Lost Connections: Why You're Depressed and How to Find Hope
Johann Hari, 2018
Why does a pill help some people and not others, and rarely all the way? Journalist Johann Hari lived with depression for years, then set out to find its causes by talking to scientists around the world. He found nine causes and seven ways to rebuild the connections we have lost. Most of the causes lie in the way we live.
Who it is for
For anyone who feels low for no clear reason: after a move, after a breakup, when the things that used to bring joy no longer do. And for anyone who wants to understand where depression and anxiety come from, looking beyond brain chemistry.
You are not a machine with broken parts. You are an animal whose needs are not being met.
The pill and the serotonin story
Eighteen-year-old Johann Hari sits in a doctor's office and hears a simple explanation for his misery. His brain is short of a chemical called serotonin, and that is why he feels so bad. The doctor prescribes an antidepressant, and within a few weeks the pain really does lift. Then it comes back. The dose goes up, the pain lifts again, and again it comes back. This goes on for more than ten years.
Hari is a British journalist. One day he asked himself a question he had been putting off for a long time: if it is all about chemistry, why had depression and anxiety risen in Britain and across the Western world almost every year of his life? To find out, he travelled some forty thousand miles. He visited labs in Baltimore, an Amish community in Indiana and a protest square in Berlin, and he questioned dozens of scientists.
The book's central idea sounds unfamiliar. In Hari's view, depression and anxiety are not only a fault in the head. Often they are a signal that a person is missing something they cannot live without. Hari counted nine causes. Two are about the body: genes and changes in the brain. The other seven lie in the way we live today: in our work, in loneliness, in our values, in childhood wounds, in a lack of respect, in our disconnection from nature and in a lost belief in the future.
This book is for anyone starting life over: after a move, after a breakup, after the things that used to bring you joy suddenly stopped doing so. You will see where this kind of pain can come from, and you will learn seven ways to rebuild the connections you have lost. Hari found these ways among people all over the world. Along the way, you will find out why a farmer in Cambodia who could not climb out of despair was given a cow instead of pills.
The pill was weaker than the chemistry story promised
The first person to shake Hari's certainty was Irving Kirsch, a researcher of the placebo effect. A placebo is a dummy pill with no medicine in it, which a person takes believing they are being treated. Kirsch set out to test how much stronger antidepressants are than a placebo. He gathered the trial data that drug companies had submitted to the American regulator, including trials that were never published.
In these trials, depression is measured on a scale devised by the psychiatrist Max Hamilton, running from zero, when a person feels fine, up to fifty-one. By Kirsch's calculations, antidepressants on average scored 1.8 points better than the dummy pill. For comparison, Hari gives another number: if a person simply starts sleeping better, their score on the same scale can improve by about six points.
What troubled Hari even more was the serotonin story itself. The scientists he spoke to explained that the simple idea of “low serotonin means depression” was never backed by solid evidence. It was a handy way to tell patients what was happening to them, but it could not explain why the pills do not work for everyone.
What Hari does not say matters too. He does not claim antidepressants are useless: he writes that some people get real relief from them. Many doctors and researchers dispute Kirsch's conclusions, and this is a journalist's book, not a medical verdict. Hari's question is a different one: if the pill does not explain everything, where is the rest?
About the author
Johann Hari is a British journalist and the author of Stolen Focus. He lived with depression for many years, and this book grew out of his effort to understand his own pain.
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