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

by Johann Hari

depression was caused by low serotonin levels, and these drugs boosted your serotonin levels.

This is called “publication bias.”7 Of all the studies drug companies carry out, 40 percent are never released to the public, and lots more are only released selectively, with any negative findings left on the cutting room floor.

When it comes to the idea that depression is caused by low serotonin, he told me: “There was never any basis for it, ever. It was just marketing copy.

So Irving asked: What do the people taking these different drugs actually have in common? Only, he found, one thing: the belief that the drugs work. It works, Irving believes, largely for the same reason that John Haygarth’s wand worked: because you believe you are being looked after and offered a solution.

The term doesn’t really make any sense, she said: we don’t know what a “chemically balanced” brain would look like. People are told that drugs like antidepressants restore a natural balance to your brain, she said, but it’s not true—they create an artificial state. The whole idea of mental distress being caused simply by a chemical imbalance is “a myth,” she has come to believe, sold to us by the drug companies.

So the authors of the DSM invented a loophole, which became known as “the grief exception.”3 They said that you are allowed to show the symptoms of depression and not be considered mentally ill in one circumstance and one circumstance only—if you have recently suffered the loss of somebody close to you. After you lose (say) a baby, or a sister, or a mother, you can show these symptoms for a year before you are classed as mentally ill.

“Staying connected to the pain of her death helps me to do my work with such a full, compassionate heart,” and to live as fully as she can. “I integrated that guilt and shame that I felt, and the betrayal, by serving others,”

As Joanne Cacciatore researched the grief exception in more detail, she came to believe it revealed a basic mistake our culture is making about pain, way beyond grief. We don’t, she told me, “consider context.”5 We act like human distress can be assessed solely on a checklist that can be separated out from our lives, and labeled as brain diseases.

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?

So George and Tirril had discovered that 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 depression when a severe negative life event came along were 75 percent.11 It was much more likely than not.

“clinical depression is an understandable response to adversity.”

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.

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.

But he found himself thinking, as he put it to me, “Where’s the ability to change? Where’s the ability to grow? Where’s the ability to really make an impact on this company that I’m working for? Because anyone can just show up on time, do what they tell you to do.”

“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.”

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

The higher up you went in the civil service, he found, the more friends and social activity you had after work. The lower you went, the more that tapered off—the people with boring, low-status jobs just wanted to collapse in front of the television when they got home.

It is, he told me, having to endure “work [that] is monotonous, boring, soul-destroying; [where] 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.

Despair often happens, he had learned, when there is a “lack of balance between efforts and rewards.”

It’s worth repeating. Being deeply lonely seemed to cause as much stress as being punched by a stranger.

Loneliness itself, John was slowly discovering as he pieced together the evidence, seemed to be deadly. When they added up the figures, John and other scientists found that being disconnected from the people around you had the same effect on your health as being obese5—which was, until then, considered the biggest health crisis the developed world faced.

lonely people are also anxious, have low self-esteem, are pessimistic, and are afraid other people will dislike them.

The only problem was that he didn’t have any money to fill the prescription, so he was sitting there, weeping, alone.

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, so no one will help them if they are hurt.

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.

A one-way relationship can’t cure loneliness. Only two-way (or more) relationships can do that. 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.

The comedian Marc Maron28 once wrote that “every status update is a just a variation on a single request: ‘Would someone please acknowledge me?’ ”

The difference between being online and being physically among people, I saw in that moment, is a bit like the difference between pornography and sex: it addresses a basic itch, but it’s never satisfying.

But more than that—our obsessive use of social media is an attempt to fill a hole, a great hollowing, that took place before anyone had a smartphone. It is—like much of our depression and anxiety—another symptom of our current crisis.

materialistic people, who think happiness comes from accumulating stuff and a superior status, had much higher levels of depression and anxiety.

The first are called intrinsic motives7—they are the things you do purely because you value them in and of themselves, not because of anything you get out of them.

At the same time, there’s a rival set of values,8 which are called extrinsic motives. They’re the things you do not because you actually want to do them, but because you’ll get something in return—whether it’s money, or admiration, or sex, or superior status.

That is what your head starts to look like when you become more materialistic. If you are doing something not for itself but to achieve an effect, you can’t relax into the pleasure of a moment. You are constantly monitoring yourself. Your ego will shriek like an alarm you can’t shut off.

Capitalism is always telling you more, more, more. Your boss is telling you work more, work more, work more. You internalize that and you think: Oh, I’ve got to work more, because my self depends on my status and my achievement. You internalize that. It’s a kind of form of internalized oppression.”

Flick through an Instagram feed or a glossy magazine, and your normal-shaped body will feel disgusting to you. Go to work and you’ll have to obey the whims of a distant boss earning hundreds of times more than you.

The more unequal your society, the more prevalent all forms of mental illness are. Other social scientists then broke this down to look at depression specifically16—and found the higher the inequality, the higher the depression.

Today, we are living with status gaps that are bigger than any in human history. If you work for a company, in living memory19 it used to be that your boss would likely earn twenty times more than the average employee. It’s now three hundred times more.

What they found was clear: the people who moved to green areas saw a big reduction in depression,6 and the people who moved away from green areas saw a big increase in depression.

When it came, I would only be able to think about the next few hours: how long they would seem, and how painful they would be. It was as if the future vanished.

How do you develop your sense of identity? How do you know who you are? It seems like an impossibly big question. But ask yourself this: What is the connecting thread that runs from your baby self, vomiting out teething biscuits, to the person who is reading this book now? Will you be the same person twenty years from now? If you met her, would you recognize her? What is the relationship between you in the past and you in the future? Are you the same person all along?

At some profound level, Michael had discovered, extremely depressed people have become disconnected from a sense of the future,

When she heard friends talking about mortgages and pensions, it sounded to her almost utopian—dispatches from a country she could only visit.

She couldn’t conjure any sense of herself in the future that looked any different from the way it did today: “I’m terrified of being as poor when we’re in our sixties and seventies as we were in our twenties,” she said.

The Italian philosopher Paolo Virno says11 we have moved from having a “proletariat”—a solid block of manual workers with jobs—to a “precariat,” a shifting mass of chronically insecure people who don’t know whether they will have any work next week and may never have a stable job.

Physiology is always paralleling psychology. It just does.” A brain scan is “a snapshot of a moving picture,” he says.

You couldn’t figure out the plot of Breaking Bad7 by dismantling your TV set. In the same way, you can’t figure out the root of your pain by dismantling your brain. You have to look at the signals the TV, or your brain, is receiving to do that.

“It is no measure of health to be well-adjusted to a sick society.”

Social scientists have known for a long time that—to put it crudely—there is a significant difference between how we think of ourselves in Western societies and how people in most of Asia conceive of themselves.