The anatomy of depression
Johann Hari, an independent English journalist and the writer of the book under review, spent much of his adolescence depressed. His doctor prescribed him antidepressants that boost serotonin levels. For too long, the conventional wisdom in the medical fraternity was that depression and anxiety are caused by a faulty brain, one whose biochemistry does not work as it should.
Mr Hari attempts to take this wisdom head-on with a mix of personal anecdotes, interviews with doctors working in the field, and his experiences with communities that have tackled depression among their ranks. His diagnosis: Depression is not nearly the monolithic outcome of a chemical imbalance in the brain. It is caused by a mix of biological, social and psychological factors.
The first stirrings of this new approach to depression were felt in the 1970s when the American Diagnostic and Statistical Manual listed nine symptoms that characterise depression. Doctors noticed that a person battling grief from the death of a loved one showed every one of those nine symptoms, yet to call such a person depressed would be incorrect. So, the Manualadded a “grief exception”, that is, a grief-stricken person who showed those symptoms was not to be diagnosed as depressed.
Soon, the limitation of the grief exception became apparent. From a relationship ending to the loss of a job, different circumstances could induce sadness in a person and, therefore, the idea that a symptom like persistent low mood definitively indicated depression began to give way. Yet, this did not create any clarity on what causes depression and how sadness, even heavy sadness, tips over into despondency.
In 1978, British psychologists George Brown and Tirril Harris published research that classified depression as emerging from a combination of two factors: A long source of stress and an immediate negative event. “We all lose some hope when we are 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 ‘generalisation of hopelessness’,” Ms Harris told Mr Hari.
Mr Hari builds on this initial research to come up what he calls the nine types of disconnection that either cause or exacerbate depression. Some of these are easily understood, such as persistent loneliness and lack of communication. Mr Hari makes a persuasive case for the inappropriateness of modern living that stresses too much on individualism. We are meant for tribalism, he tells us, picking examples from evolutionary theory and sociology to make his point.
Mr Hari presents the inspiring story of a Cambodian farmer whose left leg was blown off by a landmine and who could not make peace with an artificial limb. He showed all the signs of depression but instead of antidepressants, which were not available/known about, the community came to his aid by buying him a cow. They figured that with his artificial limb, working on the field would be impossible. In due course, as he busied himself with dairy farming, his depression went away.
Similarly, the chapter of childhood trauma is instructive. Mr Hari presents the findings of an experiment conducted by Dr Vincent Felliti of San Diego with overweight patients in the 1980s. Some of the participants lost weight after following a healthy diet and exercise regimen but regained it in no time. When he probed, Dr Felliti found that a high proportion of such recidivists had experienced some sort of abuse in their growing-up years. Weight and the anonymity it brought them made them feel safe, which a healthy lifestyle threatened.
Examples like this help us understand the sociology of disease. Mr Hari explains this with another example. The biological explanation of depression is “safe” because it takes away the causes of our sadness from our control. When we say that there is something wrong with our brain, we assume that the listener would treat us with sympathy. However, Mr Hari presents findings that indicate that this may not always be the case.
The last part of the book offers ways to better one’s lot by ameliorating the psychological basis of depression. In Mr Hari’s view, we can, if not eliminate, at least mitigate the symptoms of depression by thinking about our lives differently. This section, with its calls to “sympathetic joy”, can at times read like hokey but the larger point of Mr Hari’s advice is well worth following.
The western world, and increasingly the East, has come to rely on medication to cure depression, but the evidence on the efficacy of drugs is at best mixed. Lost Connections is an important book that makes a case for looking at depression from various perspectives, especially the social milieu and personal circumstances of the patient. This may seem obvious but Johann Hari makes it both engaging and educational.
LOST CONNECTIONS
Uncovering The Real Causes of Depression — And The Unexpected Solutions Johann Hari Bloomsbury 321 pages; ~599