Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions

Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions

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...

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Title:Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions
Author:Johann Hari
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Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions Reviews

  • Mallory

    I received a copy of this book for free from NetGalley in exchange for an honest review.

    First, I would like to note that, as a psychiatric nurse, I like to consider myself a mental health professional who knows a little something about things like depression and anxiety. Second, I’m also certified in choice theory/reality therapy, which meshes pretty well with a lot of ideas in this book. Third, as someone who copes with (self-diagnosed) anxiety and depression, I’d like to think I know a few th

    I received a copy of this book for free from NetGalley in exchange for an honest review.

    First, I would like to note that, as a psychiatric nurse, I like to consider myself a mental health professional who knows a little something about things like depression and anxiety. Second, I’m also certified in choice theory/reality therapy, which meshes pretty well with a lot of ideas in this book. Third, as someone who copes with (self-diagnosed) anxiety and depression, I’d like to think I know a few things. So there’s what I feel qualifies me to make the statement I’m about to make:

    “Duh.”

    That’s what I kept saying over and over throughout this book. As the author went through his reasons for depression, I was dumbfounded that these aren’t all accepted by the medical and psychiatric community without question. Then he gets into the scientific studies and actual research, and you may actually start to feel angry (like I did) that they aren’t. Then, if you’re as entrenched in this system as I am, you’ll know why.

    The picture of a patient laying on a couch, telling the psychiatrist all of their problems is an antiquated picture of the mental health system. Somehow, over the years, the psychiatrist’s couch has moved from a place to discuss the problems in your life and hypothesize how they came to be, to a place where you list off symptoms and are given a drug that’s supposed to fix everything. This book is important to the field of psychiatry, I only wonder how long it will take for the mainstream psychiatrists and mental health professionals to realize it.

    In conclusion, if you didn’t feel like reading this rambling review: read this book, it’s important. Even if you don’t think you’re depressed, read it. You know someone who is and maybe this book can help you to help them, even if you find nothing personally useful in it (though I’d be surprised if you didn’t).

  • Sam (Rescue Dog Mom, Writer, Hugger)

    I thank the author for writing this book and the person who gifted me a copy. Finally, the truth!!

    Every psychiatrist who believes that serotonin chemical imbalance in the brain is the reason for depression and anxiety should read this book! Anyone taking prescribed anti-depressants and not finding relief from their symptoms needs to read this book. Like the author, I was diagnosed with depression and anxiety at a young age and prescribed medication. For years I tried many different drugs includi

    I thank the author for writing this book and the person who gifted me a copy. Finally, the truth!!

    Every psychiatrist who believes that serotonin chemical imbalance in the brain is the reason for depression and anxiety should read this book! Anyone taking prescribed anti-depressants and not finding relief from their symptoms needs to read this book. Like the author, I was diagnosed with depression and anxiety at a young age and prescribed medication. For years I tried many different drugs including SSRI's, SNRI's, and even NDRI's. From some, I would experience relief for a brief period of time, but it would always wear off and my doctor would increase the dosage, then eventually switch me to a different drug. Some actually worsened my depression and anxiety and even caused difficult health issues that the drug companies like to call "side effects."

    I agree with the author on the actual reasons for depression and anxiety. It makes complete sense that having more negative and painful experiences than positive and happy occasions in your life will cause you to be depressed, anxious, and even suicidal. I've seen it happen with family and friends and have experienced it myself. It's not something to be simply dismissed as just a bad day. It's much more than that. It's numerous and severe negative incidents in life that can cause one to retreat and withdraw from society as a mode of self-protection. The cumulative effect can become debilitating for many people and also lead to self-deprecating behavior. Crying so hard and feeling actual physical pain and believing the world would be better off without you is a serious crisis that requires immediate attention. At that point it's extremely difficult, if not impossible, to have the courage to seek social interaction in hopes of obtaining positive and happy social experiences.

    If I knew then what I know now, I would not have taken any of these medications and I believe I'd be healthier both mentally and physically. I also wouldn't have wasted so much money, as some of these medications were not covered by insurance and are quite expensive. If you are suffering depression and anxiety and are taking prescribed anti-depressants that are not working for you, I encourage you to read this book with an open mind. If you know of someone who is suffering, I urge you to recommend this book to them. If you don't suffer anxiety or depression, I kindly ask you to try to understand what it's like for those of us that do.

    This book was thoroughly researched, is very well-written and easy to read. I sincerely thank you for reading my open and honest review.

  • Michelle

    Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions is by renowned UK author journalist Johann Hari. Through extensive research and interviews with a host of experts, educators and other medical professionals; the connection between depression and anxiety is established with its huge impact on all aspects of humanity. In addition, Hari shared his own stories of near death illness after food poisoning in Vietnam, and diagnosis with depression and acute anxiety

    Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions is by renowned UK author journalist Johann Hari. Through extensive research and interviews with a host of experts, educators and other medical professionals; the connection between depression and anxiety is established with its huge impact on all aspects of humanity. In addition, Hari shared his own stories of near death illness after food poisoning in Vietnam, and diagnosis with depression and acute anxiety and his prescribed treatment with psychiatric medication.

    The UK has the highest antidepressant use in Europe, 1 in 10 male American high school students are prescribed powerful stimulants for focus and attention deficits, 1 in 5 Americans are taking medication for psychiatric conditions. Addiction to illicit opioid substance has reached epidemic levels in the USA; with the life expectancy of white males decreasing for the first time in peacetime history.

    With the use of psychiatric medication skyrocketing, it is easy to trace the history of usage. For decades nearly all of the research, development of psychotropic medications are funded, advertised, marketed, and heavily promoted for public consumption by powerful corporate interests in the pharmaceutical industry. Hari found that studies submitted for FDA approval always presented these drugs in the most favorable conditions even if the clinical trial evidence showed no difference between the use of antidepressants vs. placebo’s. The side effects, he noted are very real: weight gain, profuse sweating, and sexual dysfunction. In the worst cases, there may be an increased risk of suicide. The 1960’s pop singer Dale Shannon reportedly committed suicide after taking Prozac. Despite the pharmaceutical industry payouts of exorbitant sums of money from lawsuit claims, the profit margins are increasingly higher than ever.

    There are several instances noted of the placebo effect: The “Perkins” Wand of Dr. John Haygarth at Bath General Hospital (1799) was highly effective when moved (without touching) over a patient with debilitating pain, treatments were repeated as needed with much success. During WWII when morphine ran out on the battlefield, soldiers were told that the IV saline solution was morphine-- it worked!

    When Hari began taking Seroxat (Paxill)-- he believed in the “chemical imbalance of the brain” theory. Many doctors believed that depression was caused by reduced levels of serotonin in the brain. Since no one actually knows what a chemically balanced brain looks like, this claim or explanation is a “myth” with no scientific proof according to professor Jo Anna Moncrief (University College London). Hari found his depression and sadness remained or returned after the dosages of his medication were increased, the same in 65%-85% of other patient data studies.

    Traveling over thousands of miles, Hari visited an Amish Village in Indiana to compare levels of anxiety and depression and the reasons the Amish remain separated from mainstream society. A housing project in Berlin, and a city in Brazil that banned public advertising were studied along with a clinic in Baltimore that researched the effects and experience of trauma. “Chasing The Scream” (2015) wasn’t as challenging for him to write as this book, since we have been “systematically misinformed” regarding depression and anxiety. Hari presents 9 proven causes related to disconnection with suggestions ways to reconnect that will heal and transform lives. **With thanks and appreciation to Bloomsbury Publishing USA UK via NetGalley for the DDC for the purpose of review.

  • Heather

    I included these quotes because I simply don't possess the ability -

    - to express this better than Hari did in the conclusion of this book.

    I read

    and was mind-blown by it. It challenged everything I thought I believed about drug addiction, and made an

    argument, with solid proof. This book did exactly the same thing -

    and detailed the ways he believes we, as a society, can and must change that, and it makes SO MUCH SENSE.

    I will most certainly, without a doubt, read anything

    writes.

    Not only is his research extremely extensive, he presents his findings -

    - in a way that is so easy to understand. So easy that I often found myself wondering how I didn't realize it myself, how it isn't common knowledge.

    , read this. It will really challenge you, and it will most certainly help you, and the world around you.

  • Lisa Vegan

    The book’s description field at Goodreads (

    ) 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 c

    The book’s description field at Goodreads (

    ) 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.”

  • Leo Robertson

    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 re

    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

    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

    ?! 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.

    Go you!

  • Trevor

    Disclaimer: It is not the intention of this review to tell you how you should or should not medicate yourself. Personally, I would not take anti-depressant drugs in a pink fit, and have, in the past, refused them when they have been offered to me by well-meaning doctors. You should do what you think is best given advice from your doctor – with that said, read this book so you might have some questions to ask that doctor when and if they tell you to self-lobotomise (or whatever it is the chemical

    Disclaimer: It is not the intention of this review to tell you how you should or should not medicate yourself. Personally, I would not take anti-depressant drugs in a pink fit, and have, in the past, refused them when they have been offered to me by well-meaning doctors. You should do what you think is best given advice from your doctor – with that said, read this book so you might have some questions to ask that doctor when and if they tell you to self-lobotomise (or whatever it is the chemicals they want you to buy ultimately do).

    In 2010 (one of the benefits of good reads is knowing when I read stuff) I read a book called ‘Doctoring the Mind’ – in many ways this book is an updated and slightly more left wing version of that. I would encourage you to read this book, because, well, because we live in a society that is literally driving us all insane and we need to do something about that, and what needs to be done will be more difficult and demanding than swallowing a pill, sorry about that, but it had to be said. And this book provides ways and means that could help us all shift away from our current insanity and maybe even get well.

    Like Doctoring the Mind this book argues that most depressive illnesses are simply not due to dysfunctions in brain chemistry, dysfunctions that need to be addressed by expensive tables conveniently produced by extremely wealthy drug companies – but rather that most depressive illnesses are completely predictable and rational responses to a world that is insane. Therefore, trying to fix these ‘illnesses’ by focusing on the individual and the chemistry in their brain is not only not likely to work, but in fact perpetuates the situation that caused the illness in the first place.

    In one of her books, bell hooks says that she never takes aspirin. This isn’t because she is some sort of masochist, but rather because she believes that aspirin is a metaphor for everything that is wrong in our society. People do not feel pain without a reason, pain means there is something causing you to feel pain in the situation you find yourself in. Aspirin does not address the cause of your pain, rather it removes the pain, it removes the warning that the situation you are in is causing you damage. That is, aspirin masks your need to change. When I first started going to the gym one of the instructors there told me to never take anti-inflammatory pain killers for exactly the same reason. Fix your technique, doing the wrong thing and covering the pain that causes with drugs is the road to being crippled with lasting and serious pain.

    This book confirms virtually all of my prejudices, so, naturally enough, it is getting 5 stars and recommended. I’ve already gotten my mother to read it, a woman at work and suggested it to my eldest daughter. So, what are those confirmed prejudices? Well, first of all that we are fundamentally social animals and so if something goes wrong with us, we ought to at least consider our social situation as being potentially implicated. Both Doctoring the Mind and this book stress that mental illnesses can have three causes: biological, psychological and social. The point is that for decades we have only considered one of these causes and therefore only one set of treatments. We have only concerned ourselves with the biological and that means we have only considered how brain chemistry might be the reason for these illnesses. When I first studied philosophy at university some of the people in the class were also studying psychology and I overheard one of them say when recommending someone to go see for some therapy, “make sure you go see a psychologist, not a psychiatrist, because a psychiatrist will only try to give you drugs”. Isn’t that disgusting.

    This book shows that very few depressive illnesses have anything at all to do with brain chemistry and that therefore the treatments that seek to adjust one’s brain chemistry (via drugs) are simply never going to work. He provides lots of metaphors for this – one of my favourites being trying to treat the smoke coming out of a house by blowing it away with a huge fan, something that will only make the fire inside the house that you can’t see all the worse.

    I’ve only just finished reading Bullshit Jobs – and this is a complementary story to that one. There is an excellent chapter in this about how feeling you are doing pointless work makes you feel worthless and therefore causes you real damage. And yet, the whole point of modern capitalism is to make the majority of the population virtual automatons. In fact, this is precisely the lesson of Taylor’s Scientific Management – that workers are too stupid to know how best to perform their work in the most efficient ways and so they need to submit themselves unquestioningly to the will of the scientific manager. In fact, the less the worker uses their brain, the more effective they will be. However, we know that feeling you have no control over your own actions and living in a world in which you feel completely disassociated is about as good a definition of mental illness as you can get. To be human is to be efficacious – ironically enough though, those most likely to promote the benefits of scientific management are also those who speak loudest in favour of freedom, although, admittedly they generally talk of ‘freedom from’ government regulations, rather than ‘freedom to’ do anything other than choose between various consumer goods.

    I’ve never been all that attracted to meditation – in fact, I think we are far too obsessed with ourselves and too many of those I’ve met in the past who have spoken to me about meditation have seemed a bit too self-obsessed. But there is a nice bit in this book where he talks about meditating for 15 minutes each day in an attempt to feel real joy at the good fortune of other people, even of the good fortune of your enemies or people you envy. He also talks of the deep psychological benefits that come from truly doing something to help other people. I think this is just wonderful.

    Like I said, I have a profound belief that we are primarily social animals but that modern society has moved us so far away from belonging to communities that someone like Margaret Thatcher can say there is no such thing as society and people might even well believe it. I don’t believe it. The further we become atomised, the less human we become, and the more e sick and isolated and depressed we become as a consequence. We end up suffocating in our own self-loathing. The answer is not to turn further inward, but rather to come back home to the connections that really matter.

    I want to end with something he says quite early on in the book. There are a lot of grave stones in the world – mostly these tell how much the person was loved by their friends and their family. None of them say ‘Here lies John, one of the truly great accountants of his age’. Our society forces us to be isolated individuals. We need to reconnect, it’s for our own good.

  • Zora

    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

    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.

  • Emmy Gregory

    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 ti

    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.

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