Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutionsby Published 23 Jan 2018
|Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions.pdf|
From the New York Times bestselling author of Chasing the Scream: The First and Last Days of the War on Drugs, a startling challenge to our thinking about depression and anxiety.
Award-winning journalist Johann Hari suffered from depression since he was a child and started taking antidepressants when he was a teenager. He was told—like his entire generation—that his problem was caused by a chemical imbalance in his brain. As an adult, trained in the social sciences, he began to investigate this question—and he learned that almost everything we have been told about depression and anxiety is wrong.
Across the world, Hari discovered social scientists who were uncovering the real causes—and they are mostly not in our brains, but in the way we live today. Hari’s journey took him from the people living in the tunnels beneath Las Vegas, to an Amish community in Indiana, to an uprising in Berlin—all showing in vivid and dramatic detail these new insights. They lead to solutions radically different from the ones we have been offered up until now.
Just as Chasing the Scream transformed the global debate about addiction, with over twenty million views for his TED talk and the animation based on it, Lost Connections will lead us to a very different debate about depression and anxiety—one that shows how, together, we can end this epidemic.
"Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions" Reviews
Hoo boy! Where to start? Well Hari starts by saying that everything I know about depression is wrong, which is a bold claim given that I've lived with it, waxing and waning, for most of my life. So what does he say?
Hari: Everyone thinks that depression is simply caused by a chemical imbalance in the brain!
Me: Well, of course depression is caused by chemicals in the brain. Every part of our experience is caused by chemicals in the brain. That's what the brain DOES. Love, rage and that annoying tickle behind your right knee are also caused by chemicals in the brain.
Hari: They think that life experiences and the environment are irrelevant and have no impact on people developing depression! They think it pops up out of nowhere!
Me: Literally nobody thinks that, Johann.
Hari: I've found out that people get sad because they've lost their jobs or have no friends.
Me: No shit.
Hari: A woman could have her newborn baby die, and then go to the GP the next day and be diagnosed with major depressive disorder!
Me: Ooooh, a situation that has never happened, ever, because doctors are not fucking idiots! How exciting!
Hari: Antidepressants don't really work even though Big Pharma insists that they do in order to make money. We should take St John's Wort because it's better, has no risks and no side effects.
Me: The evidence on antidepressants is complicated, and Big Pharma have indeed done some shady stuff which I won't defend. St John's Wort works because it is basically an SSRI. However, unlike substances classified as drugs, it's very badly regulated so dosage and purity are inconsistent. There are side effects. One is that it reduces the effectiveness of hormonal contraceptives, which seems like a pretty big risk to me.
Hari: In all the time I took antidepressants, not one medical professional asked if I had a reason to be sad.
Me: I flat out don't believe you, I'm afraid. If you were ever referred to mental health services, you sure as hell went through a history of your whole life in the hour-long initial appointment. Even GPs generally ask.
Hari: Everyone in medicine just thinks that antidepressants will fix everything without any context!
Me: Really? Because I'm pretty sure that NHS best practice advice on depression includes antidepressants, talking therapy, mindfulness, diet and exercise, and sleep hygiene. They've also become pretty keen on choral singing recently. Of course they don't always have the resources to offer this stuff and GPs have to get you out the door pretty quickly. But that's not because they all think pills are perfect.
Hari: Nobody ever asks about real life stressors!
Me: The last time I was referred to an NHS mental health service I was asked over and over if I had any issues with debt, housing, the police, my non-existent children, isolation, harassment etc. Social workers are a lot cheaper than psychiatrists.
Hari: But the REAL cause of depression is real life stress, not brain chemicals.
Me: This is a ridiculous false dichotomy. It's like saying "the cause of type 2 diabetes isn't having a body that can no longer get the insulin/glucose balance right. The cause is people eating too much and getting fat." There are levels of cause and effect, and interactions between these levels. Life experience affects brain activity. Brain activity then both creates and affects life experience. The problem with depression is often a feedback loop between life and the brain. The reason why antidepressants are needed is to get into this loop and push the brain in a different direction so that life can also be pushed into a different direction.
Hari: Everyone now thinks that depression is caused by too little serotonin.
Me: I don't know what "everyone" thinks, but the current medical consensus is that serotonin is one of several neurotransmitters implicated in a very complex disorder that we still don't fully understand. Because, you know, the brain is complex, similar symptoms can have different causes and different appropriate treatments, and so on.
I mean there's more I could say but this is pretty long now.
I think this book might come across as groundbreaking for people who don't know all that much about depression and the state of science around it. This is clearly what Hari was going for. But what it has actually done is build up a ridiculous straw man. Nobody thinks that depression always springs up, spontaneously, because the brain forgot to put serotonin on the shopping list. What the medical profession actually thinks is that it's a very complex disorder, with a lot of interconnected causes and a bunch of different things that can help. Of these things, there's often an antidepressant which will give the person a bit of a boost in conjunction with sorting out other stuff. But Hari doesn't engage with this. Instead he presents another wildly oversimplistic explanation and then claims credit for Figuring It All Out Unlike Those Actual Scientists And Doctors.
The book’s description field at Goodreads (https://www.goodreads.com/book/show/3...) gives a more than adequate summary of its contents so I won’t make a point here of giving any further details here.
As usual, it’s hardest for me to write reviews for books I love the most. This might be the best book I’ve ever read about depression and anxiety, and I’ve read dozens, maybe hundreds, over many decades.
It’s a book that I wish I could own. I might borrow it from the library again at some point.
I can recommend this to everyone (including several specific people I know) particularly those who have experienced depression/anxiety, those who work with sufferers to alleviate those conditions, and those who know or have known people with depression and/or anxiety, and most people living in our modern world; in other words, most readers. The book’s subtitle refers to depression but throughout the book both depression and anxiety are explored, and I appreciated that.
I should probably feel perturbed that none of the buzz on the book jacket is from professionals in the field, but I ended up not caring. This is not a pop psych book, and I hope that mental health professionals will read it. I wish this information had been published and publicized many decades ago, and accepted by those in the field. To me it’s ridiculous that this information could be considered groundbreaking but some of it feels that way given the accepted current treatment modalities for depression and for anxiety.
The book is entertaining and informative, and well structured and well written. Most of what is related is or should be common sense but I found much of what was presented thought provoking. Perhaps there was nothing earth-shatteringly new but it felt good getting validation and more to consider, and I did learn some things. The author is an engaging writer and storyteller. The account has a good mix of his personal story, others’ stories, and (scientific and informal) research results. He interviews people from around the world, people working in various disciplines, and about various organized and spontaneous social experiments that have occurred. The personal stories make the hard data even more interesting.
When I read the Contents pages before I started the book I thought I’d have an issue with the specific numbers of reasons for and solutions for these mental health issues, but I didn’t. The author is not dogmatic and the sections were useful and made sense.
I’ve never been a person especially attracted to drug use, but after reading this book I’d love to try the ingredients in mushrooms, at the high dose, under strict medical supervision, even though I suspect I might be among the 25% of users who have negative experiences when under the influence of psilocybin. I’m really curious though and I’d be willing to take the risk because I think there would be an opportunity for a special, positive experience.
I do wish that the sections on traumatic childhoods were much longer and had more details and examples.
What is said about disconnection in modern life really resonated with me, and the conclusions the author reaches about its impact on how we feel are ones with which I mostly agree. Finishing the book I feel that it can be helpful to many, and somewhat empowering, but as is made clear, many of the needed changes must happen not just by individuals but also at the societal, cultural, group, organizational-governmental level, and accomplishing this in the big way that will be required for large populations feels like a daunting goal. So I’m not sure how optimistic or pessimistic I feel regarding this epidemic, but ideas are given that individuals and small groups can implement.
The notes are worth reading, preferably at the same time as their corresponding chapters. There is an index, though when I went to look up things I didn’t always find the book’s contents there where I’d expected to find it.
One quote I really liked that is a good summary of the book’s thesis is: “You aren’t a machine with broken parts. You are an animal whose needs aren’t being met.”
At his best, Hari writes with real compassion and insight, advancing an important argument that we need to expand our understanding of both depression and of anti depressants. Popping pills to solve a chemical imbalance is not the answer, but rather identifying what it is that you/ we are disconnected from - including with the help of mental health professionals, but not exclusively. He consults experts, showcases innovative approaches and research and thinks about things ‘for a long time’ as he says more than once. It’s hard to disagree with large chunks of this - much of it sensible and attentive to the complexities of human existence - and he covers a lot of ground while maintaining the pace of a page turner. He thinks big too, indicting contemporary neoliberalism in the depression epidemic. But sometimes the tone was too proselytising & verged on condescending while the space allocated to particular issues over others was sometimes curious (pages and pages to a single LSD experiment while childhood trauma is smashed out in one of the smallest chapters). Towards the end, huge topics like the universal basic income were introduced with great fanfare only to capsize on another walk on part for a celebrity friend of his. And while he made attempts to give biology its due, once it was established that the chemical imbalance theory is basically bunk, other biological factors - most notably hormones which is a huge issue for many women suffering various forms of depression - barely got a look in. Still, I am glad he wrote it and that I read it. We do need to listen to our own pain, and to the pain of others, and to expand the possibilities of how we deal with it. In that broader sense, this is a hopeful and helpful book.
I was gonna set this to 4* but Mr Hari does leave me feeling ever so empowered :)
And seems to provide me with new reasons to criticise Russell Brand! Which I love doing anyway ;) Because unfortunately for Mr Hari I'd argue, he seems trapped into calling for revolutions.
"Hey!" his publishers say. "Do that calling-for-revolution thing you do. Really gets books flying off shelves!"
The last book I read of Hari's, Chasing the Scream, I did so when a bit younger and looking for "THE answer", so his revolution-calling got in. This time, I'm reading this book in conjunction with Jordan Peterson's 12 Rules For Life (which isn't on my GR shelves because I like to have unique experiences with books. When I add percentage read, or "currently reading", and someone likes it, it's like when you're in a shop and the salesperson goes, "Great choice! Pairs well with our new range of patterned cotton t-shirts." I know that's not how it is. GR people have no marketing-style incentive to encourage me with my reading, but of things that should be private, experiences with books are way up there. Someone just showed me a Facebook video of an alcoholic woman screaming because the government were taking away her child. I'm sure it was offered with the incentive of inducing some sort of change, but no matter the motivation, some things just need to remain private, even if they don't "technically have to" anymore. Now that we can record everything, doesn't mean we should. Look at that whole Logan Paul thing, or that prankster vlogging couple that broke up and feel like they "sold their relationship to YouTube." Privacy is a human need like water and food. So that's that!)
One of Peterson's points is that dominance hierarchies are ingrained in us, not in our culture. They can't be dismantled. I'm sure Hari would agree, but he doesn't make that explicit. He just makes the point that hierarchies in certain countries are ramped up to the extreme in a way that is massively detrimental, and advocates flattening those hierarchies as they do in Norway (omg if one more person who doesn't live here tells me how great it is...!!)
Well, read that in conjunction with this School of Life article:
Because I can't be bothered yet again to explain why no one country, and perhaps especially not Norway, has all the answers.
And the knowledge of this book is not as hidden as he makes it sound. Go into nature, for example: well, there's the whole Japanese "forest bathing" practice etc... I mean I guess I've never seen these solutions collected in this way before, and that's enough. Just something about the "woooww" tone of it was, like... Yeah, certain technological advancements and new modes of living have us lonelier than ever. I don't think that's news to anyone. The pernicious effect of advertising: yes. We're all talking about this stuff. You're not ripping our blinkers off. But thanks for providing some new thoughts on the urgency of stemming those influences. As for advocating for laws that prevent advertising that makes people feel bad?! Are you nuts? That sounds like Brave New World territory to me. Though I appreciate the sincerity of its intent, sure.
But, fine: I kinda think the point of all this reading we do is to develop our own personal philosophy.
I had a discussion with a friend about it yesterday. He was of the opinion (or was playing Devil's Advocate just to rile me, as is sometimes his wont :P) that everything has been done before.
I said it depends on the level at which you look at something. No one like him has ever existed, and what he claimed was the equivalent of saying, we're all molecules, or we're all just fleshbags or something. That, as we even know scientifically, is looking at the problem at the wrong order of magnitude.
(I often do the hard graft of beefing up other people's weak arguments for them, just so that when they know I blast those arguments to shreds that I had reason to do so. I have to provide points A and B and C and D so that I don't just refute point A, then they come back in a week and go, "Aha! I've been thinking about it! Have you considered: point B?! Gotcha!!"
Ugh. People!! I know we need them, but maybe we allow ourselves to be depressed because the monumental task of locating a network of decent friends is even more depressing!)
What makes us unique is DNA, and each of us have genomes that have never existed before—no matter how much of that code we share with others. Each of us is a discrete object, with a unique collection of experiences, experiencing life differently.
He either didn't like or understand that, so, exasperatedly, I said, "Cavemen didn't have iPads!"
That shut him up for a few seconds but he still had this look on his face. Again, while being arrogant, he couldn't express to me exactly why he thought he'd bested me, so I helped him out again. I think what it transpired that he was getting at was that, we're not the beginning or ending of anything ourselves. Okay sure. We're participating in life, which is bigger than ourselves. We're part of a fabric. Nice!
Two of my favourite aphorisms are, "Better than nothing" and "Take what works for you and let the rest go." This is how I get out of bed and go about my business and develop. Okay, so I'm not the most well-read, best engineer, greatest husband etc. Does that absolve me of responsibilities in any of those regards? No. Because worse than me doing anything to better myself would be to do nothing. Any attempt at improvement is better than nothing. That's really all I ask of myself. And then, okay, the point of my reading is almost never to agree with the writer. If I do, it's an easier task; if I don't, I have to work out why I don't. I take what works for me and let the rest go. I look at what my parents did and how they went about life. I mimic those parts of them that I appreciated and look for areas of improvement—which there always are. They're only human. And so am I.
Now, maybe almost none of this had anything to do with this book in particular, and that's on me. I always end up spilling when I relinquish journalling.
Whatever. Let's end on this note:
HEY! YOU! YOU DESERVE TO BE HERE, motherfucker. You are worthy of love, and fun, and silliness, and the beautiful mistakes you'll keep making.
Just not for me. I found that this book unnecessarily portrayed psychiatrists and anti-depressants negatively. I was presented with plenty of studies related to other causes but the idea of anti-depressant studies was quickly dismissed as being biased because of ‘Big Pharma’ funding - which I think is an insult to the men and women scientists working for companies conducting this research.
For me, the causes and ‘reconnections’ highlighted are all part of ‘psychiatric treatment’ in conjunction with anti-depressants. At the end of the day if you go to your GP saying you can’t stop crying, they’ll prescribe meds, but also set up counselling, encourage regular exercise and removing yourself from any negative life situation.
It’s a comprehensive model.
Whilst I completely agree with all the disconnections that the author described in leading to mental health issues, I just think going out there and saying anti-depressants are a conspiracy is dangerous and unnecessary. For many people, getting a prescription is the first step to seeking the support they need.