BOOKS

Lost Connections by Johann Hari

Author: Johann Hari

Rating: 4.0 / 5.0

The cruelest thing about depression, she said, is that it drains you of the desire to be as fully alive…(Lost Connections, 97)

As I’ve grown older, a staggering number of people have quietly confessed to me that they’re suffering from depression; that they’ve taken up anti-depressant (SSRI) medication, analgesic cannabis, CBD use; or that they feel no association to or joy from their religious/professional/social lives. Talking with a friend about it recently, the metaphor we arrived at was: “It’s like normal life but with the Technicolor ™ turned off or the sound turned monophonic.” The world wasn’t gone, it was just low-fi.

In this muted reality, my friends and loved ones faced a struggle, alone. This loneliness is made worse by the fact that conventional wisdom holds that artists (Sylvia Plath, Virginia Woolf, Ernest Hemingway) and geniuses (Boltzmann, Ehrenfest, Erdös) are the ones prone to depression, not us.

Yet American rates of suicide, particularly among the “not-sensitive,” working-class, “man’s men” of the no-college education, white demographic are surging. It seems no coincidence that this is the same demographic who’s recently driven the opioid abuse epidemic.

My hypothesis (with no scientific basis) is that we as a society are exhausted from modern life (“influencers”), modern noise (“Swede-programmed pop music”), modern distractions (“Red dots with numbers on smart phones”), modern struggle (“Will no one call me back about whether I need surgery or not?”), and grinding capitalism. Some are simply and permanently opting out. To get a better sense of what was at play, I turned to Johann Hari’s book, Lost Connections. The book provides a compelling thesis: that depression is the natural and right reaction to a society whose operations are at odds with our evolutionary prerogatives. Writes Hari: “…we have been left alone on a savanna we do not understand, puzzled by our own sadness (90).”

If you’re short on time, most of the major points addressed in the book are covered in an hour-long conversation between Hari and Sam Harris on the latter’s podcast.

Hari writes from a personal memoir/journalistic perspective. In this case, his approach recalls the New Journalism (à la Tom Wolfe, Gay Talese). The book telegraphs that it will be part memoir, part journalistic investigation and interviews, and part naïf-meets-experts. A lot of the “evidence” or “proof” looks like anecdotal sociology (or, less-cheritably, “just-so tales”).

I think it’s a reasonable approach, but it’s worth explicitly noting that the work isn’t proceeding from a place of double-blind, rigorously-controlled social science. Curiously, it felt like a Tom Friedman but about social psychology instead of economics. As was said of Friedman, he never let a sentence stand where a name- or brand-drop was possible, Hari never lets a simple sentence stand where an anecdote or a social experiment said the same in ten more pages.

Mechanics and structure aside, let’s pick up our leading thread, Hari’s journey with depression and anti-depressants. He is raised in a suburban environment by emigrant parents in England:

In Edgware [a suburb], people weren’t hostile. We knew our neighbors to smile at. But that was it; any attempt at engagement beyond brief chitchat was shut down. Life was meant to happen, my parents learned slowly, inside your house. I didn’t regard this as unusual—it was all I ever knew—although my mother never got used to it. “Where is everyone?” she asked me once when I was quite small, looking down our empty street, baffled (73).

This description of the suburbs rang true to my experience. Vast stretches of houses with individuals only emerging to go-somewhere or do-something. Pure being and sharing was not a communal activity outside of church, school, or the mall — all of which bear a certain performative and/or capitalist aspect.

Hari never quite fits in and, while it’s never plainly said, he alludes to an additional burden of recognizing that his sexuality is also not something that can be shared safely.

Through a maturation that includes a continuing sense of melancholy, Hari is at last set in front of a clinician who starts the years-long effort to treat him with the modern pharmacological “miracle” of selective serotonin reuptake inhibitor (SSRI) anti-depressant medication. While initial treatments are successful, their efficacy consistently wanes and induces another round of titrating dosage and see-sawing through side-effects in hopes to get his neural chemistry “right.” To be clear, this process induces acne, weight gain, lethargy, hyperactivity, etc. The medicine to return him to himself often estranges him further!

WARNING Before the next paragraph let me be clear: _To be clear, I do not support individuals adjusting or rejecting their medication without medical guidance. Please find the appropriate clinician to help you through this process if this post has moved you. My reporting of Hari’s point of view should not be taken as an endorsement. Lastly, Hari’s remedies (discussed later) in addition to the appropriate medication as determined during medical consultation seems likely to be an optimal path.

Fed up with these yo-yo periods, and wondering why the drugs aren’t working for him, Hari decides to research the industry, and what he finds is concerning. He discovers that the efficacy of anti-depressants is, in many cases, below placebo level. The magic of clinical psychotherapy seems to be that patients feel better for being heard by an expert. The pill’s chemical composure seems largely incidental. If the pill’s not measurably the thing that fixes people, Hari reasons, how did it get approved by the FDA?

Hari then explains how the pharmaceutical industry funds many of the studies that are required for FDA licensure. He also reports that their scientific processes have been methodologically questioned for under-reporting negatives while over-reporting positives. Under multi-billion dollar pharmaceutical corporations’ pressure, many of whose agents are revolving-door government-to-lobbyist career bureaucrat/lobbyists, resistance within the FDA has proven little hinderance for Big Pharma.

After approval, Big Pharma looses their dogs of marketing and advertising to create narratives that move the public and the medical establishment to their point of view. Hari recounts the advertising narrative behind the rise of SSRI sales in America in the late 80s and early-90s. At that time, advertising narratives shifted (I remember them appearing suddenly and ubiquitously on Sunday NFL ads) and sold consumers the narrative that “depression is an error in your brain chemistry” conveniently just as Big Pharma brought pills to market that fixed this error. As it was said of Listerine mouth wash: Listerine didn’t invent mouth-wash, they invented halitosis — same playbook, new problem. Big Pharma named a social narrative that allowed people to ask for their product by name.

Austin Powers: "Yay Capitalism"

Considering the behavior of Big Pharma in the age of the Opioid epidemic, the idea that the pill business is foremost an act of care and then a business, in that order, seems hopelessly naive if not downright dangerous. The ongoing litigation between the State of Pennsylvania and Purdue Pharma stands as an all-too-real testament to this fact. Pharma is foremost a business.

I’m unconvinced that SSRI prescription is ineffective or that Big Pharma is Big Snake Oil (such is not the purpose of the book); however, Hari makes a compelling case for better reporting, longer longitudinal studies, and for a government willing to act when longitudinal studies fail to show efficacy. Says Hari: “in thirteen years of being handed ever higher doses of antidepressants, no doctor ever asked me if there was any reason why I might be feeling so distressed (42).”

The pivot between Part I and Part II of his book rests on this question: “If it’s not something going wrong in our brains en masse suddenly, what is making us all feel this way?” Hari suggests that it is our manner of living that makes us feel this way and that depression is the reasonable and appropriate response to that feeling. “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 (44)?”

To retract an arm is the fitting reaction to a burning finger; to end a relationship is fitting to an abusive dynamic; depression is the response to a society where all of our evolutionary guidelines have been upended without any scaffolding for the transition. Depression is our minds’ way of saying, “Stop this!” It is “a submission response (119)” to the enveloping Matrix of modern life. Hari, in non-literary voice, is identifying David Wallace’s nightmare from Infinite Jest as the world we’re living in.

Having cast serious doubts on the exclusivity of the cause being neuroanatomical, Hari identifies seven “disconnections” that fuel the nightmare. The seven social disconnections 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
  7. Disconnection from a Hopeful or Secure Future
  8. Genes / Brain Change

Hari calls out the nonsense-scape, Idiocratic hyperreality of modern life: bullshit jobs, isolating suburban design, rampant materialism, seductive and high-def drugs/porn/infotainment, wealth inequality, and leaders whose focus is golf over climate science. Depression, Hari suggests, is the appropriate response to this system.

Unsurprisingly, reversing these disconnections (and/or addressing biological factors with medication) attenuated depression in those interviewed. Both ailment and its reverse are covered in journalistic-style interview filling out the remainder of the book.

I found the book thought-provoking. Big Pharma is worth questioning as is the assumption that depression is primarily a neurochemical phenomenon. Hari provides several examples that what people want, deep down, is to belong, be heard, and mute the non-stop cavalcade of toxic materialism. We want to like ourselves and these disconnections’ opposites are how we do it. We must exercise better judgment as to what memes we let roost in our brains. I am behind such practice and have little doubt that a healthy diet for our minds and psyches would prove prophylactic to many ills.

Notes in JSON format:

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  "title": "Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions",
  "author": "Johann Hari",
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    {
      "highlight": "Once you settle into a story about your pain, you are extremely reluctant to challenge it.",
      "location": 277,
      "annotation": ""
    },
    {
      "highlight": "We have been systematically misinformed about what depression and anxiety are.",
      "location": 326,
      "annotation": ""
    },
    {
      "highlight": "primary cause of all this rising depression and anxiety is not in our heads. It is, I discovered, largely in the world, and the way we are living in it. I learned there are at least nine proven causes of depression and anxiety (although nobody had brought them together like this before), and many of them are rising all around us—causing us to feel radically worse.",
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    },
    {
      "highlight": "depression and anxiety are not caused by a chemical imbalance",
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      "annotation": ""
    },
    {
      "highlight": "giving a person a story about why they are in pain is one of the most powerful things you can ever do. Taking",
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      "annotation": ""
    },
    {
      "highlight": "They had been forced to admit, in their own official manual, that it’s reasonable—and perhaps even necessary—to show the symptoms of depression, in one set of circumstances.",
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    },
    {
      "highlight": "in thirteen years of being handed ever higher doses of antidepressants, no doctor ever asked me if there was any reason why I might be feeling so distressed.",
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    },
    {
      "highlight": "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?",
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    },
    {
      "highlight": "it seemed likely to George that her depression had been activated by something bigger. But he couldn’t be sure how to describe it until he had his results.",
      "location": 1007,
      "annotation": ""
    },
    {
      "highlight": "This showed that experiencing something really stressful can cause depression.",
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      "annotation": ""
    },
    {
      "highlight": "make depression much more likely—having a severe negative event, and having long-term sources of stress and insecurity in your life. But the most startling result was what happened when these factors were added together. Your chances of becoming depressed didn’t just combine: they exploded.",
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    },
    {
      "highlight": "having to endure “work [that] is monotonous, boring, soul-destroying;",
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    },
    {
      "highlight": "In Edgware, people weren’t hostile. We knew our neighbors to smile at. But that was it; any attempt at engagement beyond brief chitchat was shut down. Life was meant to happen, my parents learned slowly, inside your house. I didn’t regard this as unusual—it was all I ever knew—although my mother never got used to it. “Where is everyone?” she asked me once when I was quite small, looking down our empty street, baffled.",
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    },
    {
      "highlight": "Loneliness hangs over our culture today like a thick smog.",
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    },
    {
      "highlight": "Being deeply lonely seemed to cause as much stress as being punched by a stranger.",
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    },
    {
      "highlight": "And it’s not that we turned inward to our families. The research he gathered showed across the world we’ve stopped doing stuff with them, too.",
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    },
    {
      "highlight": "Sarah Silverman talk on a radio interview about when her depression first descended on her. She was in her early teens. When her mother and stepfather asked her what was wrong, she couldn’t find the vocabulary to explain it. But then, finally, she said she felt homesick, like when she was at summer camp. She said this to the interviewer, Terry Gross20 of NPR’s Fresh Air, with puzzlement. She had felt homesick. But she was at home.",
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    },
    {
      "highlight": "notice the same threat. What was happening? Protracted loneliness causes you to shut down socially, and to be more suspicious of any social contact, he found. You become hypervigilant.",
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      "annotation": ""
    },
    {
      "highlight": "Lonely people are scanning for threats because they unconsciously know that nobody is looking out for them, so no one will help them if they are hurt.",
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      "annotation": ""
    },
    {
      "highlight": "To end loneliness, you need other people—plus something else. You also need, he explained to me, to feel you are sharing something with the other person, or the group, that is meaningful to both of you.",
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    },
    {
      "highlight": "Loneliness isn’t the physical absence of other people, he said—it’s the sense that you’re not sharing anything that matters with anyone",
      "location": 1622,
      "annotation": ""
    },
    {
      "highlight": "Just like a bee goes haywire if it loses its hive, a human will go haywire if she loses her connection to the group.",
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    },
    {
      "highlight": "we have been left alone on a savanna we do not understand, puzzled by our own sadness.",
      "location": 1770,
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    },
    {
      "highlight": "People who achieved their extrinsic goals didn’t experience any increase in day-to-day happiness",
      "location": 1874,
      "annotation": ""
    },
    {
      "highlight": "we have shifted from having meaningful values to having junk values.",
      "location": 1891,
      "annotation": ""
    },
    {
      "highlight": "Materialism is KFC for the soul.",
      "location": 1897,
      "annotation": ""
    },
    {
      "highlight": "Tim, I think, has discovered something we should call the I-Want-Golden-Things Rule.17 The more you think life is about having stuff and superiority and showing it off, the more unhappy, and the more depressed and anxious, you will be.",
      "location": 1957,
      "annotation": ""
    },
    {
      "highlight": "advertisements led them to choose an inferior human connection over a superior human connection",
      "location": 1974,
      "annotation": ""
    },
    {
      "highlight": "“You’ve got to pull yourself out of the materialistic environments—the environments that are reinforcing the materialistic values,” he says, because they cripple your internal satisfactions.",
      "location": 2037,
      "annotation": ""
    },
    {
      "highlight": "Joe is constantly bombarded with messages that he shouldn’t do the thing that his heart is telling him would make him feel calm and satisfied.",
      "location": 2075,
      "annotation": ""
    },
    {
      "highlight": "Obese people didn’t need to be told what to eat; they knew the nutritional advice better than he did. They needed someone to understand why they ate. After",
      "location": 2153,
      "annotation": ""
    },
    {
      "highlight": "Obesity, he realized, isn’t the fire. It’s the smoke.",
      "location": 2170,
      "annotation": ""
    },
    {
      "highlight": "Allen Barbour, an internist at Stanford University,15 had said that depression isn’t a disease; depression is a normal response to abnormal life experiences.",
      "location": 2218,
      "annotation": ""
    },
    {
      "highlight": "three different kinds of causes of depression and anxiety—biological, psychological, and social.",
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      "annotation": ""
    },
    {
      "highlight": "depression is, for humans, in part a “submission response”—the evolutionary equivalent of Job, the baboon at the bottom of the hierarchy, saying—No, no more. Please, leave me alone. You don’t have to fight me. I’m no threat to you.",
      "location": 2371,
      "annotation": ""
    },
    {
      "highlight": "Even the middle class—even the rich—are being made to feel pervasively insecure. Robert had discovered that having an insecure status was the one thing even more distressing than having a low status.",
      "location": 2379,
      "annotation": ""
    },
    {
      "highlight": "Today, we are living with status gaps that are bigger than any in human history.",
      "location": 2410,
      "annotation": ""
    },
    {
      "highlight": "landscapes",
      "location": 2537,
      "annotation": ""
    },
    {
      "highlight": "Move.”",
      "location": 2546,
      "annotation": ""
    },
    {
      "highlight": "that exercise",
      "location": 2548,
      "annotation": ""
    },
    {
      "highlight": "Faced with a natural landscape, you have a sense that you and your concerns are very small, and the world is very big—and",
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      "annotation": ""
    },
    {
      "highlight": "The cruelest thing about depression, she said, is that it drains you of the desire to be as fully alive as this—to swallow experience whole. “We want to feel alive,” she said. We want it, and need it, so badly.",
      "location": 2617,
      "annotation": ""
    },
    {
      "highlight": "“Almost unique to the suicidal group was a kind of across-the-board failure to be able to understand how a person could go on being the same individual,",
      "location": 2721,
      "annotation": ""
    },
    {
      "highlight": "For them, the future had disappeared. Asked to describe themselves five or ten or twenty years from now,8 they were at a loss.",
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      "annotation": ""
    },
    {
      "highlight": "extremely depressed people have become disconnected from a sense of the future,",
      "location": 2729,
      "annotation": ""
    },
    {
      "highlight": "Crow member told an anthropologist in the 1890s: “I am trying to live a life I do not understand.”",
      "location": 2829,
      "annotation": ""
    },
    {
      "highlight": "You had everything a woman could possibly want by the standards of the culture. You had nothing to be unhappy about by the standards of the culture. But we now know that the standards of the culture were wrong. Women need more than a house and a car and a husband and kids. They need equality, and meaningful work, and autonomy.",
      "location": 3013,
      "annotation": ""
    },
    {
      "highlight": "You aren’t broken, we’d tell them. The culture is.",
      "location": 3016,
      "annotation": ""
    },
    {
      "highlight": "Believing depression was a disease didn’t reduce hostility. In fact, it increased it.",
      "location": 3061,
      "annotation": "Like dogs barking at older dogs"
    },
    {
      "highlight": "Eastern philosopher Jiddu Krishnamurti,26 who explained: “It is no measure of health to be well-adjusted to a sick society.”",
      "location": 3106,
      "annotation": ""
    },
    {
      "highlight": "What solved their problems? It seemed to me it was other people standing by their side, committed to walking on the path with them, finding collective solutions to their problems. They didn’t need to be drugged. They needed to be together.",
      "location": 3505,
      "annotation": ""
    },
    {
      "highlight": "Giving people drugs for depression and anxiety is one of the biggest industries in the world, so there are enormous funds sloshing around to finance research into it (and that research is often distorted, as I learned). Social prescribing, if it is successful, wouldn’t make much money. In fact, it would blast a hole in that multibillion-dollar chemical market—there would be less profit. So none of the vested interests want to know.",
      "location": 3884,
      "annotation": ""
    },
    {
      "highlight": "Sympathetic joy is a method for cultivating “the opposite of jealousy or envy … It’s simply feeling happy for other people.” Rachel guided me through how it works.",
      "location": 4303,
      "annotation": ""
    },
    {
      "highlight": "learned about an experiment that is designed to give people back time, and a sense of confidence in the future.",
      "location": 4807,
      "annotation": ""
    },
    {
      "highlight": "If you know you have enough money to live on securely, no matter what happens, you can turn down a job that treats you badly, or that you find humiliating. “It makes you less of a hostage to the job you have,",
      "location": 4880,
      "annotation": ""
    },
    {
      "highlight": "She had—as I mentioned before—grown up in a village in Turkey, and she thought of the whole village as her home. But when she came to Europe, she learned that you are supposed to think of home as just your own apartment, and she felt alone there.",
      "location": 5116,
      "annotation": ""
    },
    {
      "highlight": "You have to turn now to all the other wounded people around you, and find a way to connect with them,",
      "location": 5122,
      "annotation": ""
    },
    {
      "highlight": "We have been tribeless and disconnected for so long now.",
      "location": 5125,
      "annotation": ""
    }
  ]
}