“Lost connections – Why you’re depressed and how to find hope” by Johann Hari.
This is the first of two books on depression that I’m going to read, so I wanted to review it before I start the next one and end up confused. This one was recommended by a friend who hadn’t actually read it (how often does that happen? Too often it seems to me). They’d read another book by the same author, on addiction, so tasked me with working out whether it was worth the effort of reading this book too. As if I have so much free time! The trouble is, I read it on the kindle, so had no idea how long it was. It took me two weeks to get through, anyway, although I sped up towards the end.
The cover has rave reviews from Elton John and Hillary Clinton, so already I was a little wary. Then, the first chapter or so was about the author’s own depression journey, with the main message seeming to be that antidepressants don’t work at all. I get put off by too much doctor bashing, although I think Big Pharma is definitely a legitimate target. Who thought a market model was the best one to find the medications that mankind needs? Capitalism is why we have a pharmaceutical industry that spends a squillion more dollars on cures for baldness rather than finding new antibiotics to fight drug resistant organisms. However, the early message of the book appeared to be that antidepressants work no better than placebo and have the downside of unpleasant side effects such as weight gain. Which is probably truer than I’d Iike.
The rest of the book was more about how the current model of thinking that depressed and anxious people have broken brains that just don’t make enough serotonin is far too simplistic. When I was in med school last century, the big new concept in thinking about ill health was the bio-psycho-social model, but this seems to have become forgotten in the race to make drugs to fix the broken biology that pharmaceutical companies want to convince us is what really underlies disease. In fact, the bio-psycho-social model fits really well with depression. It turns out that Monty Python were onto something when they said society was to blame.
We are isolated, working in unsatisfying jobs with no control over what happens, precariously living paycheck to paycheck, not knowing our neighbours, separated from nature, earning money to buy things that we don’t really need, focussing on the wrong things. Looking after number one turns out to be the complete opposite of what is needed to make us happy. The penny had never dropped for me that advertising works by making us feel inadequate.
When I learnt about depression at med school, they used to talk about reactive depression vs endogenous depression. The latter would be the one the drug companies focus on – the serotonin deficient brain. These were the people who seemed on the outside to have perfect lives, so they had nothing to be depressed about. But if you really look into these people’s stories, which of course the typical GP doesn’t have the time to do, when they could just reach for the script pad and save themselves hours of work, there is almost always a cause. Childhood trauma that hasn’t been addressed, a shallow disconnected meaningless life that engenders feelings of worthlessness. If ‘endogenous’ depression is a thing at all, it’s vanishingly less of an issue than we have been told.
So, prescribing a pill to enable us to keep going with the same destructive patterns is not a good answer. The trouble is, reconnecting is a difficult thing to achieve on your own. One solution the author suggests to improve society is the universal basic income, which I like the idea of, and seems to be becoming trendy. It will be interesting to see where that goes. Other ideas include urban design with more green spaces, limiting advertising, changing the business model to collective ownership – giving workers more rights and more of a say, reducing wealth inequality – tax the rich! Stop paying CEOs obscene amounts! Welfare! Free healthcare! These changes and more would end up paying for themselves with less sickness and crime. It all makes sense to me but then I am a socialist. How do you convince the right wingers with their ‘every man for themselves and the devil take the hindmost’ mentality?
The next book on depression I’m going to read is one recommended by the psychiatrist of one of our offspring. Yes, mental health issues have definitely affected my family, and this appears to be becoming increasingly common, just looking at the anecdotal evidence of my circle of friends. I will report back.
And, yes, I’ll be recommending my friend make the effort to read this book.