Material living conditions are overall better in today’s world than during any time in history. Worldwide life expectancies are higher and poverty lower than ever before. We’ve developed incredible medical and life-enhancing technologies. Democracy is also more widespread.
This is not to downplay the many daunting threats, injustices and stressors we face. Sociopolitical strife has always been been part of human history, but many current political situations are extremely fraught and many egregious inequalities persist. By some long-term measures, equality is improving, but if so, it’s happening far too slowly. And while technology has helped generate equality on a global scale, it may ultimately widen the class gap.
One thing that’s clear: Despite people worldwide becoming more comfortable materially, they are no happier. (In fact, some evidence suggests that humans in richer countries are more depressed than those in poorer ones.) One could infer that people are even less happy than in times past, when subsistence living was the norm. This premise is supported by rising rates—both worldwide and in the US—of depression, anxiety and suicide.
What accounts for this?
British journalist and author Johann Hari investigated this question in his best-selling book Lost Connections (Bloomsbury, 2018). He believes that cultural disconnect is to blame for a pervasive drift toward depression in the West. He insists that our modern understanding of depression is short-sighted. If we are to deal with depression and anxiety in a practical way, he argues, our methods of treatment are in need of a 21st-century upgrade.
In Lost Connections, Hari writes that we’ve become overly reliant on a biological explanation of the causes of depression—that depression is primarily a brain imbalance people are born with, to be treated with chemical antidepressants. As a result, he considers, many are left with an incomplete story about their distress; and these people are not accessing—nor are they even aware of—the best help available.
Photo via Johann Hari’s website
A Personal Tale
The book begins by describing Hari’s own struggles with depression. He recounts the story his doctor offered him about why he was depressed—and then the moment he realized the doctor’s story was incomplete.
“Being given a story for your pain is a tremendous relief.”
“When I went to the doctor as a teenager, I told him I had this feeling; sort of like pain was leaking out of me, and I couldn’t regulate it, and I didn’t know what to do,” Hari related in an interview for my podcast. “He told me a story: ‘There is a chemical called serotonin that makes people feel good. Some people are naturally lacking that chemical; you’re clearly one of them. I’m going to give you these drugs and you’re going to feel normal again.’”
“I felt a tremendous amount of relief and joy when I was told that, because being given a story for your pain is a tremendous relief, especially if it has a solution.”
Hari began taking the antidepressants his doctor prescribed. He felt significantly better for a few months, but then the depression resurfaced. He returned to the doctor, who prescribed him a higher dose of the same medication. This pattern continued until eventually his pain out-competed the drug’s maximum dose. Depression followed him into adulthood.
Challenging the Narrative
Hari had no reason to distrust his doctor; prescribing chemical antidepressants for depression was standard medical practice. Still, he wondered why—insofar as his common medical illness was being treated with commonplace medicine—he was still so depressed. Was there something uniquely broken about him?
He discovered years later that this tedious experience was actually quite common. “Far from being freakish, my experience was absolutely the standard experience of [people on] chemical antidepressants. Between 65–80 percent of people—depending on which study you look at—on chemical antidepressants are depressed again within a year.”
Hari suspected that depression and anxiety had causes and solutions beyond the scope of medical practice, and decided to investigate.
And more people are taking antidepressants today than ever before. “In fact,” Hari told me, “one in five Americans is taking a psychiatric drug; one in three women is taking a chemical antidepressant; one in eleven people around you are on chemical antidepressants at any given time.” Hari recalled, “It seemed to me it could not be that just all of us, individually, were having our brain chemistries gone awry, mysteriously, at the same time.”
His suspicions are well founded. Increased prescribing does not seem to have curbed population-level mental health problems in this country. An estimated 15.5 million Americans have been taking antidepressants for over five years, a number that has tripled since the year 2000). Yet, a recent CDC report reveals, “The US suicide rate increased 25 percent from 1999 to 2016, even though the rates of psychiatric diagnosis and treatment also greatly increased.” Why hasn’t expansion of treatment made a dent in suicide trends?
To be clear, neither Hari’s book nor this article argue against use of antidepressants—many of which are reliably demonstrated to be helpful, and do help many struggling people. The thrust, instead, is that we also need to adopt a far more holistic view of depression and try to change our society accordingly.
Hari suspected that depression and anxiety had causes and solutions beyond the scope of medical practice, and decided to investigate. He traveled 40,000 miles around the world in an effort to better understand the causes of depression. He met people in many different communities and cultures along the way: people living with depression; people who have overcome depression; and many of the world’s researchers in the field. Hari elegantly communicates his encounters and his research in the remaining pages of Lost Connections.
The Real Causes of Depression
Hari concluded that, rather than having primarily biological causes and solutions, depression is largely related to the way we live. It’s psychological, social, political and woven into the fabric of culture. Moreover, people’s innate psychological needs are decreasingly being met by our culture, which accounts for higher rates of depression.
In Lost Connections, he lists nine primary causes of depression, emphasizing the ways in which people have become “disconnected.” He spoke with me about a few of them.
“For example if you are disconnected from other people—if you’re profoundly lonely—there is evidence that’s one of the big drivers of depression around us. If you feel your work is meaningless, there’s a lot of evidence that will make you depressed and anxious in a lot of cases.”
“We need to feel we belong to a group; we need to feel we have a stable future; we need to feel that we are valued; we need to feel we have meaning and purpose in our lives.”
“Everyone knows human beings have natural physical needs,” he added. “Well, there’s equally good evidence that we have innate psychological needs. We need to feel we belong to a group; we need to feel we have a stable future; we need to feel that we are valued; we need to feel we have meaning and purpose in our lives.”
This is consistent with wider evidence of distress in the US and around the world. The US Rust Belt serves as an example. This area was once rich with manufacturing work. But the collapse of the steel industry has left many in the region unemployed, in poverty, or—if slightly luckier—forced to pursue tedious work to make ends meet. There are considerable rates of depression in these areas. One could also assert that there are likely many non-diagnosed people who are feeling isolated, disconnected, and hopeless. These people, and others in similar socioeconomic brackets in many places, are in dire need of support.
But it doesn’t stop there. Even the financially secure are less happy than in times past. One reason is that people are less engaged in their work than ever, perhaps due to monotonous work days over which they have little control.
This may seem strange on the surface when people work fewer hours worldwide than previously. But it turns out, per Hari’s research (and that of many others), human needs go far beyond comfort. Satisfying these needs is to a large extent about feeling in control of one’s life.
“We’ve collectively told a story that encourages people to look overwhelmingly to brain-chemicals to explain their pain,” Hari told Filter, “while society crumbles beneath their feet, while people become much lonelier, while they’re made far more financially insecure, while they are taught life is all about spending and showing off, while they are ever more controlled and humiliated at work, while their sense of a stable future is stripped from them. We have not explained to people that these factors (and others) are major causes of depression—that they are, in fact, the key reasons why it is rising—and that there are solutions to these problems we can pursue together.”
It’s also likely that unfettered access to information, quick pleasure and convenience, while comforting us in the short-term, contribute to increased distress population-wide. For instance, most of us now live our lives through technology. Texting and social media have replaced more active and personal ways of interacting on a regular basis.
This has been a boon for our culture in some ways, as most of us are communicating with more people more often. But we often confuse this passive and fleeting form of communication with meaningful interaction with those we care for most. In effect, many of us have become estranged from the experiences and rewards of community values.
“Depression is a signal to people—a signal that their psychological needs are going unmet.”
It is not revolutionary to say that these circumstances—and the others listed in Lost Connections—contribute to increasing rates of depression and anxiety. Hari cops to that, calling his analysis both “radical and shockingly banal.”
Yet these phenomena are often deemphasized in favor of medical heuristics. Indeed, many of the organizations tasked with advising about mental health problems merely insist that we broaden access to chemical antidepressants.
While supporting unfettered access to antidepressants, Hari also worries that their dominance as a response to depression may affect people, on a population level, in the same way his own doctor’s conclusion affected him as a teenager, when he believed his depression was driven by abstract brain mechanisms over which he had no control.
“When in fact,” he explained, “depression is a signal to people—a signal that their psychological needs are going unmet.” He added, “What my doctor should have told me was not, ‘you’re a machine with broken parts’, but rather, ‘you’re a human being with unmet needs.’”
In the final section of Lost Connections, Hari chronicles a variety of successful approaches offered by the experts he interviewed, such as the psychiatrist Dr. Derek Summerfield, and demonstrated by communities he visited.
Hari tells one story about a Cambodian rice farmer who stepped on a landmine and lost his leg. His doctors gave him an artificial limb and he returned to his work. But it was painful for him to walk through flooded fields all day, and he no longer felt in control of his work and became depressed.
The man told his doctors of his physical pain and depression. They listened carefully. They understood that farming was his livelihood and that he was having difficulty engaging positively with his work; he needed a compromise. The doctors bought the man a cow and suggested he use his existing skills, resources and environment to become a dairy farmer instead. That way, he could still be a farmer but wouldn’t have to walk through the fields. After a few weeks with the cow, his depression went away.
Hari lists nine solutions to problems of cultural disconnection, all involving social and cultural reconnection. Reconnection with the mansions of life (like values, purpose, meaningful work); with each other (family, friends and the community) features extensively; as does our relationship with (and hopes for) the future.
Hari calls for a shift in our cultural mindset, reminding us that depression is a response to life experience which cannot be fully summarized by a mechanistic medical model. Hari is often criticized for blaming doctors for high rates of depression. Quite the contrary: He is urging us to stop leaning on medical professionals to do so much of the heavy lifting.
Hari believes that we should broaden the meaning of ‘antidepressant’ from chemical antidepressant to anything that makes people less depressed and anxious.
Hari acknowledges that chemical antidepressants are valuable tools that should be available to all who want them. “For something as devastating as depression—the worst thing I have ever been through—we need every strategy and tool on the table.”
There is a further key point. Hari believes that we should broaden the meaning of “antidepressant” from chemical antidepressant (FDA-approved medicines) to anything that makes people less depressed and anxious.
In the story about the Cambodian farmer, the doctors did prescribe an antidepressant to the farmer; they considered the cow an antidepressant in and of itself. They knew intuitively that the way to help the farmer become less depressed was to help him regain control of his life and reconnect with meaningful work.
Chemical antidepressants are a marvel of the new age. As is the case with all drugs, we need to strike a balance between using them to their full benefits versus over-relying on them. Hari notes on his book’s website, “If you feel helped by them, and the positives outweigh the side effects, you carry on. Some of the people I love most take chemical antidepressants, and I have never once urged them to stop.”
As Filter contributor Stanton Peele and I wrote in our forthcoming book, Outgrowing Addiction, “Overarching everything in America is the loss of intimacy and community, a lack of connection to the world around us, and often a loss of connection to our own selves.” Drugs, alone, will not solve these human problems. Minimizing depression and anxiety will ultimately entail accessing the values, resources and communities needed to create a productive future.
Johann Hari encourages such solutions in Lost Connections. Following his suggestions may just help to bring stability to the most disadvantaged among us, and a purposeful future to all of us who have lost our way.