Depression isn't rooted in biology but in how we're living our lives, author Johann Hari explains
The way we’ve been taught to think about depression and anxiety is all wrong, says Johann Hari.
In his new book, the London-based journalist and New York Times best-selling author explains that depression is not actually the result of malfunctioning brain chemistry – it’s a response to the way we’re living our lives.
Hari spent three years traveling the world, speaking to scientists and doctors who have made ground-breaking discoveries around depression and anxiety – and who have found innovative and surprising ways to treat it.
This research and Hari’s personal experiences with his own depression have culminated in his new book, “Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions.”
In the same way Hari’s previous book, “Chasing the Scream,” helped shift the conversation around drug treatment and addiction, “Lost Connections” seeks to radically reframe the way we approach depression and anxiety.
Bloomsbury Publishing is releasing the book in the U.S. on Jan. 21, and it’s already received rave reviews from progressive icons such as Naomi Klein, Bill Maher and Arianna Huffington. According to Elton John, it’s a book that “will change your life.”
Hari recently spoke with Street Roots from his home in London. He shared what he’s learned about depression and discussed ways we can all strive to live happier lives. We began our interview by discussing why he began researching depression in the first place.
Johann Hari: I really wrote this book because there were these two mysteries that were haunting me. One was: Why was I still depressed?
When I was a teenager, I went to my doctor, and I explained I had this feeling like pain was kind of leaking out of me, and I couldn’t control it. My doctor told me a story, which is, “There is a chemical called serotonin that some people are lacking in their brains, that makes them feel terrible. You’re clearly one of these people. We’ll give you these drugs and it will make you feel good again.”
I took this drug Paxil for 13 years and I remained depressed. I had a boost when I started taking them, and then a few months later I started to feel really bad again, so I went back to the doctor and they said well, you haven’t been given a high enough dose. I was given another dose, I felt a bit better for a few months, and the feeling came back. I was basically in that pattern until I was taking the maximum allowable dose. So why was I still depressed when I was doing everything I was told to do?
The second thing was: Why were there so many other people like me?
There’s been this explosion of depression and anxiety in the United States and across the Western world. Today, 1 in 5 Americans is taking a psychiatric drug, 1 in 11 Americans is taking an antidepressant, and we’re more depressed than we’ve ever been. And we see this manifesting in all sorts of ways.
I wanted to understand this, so I ended up going on this big long journey. I went 40,000 miles meeting the best scientists in the world who’ve looked into this. I think the main thing I learned is it’s not so much a lesson about antidepressants, as it’s a lesson about depression and anxiety themselves.
I thought I was weird for still being depressed when I was taking antidepressants, but in fact I discovered I was completely normal – between 65 and 80 percent of people taking antidepressants are still depressed.
Now, it’s really important to say that’s not 100 percent. My book is not an argument against chemical antidepressants. And when it comes to chemical antidepressants, I really have only two things to say:
One is, they can’t continue to be the only thing on the menu, because for most people, they’re not working. That’s no disrespect to anyone for whom it is working, but they are a small minority.
Secondly, the story we’re told about these antidepressants is not true. That depression is caused by a chemical imbalance and therefore you need to fix the chemical imbalance – that claim, it astonished me, there is no scientific evidence for that.
Professor Andrew Skull at Princeton University says it is “deeply misleading and unscientific” to claim that depression is caused by low serotonin. Dr. David Healy, who is the main British expert on this, said to me, you can’t even say that theory has been discredited because there was never a time when it was credited. There was never a time when more than half the people in the field believed it – that was basically a claim put about by the drug company PRs.
FURTHER READING: Johann Hari talks to Stree Roots about 'the biggest moral issue about the war on drugs'
Emily Green: I was hoping that you could talk a little bit about what you discovered about all of the research – those peer-reviewed studies – that serves as evidence that chemical antidepressants work. What did you learn?
J.H.: We all know that when you take selfies, you take 29 pictures and you look like you’ve got a double chin or something, and you throw away those 29, and then the 30th one where you look good, you use that as your Tinder profile picture.
Basically a very similar thing has happened with the research in antidepressants. What happened is the drug companies only published the results where they looked good.
For example, there was one study where they studied over 250 people, and they only published the results of 27 of them – who happened to be the 27 for whom the antidepressants worked. So, we’ve ended up with a very distorted scientific picture.
What happens when you look at the real evidence, this was discovered by professor Irving Kirsch, is that while there are some people who get some relief from these drugs, they are a small minority of the people who are using the drugs.
We’ve been told that depression is just something that happens in our heads. It’s a malfunction in our skull, in our brain, and what I learned was actually that’s not true. Not entirely, but overwhelmingly, depression is a response to the way we’re living today.
That forces us to think about antidepressants in a very different way. One person that really helped me to understand this was a psychiatrist called Dr. Derek Summerfield.
He was in Cambodia in the early part of this century, when they were first introduced to chemical antidepressants, in Cambodia. He was explaining it to the doctors there, because they didn’t know what they were. And the doctors said, “Oh, we don’t need antidepressants. We’ve already got antidepressants.” And Derek said, “What do you mean?” So they told him a story.
There was a farmer who worked in the rice fields, and one day he stood on a landmine and got his leg blown off. After that, they gave him an artificial limb and he went back to work in the rice fields, but it was really painful to work in water when you’ve got an artificial limb. He was obviously in the same place where he’d gotten blown up – he was traumatized, he just cried all day and didn’t want to get out of bed. He was obviously depressed.
The doctors said, “Well, we gave him an antidepressant.” Derek said, “What do you mean?” They said, “We went and sat with him, we listened to why he was sad, we saw that it made sense, and so we figured if we bought him a cow and he became a dairy farmer, he wouldn’t be in the fields all the day, he wouldn’t be so upset, so we bought him a cow, and within a few weeks he stopped crying all the time, and now he’s fine.” They said to Derek, “So you see, doctor, that cow was an antidepressant.”
Now if you’ve been raised with the way that we’ve been taught to think about depression, which is that it’s just a chemical malfunction in your brain, now that sounds like a joke, right? But when you understand this deeper way of thinking about depression, that it’s actually a response to things happening in our lives, it makes perfect sense. The vast majority, if not all, of depressed people are depressed for perfectly understandable reasons – there are things happening to them that are making them depressed and anxious. And the core of the solution is not to try and muffle the symptoms, but to actually deal with why they feel so bad in the first place, by helping them to change their lives.
E.G.: As you went through the phase of your research where you were looking at the nine common causes of depression, was there anything that you found particularly surprising?
J.H.: There was this really interesting study by Gallup about people’s attitudes toward their work , and what it found was 13 percent love our work; we enjoy it and look forward to it. And 63 percent of people are what they called “sleepwalking through work.” They neither like it nor hate it. And 24 percent of people hate their work – hate it, dread it, fear it.
It’s kind of incredible: 87 percent of people don’t like the thing they’re doing most of the time, and you’re almost twice as likely to hate your work as love your work.
And so I began to wonder: Could there be some connection between this and depression? And it turns out there is a lot of evidence for this.
An Australian social scientist called Michael Marmot, who did the kind of definitive research on this – what he found is the less control you have over your work, the more likely you are to become depressed. Human beings have an innate need to feel that what they’re doing has meaning and purpose. And if you’re just controlled all the time, so you don’t have any autonomy, you can’t invest what you’re doing with meaning, and you will feel like shit. And this has been shown very clearly.
Now, to go back to the story about the cow, again, that opens up a very different way of thinking about antidepressants. That means that if someone is in a controlled workplace, they’re not depressed because something has gone wrong inside their brain; they’re depressed because something’s gone wrong in the world, and the way the world works.
I went to Baltimore to see an experiment in a different way of doing this, and there was this woman called Meredith Mitchell who used to go to bed every Sunday night just feeling sick with anxiety. She dreaded the week ahead. She worked in an office job. It wasn’t the worst office job in the world, but she just couldn’t believe that this was going to be the next 40 years of her life.
Her husband, Josh, had worked in bike stores in Baltimore since he was a teenager, and that’s very controlled work, and it’s very insecure work. One day Josh and his colleague thought, “What does our boss actually do all day while we fix all the bikes?”
Meredith and her husband, Josh, quit their jobs.
They decided to set up their own bike store, but they didn’t want to run it in the old way. What they did was run it as a democratic cooperative. They made all the decisions for the company together; they shared out the good tasks and the bad tasks; they shared all the profits. They had collective control.
What was interesting to me about Baltimore Bicycle Works was how quickly their depression and anxiety had gone away. It’s not like they quit their jobs fixing bikes and went to teach surfing in the Florida Keys. They fixed bikes before, and they fix bikes now. What changed was the aspect of work that makes people depressed, which is the lack of control.
E.G.: We all know people who have not suffered a major trauma, who have a nice house, who have a loving family, they seem to have it all – but they have depression. How do you explain that?
J.H.: If you read a lot of the feminist books from the ’60s, there’s a really common thing that they say, which is: Women would go to their doctor, they’d say to their doctor, “There is something wrong with my nerves because I’ve got everything a woman could possibly want. I’ve got a nice husband who doesn’t beat me, I’ve got a car, I’ve got two children, and yet I feel terrible.” And doctors would say, “Oh, you’re right,” and give them Valium or whatever.
Now, if we could go back in time and talk to those women, we’d say, “You’ve got everything a woman could possibly want, by the standards of the culture, but the standards of the culture are just wrong. You actually need much more than this culture is offering you. You need purpose, and you need to feel you have autonomy and meaning, and you need equality.”
I think that’s similar to what’s happening now. There are plenty of people who have everything you could possibly want but are still depressed. But they have everything you could possibly want by the standards of the culture, which has mistaken what human beings really need.
For thousands of years, philosophers have said, “If you think life is about getting money and status and showing off, you’re not going to be very happy.” But weirdly, no one had actually scientifically investigated this until this guy, Tim Kasser at Illinois State University, and basically what he shows is that there are two ways we can motivate ourselves as human beings.
If you play the piano in the morning just because you love playing the piano and it gives you joy, that’s an intrinsic motivation – you’re doing it not because you want to get something out of it, but just because you love the act itself.
If you play the piano in a dive bar that you hate, to pay the rent, or to impress a man to have sex with you or to please your parents, that’s an extrinsic reason for doing it. You’re not doing it because you love it, you’re doing it to get something out of it.
It turns out, the more you are driven by extrinsic motives, the more likely you are to become depressed and anxious, the more you will feel your life is inauthentic.
We have a culture which is constantly pushing us to live in an extrinsic way, to not do things because we think they’re valuable, but to do things in order to buy something else, in order to show something off, in order to look impressive on social media – just like junk food has hijacked our diet and made us physically sick, junk values have hijacked our minds, and made us mentally sick.
E.G.: You offer seven solutions to depression in your book – non-chemical forms of antidepressants, like the cow that you mentioned earlier. What are some simple changes that a typical person might be able to make in their life to become a happier person?
J.H.: One of the most interesting pieces of research I looked at, done by a guy called Dr. Brett Ford at the University of Berkeley, looked at if you consciously try to be happier, will you in fact become happier?
Dr. Ford and her colleagues studied this in four places: in the United States, in Taiwan, in Japan and in Russia. They found in the U.S., if you decided to consciously spend more time trying to be happier, you will not become happier, but in the other three places, you do. What they discovered is, if you try to become happier in the U.S., what you do is you try to pursue happiness for yourself. You buy stuff for yourself, you try to get a promotion for yourself, you build up your ego. We have an instinctually individualistic view of happiness. In the other countries, they had an instinctively collective sense of happiness, so if you tried to make yourself happier, what you do is you do something for your family. You do something for your community, you do something for someone else, not for yourself. And it turns out an individualistic model of happiness just doesn’t work. If it did, Donald Trump would be a very happy person, and he’s an incredibly miserable person, for example.
A collective vision of happiness, by contrast, does work.
Another thing would be based on the experiment happening in Canada in the ’70s. The liberal government at the time decided to do this experiment. They chose a town, seemingly at random, called Dauphin, and they said to everyone in this town, “We are going to give all of you a guaranteed basic income from now on.” I think it was the equivalent of about $17,000 in contemporary U.S. dollars. This continued for three years, and there were many results. But to me, the most interesting one was what happened to people’s mental health. There was a massive improvement in people’s mental health. Depression so severe that you had to be hospitalized fell by 90 percent. It didn’t happen in the surrounding areas.
That tells us that one of the things that’s making people depressed is profound insecurity in how we live. People who have income from property are 10 times less likely to develop anxiety disorder than people who don’t. Part of what’s making us anxious is that aspect of the way we live – and it’s an increasing insecurity. There’s a reason why depression massively spiked up after the 2008 crash, because a lot more people were insecure and having to work even harder to just keep their heads above water. And so universal basic income, which President Obama said could happen within 20 years, that is an antidepressant.
There are biological factors that can make you more sensitive to these social factors. So your genes, for example, can make you about 35 percent more sensitive to these things than someone who had a different genetic inheritance. But your genes aren’t causing it. They’re just making you more sensitive to these factors in the environment and in your psychology.
This requires us to really reframe what’s going on, because we’ve been told a story that has really disconnected us from the source of our own pain, and because we haven’t understood what’s causing it, the solutions that we’ve been using haven’t worked very well.
Email Senior Staff Reporter Emily Green at emily@streetroots.org . Follow her on Twitter @greenwrites
Street Roots is an award-winning, nonprofit, weekly newspaper focusing on economic, environmental and social justice issues. Our newspaper is sold in Portland, Oregon, by people experiencing homelessness and/or extreme poverty as means of earning an income with dignity. Learn more about Street Roots.
