All of us, even if do not suffer from depression ourselves, know people, often many people, who do suffer from it. It is telling that often, when we are informed that someone has depression, we ask whether it is ‘clinical depression’, a term that suggests that it is not some transient phenomenon caused by some immediate factor whose effects may decrease with time (like the death of a loved one), but is instead caused by something that is not just deep-rooted but also based in biology.
This way of thinking has resulted in the widespread prescribing of anti-depressants to control the levels of serotonin released into our brains, the lack of which is widely supposed to be a major cause of depression. Johann Hari was a columnist for the British newspaper The Independent. He is a good writer and I used to read him but then he disappeared from sight and I did not know why. I just learned that in 2011 he had been accused of plagiarism and that resulted in him losing his job.
He is back with a book about depression. He himself began to have depression when he was a teenager and was prescribed anti-depressants. His symptoms immediately went away but eventually came back and his dosage had to be increased. That cycle continued until he was taking large doses of drugs and still not getting relief. After 13 years of this, he started on a personal journey across the world to try to find out what was causing depression and how different people in different countries were dealing with it. He finds that there are more factors than biology at play and that we should not ignore them and focus too much on purely pharmaceutical solutions.
He presents the results of his investigations in the form of a book Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions and has published a long edited extract that summarizes his findings.
To find the answers, I ended up going on a 40,000-mile journey across the world and back. I talked to the leading social scientists investigating these questions, and to people who have been overcoming depression in unexpected ways – from an Amish village in Indiana, to a Brazilian city that banned advertising and a laboratory in Baltimore conducting a startling wave of experiments. From these people, I learned the best scientific evidence about what really causes depression and anxiety. They taught me that it is not what we have been told it is up to now. I found there is evidence that seven specific factors in the way we are living today are causing depression and anxiety to rise – alongside two real biological factors (such as your genes) that can combine with these forces to make it worse.
Once I learned this, I was able to see that a very different set of solutions to my depression – and to our depression – had been waiting for me all along.
…Let’s look at one of those causes, and one of the solutions we can begin to see if we understand it differently. There is strong evidence that human beings need to feel their lives are meaningful – that they are doing something with purpose that makes a difference. It’s a natural psychological need. But between 2011 and 2012, the polling company Gallup conducted the most detailed study ever carried out of how people feel about the thing we spend most of our waking lives doing – our paid work. They found that 13% of people say they are “engaged” in their work – they find it meaningful and look forward to it. Some 63% say they are “not engaged”, which is defined as “sleepwalking through their workday”. And 24% are “actively disengaged”: they hate it.
Most of the depressed and anxious people I know, I realised, are in the 87% who don’t like their work.
…It turns out if you have no control over your work, you are far more likely to become stressed – and, crucially, depressed. Humans have an innate need to feel that what we are doing, day-to-day, is meaningful. When you are controlled, you can’t create meaning out of your work.
…If you are depressed and anxious, you are not a machine with malfunctioning parts. You are a human being with unmet needs. The only real way out of our epidemic of despair is for all of us, together, to begin to meet those human needs – for deep connection, to the things that really matter in life.
In an interview, he talks about the things he did that brought him and his career down but also expands on the issue of depression.
There are three kinds of causes of depression and they interact. There’s the biological causes, which are real, and can make you more vulnerable to depression, but don’t cause it on their own. There’s environmental causes, which are about how we live together socially. And then there are psychological causes, which are about how we think about the world. Clearly, therapy speaks most to the psychological causes, which are very real. Therapy helped me to think about that aspect of it.
…I wouldn’t want to overstate [drugs’] ineffectiveness. Between 65 and 80% of people taking antidepressants become depressed again within a year. However, that’s not 100%. Of course some people would have recovered anyway through natural processes. I’m not critical of doctors for this. Part of the problem is that we’ve put the onus for solving these problems on to people who are not in a position to solve them alone.
…What this book is not is a simplistic guide saying: “Hey, I did these things, and now you can do them too.” I think that would be quite cruel because I was in this incredibly privileged position. I had money from my previous book, which meant that I could change my life in quite radical ways in order to strip out some of the causes of my depression. Lots of people are not in a position to do that.
A big part of the argument of the book is to say that we need to change our culture so that more of us are free to do the things that I was very fortunate to be able to do. In my own life I’ve been able to devote much less time to seeking status and external achievement and much more to engaging with what I think really matters, the people I love and the causes that I think are important. Before, when I started to feel bad, I would have done something for myself. Now, I can see it’s better to cheer someone else up. That’s had a radical effect on my mental health.
The tragedy is that, as Henry David Thoreau wrote, “The mass of men lead lives of quiet desperation” and one should not be surprised that this can trigger depression, esepcailly in people who may already have a biological susceptibility to it.
As with the treatment of pain, the pendulum seems to be swinging away from largely pharmaceutical responses to ones where the full context in which the problem occurs is being taken into account, so as to not risk solving one problem (pain or depression) while creating another (addiction).
Last word typo’d? Should be addiction, not addition?
Thanks! I have corrected it.
Admittedly, “creating another [problem]” is addition, so it kind of works.
“I wouldn’t want to overstate [drugs’] ineffectiveness. Between 65 and 80% of people taking antidepressants become depressed again within a year.”
I’m sorry, but no. Just no. Drugs save lives.
Depression does come and go. Some days are worse than others. That’s just how depression works.
https://www.google.co.uk/amp/s/amp.theguardian.com/science/brain-flapping/2018/jan/08/is-everything-johann-hari-knows-about-depression-wrong-lost-connections
@ sonoforjblake
I had just finished reading that when you published the link.
From my reading and a couple of discussions I have the impression that psychiatrists have been over-subscribing drugs, at least in the US and Canada for years. The battles over the most recent DSM seem to confirm this. This is not just for depression.
However, as WMDKitty, “Drugs save lives”. And they do. The proper drugs used appropriately can do wonders.
It is more that psychiatry does not seem to be doing enough to work on other treatments that can be used alone or in conjunction with drug therapies.
I have heard some very interesting results suggesting that something as simple as regular exercise programs can help with some (minor?) depressions. Certainly stress reduction seems a likely area for research. Both would be a bugger to research and probably to fund. RCT’s are not going to work.
I did find Dean Burnett’s jab at Irving Kirsch amusing. He says, “like Irving Kirsch who gets unwavering support from Hari despite not getting it from the wider psychiatric community”.
Duh, maybe Kirsch does not get support from the wider psychiatric community since a) he is not a psychiatrist, and b) claims, based on what looks like some pretty decent research, that many psychiatric drugs have little effect beyond a placebo effect. Suggesting to a profession that a good proportion of its armamentarium is up there with 19C bleeding and leaches is unlikely to endear one to practising psychiatrists.
I swear I heard an interview with a president of the American Psychiatric Association where he was almost gibbering when the topic of Kirsch’s research came up.
All that said, we still have an amateur diagnosing a field.
@ Mano
holistic approach may not be a felicitous phrase. It and terms such as “complimentary medicine” are often used by quacks and grifters to encourage the legitimization of pure quackery into the health field.
Damn it, “as WMDKitty says”.
This is totally personal and anecdotal, but I have been told clearly by psychiatrists whom I have seen that medications that they prescribe are not panaceas and that I can’t expect my difficulties (OCD in my case) to be solved by medication alone. Other factors are also important, ranging from cognitive behavioral therapy and consciously changing the way I think about certain things to what might be called “lifestyle” changes. I haven’t always been successful in keeping my OCD at bay, but the professionals I have worked with have been very up front about the fact that it is a complex problem and that there usually aren’t “magic bullet” solutions.
One cause of over dependence on medication might just be the time and expense involved with therapy, and the question of finding a good therapist who will accept your insurance.
I’d like to try LSD microdosing with guidance from a psychiatrist. It’s supposed to have good potential.
@ 8 springa
One cause of over dependence on medication might just be the time and expense involved with therapy and the question of finding a good therapist who will accept your insurance
I live in Canada where the expense and issue of insurance (to the patient) may not be a crucial factor but the availability of therapists is an constant problem.
This probably is at least partly related to overall funding in the field. I suspect it is also somewhat limited to our resources to train competent, well trained therapists even with decent funding.