I just finished reading Johann Hari’s book, Lost Connections: uncovering the real causes of depression-and the unexpected solutions, and it was eye opening and well put together. It would not be an understatement to say that Hari pulled the rug out from under a decades old conspiracy. Dismantling the notion that depression and anxiety are caused by chemical imbalances in the brain, and simply require us to take SSRI’s (selective serotonin reuptake inhibitors) such as Celexa, Prozac, Paxil, and Zoloft. This problem is in fact- not so simple. Hari embarks on a journey around the world, documenting and detailing the personal and environmental causes. Hari shows us how we’ve been looking at this problem the wrong way for far too long.
Let us look at how Hari breaks down the causes of depression and anxiety:
Disconnection: Nine Causes of Depression and Anxiety
Cause One: Disconnection from Meaningful Work
Cause Two: Disconnection from Other People
Cause Three: Disconnection from Meaningful Values
Cause Four: Disconnection from Childhood Trauma
Cause Five: Disconnection from Status and Respect
Cause Six: Disconnection from the Natural World
Cause Seven: Disconnection from a Hopeful or Secure Future
Causes Eight and Nine: The Real Role of Genes and Brain Changes
Reconnection: Or, a Different Kind of Antidepressant
Reconnection One: To Other People
Reconnection Two: Social Prescribing
Reconnection Three: To Meaningful Work
Reconnection Four: To Meaningful Values
Reconnection Five: Sympathetic Joy, and Overcoming the Addiction to the Self
Reconnection Seven: Restoring the Future
Before diving into the real causes of depression, Hari, Driven by his own long battle with depression, seeks to understand the old notion that most people are depressed because there is a chemical imbalance in the brain. Which has been brought on through the persons genes, or other things completely out of control of the depressed person. In the mid 20th century scientists and doctors studying depression made a guess about a certain chemical (serotonin) and hypothesized that raising the levels of serotonin in depressed people could potentially help them recover. Of course there is nothing wrong with making guesses in science, this is how we discover new things. We make educated guesses on the information we have, test, review the data, and adjust. The problem comes when we don’t adjust, and we get fooled into a particular thinking for long enough that it becomes something most of us, non-sciencey people, will take for granted is scientific- when in fact it’s not. This could be for political reasons, or more likely, monetary. The problem is, Antidepression medication does work- a little- for some people. Scientists now know that SSRI’s can have a 1.8 point decrease on the Hamilton scale (Rating scale for depression). But this improvement is even less that what we can gain from getting a good nights rest- and potentially caused by placebo type effects. The ‘real’ solutions to depression are not so easy to nail down. What has been known for decades but for some reason is getting lost in the wash is that depression and anxiety are cause by biological, psychological and social changes. But the solutions, most of the time, are not so easy to see.
Let’s go to the book
I went to see one of the first scientists to study these new antidepressants in Britain, Professor David Healy, in his clinic in Bangor, a town in the North of Wales. He has written the most detailed history of antidepressants we have. When it comes to the idea that depression is caused by low serotonin, he told me: “There was never any basis for it, ever. It was just marketing copy. At the time the drugs come out in the early 1990’s, you couldn’t have got any decent expert to go on a platform and say, ‘Look, there’s a lowering of serotonin in the brains of people who are depressed’… There wasn’t ever any evidence for it.” It hasn’t been discredited, he said, because “it didn’t ever get ‘credited,’ in a sense. There wasn’t ever a point in time when 50 percent of the field actually believed it.” In the biggest study of serotonin’s effects on humans, it found no direct relationship with depression. Professor Andrew Skull of Princeton has said attributing depression to low serotonin is “deeply misleading and unscientific.”
Wow. So now, here in the 21st century, something that many of us believe to be a common scientific known, was never actually shown to be the case. And once the pharmaceutical companies heard a whif of a potential drug that had to be taking daily, and by an increasing number of the population, well the rest is history. It’s a sad truth that while finding the cure to, say cancer, would be the achievement of a lifetime, it will not pay out as well as drugs that need to be taking daily for the rest of the ‘customers’ life- sleeping pills, anxiety medications, allergy meds, etc.
Well it’s easy to see why the pharmaceutical companies started to push SSRI’s, and why the desperately depressed were so easy to grasp onto a seemingly so simple intervention. Why though, did the scientific community, or the public as a whole, never push back on this theory and question it.? Why not thoroughly study the evidence and efficacy, and publish what was going on?
It’s a tough subject. There is still stigma and shame associated with mental health. And working in this environment, I see it. It is so complex and there is so much to learn and understand. Things have come a long way, but there is a lot we don’t know. Because this is such a hard subject to broach, especially to someone who is suffering, most don’t. There is so much in our society that is dedicated to our physical health, but finding care for mental health, especially acute care, is almost impossible. Almost all hospital emergency rooms do not have a mental health expert during the triage process, first responders may have some training, but are focused on preserving life and limb (rightly so), and telephone help lines and internet programs for those in a crisis are virtually unknown. Most just resort to dialing 911. The public tends to avoid the subject of mental health, and in my opinion, has contributed to why this myth about low serotonin has persisted for so long.
I wont talk about all the causes, but let’s look at a few
Cause One: Disconnection from Meaningful Work
In the book Hari talks with Joe, a paint salesman from the United Sates. Joe works hard but he feels no connection to the job, he’s not ‘in it’. He sleepwalks through his job and dreams of being a fishing guide off the coast of Florida. How many people out there work jobs like Joe’s? But get stuck in a feedback loop where they can’t break out because, of course, they don’t have time to follow their passion- they have to pay the bills and most passion projects won’t put food on the table.
To the book,
He would leave home around seven in the morning, work all through the day, and get home at seven at night. He began to wonder - you “go through this forty- to fifty-hour workweek, and if you don’t really like it, you’re just setting yourself up for depression, and anxiety. And questioning- why and I doing this? There’s got to be something better than this.” He started to feel, he said, that there was “no hope. What’s the point?”
“You have to be challenged in a healthy way,” he told me, shrugging a little; I think I feel embarrassed to say it. “You have to know your voice counts. You have to know that if you have a good idea, you can speak up, and change something.” He had never had a job like that, and he feared he never would.
It’s easy to see how this situation will cause someone mental stress and ultimately depression. But what can we do about it? Hari points out a few things, including starting a cooperative work environment with the other employees to create an environment where everyone has an impact. I love this idea and think it’s spot on. But what if you can’t radically change your job or your work environment right away? Maybe you can find meaning somewhere else? Is there an organization you would like to volunteer for? Could you start an organization of your own? Maybe it’s as small as creating and curating an online community of people who are into the same weird hobbies as you. Maybe you start a side hussle in the hopes of becoming your main job in a few years. Make your own T-shirts, buy and sell cheap stuff you found online or at garage sales, or create some how-to videos on YouTube about something your particularly good at.
These commitments don’t have to be too much. A couple hours in the evening one day, or on the weekends. It will take some work, yes, but if it’s work you love, it doesn’t matter. It will be 10 times better for you in the long run instead of sitting on your ass and watching Netflix for 2 hours. If you dread going to work everyday and you have 30 more years of it, it’s not an understatement to say- your life may depend on it.
Cause Two: Disconnection from Other People
To think of this next cause you might pause and say to yourself- well since the internet has been invented we are now, more than ever, connected to each other. Yes for sure, we have access to more people in more places than we ever have before. But are we really connected to them? Take a look at the average suburban neighborhood. There’s probably around 100 to 150 people living in 3 or 4 blocks and almost all of them don’t even know each other’s names. Not only that, people would rather spend their day inside their homes interacting with their immediate family, instead of getting to know the people in their neighborhoods. Of course this is just a generalizing and not indicative off all neighborhoods and the people that are in them, but with the increasing number of hours we spend at work and the time we dedicate to our children and our families, there is hardly enough time left in the day to socialize with our immediate world.
We now live in a more and more lonely world. Even though there are now 7 billion people on this planet. Johann Hari talks in his book about a theory that, because we lived in tight knit bands of 100 to 150 people for thousands of years, we developed an alarm system for making sure anyone who got caught stuck alone out of his or her group would be driven back to the safety and security of the tribe. But now, because we are forcing ourselves to live a lonely life, this alarm system- an ominous and anxious feeling- is being left uncorrected for far too long that it’s causing depression.
Hari writes about talking with a neuroscience researcher named John
… For example, John learned that in the Dakotas, there’s a very closed, highly religious farming community- a bit like the most fundamentalist wing of the Amish- called the Hutterites. They live off the land, and they work and eat and worship and relax together. Everyone has to cooperate the whole time…
So John teamed with anthropologists who had been studying the Hutterites for years, to figure out how lonely the Hutterites are. There’s one neat way to test it. Anywhere in the world where people describe being lonely, they will also- throughout their sleep- experience more of something called “micro-awakenings”. These are small moments you won’t recall when you wake up, but in which you rise a little from your slumber. All other social animals do the same thing when they’re isolated too. The best theory is that you don’t feel safe going to sleep when you’re lonely, because early humans literally weren’t safe if they were sleeping apart from the tribe. You know nobodys got your back- so your brain wont’ let you go into full sleep mode. Measuring these “micro-awakenings” is a good way of measuring loneliness. So John’s team wired up the Hutterites, to see how many of them they experienced each night.
It turned out they had barely any. “What we found was that the community showed the lowest level of loneliness that I’d seen anywhere in the world,” John explained to me. “It literally stunned me.”
This is eye opening for sure. Not only because of the data gathered from the Hutterites, but the link between sleep disruption and loneliness. Talk with your friends and family, your colleagues at work. You will discover that trying to get a good night’s rest is a huge battle for the majority of people. What can we do? How can we connect with more of our Tribe? Well, after reading this chapter, I asked my neighbor if he wanted to help me put on a BBQ on our street. Invite everyone that lives on our block and let them know were having a big get together. The more we know our community, the families, the lives, the goals and the problems, we will be in a better position to support each other. There are other things too. Our kids play in sports leagues, why can’t we? There are lots of adult sports leagues out there. Who cares if you are no good. Get out there, get some exercise, have some fun, make some new connections, and get some better sleep.
Cause six: Disconnection from the Natural World
Yes, even in Canada- with all this space, we are still becoming increasingly disconnected from nature. And this is something that we hold as very important to our mission with Warrior Adventures Canada. Taking people out into the wilderness to experience nature (and experience themselves within the natural environment) away from all the distractions of the 21st century, we’ve noticed a great effect.
A group of scientists at the University of Essex in Britain have conducted the most detailed research into this question so far. They tracked the mental health of more than five thousand households over three years. They wanted to look at two types of households in particular-people who moved from a leafy green rural area to the city, and people who moved from a city to a leafy green rural area. They wanted to know-Would there be any changes in how depressed they got?
What they found was clear: the people who moved to the green areas saw a big reduction in depression, and the people who moved away from the green areas saw a big increase in depression. This was just one of many studies with similar findings, it turns out.
This is a relatively easy fix for most of us. We can all find ways to add a little of the natural world into our lives. We can get outside more on the weekends, even if it’s as simple as eating a meal in the backyard. And, if we have time, we can take a walk or run through a green space on our lunch break at work. These might seem like too simple, too short, and not enough time to have an impact. But there has been a study that compared the mental health of two groups who exercised for 30 minutes a day. One group ran for 30 minutes on a treadmill and the other ran outside. When the study concluded, it showed the group that ran outside had a measurable lower rate of depression and anxiety.
I’ve only just scratched the surface of this book, and I hope you pick it up and read it- there is so much in there. The battle against mental health is a tough one. It’s a long war. We’ve been taking 2 steps forward and 1 step back for 50 years. But we must keep working at it, we must keep learning. Johann Hari’s book is definitely 2 steps forward.
There is so much happening in our lives. So many outside forces playing against us. How is our doctor suppose to know what’s really going on with us when we walk into her office and say- I feel sad. Our doctors shouldn’t be whipping out the prescription pad and writing down a script for Zoloft. They should be asking about your life. Or better yet, you should be asking that question first. And of course there are extenuating circumstances. If your mother, or brother, or someone you love has just died, you are going to feel like shit. Your are going to be grieving and you’re going to be depressed. It’s when we don’t know why we feel that way, when it’s been years in the trenches. Our bodies are sending us a signal. We need to look in the mirror and asks ourselves- What is my body trying to tell me?