Drug companies would fund huge numbers of studies and then only release the ones that showed success
Well-known author and journalist, Johann Hari, suffered from depression as a teen, taking anti-depressants from a tender age. Told, like so many others, his depression was the cause of a chemical imbalance in his brain, he later studied social sciences and embarked on a quest to discover the truth about the cause of his depression. He swallowed antidepressants like millions of others, and after 13 years of pills, without much change, and a broad investigation into the true causes of depression, he is calling for a different approach.
He says that between 65% and 80% of people on antidepressants are depressed again within a year. There is a tickbox list on the DSM Website which is used to diagnose someone as mentally ill and suffering from chronic depression.
WE’VE BEEN TELLING OURSELVES THIS CHEMICAL STORY FOR 35 YEARS AND EVERY YEAR DEPRESSION AND ANXIETY GETS WORSE.
I was a teenager when I swallowed my first antidepressant. I was standing in the weak English sunshine, outside a pharmacy in a shopping centre in London. The tablet was white and small, and as I swallowed, it felt like a chemical kiss. That morning I had gone to see my doctor and I had told him – crouched, embarrassed – that pain was leaking out of me uncontrollably, like a bad smell, and I had felt this way for several years. In reply, he told me a story. There is a chemical called serotonin that makes people feel good, he said, and some people are naturally lacking it in their brains. You are clearly one of those people. There are now, thankfully, new drugs that will restore your serotonin level to that of a normal person. Take them, and you will be well. At last, I understood what had been happening to me, and why.
However, a few months into my drugging, something odd happened. The pain started to seep through again. Before long, I felt as bad as I had at the start. I went back to my doctor, and he told me that I was clearly on too low a dose. And so, 20 milligrams became 30 milligrams; the white pill became blue. I felt better for several months. And then the pain came back through once more. My dose kept being jacked up, until I was on 80mg, where it stayed for many years, with only a few short breaks. And still the pain broke back through.
People who suffer from depression and anxiety have experienced stresses and traumas in their development that predispose them to mood disorders. Garden-variety psychodynamic theory teaches us that issues involving loss, neglect, guilt, and rejection usually figure prominently in the backgrounds of people who present with significant symptoms of depression and anxiety. The treatment of depression today usually relies heavily on pharmacology, and drug companies have spent billions making sure that this explanation is widely accepted. Someone in five US adults is taking at least one drug for a psychiatric problem; nearly one in four middle-aged women in the United States is taking antidepressants at any given time, and around one in 10 boys at American high schools are being given powerful stimulants to make them focus.
I FOUND THERE IS EVIDENCE THAT SEVEN SPECIFIC FACTORS IN THE WAY WE ARE LIVING TODAY ARE CAUSING DEPRESSION AND ANXIETY TO RISE–ALONGSIDE TWO REAL BIOLOGICAL FACTORS (SUCH AS YOUR GENES) THAT CAN COMBINE WITH THESE FORCES TO MAKE IT WORSE.
Since it’s well known that psychological events produce biological changes, it remains debatable whether or not disorders of our biochemistry are causes or effects. What we do know is that untold amounts of money have been spent by the pharmaceutical industry to finance research and public relations designed to enshrine biochemistry and pharmacology as primary in the diagnosis and treatment of depression and anxiety.
However, what of the social, cultural, and even political contexts that contribute to emotional suffering?
- Disconnection from meaningful work: Researchers found that 13% of people say they are “engaged” in their work – they find it meaningful and look forward to it. Some 63% say they are “not engaged”, which is defined as “sleepwalking through their workday”. And 24% are “actively disengaged”: they hate it.
- Social isolation and loneliness have been shown to have a wide range of negative physical/health consequences. Feeling lonely, for example, causes our cortisol levels to soar, a hormonal outcome that causes wide-ranging damage to the body and mind. In fact, acute loneliness is seen as every bit as stressful as being physically attacked. Human beings are wired to be in groups, and, when we aren’t for too long, we feel alienated and insecure. Loneliness and social isolation is increasingly a public health epidemic in America.
- No “meaningful values.” In this section, he offers a critique of our consumer culture clearly dominated by an addiction to material possessions, money, and status. He points out that advertising experts have admitted since the 1920s that their job is to make people feel inadequate and to then offer their products as the solution to the very inadequacy they have created. A capitalist economy and culture that tells us that there is never enough and that we are never enough, provides us with what Hari calls “junk values.”
- Disconnection from status, respect, and social approval by virtue of the gross and radical imbalances of income and wealth in our society, as well as being disconnected from the natural world in a society in which most people live in cities and conduct most of their life indoors. There is powerful scientific evidence that suggests that societies with greater equality have less psychiatric illness and that being out in nature reduces depression and anxiety.
So, what is really going on? When I interviewed social scientists all over the world – from São Paulo to Sydney, from Los Angeles to London – I started to see an unexpected picture emerge. We all know that every human being has basic physical needs: for food, for water, for shelter, for clean air. It turns out that, in the same way, all humans have certain basic psychological needs. We need to feel we belong. We need to feel valued. We need to feel we’re good at something. We need to feel we have a secure future. And there is growing evidence that our culture isn’t meeting those psychological needs for many – perhaps most – people. I kept learning that, in very different ways, we have become disconnected from things we really need, and this deep disconnection is driving this epidemic of depression and anxiety all around us.
We have to acknowledge that some real people get better in real ways on antidepressants. However, it is also true that these benefits are less than advertised and results often diminish over time. Locating the cause of depression entirely in the brain and advocating a primarily pharmacological approach to its treatment is a paradigm with limited efficacy.
Hari argues that depression and anxiety should be considered two sides of the same coin. He asserts that everything that causes an increase in depression also causes an increase in anxiety and the other way around. He points out that these two types of distress “rise and fall together.” Again, this aligns with my own experience treating patients with depression and anxiety. In my clinical experience, it’s rare to see one without the other.
The notion that trauma and stressful life experience cause depression and anxiety is really no longer controversial. For example, in the mid-1990s, Dr. Vincent Felitti of Kaiser Hospital in San Diego conducted an extraordinary and simple study, called the Adverse Childhood Experiences Study—or ACE Study. He sent out a questionnaire to 17,000 people who were seeking healthcare from Kaiser, a questionnaire asking people to check off which of 10 different categories of childhood trauma they had experienced. These traumas included most of the terrible things that can happen to you when you’re a child, including various types of sexual, physical or emotional abuse. In addition, respondents filled out a detailed medical questionnaire testing for all sorts of things that could be problematic, such as obesity, addiction, or depression. The results stunned even Dr. Felitti: For every category of traumatic experience that someone went through as a child, that person was radically more likely to become depressed as an adult. The correlation was almost perfect—the greater the trauma, the greater the risk for depression, anxiety, or suicide. For example, if you had six categories of traumatic events in your childhood, you were five times more likely to become depressed as an adult than someone who didn’t have any. If you had seven types of traumatic events as a child, you were 3100% more likely to attempt to commit suicide as an adult.
As Hari says, quoting Dr. Robert Anda who worked on the ACE study, “when people have these kinds of problems, it’s time to stop asking what’s wrong with them, and time to start asking what happened to them.”
“Solutions” involve making radical changes in social life. Further, experiments in cooperative, more democratic and egalitarian work arrangements have shown that such innovations, by reducing the alienation and estrangement people feel at work, can significantly decrease stress while not sacrificing success in the marketplace. Hari says that we need to ask depressed people not “what’s the matter with you,” but, instead, “what matters to you?”
Hari eloquently states this case in his last chapter when he says: “You aren’t a machine with broken parts. You are an animal whose needs are not being met. You need to have a community. You need to have meaningful values, not the junk values you’ve been pumped full of all your life, telling you happiness comes through money and buying objects. You need to have meaningful work. You need the natural world. You need to feel you are respected. You need a secure future. You need connections to all these things. You need to release any shame you might feel for having been mistreated.”
I think it’s fair to say that in order to achieve these things, we need a revolution.
Why you should listen
Johann Hari’s first book, Lost Connections: Why You’re Depressed and How to Find Hope, is being translated into 27 languages and has been praised by a broad range of people — from Elton John (who said it “will change your life”) to the British Journal of General Practice, who called it “one of the most important texts in recent years.” His second book, Chasing the Scream: The First and Last Days of the War on Drugs, has been translated into 15 languages and is currently being adapted into a major Hollywood film by Oscar-winning director Lee Daniels, and into a non-fiction documentary series.
Hari graduated from Cambridge University with the highest degree grade, a Double First, in social and political sciences. He grew up in London, with a Swiss father who was a bus driver and a Scottish mother who worked in a shelter for victims of domestic violence. Today, he lives half the year in London, and he spends the other half of the year traveling to research his books.
Hari has written over the past eight years for some of the world’s leading newspapers and magazines, including the New York Times, the Los Angeles Times, the Guardian, the Spectator, Le Monde Diplomatique, the Melbourne Age and Politico. He has also appeared on leading TV shows, including HBO’s Realtime With Bill Maher. He was twice named “National Newspaper Journalist of the Year” by Amnesty International. He has also been named “Cultural Commentator of the Year” and “Environmental Commentator of the Year” at the Comment Awards, and “Gay Journalist of the Year” at the Stonewall Awards. Read about what Johann is working on now.