Book review: Lost connections – Why you’re depressed and how to find hope by Johann Hari

(Important update at March 2023 – please read this post art and science of overcoming clinical depression (2021) by Oliver Kamm” ( Today is World Mental Health Day. As a psychologist, counsellor and trustee of a mental health charity I thought I’d share my thoughts on this brilliant book. “Lost connections – Why you’re depressed and how to find hope” by Johann Hari was a revelation. Everyone is aware of the growing problem in mental health. This book helps us understand the causes of depression in an accessible way whether we are suffering ourselves or caring for those who are. Employment – particularly the lack of meaningful work, status, respect and a secure future – is shown to be a source of several potential causes of depression so it is important that leaders and employers understand their role. It also has important lessons for those developing land, communities and property. There’s also support to reduce your consumption of advertising and social media and increase your connections to others to improve your own mental health.  I can’t do justice to this great book with a short review so I urge you to read a copy yourself.

Mental health statistics

The statistics on mental health are alarming:

  • Depression is now 10 times higher than it was in 1960
  • The mean age for depression today is 14.5 years compared to 29.5 years in 1960
  • At any one time 2% of the population is suffering from depression and 14% of people will experience it by the age of 35
  • One in five US adults are taking at least one drug for a psychiatric problem; nearly one in four middle—aged women in the United Stes is taking antidepressants at any given time
  • Total prescriptions issued for antidepressants across the UK in 2017 stood at over 82 million – a figure that has doubled over the last decade
  • Everything that causes an increase in depression also causes an increase in anxiety and the other way around
  • While some say that one in four people will experience poor mental health at some point in their lives – others put this figure as high as 50%

Dispelling myths about depression

The author wrote the book having spent a lifetime taking medication for depression on the understanding that it was caused by a chemical imbalance in his brain (endogenous depression – a malfunction). He tells the story of his investigation into the causes of depression and other ways to recover. I was shocked at how persistent inaccuracies – and lies – about the efficacy of antidepressants have prevailed.

In one research paper he describes:

  • 25% of the effect of antidepressants were due to natural recovery
  • 50% were due to the story you had been told about them (the placebo effect)
  • 25% from the actual chemicals

He quotes Professor Andrew Skull of Princeton who said attributing depression to low serotonin is “deeply misleading and unscientific”. He also observed that people who were suffering grief at the loss of a loved one – the bereaved – displayed the symptoms of depression and were often diagnosed as being clinically depressed. Yet it is a natural response to the loss of connection to a loved one. This was named “reactive depression” as a response to something bad happening in your life. The author then asks “Why is a death the only event that can happen in life where depression is a reasonable response?”. He shifts the emphasis from mental health to emotional health.

He asks “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?”.

Another study compared women diagnosed with depression with a comparable group who didn’t have depression. They analysed the “difficulties” the women experienced as well as the “stabilisers” (the things likely to protect you from despair such as close friends). The study found that experiencing something really stressful can cause depression. It turned out that depressed women were three times more likely to be facing serious long-term stressors in their lives. So it wasn’t just a bad event that caused depression – it was also long-term sources of stress. The researchers concluded that “clinical depression is an understandable response to adversity”. Where stress or bad events are sustained over a long period of time, what you get is “the generalization of hopelessness”. Depression isn’t just a problem caused by the brain going wrong. It is caused by life going wrong.

So the thinking about depression moved to have three kinds of cause: biological, psychological and social.

Nine causes of depression and anxiety

Hari argues that the nine causes of depression and anxiety are:

  1. Disconnection from meaningful work
  2. Disconnection from other people
  3. Disconnection from meaningful values
  4. Disconnection from childhood trauma
  5. Disconnection from status and respect
  6. Disconnection from the natural world (hence the increase in social prescribing)
  7. Disconnection from a hopeful or secure future
  8. Brain changes
  9. Genetics (potentials activated by the environment)

Disconnection from meaningful work

In 2011 and 2012 Gallup studied millions of workers across 142 countries and found that:

  • 13% say they are engaged in their jobs
  • 63% say they are not engaged
  • 24% say they are actively disengaged – undermining what others accomplish

A common symptom of depression is “derealisation” – where you feel that nothing you are doing is authentic or real. Another study into 18,000 people in the civil service found that people at the top were four times less likely to have a heart attack than those at the bottom. There was also a correlation between your likelihood of depression – it declined the nearer you were to the top of the hierarchy. They tested the hypothesis that top civil servants had more control over their work. They also discovered that the higher up you were the more friends and social activity you had after work. Disempowerment is at the heart of poor health – physical, mental and emotional. Despair happens when there is a lack of balance between efforts and rewards.

The link between meaningful work and stress is mentioned here:

Disconnection from other people and loneliness

The paradox of social isolation while living in a highly-connected Internet society is acknowledged. People check their phone once every six and a half minutes and 42% of people never turn their phones off. Internet addiction is thought to be a distraction strategy to avoid anxiety. But social isolation and loneliness were found to be more serious than expected: “Becoming acutely lonely, the experiment found, was as stressful as experiencing a physical attack”.

“Lonely people are also anxious, have low self-esteem (see, are pessimistic and are afraid other people will dislike them”. The author reports on an experiment that people who had been triggered to feel lonely became radically more depressed and the people wo had been triggered to feel connected became radically less depressed.

Protracted loneliness causes people to shut down socially and to become hypervigilant as lonely people are constantly scanning for threats. Another researcher found that to end loneliness you need to feel you are sharing something with the other person or a group that is meaningful to both of you. To end loneliness you need to have a sense of mutual aid and protection. Social neuroscience is where you brain alters according to how you use it.

Harvard professor Robert Putname found that several decades ago, the average number of close friends an American had was three. By 2004, the most common answer was none. He concluded that every human is honed not for life on your own, but for life in a tribe. Humans need tribes as bees need a hive. Lonely people even experience more “micro-awakenings” during sleep. In another experiment, isolated rats developed 84 times the number of breast cancer tumours as the rats who had a community. Dr Hilarie Cash, a psychotherapist specialising in addiction, argues strongly for the need for face-to-face connection rather than mediated by a screen.

Disconnection from meaningful values

This chapter relates to values and authenticity. Materialistic people – people who think happiness comes from accumulating stuff and a superior status – had much higher levels of depression and anxiety. They had shorter and poorer quality relationships.

There are lessons here about intrinsic motivation (things you do because you value them) and extrinsic motivation (things you do to get something in return – like money). Motivation is explained further here: He argues that “materialism is KFC for the soul” – it brings only fast and temporary relief.

The author cites research that we get the most pleasure from “flow states” – moments where we simply lose ourselves doing something we love. He mentions the Golden Rule – that we should do unto others as you would have them do unto you. There was condemnation for advertising which led to greater materialism.

Disconnection from childhood trauma

There are fascinating insights into the links between childhood trauma and obesity which can provide sexual and physical protection and reduce people’s expectations of you.

Adverse Childhood Experiences (ACE) studies showed that emotional abuse (e.g. being treated cruelly by parents) was more likely to cause depression than any other kind of trauma. It supports the authors’ assertion that depression is a normal response to abnormal life experiences.

Disconnection from status and respect

With references to tribes of baboons who live in a strict hierarchy, they found that the lower you are I the hierarchy, the more stressed you are. Depressed humans are flooded with the same stress hormones that are found in low-ranking baboons. Psychologist Paul Gilbert made that case that depression is, for humans, in part a “submission response”. Researchers found that having an insecure status was the one thing more distressing than having a low status.

Kate Pickett and Richard Wilkinson’s research found that in highly unequal societies like the United States they would find higher levels of mental distress.

Disconnection from the natural world

When animals in captivity are deprived of their natural habitat they will often develop symptoms like extreme forms of despair. It’s known that mental health problems are considerably worse in cities than in the countryside. Researchers found that people who moved to green areas saw a big reduction in depression and people who moved away from green areas saw a big increase in depression.

There’s scientific evidence too that exercise significantly reduces depression and anxiety. All humans have a natural sense of “biophilia” – an innate love for landscapes – and a preference for landscapes evoking savannas of Africa.

Disconnection from a hopeful or secure future

This explores depression where people have a failure to understand how they can go on being the same individual. There’s a touching story here about Native Americans. Extremely depressed people have become disconnected from a sense of the future. Many in the self-employed, zero hours or gig economy are at risk.

Role of genes and brain changes

“Neuroplasticity is the tendency for the brain to continue to restructure itself based on experience”. Where you feel intense pain for a long period your brain will assume this is the state in which you are going to have to survive and starts to shed synapses that relate to the things that give you joy and pleasure and strengthen the synapses that relate to fear and despair.

37% of depression is inherited and between 30% and 40% of severe anxiety. Scientists have identified a gene – 5-HTT – which relates to becoming depressed and increases the risk of depression in certain environments. The author asserts that a new way to think about depression is a reaction to the way we are living. It is a rational and sane response to our environment.

Reconnection – a different kind of antidepressant

The author reveals seven kinds of reconnection that evidence suggests can begin to heal depression and anxiety. He provides hope and tools with which we can improve our own mental health.

A sense of community – There is a story about people from many different cultures came together in a deprived estate in Berlin and healed each other by caring for each other.

Help other people – Individualistic cultures (such as in USA and Western Europe) are more likely to be unhappy than collective cultures (e.g. in Asia). Helping others in your group or tribe can relieve depression. There’s evidence to show that the closed and close Amish communities have less depression than others.

Social prescribing – Learning about nature (with a story about turning a wasteland into a garden) can guard against depression. There’s an inspiring story of a health centre where you can see a doctor or be referred to one of more than a hundred social programmes. Therapeutic horticulture reduced depression significantly in a study in Norway.

Meaningful work – 87% feel neither disengaged or engaged by their jobs. Democratic co-operatives were found to be particularly effective at restoring respect and dignity to workers.   “Happiness is really feeling like you’ve impacted another human positively, I think a lot of people want their work to be like that”.

Meaningful values – One city banned all outside advertising which they saw as mental pollution. This removed satisfaction from buying products (ie reduced materialism). Encourage people to list what they really value (exploring intrinsic and extrinsic values) rather than spending to fill a loneliness gap.

Sympathetic joy and overcoming addiction to self – Reduce anger and envy by spending less time on social media. Sympathetic joy is the cultivation of feeling happy for other people. Use meditation to start feeling differently about yourself and other people. Spiritual change through prayer or cognitive change through CBT and psychotherapy can help.

Acknowledge and overcome childhood trauma – Sharing the traumatic experience without being judged was seen to be transformative. There is evidence that humiliation plays a big role in depression.

Restore the future – Develop confidence about the future, The link between poverty and depression and other illnesses is clear and there have been experiments with universal basic income to address this. Having money removed the stress of worrying about food and shelter and restored the power that you didn’t have to remain in a terrible, demeaning job,

Conclusion – Homecoming. The World Health Organisation (WHO) in 2011 explained “Mental health is produced socially: the presence or absence of mental health is above all a social indicator and therefore requires asocial, as well as individual, solutions”. There’s a suggestion that there the focus on chemical imbalances is shifted to power imbalances. The book ends on a powerful note “Deep grief and depression have identical symptons for a reason. Depression is itself a form of grief – for all the connections we need, but don’t have”.

The book also supports other findings that the opposite of addiction is connection, See the author’s TED video

Another favourite book of mind relates to stress in the modern world

Richmond Borough Mind is a source of information on mental health issues and signposts many other sources of help for those suffering from poor mental health or caring for those who do