I am a big fan of Johann Hari's previous work, Chasing the Scream, so I was looking forward to reading Lost Connections. For those not familiar with Johann Hari, he is an investigative journalist with a gift for distilling complex scientific data into layman's terms for the general public. If you are a fan of Malcolm Gladwell, you will find Hari's prose similar and his arguments and insights enlightening.
In Lost Connections, Hari tackles an enormous problem that has become manifest in the Western World since the 1990s—the rapid rise of depressed and anxious people and the use of Selective Serotonin Re-uptake Inhibitors (SSRIs) to correct the "faulty brain chemistry" that doctors have, for decades, said is the primary cause of both depression and generalized anxiety disorder. I would venture to guess that most people could point to at least one person in their life (either a family member or friend) who has suffered bouts of depression. Hari has a personal history with severe depression and anxiety dating back to his late-teenage years. As he admits, this was likely the result of childhood trauma (he doesn't elaborate, but he intimates that he grew up in a physically abusive environment at times), and he was medicated with Paxal, Prozac, and other SSRIs for roughly 14 years.
The book is peppered with dozens and dozens of interviews Hari conducted with leading experts in the clinical study of depression and anxiety from around the world. He is careful to distinguish his own opinions from those of the leading experts whom he quotes judiciously throughout the text.
Hari divides the book into roughly three parts. In the first, he reflects back on the fact that no matter what anti-depressant he took he would always experience a regression back into the trough of depression. Thus, the first part of his investigative journey into studying the causes and treatments of depression is to find out how effective SSRIs really are for treating depression. This portion of the book will likely be difficult for many people to stomach, especially if they have taken SSRIs and believe in their efficacy. But, based on the evidence Hari collects, it appears that Big Pharma has systematically obscured the true success rate of SSRI treatment. Many leading experts now concur in their opinion that only about 1/4 of patients receiving an SSRI actually see some benefit from its chemical composition—for the other 75% it operates more as a placebo, but with severe side-effects such as rapid weigh gain, sweating, and impotence.
His conclusion in this first portion of the book is that depression and anxiety must have other psychological and social causes that cannot be reduced simply to a physiological problem within the brain. This is such an overtly simply point that its incredulous physicians, psychologists and others have not really thought about depression/anxiety as a mental state resulting from multiple, complex problems in a person's life. However, throughout, Hari shows how Big Pharma and its legions of scientists producing reams of reports on the efficacy of SSRIs and the neurochemical origins of depression have turned "brain problems" into a $100 billion dollar industry.
The second part explores the psychological and social causes of depression. I won't elaborate overmuch, but Hari breaks it down into roughly seven causes:
1. The lack of meaningful work—i.e. studies have found 87% of people either hate their job or find it mentally deadening. This "disconnection" (a term Hari uses throughout the book) can potentially cause depression and anxiety.
2. The loss/lack of social connections—i.e. There is a distinction between talking to people throughout the day and having meaningful relationships that enrich your life. Studies have shown that in the western world, more people report having zero "true" friends in their lives, despite the irony that we are far more "connected" to each other through social media now. The lack of meaningful social connections leads to loneliness which, studies have shown, increase stress and the likelihood of becoming depressed/anxious.
3. Childhood trauma—this is self-explanatory. Victims of child abuse, sexual abuse, etc. are far more likely to become depressed/anxious as adults unless they have some way of coping with past trauma.
4. Poor cultural values ("junk values")—summed up as the western obsession with materialism and the pursuit of wealth for extrinsic reasons. Numerous studies show that the more an individual connects their self-worth to their material possessions, the more likely they are to be depressed or unhappy.
5. Cut off from the natural world—this is a smaller chapter in the book, but suggests that city-living has disconnected us from our "natural" environment and there are implications there for becoming depressed.
6. Problems of Respect/Status—this is related to employment, but some very interesting studies found that those who worked within the bottom of hierarchies and thus did not feel respected, valued, or acknowledged in their daily work were far more likely to be stressed and/or depressed.
7. The Brain—within the context of these various social and psychological origins of depression, Hari brings back into the conversation "brain chemistry." Studies have suggested that when things go wrong in our lives and we become depressed that it actually does change our brain in various ways (i.e. brain plasticity) that can exacerbate our feelings of despair and unhappiness.
The third, and final, part of the book tentatively explores some remedies to depression outside of pharmacological intervention. These are mostly intuitive solutions related to the six primary psychological and social causes of depression. For example, seeking out meaningful work (he explains some ways that people have achieved this seemingly impossible goal), reconnecting with others through social organizations, meditation, etc.
On the whole, I thought this was a brilliant book that offers fresh perspectives on depression and anxiety. There are many aspects of the book that I can see people criticizing harshly.
For some, they will read this as an attack on the efficacy of SSRIs, or a condescending message to get off pharmaceutical drugs. But an important point to make is that Hari does not suggest people abandon SSRIs or other drugs. He is not Tom Cruise on the Today Show rebuking and ridiculing people for "drugging themselves." Indeed, Hari himself took SSRIs for over a decade. Instead, what he is arguing is that in many cases, SSRIs are not enough to overcome depression and anxiety if you have not fixed the psychological and social problems that have likely caused it and continue to aggravate it.
Others will inevitably say: "Well, that may be true for X, Y and Z...but what about this other form of depression you haven't covered?" Or, "well you say not having a meaningful job causes depression, but I have meaningful work and I'm still depressed." In both of these cases, which I alway call "You didn't write the book I wanted to read criticisms," he readily acknowledges that his six or seven causes and solutions are no where near the end all of the conversation. More so, he tends to limit his discussion of depression and anxiety for severe forms of clinical depression. Although he could have done a better job defining his terms, I do not think he is really talking about postpartum depression, seasonal affective disorder, or even grieving (although he touches on this subject to an extent). He primarily gears his discussion to his own experiences with a severe, ongoing, and persistent form of clinical depression that did not respond well to pharmacological intervention.
High recommend!
