The real causes of depression and anxiety
I love getting books for Xmas! Initially, “Sunday Times Bestseller” along with quotes from Elton John and Hilary Clinton on the front page of a book about depression didn’t entirely convince me. But I trust the judgement of the friend who gave it to me, so decided to give it a go. This is how I came to read “Lost Connections” by Johann Hari. And I am very glad that I did.
There is a lot I can say about this book. I would highly recommend it even though I did not find a lot of what it said surprising. To me the messages in this book sit within the social and economic determinants of health and wellbeing and are thus very consistent with the framework we work in in the NFP community mental health sector. Says Hari “The primary reason for all this rising depression and anxiety is not in our heads. It is, I discovered, largely in the world, and the way we are living in it.” (p.14) But what makes this book stand out is the amazing way the information is woven together, supported and articulated. It is filled with evidence and compelling case studies – wherever you open this book you find something interesting. It is extraordinarily accessible and readable.
Hari is a man with long experience of living with depression and anxiety. He is both an award-winning journalist and someone exposed earlier on for plagiarism. To write this book he draws on his personal experiences and travels the world interviewing scientists who are uncovering evidence that depression and anxiety are not caused by a chemical imbalance in our brains. Instead he points to nine causes associated with the loss of connections from meaningful work, people, values, childhood trauma, status and respect, nature and hope. He also looks at the role of genes and brain changes.
I found his evaluation of the medical model alarming in terms of the shortfalls in evidence. As Hari writes “I was surprised to discover that nobody seems to know quite what [antidepressants] do to us, or why – including the scientists who most strongly support them” (p.19), and a bit further on: “Here was the drug I started taking as a teenager, and here was the company that manufactured it, saying, in their own words, that it didn’t work for people like me – but they were going to carry on promoting it anyway.” (p.26)
He does not dismiss the medical model entirely, noting towards the end of that section “Chemical antidepressants may well be a partial solution for a minority of depressed and anxious people ... If you feel helped by them and the positives outweigh the side effects, you should carry on. But it is impossible, in the face of this evidence to say they are enough, for a big majority of depressed and anxious people.” (p.37)
In the chapter on disconnection from other people Hari muses that “Loneliness hangs over our culture today like a thick smog. More people say they feel lonely than ever before – and I wondered if this might be related to our apparent rise in depression and anxiety.” (p.73) He investigates the work of a neuroscience researcher, Professor John Cacioppo, who early in his career asked “what would happen if, instead of studying the brain as if it were an isolated island … we tried to study it as if it were an island connected by a hundred bridges to the outside world, where things are carried on and off all the time you receive signals from the world?” At first scoffed, he nonetheless went on to do significant work in this area (see citations on p. 281).
On p.181, Hari confesses: “When I started work on this book, I wanted quick solutions to my depression and anxiety – ones that I could pursue on my own, fast.” The final section of his book is called “Reconnection. Or, a different kind of antidepressant.” Unsurprisingly this is about how we can live a life of positive mental health and wellbeing. Unsurprisingly also for those of us who work in this sector, this includes reconnecting to other people, meaningful work, what he refers to as ‘social prescribing’ and ‘sympathetic joy and overcoming addiction to the self’, acknowledging and overcoming childhood trauma and restoring the future. He quotes clinical psychologist Dr. Lucy Johnstone posing a different world view: “How different would it be if when you went to your doctor, she diagnosed us with disconnection? What would happen then?” (p.161)
A case study (p.160), set in Cambodia focusses on the depression people experience after losing limbs from land mines - in this example, a farmer who lost his leg. After realising this man was despondent, his doctor and neighbours sat with him and talked through his life and his troubles. They realised that even with his new limb, his old job working in rice paddies was just too difficult. He was constantly in pain and stressed, and this was making him want to stop living. So, they gave him a cow and set him up as a dairy farmer. Over time his profound depression disappeared. “To them, an antidepressant wasn’t about changing brain chemistry, an idea that seemed bizarre to their culture. It was about the community, together, empowering the depressed person to change his life.” (p.160)
One of my favourite stories is in Chapter 15 – ‘We built this city’. It is about a housing project in Berlin and begins with a 63 year old woman posting a notice in her window saying that she was being evicted from her home for being behind in her rent, and that in a weeks’ time she was going to end her life. This began a process of extraordinary social connection. Her sign “stopped people on the housing project in their tracks, not just out of sympathy, but because they identified with her.” (p.165). Two years later this culminated in the largest number of signatures gathered for a referendum in the history of Berlin, for a package of reforms that would help keep rents low for everyone. (p.177)
In the final paragraph of the book Hari concludes: “You need your pain. It is a message, and we must listen… All these depressed and anxious people, all over the world – they are giving us a message. They are telling us something has gone wrong with the way we live. We need to stop trying to muffle or silence or pathologize that pain… It is only when we listen to our pain that we can flow it back to its source – and only there, can we see its true causes, can we begin to overcome it.” (p.261)
In the words of Naomi Klein: “Yes [this book] is about depression but it is also about the way we live now – and the havoc perennial isolation is wrecking on our collective mental health and general wellbeing”.
A warning though – you will have to endure Hari’s view that he has discovered something unique in pulling together all of this. But perhaps, by bringing it together so eloquently, he has?
Policy and Sector Development Manager, MHCC ACT You can purchase and find out more about this book at thelostconnections.com