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

by Johann Hari

But I was going to learn that neither of these stories is true. The primary cause of all this rising depression and anxiety is not in our heads. It is, I discovered, largely in the world, and the way we are living in it. I learned there are at least nine proven causes of depression and anxiety (although nobody had brought them together like this before), and many of them are rising all around us—causing us to feel radically worse.

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.

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.

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. But if you continued to be profoundly distressed after this deadline, you will still be classified as having a mental disorder. As the years passed and different versions of the DSM were published, the time limit changed: it was slashed to three months, one month, and eventually just two weeks.

In most cases, Joanne says, we would have to stop talking about “mental health”—which conjures pictures of brain scans and defective synapses—and start talking about “emotional health.” “Why do we call it mental health?” she asked me. “Because we want to scientize it. We want to make it sound scientific. But it’s our emotions.”

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.

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

So Michael explained to the tax office bosses that a lack of control and a lack of balance between efforts and rewards were causing such severe depression that it was leading their staff to suicide.

loneliness, he concluded, is causing a significant amount of the depression and anxiety in our society.

So every human instinct is honed not for life on your own, but for life like this, in a tribe. Humans need tribes12 as much as bees need a hive.

I think I understand what was happening to her. 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.

When the results came back4 and were all calculated out, Tim was struck by the results: materialistic people, who think happiness comes from accumulating stuff and a superior status, had much higher levels of depression and anxiety.

When he calculated out the results, he found—again—higher depression among the materialistic students; but there was a result more important than that. It really did seem that materialistic people were having a worse time, day by day, on all sorts of fronts. They felt sicker, and they were angrier. “Something about a strong desire for materialistic6 pursuits,” he was starting to believe, “actually affected the participants’ day-to-day lives, and decreased the quality of their daily experience.” They experienced less joy, and more despair.

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. When a kid plays, she’s acting totally on intrinsic motives—she’s doing it because it gives her joy. The other day, I asked my friend’s five-year-old son why he was playing. “Because I love it,” he said. Then he scrunched up his face and said “You’re silly!” and ran off, pretending to be Batman. These intrinsic motivations persist all through our lives, long after childhood.

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.

What he wanted to know was—Does achieving extrinsic goals make you happy? And how does that compare to achieving intrinsic goals?

The results, 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. They spent a huge amount of energy chasing these goals, but when they fulfilled them, they felt the same as they had at the start. Your promotion? Your fancy car? The new iPhone? The expensive necklace? They won’t improve your happiness even one inch.

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. Being a better dad? Dancing for the sheer joy of it? Help...

Materialism is KFC for the soul.

to study two hundred people in depth, and 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. And at the same time, if all you’re interested in is the surface of another person, it’s easy to see why you’ll be less rewarding to be around, and they’ll be more likely to dump you, too. You will have fewer friends and connections,12 and they won’t last as long.

There’s strong scientific evidence that we all get most pleasure from what are called “flow states”13 like this—moments when we simply lose ourselves doing something we love and are carried along in the moment.

But when Tim studied highly materialistic people, he discovered they experience significantly fewer flow states14 than the rest of us. Why would that be? He seems to have found an explanation. Imagine if, when Tim was playing the piano every day, he kept thinking: Am I the best piano player in Illinois? Are people going to applaud this performance? Am I going to get paid for this? How much? Suddenly his joy would shrivel up like a salted snail.

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.

That’s a heavy load to bear, instead of walking around doing what it is you’re interested in doing, or being around people who love you just for who you are.”

You have to picture all the values that guide why you do things in your life, Tim said, as being like a pie. “Each value” you have, he explained, “is like a slice of that pie.

And the pressure, in our culture, runs overwhelmingly one way—spend more; work more. We live under a system, Tim says, that constantly “distracts us from what’s really good about life.” We are being propagandized to live in a way that doesn’t meet our basic psychological needs—so we are left with a permanent, puzzling sense of dissatisfaction.

For millennia, humans have talked about something called the Golden Rule. It’s the idea that you should do unto others as you would have them do unto you. Tim, I think, has discovered something we should call the I-Want-Golden-Things Rule.17 The more you think life is about having stuff and superiority and showing it off, the more unhappy, and the more depressed and anxious, you will be.

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.” But often, he says, you will hit up against a limit in our culture. You can make improvements, but often “the solutions to the problems that I’m interested in can’t be easily solved at the individual person level, or in the therapeutic consulting room, or by a pill.” They require something more—as I was going to explore later.

Obesity, he realized, isn’t the fire. It’s the smoke.

“It takes away an experiential process and substitutes a mechanistic process.” It turns your pain into a trick of the light that can be banished with drugs.

When they were finally able to plot the data on a graph, they were startled by how close the relationship was. 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. This is true if you compare different countries,17 and if you compare different states within the United States.

When you have a society with huge gaps in income and status, Richard told me, it creates the sense that “some people seem supremely important, and others seem of no importance at all.” This doesn’t affect only people at the bottom. In a highly unequal society, everyone has to think about their status a lot. Am I maintaining my position? Who’s threatening me? How far can I fall? Just asking these questions—as you have to when inequality grows—loads more and more stress into our lives.

It was, he concluded, the loss of the future that was driving the suicide rates up. A sense of a positive future protects you. If life is bad today, you can think—this hurts, but it won’t hurt forever. But when it is taken away, it can feel like your pain will never go away.

I wanted to see it as a brain malfunction, I realized now—because I didn’t want to see what our culture was doing to him. I was like a doctor telling a 1950s housewife that the only reason a woman could be unhappy—without work, without creativity, and without control over her own life—was a defect in her brain or nerves.

It turns out that you were more likely to hurt somebody if you believed their mental illness was the result of their biochemistry than if you believed it was the result of what had happened to them in life. Believing depression was a disease didn’t reduce hostility. In fact, it increased it.

The first thing that happens when you’re told this is “you leave the person disempowered, feeling they’re not good enough—because their brain’s not good enough.” The second thing is, he said, that “it pitches us against parts of ourselves.” It says there is a war taking place in your head. On one side there are your feelings of distress, caused by the malfunctions in your brain or genes. On the other side there’s the sane part of you. You can only hope to drug the enemy within into submission—forever.

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

He had explained to me: It’s not the work itself that makes you sick. It’s three other things. It’s the feeling of being controlled—of being a meaningless cog in a system. It’s the feeling that no matter how hard you work, you’ll be treated just the same and nobody will notice—an imbalance, as he puts it, between efforts and rewards. And it’s the feeling of being low on the hierarchy—of being a low-status person who doesn’t matter compared to the Big Man in the corner office.

It’s not so much what happens in those fifteen minutes—Rachel has come to feel that “you’re planting seeds during the meditation, [and] it flowers spontaneously during your day, and your life.”

The goal was to offer the patient two things at the same time. The first was an opportunity to describe the traumatic experience—to craft a story about it, so the patient could make sense of it. As this experiment began, one of the things they discovered almost immediately is that many of the patients had literally never before acknowledged what happened to them to another human being.

Depression and anxiety have three kinds of causes—biological, psychological, and social. They are all real, and none of these three can be described by something as crude as the idea of a chemical imbalance. The social and psychological causes have been ignored for a long time, even though it seems the biological causes don’t even kick in without them. These causes aren’t some kooky fringe theory, I would explain.

“Mental health is produced socially: the presence or absence of mental health is above all a social indicator and therefore requires social, as well as individual, solutions.”

You aren’t a machine with broken parts. You are an animal whose needs are not being met. You need to have a community. You need to have meaningful values, not the junk values you’ve been pumped full of all your life, telling you happiness comes through money and buying objects. You need to have meaningful work. You need the natural world. You need to feel you are respected. You need a secure future. You need connections to all these things. You need to release any shame you might feel for having been mistreated.

You are not suffering from a chemical imbalance in your brain. You are suffering from a social and spiritual imbalance in how we live. Much more than you’ve been told up to now, it’s not serotonin; it’s society. It’s not your brain; it’s your pain. Your biology can make your distress worse, for sure. But it’s not the cause. It’s not the driver. It’s not the place to look for the main explanation, or the main solution.

For decades, long before these new antidepressants were developed, we have been disconnecting—from each other, and from what matters. We have lost faith in the idea of anything bigger or more meaningful than the individual, and the accumulation of more and more stuff. When I was a child, Margaret Thatcher said, “There’s no such thing as society, only individuals and their families”—and, all over the world, her viewpoint won. We believed it—even those of us who thought we rejected it. I know this now, because I can see that when I became depressed, it didn’t even occur to me, for thirteen years, to relate my distress to the world around me. I thought it was all about me, and my head. I had entirely privatized my pain—and so had everyone I knew.

In a world that thinks there’s no such thing as society, the idea that our depression and anxiety have social causes will seem incomprehensible. It’s like talking in ancient Aramaic to a twenty-first-century kid.

Big Pharma was offering the solution that an isolated, materialistic culture thought it needed—one you can buy. We had lost the ability to understand that there are s...

Depression and anxiety might, in one way, be the sanest reaction you have.6 It’s a signal, saying—you shouldn’t have to live this way, and if you aren’t helped to find a better path, you will be missing out on so much that is best about being human.

You need your nausea. You need your pain. It is a message, and we must listen to the message. All these depressed and anxious people, all over the world—they are giving us a message. They are telling us something has gone wrong with the way we live. We need to stop trying to muffle or silence or pathologize that pain. Instead, we need to listen to it, and honor it. It is only when we listen to our pain that we can follow it back to its source—and only there, when we can see its true causes, can we begin to overcome it. To

Any and all errors in this book are entirely my responsibility. It’s very important to me to make sure all the facts in this book are correct. If our extensive fact-checking process has missed any errors, please e-mail me at chasingthescream@gmail.com and we’ll get them corrected in later editions—go to this book’s website for a full list of any I have been made aware of.