What if depression isn’t just some brain defect or a chemical imbalance but it’s actually a message to you that there’s something not right in your environment or your life? That’s the hypothesis behind Johann Hari’s best-selling book, Lost Connections. And in my opinion, there’s an element of truth to it. So let’s look at what he says about the causes of depression and what the research has to say about it.
So in my last video I discussed how Johann Hari in his book Lost Connections demolishes the overly simplistic idea that depression is just a chemical imbalance. He addresses how the pharmaceutical companies used marketing campaigns to spread this overly simplistic idea and to oversell the effectiveness of the medication that they were selling.
And I discussed how the causes of depression are actually quite a bit more complicated than both the messaging that the pharmaceutical companies were selling and also the message that Johann was putting out.
But that being said, he does an excellent job addressing one side of the common three-sided approach to depression that most mental health providers adhere to. This is the bio-psycho-social approach. This means that depression and most mental health concerns are a combination of biological, psychological, and social factors.
This approach is pretty well research-backed, and Johann does a pretty great job explaining the social factors that contribute to depression.
The Social Factors of Depression
So now we’re 70 pages into the book, and Johann begins to address what he calls the true causes of depression, the environmental causes of depression.
He says that the myth of the chemical imbalance is comforting, but it also causes despair because it convinces us that our pain is meaningless, that it’s simply a chemical defect in our brain and there’s no logical reason that it exists, but that the only logical solution is antidepressant medication and just coping.
But he asks, “What if our pain makes sense? What if pain has meaning?” And he says your pain does make sense. Pain and depression serve a function to message you about something not being right in the world.
So real quick, let’s talk about the grief exception.
So for a long time in the DSM — the DSM is kind of like the bible, the Diagnostic and Statistical Manual for mental disorders; it’s what everyone references to determine what’s a diagnosis — basically, for a long time in the DSM there was this long list of symptoms of depression, and you qualified for a depression diagnosis if you had x number of these symptoms, except if you were grieving the recent loss of a loved one. This was a weird caveat.
So basically the psychologist handbook said your depression is a mental illness except in this one singular unique situation, where all of the sudden the symptoms of sadness and pain make sense, and then in that situation it’s not a disorder; it’s an outcome of your experiences.
And here’s where Johann calls the BS. He says there are so many other factors that make sense to feel pain, that it makes sense to feel depressed. He says that our pain sends a message that there’s something wrong with our environment, with our society, and to find real, effective healing we need to change our society.
So here’s what Johann identifies as the nine true causes of depression. And I would call them the nine social causes of depression because there’s a lot of real causes of depression.
1. Disconnection From Meaningful Work
So number one: disconnection from meaningful work. This is feeling helpless, feeling controlled by other people, feeling meaningless.
So a lot of us have menial jobs, jobs with little to no say about how the company runs and no ownership of the process, and this can lead to feelings of discouragement, despair, and feeling like everything is pointless.
2. Disconnection From Other People
Number two: disconnection from other people. Johann shared studies where participants were rejected or shunned by people planted into their experiment. They tested the level of these people’s stress hormones and found that becoming acutely lonely was as stressful as experiencing a physical attack.
And our society is the loneliest it has ever been in the history of the world. People live in their own homes, they don’t interact nearly as much, they’re far less likely to have many close friends or a local community to support them. And this unnatural state leads to depression.
3. Disconnection From Meaningful Values
Number three is disconnection from meaningful values. So essentially this point he makes is about materialism and how advertising makes us feel inadequate until we buy something. He shared a lot of stories about how marketing and advertising affects children’s brains and basically leaves us feeling emptier and emptier.
4. Disconnection Due to Childhood Trauma
Number four: disconnection due to childhood trauma.
He talks about the ACEs study that showed that childhood trauma makes it much more likely that you develop depression. The ACEs questionnaire asked about 10 types of childhood trauma, things like abuse, neglect, and loss of a parent, and found that if you experienced 6 of them as a child you were 5 times more likely to develop depression, and if you experienced 7 of them you were 31 times more likely to attempt suicide as an adult.
So basically, this impact of childhood trauma and childhood abuse is so overwhelming that it has to be counted as one of the real causes of depression.
5. Disconnection From Status and Respect
Number five is disconnection from status and respect.
Johann shares the example of a group of wild chimpanzees that researchers observed for a long time. And the alpha champ, the boss champion was the strong, happy guy who enjoyed the first access to food and the lovely lady chimps, more opportunities to make babies because of his status.
He was healthier than the other monkeys, but he got older and along came a younger, stronger chimp who started doing it with all the ladies. And eventually the two of them fought. The younger chimp won.
The older chimp sank in status, and at that point he seemed depressed. He stopped eating as well. He stayed on the sidelines of the community and eventually wandered off alone into the wild where he presumably died.
Now, we see this happen in human society as well. A loss of status and respect contributes to depression for many in our society. And there’s so many people who are marginalized: the young, the old, the poor, and people marginalized by race or gender or education or other situations.
Now, for us to be mentally healthy we need a group of people who respect us, who we belong to, who we have influence with. And I don’t mean that the only people who can be mentally healthy are the powerful or the rich, but the opposite of that is certainly an obstacle to mental health in our society.
6. Disconnection From the Natural World
Number six: disconnection from the natural world. Now, here Johann cites a prison study: inmates who could see out the windows were 24% less likely to get physically or mentally ill. So essentially our separation from nature makes us sick, and being in nature can make us healthier.
Johann says, “Here is a treatment that has very few side effects, it’s not expensive, it doesn’t require a trained or licensed professional to prescribe it, and it has pretty good evidence of efficacy so far. But the research is very hard to find funding for because a lot of the shape of modern biomedical research has been defined by the pharmaceutical industry, and they’re not interested because it’s very hard to commercialize nature contact. You can’t sell it, so they don’t want to know.”
We haven’t seen advertisements on TV saying, “Are you feeling depressed? It might be a nature imbalance. Go spend 15 extra minutes a day in nature, and your brain chemistry might change.”
7. Disconnection From a Hopeful or Secure Future
Number seven: disconnection from a hopeful or secure future. There were some really interesting studies in the book that Johann shared showing that people with depression were not able to visualize the future compared to non-depressed people. So as we get disconnected from our future, it’s easy to become more depressed.
8/9. The Real Role of Genes and Brain Changes
Causes eight and nine: he calls this the real role of genes and brain changes. So the chemicals in your brain, the structure of your brain, changes depending on how you use it. Depression isn’t just a simple chemical imbalance; it’s an interaction of biology and environment and how you think and act.
So Johann discusses neuroplasticity, which is one of my favorite topics. Johann describes how when you’re depressed your brain physically changes, and how when you recover your brain physically changes. So let me just read you this part.
“Imagine that your marriage just broke up and you lost your job and, you know what, your mother just had a stroke. It’s pretty overwhelming.
“Because you are feeling intense pain for a long period, your brain will assume this is the state in which you are going to have to survive from now on, so it might shed the synapses that relate to the things that give you joy and pleasure and strengthen the synapses that relate to fear and despair.
“That’s one reason why you can often start to feel you have become somehow fixed in a state of depression or anxiety, even if the original causes of the pain seem to have passed.”
John Cacioppo, one of the scientists that Johann worked with, called this a snowballing effect. So while depression shows up in your brain and you can’t just magically make it go away, when you change how you think and you act or when you find other ways to treat it, your brain can change back to a more normal brain and a healthier brain.
Now, Johann also addresses some of the genetic factors behind depression. They’re just different than we assumed. It’s just not so simple as just low serotonin or chemical imbalance.
So he says, “With the best twin research, according to the National Institutes of Health, that for depression 37% of it is inherited, while for severe anxiety it’s between 30 and 40%. To give you a comparison, how tall you are is 90% inherited. Whether you can speak English is 0% inherited. So people who study the genetic basis for depression and anxiety have concluded that it’s real, but it doesn’t account for most of what’s going on.”
Hari then shares some fascinating studies explaining the interaction of environment and genes. So he says, “We are all born with a genetic inheritance, but your genes are activated by the environment. They can be switched on or off by what happens to you.
“And Avshalom discovered, as Professor Robert Sapolsky explains, that if you have a particular flavor of 5 HTT you have a greatly increased risk of depression, but only in a certain environment. If you carried this gene, the study showed, you were more likely to become depressed, but only if you had experienced a terribly stressful event or a great deal of childhood trauma.”
Solutions for These Causes of Depression
So those are the nine social causes of depression according to Johann Hari, and here are his proposed solutions.
1. Reconnect to Other People
Number one: reconnection to other people.
One of my favorite studies in the book was a study on what happens when people try to be happier. I’m making a video on this, but the short version is that when people try to be happy by doing something for themselves it makes them feel worse, but when people try to be happier by connecting with others, by making others happier, they actually do feel happier.
Number two: social prescribing.
So when loneliness is rampant, you can’t just tell someone with depression, “Oh, you should get out more.” You can’t just put the burden on the depressed person. So instead, you create an environment where they build social connection, they build social support.
And he tells about a program in England where people with depression are prescribed by their physician to join a structured group. And the example he gave was of a woman who was assigned to join a gardening group and how that led to her recovery from depression.
3. Reconnect to Meaningful Work
Number three is reconnection to meaningful work. And he tells the story of workers in a bike shop who were not being treated well. They left.
They formed their own cooperative bike shop where every worker had a chance to become a partner, everyone got a say in the meeting, everyone had a chance to contribute to the success of the business, and their voices were heard, and how that dramatically increased their mental well-being. It decreased their stress.
And basically his proposal is that governments or businesses work to make the workplace more democratic, where people have a say, where they feel like their work is meaningful and they can contribute.
4. Reconnect to Meaningful Values
Number four: reconnection to meaningful values.
Basically, he thinks we should decrease our exposure to advertising, which is designed to make us feel inadequate and to believe that the solution to our problems is buying more stuff.
5. Reconnect to Sympathetic Joy
Number five: his solution is reconnection to sympathetic joy. Meditation and loving kindness practices were described as valid treatments. And then he also tosses in psychedelics as an emerging treatment option.
So this is really fascinating. And they’re starting to build up some evidence as to the effectiveness of psychedelics. And I’m definitely gonna make some more videos that address the topic of psychedelic medication.
6. Reconnect to Trauma
Number six is reconnection to trauma.
So Johann follows up on the ACEs study with a pretty astounding story from Kaiser. So that’s the same company that asked people about their trauma and then followed up by giving them a chance to talk about it.
All that Kaiser did was at the next doctor visit they had the doctor say, “I see that when you were a child, this happened to you. I’m sorry. Would you like to talk about it?” And for some people, that was the first time in their lives that they had ever told anyone their trauma story, and it helped them break down the shame.
They found out that these patients were 50% less likely to come back to the doctor saying they felt physically ill or seeking drugs. And no, it wasn’t because they had a bad experience. They received literally no complaints about this.
So basically, Johann suggests that to treat the depression epidemic we need to create change on the societal level. We need to make trauma treatment more accessible. We need to spend more time in nature and less time around advertising. We need to spend more time with real people and make real connections instead of being isolated or in our ego pursuits.
7. Believe that Societal Change Can Happen
And that’s where he comes to his point number seven, which is basically believing that social change can really happen.
So overall, Johann’s solution to depression really addresses the environmental and social causes of depression, and his solution is very communal. He basically says we need a societal change to address this. And I I agree with this, but it’s also really difficult for me to wait for. So I personally really like small, actionable steps that individuals can take to address depression.
So when a client comes in to see me I don’t spend a lot of time dwelling on the society-level difficulties that they face. We just focus on the things they can change, things like building a support network, getting some exercise and some sunlight, changing some thinking patterns, practicing gratitude, or mood tracking. You know, these really basic things that just don’t seem as overwhelming for someone with depression as the need to change our entire society.
But that being said I can totally see where Johann is coming from. Our society, our culture is a leading contributing factor to depression.
Overall, I enjoyed this book immensely, especially those first four chapters where he kind of systematically tears down the pharmaceutical advertising campaigns.
And I think his approach is not particularly well-rounded when it comes to addressing all of the effective treatment options for depression. I mean, he gives therapy and CBT about one sentence, and he doesn’t really mention the physical factors contributing to depression, but he does add a powerful perspective to the conversation about depression that I think is a helpful addition to take us past the overly simplistic explanations of depression as just being a chemical imbalance.
I hope you found this helpful. I hope you found one area of your life that you could consider and create a change.
Thank you for watching, and take care.
For more ways to help with depression, check out my course, Change Your Brain, below.