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by
Johann Hari
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May 28 - June 4, 2023
Without talking about it much, we’ve accepted that a huge number of the people around us are so distressed that they feel they need to take a powerful chemical every day to keep themselves together.
Everything that causes an increase in depression also causes an increase in anxiety, and the other way around. They rise and fall together.
The forces that are making some of us depressed and severely anxious are, at the same time, making even more people unhappy.
Scientists measure the depth of someone’s depression using something named the Hamilton scale, which was invented by a scientist named Max Hamilton in 1959. The Hamilton scale ranges from 0 (where you’re skipping along merrily) to 51 (where you’re jumping in front of trains). To give you a yardstick: you can get a six-point leap in your Hamilton score if you improve your sleeping patterns.
What Irving found is that, in the real data that hadn’t been run through a PR filter, antidepressants do cause an improvement in the Hamilton score—they do make depressed people feel better. It’s an improvement of 1.8 points.
In the biggest study of serotonin’s effects on humans, it found no direct relationship9 with depression.
Some people said to Irving—so what? Okay, so say it’s a placebo effect. Whatever the reason, people still feel better. Why break the spell? He explained: the evidence from the clinical trials suggests that the antidepressant effects are a largely a placebo, but the side effects are mostly the result of the chemicals themselves, and they can be very severe.
the proportion of people on antidepressants who continue to be depressed is found to be between 65 and 80 percent.
Almost everybody who is grieving, it turns out, matches the clinical criteria for depression. If you simply use the checklist, virtually anyone who has lost someone should be diagnosed as having a clear mental illness.
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?
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.
“clinical depression is an understandable response to adversity.”
“I mean—it seems incredible now, really, to think that we had to convince people that life events were relevant [to depression and anxiety], you know?” Tirril Harris—the coauthor of this research—said to me,
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
The concept of “work hours” is vanishing for most people—so this thing that 87 percent of us don’t enjoy is spreading over more and more of our lives.
If you plotted it on a graph, as your position in the civil service rose, your chances of developing depression fell, step by step. There was a very close relationship between becoming depressed and where you stood in the hierarchy.
If you worked in the civil service and you had a higher degree of control8 over your work, you were a lot less likely to become depressed or develop severe emotional distress than people working at the same pay level, with the same status, in the same office, as people with a lower degree of control over their work.
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.”
“You could do it tomorrow,” I said. “What’s stopping you?” There’s a part of all of us, he says, that thinks “if I keep buying more stuff, and I get the Mercedes, and I buy the house with the four garages, people on the outside [will] think I’m doing good, and then I can will myself into being happy.” He wanted to go. Yet he was being blocked by something neither he nor I fully understood.
Cause Two: Disconnection from Other People
Loneliness hangs over our culture today like a thick smog. More people say they feel lonely than ever before—and I wondered if this might be related to our apparent rise in depression and anxiety.
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.
What he wanted to know was—would the isolated people get sicker than the connected people? It turned out that they were three times more likely to catch the cold than people who had lots of close connections to other people.
The people who had been triggered to feel lonely became radically more depressed, and the people who had been triggered to feel connected became radically less depressed.
For example, social scientists have been asking a cross-section of U.S. citizens a simple question for years: “How many confidants do you have?” They wanted to know 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.
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. Our sense of home has shriveled so far and so fast it no longer meets our need for a sense of belonging. So we are homesick even when we are at home.
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.
To end loneliness, you need other people—plus something else. You also need, he explained to me, to feel you are sharing something with the other person, or the group, that is meaningful to both of you.
Loneliness isn’t the physical absence of other people, he said—it’s the sense that you’re not sharing anything that matters with anyone else.
If you’re a typical Westerner27 in the twenty-first century, you check your phone once every six and a half minutes. If you’re a teenager, you send on average a hundred texts a day. And 42 percent of us never turn off our phones. Ever.
When we look for an explanation for how this change happened, we keep being told it’s mainly caused by something inside the technology itself. We talk about how each new e-mail that arrives in your in-box gives you a little dopamine hit. We say there’s something about smartphones themselves that is addictive. We blame the device. But as I spent time in this Internet rehab center, and as I reflected on my own Internet use, I began to wonder if there was a different and more truthful way of thinking about it.
Of all the people they’ve treated at this rehab center, Hilarie told me, there are certain things almost everyone has in common. They were all anxious or depressed before the compulsion began. For the patient, the Internet obsession was a way of “escaping his anxiety, through distrac...
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The compulsive Internet use, she was saying, was a dysfunctional attempt to try to solve the pain they were already in, caused in part by feeling alone in the world.
Cause Three: Disconnection from Meaningful Values
For thousands of years, philosophers2 had been suggesting that if you overvalue money and possessions, or if you think about life mainly in terms of how you look to other people, you will be unhappy
materialistic people, who think happiness comes from accumulating stuff and a superior status, had much higher levels of depression and anxiety.
when he calculated them out,9 were quite startling. People who achieved their extrinsic goals didn’t experience any increase in day-to-day happiness—none.
But people who achieved their intrinsic goals did become significantly happier, and less depressed and anxious. You could track the movement. As they worked at it and felt they became (for example) a better friend—not because they wanted anything out of it but because they felt it was a good thing to do—they became more satisfied with life.
they found that the more materialistic you become, the shorter your relationships will be, and the worse their quality will be. If you value people for how they look, or how they impress other people, it’s easy to see that you’ll be happy to dump them if someone hotter or more impressive comes along.
If you are doing something not for itself but to achieve an effect, you can’t relax into the pleasure of a moment.
When you are extremely materialistic, Tim said to me, “you’ve always kind of got to be wondering about yourself—how are people judging you?” It forces you to “focus on other people’s opinions of you, and their praise of you—and then you’re kind of locked into having to worry what other people think about you, and if other people are going to give you those rewards that you want.
All of us have certain innate needs—to feel connected, to feel valued, to feel secure, to feel we make a difference in the world, to have autonomy, to feel we’re good at something. Materialistic people, he believes, are less happy—because they are chasing a way of life that does a bad job15 of meeting these needs.
In 1978, two Canadian social scientists got a bunch of four- and five-year-old kids and divided them into two groups. The first group was shown no commercials. The second group was shown two commercials for a particular toy. Then they offered these four- or five-year-old kids a choice. They told them: You have to choose, now, to play with one of these two boys here. You can play with this little boy who has the toy from the commercials—but we have to warn you, he’s not a nice boy. He’s mean. Or you can play with a boy who doesn’t have the toy, but who is really nice. If they had seen the
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Tim told me people can apply these insights to their own life, on their own, to some extent. “The first thing is for people to ask themselves—Am I setting up my life so I can have a chance of succeeding at my intrinsic values? Am I hanging out with the right people, who are going to make me feel loved, as opposed to making me feel like I made it? … Those are hard choices sometimes.”
Cause Four: Disconnection from Childhood Trauma
When five of his colleagues came in to conduct further interviews, it turned out some 55 percent of the patients in the program had been sexually abused—far more than people in the wider population. And even more, including most of the men, had had severely traumatic childhoods.
It turned out that for every category of traumatic experience you went through as a kid, you were radically more likely to become depressed as an adult. If you had six categories of traumatic events in your childhood, you were five times9 more likely to become depressed as an adult than somebody who didn’t have any. If you had seven categories of traumatic events as a child, you were 3,100 percent10 more likely to attempt to commit suicide as an adult.
Curiously, it turned out emotional abuse was more likely12 to cause depression than any other kind of trauma—even sexual molestation. Being treated cruelly by your parents was the biggest driver of depression, out of all these categories.
Cause Five: Disconnection from Status and Respect
