Surrounded but starving. You can be praised by everyone and fed by no one. Dr. Mogire gets everything but Job gets nothing.
I need to tell you about the reception after a keynote address I gave in Nairobi, sometime in 2019. The room was full. The talk had gone well, which I knew because the applause had the specific quality that live audiences produce when they are not being polite but are actually responding to something that found them. People came to shake my hand afterward. A woman told me the talk had changed something for her. A man who was a surgeon took a photograph with me and told me he was going to quote something I had said to his residents.
I drove back to the hotel at eleven that night and sat in my room and felt something I can only describe as the particular emptiness that follows a full room. The room had been full of connection. I had received warmth from every direction. And I was sitting alone in a Nairobi hotel room feeling, without exaggeration, unfed.
The applause is sound. Nourishment is presence. They arrive in different rooms.
The physician Julianne Holt-Lunstad at Brigham Young University has been studying social isolation for more than a decade, and her 2015 meta-analysis across 148 studies and more than 300,000 participants found that adequate social relationships were associated with a fifty percent greater likelihood of survival, with a population-level impact comparable to smoking fifteen cigarettes a day (Holt-Lunstad et al. 2015, Perspectives on Psychological Science, https://doi.org/10.1177/1745691614568352). Honesty Scale: Solid (5/5). This is one of the most cited studies in the social connection and health literature. The methodology has been scrutinized and the findings replicated. The specific number of “fifteen cigarettes” is a relative risk comparison that requires context but is not misrepresented.
The United States Surgeon General’s 2023 advisory on loneliness and isolation made a point that landed differently because it came from an institution not generally given to philosophical language: the advisory named loneliness as a public health crisis, noted that approximately half of American adults reported measurable loneliness, and identified high-functioning professionals as a population at particular, underappreciated risk (Murthy 2023, Our Epidemic of Loneliness and Isolation, U.S. Department of Health and Human Services, https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf). Honesty Scale: Solid (5/5). The advisory is a synthesis of peer-reviewed research, not primary research itself, but draws on a robust and replicated evidence base.
What makes this category of loneliness different from ordinary loneliness is that it is invisible to the people who have it, and often invisible to the people around them.
Ordinary loneliness has a social signature. The person who is lonely is visibly alone, has fewer social interactions, is available for intervention by the people around them who notice the aloneness and respond to it. The loneliness I am describing does not have this signature. The person is at the center of every room. They have more invitations than they can accept. They have colleagues, collaborators, colleagues who call themselves friends. They have audiences.
What they do not have, very often, is a single person in front of whom they do not need to perform.
This is the specific quality of what I am calling nourishment: it requires the absence of performance. Not the absence of excellence, not the absence of achievement, not the pretense of being less than you are. The absence of the effort required to maintain a particular image of yourself for the benefit of the person across from you. In the presence of that absence, something relaxes. Something that has been held in tension releases. The body does something it was not doing in the applauding room.
I grew up in a village where the elders sat together after the day’s work and talked about things that were not transactions. They sat not because they had business but because the sitting was the thing. In Sengera, the evening fire was not for warmth only, it was for the specific kind of conversation that has no agenda. The Ekegusii called the quietness of that gathering something close to engako, the calm behind the rock, the place where the current does not require you to swim.
I had achieved my way out of sitting by the fire.
The boda boda story is relevant here. The night I met Tiffany, I arrived at that hotel with a borrowed watch, fourteen keys only two of which worked, and a cologne whose name I had misread entirely, and in the hours that followed, something happened that has nothing to do with the borrowed accessories. Tiffany and I talked for a long evening. I was broke and I was young and I was performing several things simultaneously, including confidence and sophistication and a familiarity with credit cards that I did not possess. But the conversation that happened across that table was real in a way that many of my later, more polished conversations were not.
The polish is, at some point, the problem.
When you become very good at performing your best self, the performance can colonize the relationships that were supposed to be the space where performance is not required. The dinner where you are still making the right impression. The friendship where you are still holding something back. The marriage where a version of the professional register has crept into the evenings because it is the only register you have kept sharp.
Dr. Mogire gets the applause. Job, the person who grew up ekerentane and survived the village and made it to medical school and still, at the bottom of a long day, needs to be known by more than what he produces: Job gets almost nothing.
The person sitting in the Nairobi hotel room at eleven was not Dr. Mogire. He had gone to sleep already, satisfied with the evening. The person in the room was Job, and Job was hungry.
If you recognize this, I want to be careful not to assign it a clinical name too quickly. You are not disordered. You are not doing something wrong. You have built something impressive, and the building has taken time and attention that might otherwise have gone into the kinds of relationships that do not serve the building, that are simply present with you in whatever condition you are in.
Those relationships are findable. Some of them may be right where you left them, patient in the way that genuine connections tend to be patient. They were waiting before you had the awards. They are still waiting.
The loneliness-and-health research is sobering enough that I want to stay in it a moment longer than comfort would prefer. The cardiovascular effects of social isolation are, by the best current evidence, in the same range as the cardiovascular effects of moderate smoking. I have spent twenty years telling patients to stop smoking. I have spent far less time asking them whether anyone in their life knows them. The physiology does not distinguish between the two risks. The evidence suggests I have been poorly prioritized in that regard, and I am not alone among my colleagues in that failing (Holt-Lunstad et al. 2015, cited above).
The specific mechanism, insofar as we understand it, is activation of the threat response in chronically isolated people, a persistent low-grade activation of the sympathetic nervous system that drives the same downstream risks as other chronic stressors: elevated inflammatory markers, impaired sleep quality, disrupted heart rate variability. The body does not experience loneliness as a social problem. The body experiences it as a threat. And the body responds accordingly.
For the high-achieving person whose loneliness is invisible because it lives inside applauding rooms, the threat signal runs quietly underneath the performance for years. The cardiologist cannot read it on the EKG. But the patient knows it, usually, in the 3 a.m. hours when the performance has stopped and the body is honest.
Applause is sound. Nourishment is presence. The two arrive in different rooms. The question is whether you are building a life that includes both rooms, or a life where the applauding room has expanded until the other room has no door.
A Mirror
Name one person in your current life with whom you do not feel required to perform. If you cannot name one, that is the most important data this chapter contains. (Listening for: the presence or absence of a relationship that is free of performance. The quality of the answer, and its specificity, are both telling.)
When was the last time you were genuinely fed by an interaction, in the way the body knows it has been fed? What was different about that interaction compared to your usual social and professional ones? (Listening for: the qualities that distinguish nourishment from applause. The person’s description of what made it different often reveals what is missing in their regular interactions.)
Has the performance you bring to professional life begun to appear in personal relationships? Name one place this has happened. (Listening for: the colonization of intimate space by professional register. This is extremely common and almost never intentional.)
Who in your life has been waiting for Job while you were busy being Dr. Mogire, or your own equivalent of that distinction? (Listening for: the specific named person, and what it costs the person to recognize that the waiting is happening.) ---
Letter from Dr. Job
Subject: Praise and food
I received a long night of applause once and went back to a hotel room with nothing in my stomach. I do not mean metaphorically. I mean the specific experience of having been in a room full of people who appreciated me, and then being alone, and knowing the difference between appreciation and company.
You know the difference too.
I want to say something simple: you are allowed to be hungry. Not performing. Not curating. Not delivering value. Just a person who is hungry and who needs to sit at a table where the food is real and the conversation costs nothing.
If you cannot think of a table like that right now, that is not a verdict on you. That is a map. It shows you where the next work is.
The next chapter will not be about praise. It will be about what you have been carrying long enough.
— Job