Lost Connections- Beating back depression through meaningful relationships

Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions Johann Hari 2018

Why do we get depressed? Is it a defect of only certain humans? Is it an understandable reaction to a disconnected world? Or is it an imbalance of brain chemicals?

Depression can lead directly to suicide, and the darkness and despair that the disease brings is well-known to many families. Statistics on depression are hard to come by because of stigma, but the symptoms- loss of energy, sleep problems, feelings of hopelessness, concentration problems, anger, and self-loathing are common in the age of Covid. Sales of anti-depressants have skyrocketed in 2020 as people all over the world are looking to combat this and other mood disorders.

Lost Connections was a New York Times bestseller, and it turns the world of depression on its head. The author, who experienced the disease personally, is a British journalist and playwright. Johann Hari takes a deep look at the disease of depression, its causes and treatments, and sees it primarily as a symptom of disconnection from things that give us meaning in the world.

Hari takes aim at the common theory that depression is mainly caused by a chemical imbalance in the brain. Serotonin, a valuable feel-good chemical, can be in short supply with depressed patients, and the theory goes that this is the cause of the dark feelings. Drugs that work on serotonin transmitters like Paxil, Zoloft, and Lexapro (aka SSRI's) have been the go-to answer for 50 years to relieve the symptoms of depression.

According to the author, much of the success of today's antidepressants is due to the placebo effect. People expect them to help, so their minds make it happen. Research referenced by this book says that some 50% of the improvements shown with antidepressants is from the placebo effect, another 25% is from the body's natural recovery systems, and maybe 25% if from the drugs themselves. He goes into how drugs are developed and how only two positive trials are required for approval (even if 200 other similar trials don't show any benefits). Now some 13% of Americans take them regularly and the antidepressant industry is a $15 Billion cash cow for the pharmaceutical industry.

With a few notable exceptions, (thyroid disease, postpartum depression, grief,) Hari theorizes that most cases of clinical depression have to do with chronic problems with people's lives. The causes are out there in the environment, and not just a case of chemical brain imbalances. To be fair, no competent psychologist pushes the brain chemical theory only, but any emphasis on pharmaceuticals is a de-facto surrender to serotonin theory. It's much, much easier to down a pill than make difficult changes to one's life.

So after dispensing with brain chemicals, the book takes a turn and looks at nine areas of disconnection that the author believes are behind most cases of depression. Because we are so disconnected from ourselves and each other, depression is an understandable response to a life that seems to have little to offer. Here are the seven areas of disconnection that the author details.

1- Disconnection from meaningful work. According to Gallup, only 13% of workers are actively engaged in their jobs. The other 87% are either not engaged or actively disengaged. This especially applies to people at the bottom of the work hierarchies. People don't feel that their efforts matter, or are even noticed or appreciated.

2- Disconnection from other people. There is a loneliness epidemic that has been mentioned many places. Protracted loneliness causes a death spiral of antisocial behavior, illnesses, fear, and suspicion. Here loneliness doesn't necessarily mean you aren't around other people all day- it means that you don't have a sense of sharing anything that matters with those around you.

3- Disconnection from meaningful values. Too many values in today's society are extrinsic. We seek goals, worry about other's opinions, aspire to richer and materialistic lifestyles, and devour ads that tell us we aren't enough. We need more intrinsic, meaningful values that match our innate needs of security, love, and purpose.

4- Disconnection from childhood trauma. Traumas during childhood can have profound effects on people once they grow up. Over 60 percent of adults in one survey reported that they observed at least one adverse childhood experience (ACE) and one in six reported four or more. ACE's

that are never dealt with or overcome become like bleeding sores that never heal. Examples of childhood traumas include things like experiencing physical or sexual abuse, witnessing violence in the home or community, or living with neglectful, addicted, or mentally ill parents.

5- Disconnection from status and respect. Hari looks at baboon societies and how low-status members experience much higher levels of stress, while exhibiting disturbing behaviors. Increasing income and wealth inequality in the US has led many to devalue themselves because of the bigger and bigger distances between the rich and the poor.

6- Disconnection from nature. Humans sometimes forget that they are also biologically animals, evolved from apes that roamed savannahs. When we are confined to sterile buildings and urban landscapes, we feel separated from trees, water, natural beauty, and the calming influence they can have on us.

7- Disconnection from hope and the future. People need to feel in control of their lives and hopeful for their future. Without this hope, life becomes a pointless exercise in declining results and accumulating failures. The sense of a positive future protects you from everyday worries and minor setbacks. Today there is less security as jobs are less reliable, communities are in flux, and institutions can't be counted on.

The book ends with many touching stories and some interesting suggestions on how to re-connect. The problems presented won't be fixed easily, but at least recognizing that there is more to depression than brain chemicals and drugs is a promising start. Hari looks at all the disconnections above and presents some fixes to at least get things started.

- Therapeutic horticulture not only helps people get back to nature, but in groups it helps them connect with others.

- A bicycle shop that used the co-op model of ownership was able to make a profit and create meaningful work that gave employees a sense of purpose.

- Banning advertising in more public spaces would have the added benefit of encouraging intrinsic values instead of rampant consumerism.

- Loving-kindness meditation is a type of meditation where you actively wish well for others. Done correctly, it can reduce fear and envy while reconnecting people with other people.

- Hallucinogens and psychedelics have been proven to help people reconnect with themselves and their purpose in life, alleviating depression and anxiety as a bonus.

- Universal basic income has been experimented with in many places, and the study presented in this book from Canada shows that even a modest UBI made people more hopeful for the future, while improving both physical and mental health. People going went to school more and worked a little less, but reported being more happy.

This was an enlightening book with many documented studies from all over the globe. While the author goes hard at antidepressants, even he admits that they do help many people, and should be utilized when they help. Most psychological professionals caution using drugs only as a crutch to get through the rough patches, while things like therapy and lifestyle adjustments are what's needed to get to the bottom of many mental illnesses.

The seven "lifestyle adjustments" presented in this book are big ones that will require concerted effort from leaders in mental health and all aspects of society. Meaningful work is hard to come by anymore, and in the age of the gig economy, connection with work and fellow workers is fleeting and unstable at best. Families are more spread apart, income inequality is the highest its been in a century, and rampant individualism and partisan politics have torn apart the political and social bonds that used to unite us. I can see how this might make someone depressed.

We don't have to accept this as inevitable. We get to choose our attitudes to disconnection (and everything else) every day. We need to find new ways to reconnect with ourselves and our fellow humans. Covid has made that harder, but not impossible. We are either part of the problem or part of the solution- so to be the latter we need to re-connect, reach out, reject cynicism and despair, and envision a world in which we feel happy and loved while feeling like our lives made a difference.

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