What really causes depression and anxiety? And how can we genuinely solve these issues? Answering these questions is the task journalist Johann Hari sets himself in his newly released book, Lost Connections.
Needless to say, these are big and complex questions. But Hari makes significant progress by placing depression in its material, social context: a world that is increasingly falling apart, with “treatment” provided by a system that is equally falling apart.
This is a refreshing and holistic approach. All too often the subject of depression, and mental health in general, is treated in a narrow, biological way. Underlying causes are overlooked. But there is - despite what Margaret Thatcher may have asserted - such a thing as society.
A symptom of a deeper problem
In the first chapter, Hari exposes the fraud of scientific studies sponsored by big pharmaceutical companies. This research is done for a very specific reason: the pharma giants want to be able to market their own drugs and make a profit out of them. That is why the drug companies conduct studies in secret, and only publish the results that make their products look good.
When you delve deeper, as Hari does together with several scientists, it turns out that a large proportion of studies show that many major antidepressants are about as effective as a placebo. All that it takes to get a drug approved is two trials showing some success. This means that you could have “a situation in which there are 1000 scientific trials, and 998 find the drug doesn’t work at all”.
The opening chapters also cast doubt on the ‘serotonin story’. This essentially diagnoses depression as being a chemical imbalance in the brain. But the science for this is weak. As one interviewee says:
“[This approach is] like putting a band-aid on an amputated limb. [When] you have a person with extreme human distress, [we need to] stop treating the symptoms. The symptoms are messengers of a deeper problem. Let’s go to the deeper problem.” (p43)
Not surprisingly, in-depth studies that have been done in the field - with hundreds of depressed people interviewed and checked against a control group - show that experiencing something really stressful can cause depression.
One large-scale study in particular showed that depressed women were three times more likely to face long-term stressors in their lives in the year before they developed their depression than women who didn’t get depressed.
But it is not just a traumatic event that can cause depression - there are also long-term sources of stress. If you have some positive stabilisers in your life, that greatly reduces the chances of developing depression.
It has therefore been discovered that two things make depression much more likely. Firstly, having a severe negative event (like the loss of a child). And secondly, having long-term sources of stress and insecurity in your life (such as with work or finances). When these factors are added together, the chances of developing depression not only combine – they increase exponentially.
It has been proved that depression is, to a significant degree, not a problem of the brain, but of life in general. In that sense, depression is not a mystical and irrational illness. It is a very rational and understandable response to the adverse conditions of capitalist society.
“Disconnection” from work and people
The second part of the book examines some of the factors that Hari calls “disconnection”. To his credit the author names as cause no.1: disconnection from meaningful work.
The book follows a few people stuck in meaningless jobs. For example, there is Joe, who works in a paint shop in Philadelphia, and who mixes paint day in and day out.
“Nobody ever noticed whether Joe did it well or badly. The only thing his boss ever commented on was if he was late, and then he’d get bawled out.” (p61)
We are also presented with the case of UK civil servants in the 1970s. These office workers are divided into grades, with strict levels that determine how much they get paid and how much responsibility they are given at work. Researchers wanted to examine whether those differences affect physical and mental health.
“At this time, most people thought they already knew the answer, and so this study was pointless. Picture a man running a big government department, and a guy whose job – eleven steps down the pay scale – is to file his papers and type up his notes. Who’s more likely to have a heart attack? Who’s more likely to be overwhelmed? Who’s more likely to become depressed? Almost everyone believed the answer was clear: it was the boss. He has a more stressful job. He has to take really tough decisions, with big consequences. The guy doing his filing has a lot less responsibility; it will weigh on him less; his life will be easier.” (p67)
After years of intense interviewing, however, it turned out that the people at the top of the civil service were four times less likely to have a heart attack than the people at the bottom of the Whitehall ladder. Furthermore, 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.
The question then was: as you rise up in the civil service, what actually changes in your work that explains this shift? The answer is (lack of) control. “Think about your own life…Just examine your own feelings. Where you feel worst about jobs – and probably life – is when you feel out of control.” (p68)
“The worst stress for people isn’t having to bear a lot of responsibility. [It is having to endure] work that is monotonous, soul-destroying; [where people] die a little when they come to work each day, because their work touches no part of them that is them.” (p69)
The need for community
Other causes of “disconnection” are the disconnection from other people. Various social experiments show that the more friends and healthy social connections you have, the less likely you are to become ill or depressed. Loneliness, in particular, causes a significant amount of depression and anxiety in modern capitalist society.
But why? Here the book goes back into history and points to human evolution.
“Human beings first evolved in the savannas of Africa, where we lived in small hunter-gatherer tribes of a few hundred people or less. You and I exist for a reason – because those humans figured out how to cooperate. They shared their food. They looked after the sick…They only made sense as a group.” (p77)
The example is given of humans who became separated from the group and were alone for a protracted period of time. This isolation meant you were in terrible danger and vulnerable to predators. If you got sick nobody would be there to nurse you. And the rest of the tribe was more vulnerable without you too. You would be right to feel terrible. Humans need tribes as much as bees need a hive. We need to belong and we need a purpose.
Harvard professor Robert Putnam is mentioned for documenting an important trend of our time: the rapid decrease of things we as humans do as a group. From sports teams, to choirs, to volunteer groups: all of these social activities have been in free fall for decades.
The example given is bowling in the United States - one of the most popular American leisure activities. People used to do this in organised leagues, as part of a team competing against other teams. Now people still bowl, but they do it alone, in their own lane. The collective structure has collapsed and the sense of community has mostly gone.
Later chapters deal with a plethora of other causes of depression. The loss of meaningful values; trauma; disconnection from nature; disconnection from a secure future; and the real role of genes (confirming the dialectical materialist position put forward in Reason and Revolt: genetic disposition matters, but the decisive influence is one’s environment).
Up until this point, when dealing with the causes of depression, the book is very readable and interesting. Less convincing are the solutions offered in the final part.
To be fair, the author goes to great lengths to identify possible ways, in his words, to “reconnect”. Hari makes the point that you could fill aircraft hangars with studies of what happens in the brain of a depressed person. But you would only fill an aircraft with the research that has been conducted into the social causes of depression and anxiety. And you could barely fill a toy airplane with the research into possible solutions.
We are told the story of a Cambodian rice farmer whose leg was blown off by a land mine and who had been anxious and full of despair ever since. The local community decided he didn’t need antidepressants. Instead they bought him a cow. He was perfectly capable of being a dairy farmer, which would involve less painful walking on his false leg and fewer disturbing memories.
In the following years, his life changed and his depression went away. To the Cambodians, dealing with depression was not a matter of changing the chemistry of the brain. This seemed bizarre to their culture. Instead, the solution was about the community coming together and empowering the depressed person to change his life. It was not an individual solution, but a collective one.
Another example of collective action is the Kotti housing project in Berlin. Here, hundreds of people from various backgrounds came together in protest against rent increases. This lifted the mood of all people involved.
Or there is the story of the Baltimore Bicycle Works workers. They kicked out their boss and started to run their bike shop as a workers’ cooperative. Changing the structure and infusing it with democracy radically improved the well-being of the workers. No longer did they feel like meaningless cogs in a system. In the words of Josh, one of the cooperative members:
“I can certainly see depression and anxiety being related to the fact that people feel really, really confused and helpless…I think it’s hard for people to live in a society where you have got no control over anything…You don’t control your economic life, from the standpoint that it’s precarious whether you’ve got work at all, and then if you do have a job, you walk into the place, spend forty, fifty, sixty hours a week in this place. You don’t have free speech. You don’t have any sort of voting” (p207)
This is quite an apt summary of work under capitalism!
The C and S word
This too is the frustrating part of Lost Connections. Hari has put in a sterling effort interviewing people all over the world about a complex subject. He is good at pointing out the material basis for mental illnesses, saying that it is a well-established fact that the poorer you are, the more likely you are to become depressed or anxious (page 247).
At some point, however, you have to call a spade a spade and point the finger at the C word: capitalism. Hari never really does this (probably because he doesn’t want to upset the various liberal celebrity endorsers like Elton John - and, of all people, Hillary Clinton). Towards the end, the book even becomes slightly cringe-worthy, when Barack Obama is ushered in to promote the idea of a universal basic income.
To give credit where it is due, Lost Connections remains a very useful introduction to the topic of depression and anxiety. In particular, it is good to hear the author argue against “privatising your pain” and making it all about you.
Yes, antidepressants and individual techniques (like surrounding yourself with nature and exercise; limiting social media; trying meditation and “mindfulness”, etc.) do have a certain place and can be helpful. But as Hari himself states, the self is ultimately not the solution – the only answer lies beyond it.
In his search for a solution, Hari naturally drifts towards radical ideas:
“Yes, the changes we need now are huge. They’re about the size of the revolution in how gay people were treated. But that revolution happened…There’s a huge fight ahead of us to really deal with these problems. But that’s because it’s a huge crisis…The response to a huge crisis isn’t to go home and weep. It’s to go big. It’s to demand something that seems impossible – and not rest until you’ve achieved it.” (p254, our emphasis)
“I don’t want to abandon the modern world and go back to a mythical past that was more connected in many ways but more brutal in many more. I want to see if we can find a synthesis in which we move closer to the togetherness of the Amish without suffocating ourselves or turning to extreme ideas that are often abhorrent to me.” (p188)
As it happens, there was a man who knew a thing or two about history, politics and economics; someone who more than 150 years ago provided a scientific basis for exactly this “synthesis”. His name was Karl Marx, and revolutionary socialists have been fighting ever since for these “impossible demands”. We call them socialism.
These ideas are not “extreme”. They are the only ones that address the root cause of the problems of individualism, loneliness, and alienation under capitalism.
Advocating a shorter working week and a universal basic income is not enough. We won’t get very far unless we pose the question of who actually owns and controls the wealth and technology in society - and why.
The only way to ensure that people are not alienated from the world around them is to give them genuine control over their lives. This is the only way to give people the necessary stability and time to develop themselves. And only a socialist revolution can achieve this.