On today’s episode, Gabe interviews Dr. Margaret Rutherford, a clinical psychologist and the host of “The SelfWork Podcast.” They discuss the pressing issue of loneliness as a global health threat, likening its mortality effects to smoking 15 cigarettes a day, and explore its close relationship with depression. Rutherford emphasizes the importance of practicing social interaction, reevaluating perceptions of being alone, and taking small proactive steps to combat loneliness and build meaningful connections.

“I think you have to look at your definition of alone. And what are you telling yourself about being alone? I’m alone because, what? Because I’m a failure? Because I am undesirable? What are you heaping on yourself about being alone that is detrimental to you? As long as you are engaged in constant negative appraisal of you spending an evening alone or a week alone or whatever it is, as long as you are calling that highly undesirable and actually that means you are less than, then you’re going to run into trouble.” ~Dr. Margaret Rutherford

Margaret Robinson Rutherford, PhD
Margaret Robinson Rutherford, PhD

Margaret Robinson Rutherford, PhD, is a clinical psychologist with 30 years of experience, an author, TEDx speaker, and podcast host. Her book, “Perfectly Hidden Depression: How to Break Free from the Perfectionism That Masks Your Depression,” has reached thousands in the United States and is having an international impact, with translations reaching Korea to Italy, Turkey to Germany. Her podcast, “The SelfWork Podcast,” has been continuously rated as one of the best podcasts for mental health and depression.

gabe howard
Gabe Howard

Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hey, listeners, welcome to the show. I’m your host, Gabe Howard. Calling in to the show today, we have Margaret Rutherford, PhD. Dr. Rutherford is a clinical psychologist and host of the SelfWork podcast, which has been continuously rated as one of the best podcasts for mental health and depression. Her TEDx talk, How to Recognize Perfectly Hidden Depression, ranked in the top 50 of all Ted talks in 2023. Dr. Rutherford, welcome to the podcast.

Dr. Margaret Rutherford: Thank you. And please, it’s Margaret and hello, Gabe. It has been a few years since you and I have talked, and I’m just so glad to talk with you and have you on SelfWork also. So thanks for inviting me here. I really appreciate it.

Gabe Howard: Oh, Margaret, thank you so much for being here and I am excited to be on your podcast as well. So for our listeners, you’ll have to check that out. Now to the topic at hand. The World Health Organization has declared loneliness to be a pressing global health threat. In fact, the US Surgeon General declared that its mortality effects are equivalent to smoking 15 cigarettes a day. And yet, by and large, we’re not really addressing it now. Typically, people experiencing loneliness, they sort of feel like it’s a personal failing. Society at large only really seems to care about loneliness when it impacts them personally and directly. They don’t really care so much when it’s happening to others. But Dr. Rutherford, I have to ask or I apologize, Margaret, I have to ask. From your perspective, is loneliness a serious public health risk?

Dr. Margaret Rutherford: Yes, I think so. Of course, it doesn’t take any letters after my name to say that the pandemic was vital in those of us who have certain kinds of skills to reach out and connect with other people. Those skills got rusty. And then those people who were more introverted probably got more introverted. Extroverts really struggled. But again, trying to address safety issues, belief issues. You add on to that, that our political environment here and of course around the world as well, but here in the United States has been highly charged. And there are there’s a lot of fracture in families and even friendships because of these divides. And so there’s just been a lot of upheaval in our connectedness with each other.

Gabe Howard: When I think about loneliness, I think of how close it is to depression. One of the reasons that I wanted to talk to you about this specifically is because of your research and your writing and your history with the perfectly hidden depression model where

Dr. Margaret Rutherford: Mm-hmm.

Gabe Howard: You talk about people don’t even realize that they have depression. It is loneliness so close to depression that that people get the two conflated or confused. And does this help sort of contribute to the fact that we’re ignoring it because people sort of have this? Oh, well, I’ll just make friends and buck up mentality.

Dr. Margaret Rutherford: Yeah, right.

Gabe Howard: Is there a correlation there, or am I just completely off the mark?

Dr. Margaret Rutherford: No, Gabe, I think you are on the mark and I’ll let me get to perfectly hidden depression in a second. What I want to say, though, is, you know, one of the criteria, so to speak, for diagnostic criteria for depression is isolated-ness. And so, you know what’s the difference between isolated-ness and loneliness? I mean, they are inherently meaningful or interactive with one another because isolation is perhaps more of a we would think of it as more of a choice. I’m choosing to isolate. And yet when you are depressed, it doesn’t feel like a choice that you’re doing that. It feels like I have to. That you don’t feel comfortable in your own skin, that you, you distrust what other people might project on, you know, you want to closet yourself and, and try to handle things on your own. Whereas loneliness is not necessarily a choice. Many people are lonely because they simply don’t feel connected to anyone. They may struggle to even know how to connect with anyone.

Gabe Howard: Well, now, that’s an interesting point that you make, because it sounds like you can be around people and still feel lonely, which I think is counterintuitive. Many people believe that if they come from a big family or if they have a lot of friends, or if they go to work every day, or if they’re constantly surrounded by people, that it’s not loneliness. It sounds like you’re saying that you can absolutely be lonely in those scenarios.

Dr. Margaret Rutherford: Oh, extremely lonely. In fact, I in my in my research for perfectly hidden depression, I interviewed people who said they were identifying with what I was talking about, and I did 60 interviews. And so these were people from all over the world who were choosing to talk to a stranger about their past. And I asked them all, Gabe. I said, what is your motivation for doing this? You don’t know whether you can trust me or not. I’m a perfect stranger to you. And they said, because I do not want anyone else to be as lonely as I have been in my lifetime. It is horrible emptiness and loneliness because no one knows who I am. So I do think that you can be in the midst of families, cultures, whatever, whatever, whatever groups you together churches, you know, whatever and feel this. No one really knows me. Now, you know, I do think social media has played a role in this, moving away from quote unquote being who you are. I, I, I’ve had people sitting on my couch who are talking about maybe even a darker thought is suicidal ideation or suicidal thinking. And they’ll show me something on their Instagram and it will look perfect. And so I do think it is it is translated into this sense of, well, I don’t my life doesn’t equate with that life. And. So I will pull back. I will pull back because I. I don’t belong anywhere. And that sense of not belonging can have an incredible impact on your sense of loneliness. You know, one of the things that, of course, is huge in your ability to connect or your desire to connect and try not to be so lonely is this whole introversion extroversion component of it? You know, introverts, the depression gets worse on days they have no activities. I am much more introverted than I am extroverted,

Dr. Margaret Rutherford: So, I think that you have to practice. I, you know, we, we think we should be good at something when we haven’t even practiced it. And if you don’t know the value of being alone, and especially that’s not where you find your if you’re extroverted, that’s not where you find your stability. You find your stability in being with other people. And so that’s over with. Your day is over and you add that you’re you’re struggling with some depression, then you can get home. And if you have not practiced, if you have not tried, well, what could I do to structure that time where I I’m okay with having dinner by myself? I remember after I got my second divorce. My second divorce. I hope you caught that. I practiced going out to dinner by myself because I was already feeling horrible about myself. I was very lonely, but I was determined not to start just being dependent on. I’ve got to have somebody to do something with. I remember the first time I did it, I went to this place where I had loved, and it was a real dark Italian place. And I uttered, fettuccine Alfredo. I mean, I ordered fettuccine Alfredo, which back then I could eat with abandon because I was very thin and and I got it and it smelled just great. And I’d been reading my book and I was just fine. And I picked up the cheese and I spread it all over it, and I took my first bite. It wasn’t cheese, it was sugar

Gabe Howard: Oh, wow.

Dr. Margaret Rutherford: That I had spread all over my pasta. Well, Gabe, I started crying and I thought, I’m an utter idiot and I should never have tried this. This is a little simple story, but it’s like I scraped as much as the sugar as I could off, and I ate that darn pasta. But I walked out of the restaurant saying, I’ll never do that again. I’ll never try that again. But you know, you have to you have to practice being on your own and finding go watch a sunset by yourself. Go watch a sunrise by yourself. You know, do things that where even if you’re extroverted, do things that you will find value in being alone. Journal do things that are that will build a little more a greater sense of sort of a rich, a rich inner life is what they call it, just kind of a knowing being, being aware of your feelings and being able to really enjoy them and deepen them.

Gabe Howard: As I was listening to your story, Margaret, of you accidentally putting sugar on your fettuccine Alfredo, I’m reminded of a time that my father used Cool Whip, literal Cool Whip to butter a roll.

Dr. Margaret Rutherford: [Laughter] Oh, god.

Gabe Howard: And yeah, it’s hilarious. It’s just I we still laugh at this as a family, but here’s why it popped into my mind. Because my dad was with his whole family. It wasn’t just that he was with one other person. He was with his children, his wife. And yet he still did it. And none of us stopped him. Is this an example of where even if you had been with a big group of people and you just reached over and grabbed the sugar, chances are nobody would have stopped you. They probably wouldn’t have noticed because they would have been paying attention to their own food. But

Dr. Margaret Rutherford: Right.

Gabe Howard: Because you were alone, it

Dr. Margaret Rutherford: Right.

Gabe Howard: Sounds like you thought, oh, the reason I added the sugar is because I’m so lonely and I’m isolated

Dr. Margaret Rutherford: Right, right.

Gabe Howard: And nobody wants to be around me, when in actuality it’s. Does this lead to these exacerbated feelings of loneliness?

Dr. Margaret Rutherford: Yeah, yeah. No wonder I’m divorced twice. I’m an idiot, you know. What was I thinking? I’m not aware of my surroundings. You know, I just went on and on. The negative spiral went on and on and on. And again, it’s a it’s a apparently silly thing, but the reason why I tell the story is that we use those things to, to say, well, no one would want to be around me anyway. I’m a failure. I’m a I’m a zombie, I’m a moron. And when you when you feel that way, then you’re not going to risk connection. One of the things that I have people do who have a lot of social anxiety and they’ll say, oh, I don’t want to go to that tailgate or I don’t want to go to the whatever. I’ll say, okay, have this in mind. When you walk in, go look for the person that looks. More miserable than you are. And when you have as a goal, I need to. I need to go help somebody. Then all of a sudden, a lot of times, not all of your anxiety disappears. You know, that’s silly. But by saying, gosh, that guy’s over there, he has he has taken ten minutes to eat that cheese and cracker because he, you know, obviously he’s putting off having to talk to anybody and looks like he’s a completely absorbed in his cheese and cracker. I’ll go over to him and say, gosh, I’m kind of nervous being here. Are you? And he goes, oh my God, I hate these things. And then you sit down and you and you’ve found a connection. It’s there are ways to approach social engagements and social events and, and in relationships where you, you, you admit and you reveal some of your own discomfort. And that is incredibly powerful.

Gabe Howard: How do you practice that?

Sponsor Break

Gabe Howard: And we’re back talking about loneliness with Dr. Margaret Rutherford, host of the SelfWork podcast. I mean, aside from just going to the event, which again,

Dr. Margaret Rutherford: Yeah.

Gabe Howard: Especially people with social anxiety, people who are lonely, it just I it, I know this is the longest way to word this question, but if you’re lonely just go talk to people. Seems like equivalent advice to if you don’t have enough money, just make more money.

Dr. Margaret Rutherford: Yeah. Just make more money.

Gabe Howard: Like, I can’t disagree with the advice, but I mean, if you’re feeling lonely, getting up, getting dressed, going to a party, and walking over and talk to a stranger can just be extraordinarily difficult.

Dr. Margaret Rutherford: Great question. And I’m going to say practice again. You practice. We all go to the grocery store. Now, some of us who really want to avoid social connection or are lonely and are afraid, we’re terrible people. We go at 2:00 in the morning. But even at 2:00 in the morning, you have a, you know, you have to talk to somebody typically to, to get out of the store. You make small talk. You say, how long have you worked here? Do you always work at 2:00 in the morning? You take the opportunities that are natural opportunities in your life. If you’re if you’re riding the subway, if you are waiting in line, oh, gosh. In the myriad of places that we wait in line, you simply you don’t just stand there. You risk little bits, just little bits. I have a lot of people do a lot of work in grocery stores, and they’ll look at me first like I’m crazy. And I’ll say, you know what? Go to the grocery store and try to talk to somebody. They’ll actually avoid you. You know, oh, you bought those blackberries? I’ve never eaten a blackberry before. How is it different than a blueberry? I mean, I don’t care what you say. I don’t care how stupid it sounds to you. A person will kind of look at you and go, well, it’s a little sweeter sometimes. I mean, they’ll be, they’ll be glad you ask them a question. So again, we can’t expect ourselves to be comfortable with doing something we haven’t practiced.

Gabe Howard: I really think there’s the disconnect, though. You said that they would be glad they asked you a question, and the first thing that popped in my mind is no, they’ll be annoyed. They’ll think I’m bothering them. They’ll think I’m hitting on them or I’m trying to run a scam,

Dr. Margaret Rutherford: [Laughter]

Gabe Howard: Or I like all these things that started jumping into my head like, no, no, no, no, no. They’ll think that I’m doing the following things. And all of the following things were all negative things, like people are just really on guard. That’s the I think that’s what we have sort of that’s what we put out in the world, that people are afraid of other people and that if you talk to them, you must be a con artist and you must be up to something. I think people believe that society’s thinking on talking to strangers has changed. I think that we think that it’s a bygone era to strike up a conversation with a stranger.

Dr. Margaret Rutherford: Well, I told you I was 70 years old.

Gabe Howard: Because, after all, only sociopaths would strike up conversations with strangers. Now, as an extrovert, I love talking to strangers and I want the listeners to know people talk to me all the time, and I love it. But

Dr. Margaret Rutherford: Mm-hmm.

Gabe Howard: I talk to people all the time, too, and they’re just they always express. They’re just like, well, we need a Gabe in the room because nobody else talks to anybody. It’s a compliment. But it also makes me really sad that they think that I’m that aberrant, just to be willing to talk to a stranger.

Dr. Margaret Rutherford: It’s a great point, and I understand that, you know, if you march up to somebody and then you, you say, hey, I’ve noticed you in the store before. And what about this blackberry thing? I mean, but I do think that people in general, if you approach calmly and without, you know, a lot of anxiety what people like to be asked their opinion they like to be asked. I mean, I don’t know, I think that we have forgotten. I think your point is good. We’ve gotten very distrustful of one another. I agree with that. And of course COVID was, well, are you a vaxxer? Are you not a vaxxer or are you a, you know, are you wearing a mask? Are you not wearing a mask? So all of that has heightened that. But at the same time, I would I would suggest that knowing how to comfort yourself and. And give comfort to other people is something that is an admirable goal.

Gabe Howard: It really sounds like stepping outside of your comfort zone is basically the first step and key to combating loneliness.

Dr. Margaret Rutherford: I believe so because again, when you say I am so lonely, you get this paralysis. You know, no one wants to talk with me. Everybody has a partner. I’d be a third wheel. Blah, blah blah, blah, blah. And so what you can do is look at other aspects of your life, maybe don’t tackle that particular thing at first, but you’ve got to tackle this thing of I, I can’t act proactively in my own best interest. There’s nothing I can change because if you take small enough steps, there is something you can change.

Gabe Howard: Margaret, are there any other quick tips that you have for folks before we get out of here?

Dr. Margaret Rutherford: You know, Gabe. Probably the loneliest I’ve ever been in my life. Was when I was in a relationship with a husband who was extremely possessive and abusive to me. And I thought I’d never get out of it. I thought I, I did this to myself. I made this choice and I couldn’t talk about it because of shame. I couldn’t talk about it because of a sense of, you know, I had been a part of creating it. And so I just. I mean, I made it through, but with difficulty, and it wasn’t until I began risking just a little bit. That I began to say, connect with other people. That actually gave me a different version of myself than the abusive, possessive guy I was with. And actually one of the ways I did that, I had panic attacks and I had not. He knew it and my parents knew it, but I had never told anybody else. And I told someone, I have panic attacks. And they looked at me like you. You seem so comfortable with yourself. No, I have performance anxiety. I have panic attacks. I opened that and I they didn’t go, whoa, gross. Or that’s weird, or I’m mad at you about, I mean, well, I don’t want to be your friend. Instead they go, well, gosh, you know, I get anxious too, I began sharing. And I was scared to death to do it. But I will say 30 years later, I’m. I mean, I have my lonely moments, just like everybody does, but I don’t have that kind of loneliness anymore.

Gabe Howard: Margaret, thank you so much for being here. I really appreciate you. Where can folks find you? Where can folks find your podcast and where can folks find your book?

Dr. Margaret Rutherford: We’ll come to Arkansas.

Gabe Howard: [Laughter]

Dr. Margaret Rutherford: A lot of people came to Arkansas for the eclipse, so we had a bunch of folks around here. My website is DrMargaretRutherford.com. My podcast is the SelfWork podcast. Self-work. My book is called “Perfectly Hidden Depression: How to Break Free from the Perfectionism that Masks Your Depression.” It has been it has been translated into nine different languages. So if you’re in Germany or Italy or Poland or Czechoslovakia, there’s a there’s a version of it for you. Korea. And just put in Doctor Margaret Rutherford, you know, and I’ll pop up somewhere and oh, you can email me at AskDrMargaret@DrMargaretRutherford.com.

Gabe Howard: That is wonderful. Thank you once again for being here.

Dr. Margaret Rutherford: You’re welcome. My pleasure.

Gabe Howard: I want to give a big thank you to all of our listeners. My name is Gabe Howard and I’m an award-winning public speaker who could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. However, you can grab a signed copy with free show swag or learn more about me just by heading over to my website, gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. And hey, can you do me a favor? Recommend the show to the people you know. Share your favorite episodes on social media. Mention us on a support group. Send somebody a text. Because sharing the show with the people you know is how we grow. I will see everybody next time on Inside Mental Health.

Announcer: You’ve been listening to Inside Mental Health: A Psych Central Podcast from Healthline Media. Have a topic or guest suggestion? E-mail us at show@psychcentral.com. Previous episodes can be found at psychcentral.com/show or on your favorite podcast player. Thank you for listening.