting live is not an option, employers should try to create opportunities for live meetings and gatherings. My current employer regularly hosts different gatherings for physician leaders and there are priceless interactions and connections I’ve made which have often led to breakthrough innovations and ideas.

Pay attention to your own personal diet of these different forms of people exposure and see how you feel as you adjust the intake of each. Like me, realize that you might be conveniently underdosing APE and PPE and not recognizing the impact it’s having on your emotional health. Do the same for children and other loved ones. Many seniors are overdosing on DPE spending hours watching the news, Youtube, researching various topics, etc., while socially isolating themselves. They too are susceptible to social media comparison envy like teenagers, as they watch their friends gathering with family or taking exotic vacations when they may not have access to these types of gatherings on a regular basis.

I know I’ve come off as a Luddite so far, but I fully recognize that we are in a mental health crisis with a shortage of mental health providers that will require some tech-based solutions. Mental health chatbots, avatars, and immersive digital landscapes paired with meditation and cognitive skills training are exciting and necessary ways to help bridge the gap, and even enhance the arsenal of tools that mental health providers can use to help those who are suffering. How do we use next gen DPE as a supplement to a minimum threshold dose of APE and PPE, to help humans optimize their mental health and feel their best? Perhaps practicing eye contact and conversation with lifelike avatars will give individuals the confidence and skills to do this naturally with live human beings, while reducing social anxiety. Just like nutritional supplements shouldn’t be a replacement for healthy and natural foods, let’s strive for not making DPE a complete replacement for APE and PPE.