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

by Johann Hari

“The field is just sick and bought and corrupted, and I can’t describe it otherwise.” I asked him how it made him feel to have learned all of this. “It’s depressing,” he said. That’s ironic, I replied. “But it’s not depressing,” he responded, “to the severe extent that I would take SSRIs [antidepressants].” I tried to laugh, but it caught in my throat.

“We know that SSRIs [the new type of antidepressants] in particular contribute to sexual dysfunction, and the rates for most SSRIs are around 75 percent of treatment-engendered sexual dysfunction,”

there was something significant about the fact that grief and depression have identical symptoms. Then one day, after interviewing several depressed people, I asked myself: What if depression is, in fact, a form of grief—for our own lives not being as they should? What if it is a form of grief for the connections we have lost, yet still need?

This showed that experiencing something really stressful can cause depression.

It turned out depressed women were three times more likely to be facing serious long-term stressors in their lives in the year before they developed their depression than women who didn’t get depressed. It wasn’t just a bad event that caused depression—it was also long-term sources of stress. And if you had some positive stabilizing things in your life, that massively reduced the chances of developing depression. For every good friend you had, or if your partner was more supportive and caring, it reduced depression by a remarkable amount.

two things make depression much more likely—having a severe negative event, and having long-term sources of stress and insecurity in your life. But the most startling result was what happened when these factors were added together. Your chances of becoming depressed didn’t just combine: they exploded. For example—if you didn’t have any friends, and you didn’t have a supportive partner, your chances of developing ...

every bad thing that happened to you, every source of stress, every lack of support—each one accelerated the risks of depression more and more. It was like putting a fungus in a place that’s dark and wet. It wouldn’t just grow more than it would in a place that was just dark, or...

depression is—in fact—to a significant degree a problem not with your brain, but with your life. After it was published, one professor—summarizing the general view among scientists—called it “a quantum leap ahead”12 in our understanding.

We are told in our culture that depression is the ultimate form of irrationality: that’s how it feels from the inside, and that’s how it looks to the outside. But on the contrary, George and Tirril were reaching the conclusion that, as they wrote then, “clinical depression is an understandable response to adversity.”13 Think about Mrs. Trent, trapped in a dead marriage with a man who couldn’t get work, scrambling to survive, with no chance of a better life—she was being given a guarantee that her life would be a stressful, joyless scramble forever. Didn’t it make more sense, they wondered, to say the “fault” for her depression lay “in the environment,14 rather than in the person”?

data showed it was too crude to say the poverty caused the depression. No: something more subtle was happening. People in poverty were more likely to become depressed because on average they faced more long-term stress, and because more negative life events happened to them, and because they had fewer stabilizers. But the underlying lessons were true for everyone, rich, middle-class, or poor. We all lose some hope when we’re subjected to severe stress, or when something horrible happens to us, but if the stress or the bad events are sustained over a long period, what you get is “the generalization of hopelessness,” Tirril told me. It spreads over your whole life,15 like an oil slick, and you begin to want to give up.

It wasn’t just a problem caused by the brain going wrong. It was caused by life going wrong.

evidence that environmental factors are a key part of depression and anxiety was steadily building up among academics, until in most scientific circles it became undeniable.

Most mainstream training courses began to teach that forms of mental distress such as depression and anxiety have three kinds of cause: biological, psychological, and social.19 They are all real. This is known as the “bio-psycho-social model.”20 It’s simple. All three sets of factors are relevant, and to understand a person’s depression and anxiety, you need to look at them all.

I realized every one of the social and psychological causes of depression and anxiety they have discovered has something in common. They are all forms of disconnection. They are all ways in which we have been cut off from something we innately need but seem to have lost along the way.

Cause One: Disconnection from Meaningful Work

“You have to be challenged in a healthy way,” he told me, shrugging a little; I think he felt embarrassed to say it. “You have to know that 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. If you spend so many of your waking hours deadening yourself to get through the day, it’s hard—he explained—to turn that off and be engaged with the people you love when you get home.

he knew he should be grateful. But he said he couldn’t stand the thought that his life would be like this for another thirty-five years until he retired. “Like—you like what you do, right?” he said to me. I stopped writing in my notebook for a moment. “When you wake up in the morning, you look forward to your day. When I wake up, I don’t look forward to work … It’s just something I have to do.”

63 percent say they are “not engaged,” which is defined as “sleepwalking through their workday, putting time—but not energy or passion—into their work.” And a further 24 percent are “actively disengaged.” They, Gallup explained, “aren’t just unhappy at work; they’re busy acting out their unhappiness. Every day, these workers undermine what their engaged co-workers accomplish … Actively disengaged employees are more or less out to damage their company.”

Nearly twice as many people hate their jobs as love their jobs.

this thing that most of us don’t like doing—that feels like sleepwalking, or worse—now takes up most of our waking lives.

nine to five is indeed a relic of the past.

A common symptom of depression is something called “derealization”4—which is where you feel like nothing you are doing is authentic or real.

they die a little when they come to work each day, because their work touches no part of them that is them.”

“Disempowerment,” Michael told me, “is at the heart12 of poor health”—physical, mental, and emotional.

If these tax inspectors worked really hard and gave it their best, nobody noticed. And if they did a lousy job, nobody noticed, either. Despair often happens, he had learned, when there is a “lack of balance between efforts and rewards.”

depth and intellectual with all that stuff, but when it comes down to it—doing anything, and not having a purpose behind it, and then feeling like you don’t have any other option except to continue: it’s terrible. At least for me, it turns into—well, what’s the point?”

Feeling lonely, it turned out, caused your cortisol levels to absolutely soar—as much as some of the most disturbing things that can ever happen to you. Becoming acutely lonely, the experiment found,2 was as stressful as experiencing a physical attack. It’s worth repeating. Being deeply lonely seemed to cause as much stress as being punched by a stranger.

In this state of nature, connection and social co-operation did not have to be imposed … Nature is connection.”

it meant that when they were with the tribe, they had an incentive to treat people well so they didn’t get thrown out. “A strong impulse in favor of connection,” he explains, “simply produces better outcomes for survival.” Or, as he told me later: loneliness is “an aversive state that motivates us to reconnect.”

“Evolution fashioned us not13 only to feel good when connected, but to feel secure,” John writes. “The vitally important corollary is that evolution shaped us not only to feel bad in isolation, but to feel insecure.”

the Hutterites. They live off the land, and they work and eat and worship and relax together. Everyone has to cooperate the whole time.

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,

the community showed the lowest level of loneliness that I’d seen anywhere in the world,”

loneliness isn’t just some inevitable human sadness, like death. It’s a product of the way we live now.

There are all sorts of ways human beings can come together to do something as a group—from a sports team, to a choir, to a volunteer group, to just meeting regularly for dinner. He has been gathering figures for decades about how much we do all these things—and he found they have been in free fall.

bowling is one of the most popular leisure activities in the United States, and people used to do it in organized leagues—they would be part of a team that competed against other teams, who would mingle and get to know each other. Today, people still bowl, but they do it alone. They’re in their own lane, doing their own thing. The collective structure has collapsed.

“In the ten short years between 1985 and 1994”17 alone, he wrote, “active involvement in community organizations … fell by 45 percent.” In just a decade—the years of my teens, when I was becoming depressed—across the Western world, we stopped banding together at a massive rate, and found ourselves shut away in our own homes instead. We dropped out of community and turned inward, Robert explained when I spoke with him. These trends have been happening since the 1930s, but they hugely accelerated during my lifetime.

people’s sense that they live in a community, or even have friends they can count on, has been plummeting.

how many people you could turn to in a crisis, or when something really good happens to you. When they started doing the study several decades ago, the average number of close friends an American had was three. By 2004, the most common answer was none.18

there are now more Americans who have no close friends than any other option.

And it’s not that we turned inward to our families. The research he gathered showed across the world we’ve sto...

The structures for looking out for each other—from the family to the neighborhood—fell apart. We disbanded our tribes. We embarked on an experiment—to see if humans can live alone.

All through my childhood, until my early teens, I had a daydream. It was that my parents’ friends—who were scattered across the country, and who we’d see only a few times a year—would all move to live on our street, and I’d be able to go and sit with them when things were hard at home, which was a lot of the time. I would have this daydream every day. But our street consisted only of other people, equally shut away, equally alone.

When her mother and stepfather asked her what was wrong, she couldn’t find the vocabulary to explain it. But then, finally, she said she felt homesick, like when she was at summer camp. She said this to the interviewer, Terry Gross20 of NPR’s Fresh Air, with puzzlement. She had felt homesick. But she was at home.

When we talk about home today, we mean just our four walls and (if we’re lucky) our nuclear family. But that’s never been what home has meant to any humans before us. To them, it meant a community—a dense web of people all around us, a tribe. But that is largely gone.

Protracted loneliness causes you to shut down socially, and to be more suspicious of any social contact, he found. You become hypervigilant. You start to be more likely to take offense where none was intended, and to be afraid of strangers. You start to be afraid of the very thing you need most. John calls this a “snowball” effect, as disconnection spirals into more disconnection.

Lonely people are scanning for threats because they unconsciously know that nobody is looking out for them,

This snowball effect, he learned, can be reversed—but to help a depressed or severely anxious person out of it, they need more love, and more reassurance, than they would have needed in the first place. The tragedy, John realized, is that many depressed and anxious people receive less love, as they become harder to be around. Indeed, ...

What is loneliness? This turned out to be unexpectedly difficult to answer. When he asked people “Are you lonely?” they wouldn’t find it hard to see what he was talking about, but it’s hard to pin down.

it turned out that feeling lonely was different from simply being alone. Surprisingly, the sensation of loneliness didn’t have much to do with how many people you spoke to every day, or every week.