DRUGS NOT ONLY FIX FOR DEPRESSION, AUTHOR SAYS
Loneliness of modern life may be the real problem, Johann Hari writes
A few years ago author Johann Hari in his book, Chasing the Screams, faced off against the commonly held beliefs around what causes addiction. Now, the celebrated journalist and TED Talks video superstar wants us to look at depression differently. His new book, Lost Connections: Uncovering the Real Causes of Depression — and the Unexpected Solutions, suggests that depression isn’t just caused by chemical imbalances in our brain. He suggests it’s the way we live that’s leaving us feeling blue. Years and years of lessening personal connections and increased consumerism and material gains have left us down in the dumps.
“We’ve traded floor space for friends. We have traded stuff for connections,” says Hari, who spent a lot of time researching this book in Canada, including in Vancouver’s Downtown Eastside. “The result is we are one of the loneliest societies we have ever seen.”
The U.K.-based Hari gave the keynote address, Rethinking Addiction: Social Recovery in the Age of Loneliness, at the New Horizons in Responsible Gambling Conference last week at the Hyatt Regency Hotel in Vancouver.
Hari answered a few questions for Postmedia News.
Q What is wrong with the way we look at and treat depression, treat anxiety?
A Everyone reading this knows that they have natural physical needs — you need food, you need water, you need shelter. If I took those away from you, you’d be in trouble really fast. I learned there’s equally strong evidence that we have natural psychological needs. You need to feel you belong. You need to feel your life has meaning and purpose. You need to feel that you have freedom. You need to feel you have a future. As a culture, we have been getting less and less good at meeting people’s basic psychological needs — and that’s the key reason why depression and anxiety are hugely rising.
Q This is a big topic that affects you personally. That said, how did you decide that now was the time to dig deeper, to look at your own experience?
A When I was a teenager, I went to my doctor — ashamed, afraid — and said I felt like pain was leaking out of me, and I couldn’t control it. He told me a purely biological story about why I felt this way — he said it was just because I was lacking a chemical, serotonin, in my brain, and the solution was only to drug myself. I took the maximum possible dose for 13 years, and while I felt some relief at first, I remained deeply depressed. After 13 years, I realized I had to learn more — so I went on a long journey all over the world, and interviewed the leading experts about what really causes depression and anxiety, and how to really solve them.
I learned that there are real biological contributions to depression, and drugs play some role in giving relief — but there’s a far bigger picture we need to look at. I learned there are nine causes of depression and anxiety for which there is scientific evidence. I met with scientists all over the world who are coming up with creative ways to reduce the reasons why we are in such deep pain in the first place. What they taught me changed my life. They made me realize — if you are depressed, if you are anxious, you’re not crazy. You’re not a machine with broken parts. You’re a human being with unmet needs. Your pain makes sense.
Q What was the most difficult part of this endeavour?
A A wonderful scientist called Dr. Vincent Felitti had discovered that childhood trauma is a huge cause of depression and anxiety. If you had a severely traumatic childhood, you are 3,100 per cent more likely to attempt suicide as an adult. I found this very difficult to confront — because I had experienced some very extreme acts of violence as a kid from an adult in my life. I didn’t want to think about it — it’s one reason I clung to the oversimplified story that depression is just caused by a chemical imbalance for so long. I didn’t want to think about the harm that had been done to me or to believe that it continued to have power over the way I live today. But Felitti has shown that if you can give people a safe space in which to talk about their trauma, and to release their shame, it leads to a big fall in depression and anxiety. Forcing myself to look at this new story ended up being freeing. It’s what made me realize we have to look at these deeper reasons — because they point to the best solutions.
Q When you started researching this book, what information really jumped out at you?
A The nine causes of depression and anxiety are all around us — and so are the solutions. Prof. Michael Marmot has proven that if you go to work today, and you feel you are controlled and don’t have many choices, you are significantly more likely to become depressed (and even to die of a heart attack). The epidemic of controlled, meaningless work in our culture is one of the key causes of depression. Giving people back control over their workplaces is one of the most effective ways to reduce depression — and the act of coming together to fight for that is, in itself, empowering and reduces anxiety.
I was learning intellectually from all these experts about what really causes our depression — but it really fell into place for me when I interviewed a South African psychiatrist called Dr. Derek Summerfield. He was in Cambodia in 2001 when they first introduced chemical antidepressants there, and the local doctors didn’t know what they were, so he explained.
They said to him that they didn’t need them, because they already had anti-depressants. He asked what they meant — and they told him a story. There was a local rice farmer who had stood on a landmine and had his leg blown off. They gave him an artificial limb and he went back to work, but it’s really painful to work underwater with an artificial leg, and he was traumatized. He developed depression.
So the doctors went and sat with him, and listened to him. They realized his pain made sense. They figured if they bought him a cow, he could become a dairy farmer — and the causes of his depression would be got rid of. After a few weeks with the cow, his depression went away.
“So you see doctor,” they told Derek, “that cow was an antidepressant.” What those Cambodian doctors knew intuitively is what the World Health Organization has been trying to tell us for years — that our depression is largely a response to life.
The solution is to give depressed people love and support to get the things that are causing such deep pain out of their lives.
Q Is there political will to look at depression and try to support a different model of help? Or has big pharma hijacked everything?
A Chemical anti-depressants give relief to some people, and if you’re feeling benefits and they are outweighing the side-effects, you should continue taking them.
The problem is a little different to this. Firstly, it’s that drugs are often the only tool we have given to doctors — when we need to radically expand the menu. Secondly, we have told people a really oversimplified story. If you tell someone their pain is just due to a malfunction in their head, it cuts them off from uncovering the real causes and solutions in the way we live.
How can we change things, make things better?
I discovered evidence for seven different kinds of antidepressant — ones that deal with the deeper problem. I’ll give you one example. One of the heroes of Lost Connections is a doctor called Sam Everington, who works in a poor part of East London in England. He was really uncomfortable, because lots of depressed and anxious people were coming to him, and he’d been instructed to just tell them they had a chemical malfunction and just drug them. Like me, he’s not opposed to the drugs — but he could see the patients were (for example) deeply lonely, and they needed help with the causes of their depression, too. So he pioneered a different approach.
A woman called Lisa Cunningham came to him, who I got to know. Lisa had been shut away in her home, crippled with anxiety and depression, for seven years. Sam prescribed something new — he prescribed for her to take part in a group. There was a patch of scrubland behind the surgery, and he asked her to meet twice a week with a group of depressed people and turn this scrubland into a beautiful garden. At the first meeting, Lisa was literally physical sick with anxiety. But as the weeks and months passed, the group taught themselves gardening. They began to reconnect with nature — a hugely powerful natural anti-depressant. And they began to reconnect with each other. They had something to talk about that wasn’t how bad they felt. As Lisa put it to me, as the flowers began to bloom, they began to bloom. A study of a very similar program in Norway found that it was more than twice as effective as chemical anti-depressants — because it dealt with two of the key reasons they felt so bad in the first place. All over the world, from Sao Paulo to Berlin, I saw that the most effective responses to depression are about dealing with the nine deep underlying causes.