- why Prozac is a lot like Haygarth’s wand;
- how we can learn about a healthy work environment from a Baltimore bike shop; and
- how a prescription for social activities might be more affective than one for medication.
Lost Connections Key Idea #1: Contrary to common belief based on claims from pharmaceutical corporations, depression is not the result of a chemical imbalance.When the author, Johann Hari, was 18 years old, he took his first antidepressant medication, but he’d already experienced years of depression prior to this. Even in his youth, Hari had his fair share of moments crying alone in a room. Eventually, he understood that he was experiencing symptoms of depression. When he finally sought out medical help, he was told by his doctor that depression was a chemical imbalance in the brain, and therefore, something that can be alleviated with prescription antidepressants. For Hari, this meant taking Paxil, one of many drugs in the category of selective serotonin reuptake inhibitors (SSRIs), which claim to raise a person’s serotonin levels to that of a “normal,” non-depressed person. Like many patients taking SSRIs for the first time, Hari experienced some relief at first, but it didn’t last long. This prompted his doctor to up the dosage, which lead to another short period of relief followed by a relapse back into depression, and then yet another increase in the dosage. The one thing Hari did know for sure though was that the side effects of Paxil were causing weight gain and excess sweating. Eventually, well into his 30s, Hari was faced with the truth: after over a decade of Paxil, he was still depressed. Once he’d made this realization, he embarked on an extensive period of research on the relationship between depression and antidepressants, and what he discovered was truly shocking. After speaking to a number of researchers, Hari found that there was actually very little evidence supporting the claim that depression is caused by a chemical imbalance in the brain, or even that SSRIs are an effective treatment for everyone suffering with depression. In the mid-90s, Harvard professor Irving Kirsch took a closer look at the research on antidepressants. What he found was that the clinical tests pharmaceutical companies published were routinely skewed toward getting their medications released. Fore example, during the clinical testing for Prozac, 245 patients were tested, but in the published results, there was only mention of the 27 patients who experienced positive results. As for Paxil, actual results of one clinical test showed that patients responded better to the placebo than to the actual medication. Kirsch also looked deeper into the link between depression and the neurochemical serotonin. In his research he found the relationship to actually be an “accident of history” meaning scientists had misinterpreted findings, which lead to pharmaceutical companies latching onto this misinformation to sell drugs. As University of London professor Joanna Moncrieff told Hari, when it comes to anxious and depressed brains, “There’s no evidence that there’s a chemical imbalance.”
Lost Connections Key Idea #2: Any effects one might feel from taking prescription antidepressants is likely due to the placebo effect.Hari was dumbfounded by the information he was hearing from researcher after researcher: drug companies have been pushing wrong information on an unwitting public, and after countless tests, prescription antidepressants have been shown to be of negligible use. What this actually means is that even phony stories are incredibly effective in producing a placebo effect. The placebo effect is well known in the medical community. For example, take Henry Beecher, a WWII medic who ran out of morphine while trying to treat an unending amount of wounded soldiers. His final decision was to tell his patients that they were receiving morphine, when in fact, he was giving them a placebo of sugar water. Remarkably, the sugar water injections still managed to ease the pain and calm his patients. An even more remarkable story is that of Haygarth’s wand: a metal rod sold to patients as a miracle cure in 1799. For the wand to work, all you had to do was wave the rod over your ailment and believe in the fact that you were cured! Sure enough, patients believed in the miraculous story, and for at least some time their ulcers were healed an their inflammation was soothed. This whole idea shows how strong simply believing something can be. Looking at the evidence, or lackthereof, surrounding prescription antidepressants, it seems fairly clear that drugs such as Paxil and Prozac aren’t very different from Haygarth’s wand. People with depression often hear that they don’t have enough serotonin in their brains, so taking medication will give them more, which will make them better. Just as it happened with Haygarth’s wand, this only results in a short term benefit, which eventually wears off. You might be thinking: if the placebo effect still provides relief, this misinformation isn’t so bad. But these medications also come with long lists of side effects including weight gain and sexual dysfunction – which makes those temporary benefits seem all the more questionable. But if depression isn’t caused by a chemical imbalance, then what doescause it? As we’ll see in the next book summary, there’s more than one reason for feeling sad and hopeless.
We read dozens of other great books like Lost Connections, and summarised their ideas in this article called Depression
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Lost Connections Key Idea #3: There are at least nine causes for depression if we look at it from the point of view of it being caused by common life circumstances.What isthe underlying cause then, if depression doesn’t come from a chemical imbalance? Through his own experiences and conversations with researchers about their extensive studies about depression, the author found that there are nine primary causes of depression. The thing that connects each of the nine causes is life circumstances. In the 1970s, George Brown theorized that there might be two parts of the cause of depression: something going on in the brain and something going on in the person’s life. To test this theory, he conducted an extensive study of 144 women who’d been previously diagnosed with depression, and an additional 344 women who’d never been diagnosed with a disorder. He also made sure that all participants came from the same economic background. If depression was only caused by low serotonin levels, the results of the study would have shown that the lives of the participants didn’t have any significance on their mental health. However, Brown discovered that 68 percent of the group that had been diagnosed with depression had recently experienced a troubling event in their lives. He found that the depressed women were three times more likely to have what he called a “long-term chronic stressor” in their lives. Brown’s study also shed light on the differences, or lack thereof, between those diagnosed with “reactive depression,” – the clinical term for an event-caused depression – and “endogenous depression,” which is the type of depression categorized by a chemical imbalance. Remarkably, the results showed that each group’s past negative experiences was about equal. Basically, Brown was surprised to find overwhelming evidence that depression is primarily caused by psychological and social factors, not biological ones. Brown’s results were published in 1978, and yet although other studies conducted by social scientists around the world have supported Brown’s findings, much of the medical community has remained stubbornly focused on neurotransmitters.
Lost Connections Key Idea #4: The first cause of depression is a disconnect from meaningful work – something that can be helped by feeling empowered as an employee.Through his research and numerous interviews, Hari found nine main causes, or disconnections, that lead to depression, and he also found seven ways for people to actually reconnect. The first disconnection is one from meaningful work. This is perhaps best reflected by the astounding statistic which says that, from 2011 to 2012, only 13 percent of people would describe themselves as being “engaged” by their work. Psychiatrist Michael Marmot conducted one of the most thorough studies examining the relationship between work and health in the 1970s. After studying 18,000 British civil servants, Marmot discovered that it wasn’t the bosses with big responsibilities who were the most prone to heart attacks, but that it was the bosses who were actually four times less likely than others to have heart attacks. In order to look deeper into who experienced the most stress and depression, Marmot looked at people with the same pay level, status, and even the same office workspace. The results were clear: those who had less control and authority over their own decisions were more likely to be depressed. How bad can lack of control get? Years later, the British tax office asked Marmot to help when staff suicides were happening at alarming rates. It was found that the problem there was that work kept piling up and employees couldn’t do anything to alleviate the amount. He also found that there was also no correlation between effort and reward. No one seemed to care whether employees worked hard or slacked off. Marmot soon concluded that the overwhelming feeling of being powerless had become so unbearable that people had taken their own lives. Fortunately, there are ways to reconnect yourself with meaningful work. In Baltimore, the author met with the owners of a bike shop who found one answer to this feeling of powerlessness: democracy. Josh, his wife, and a small group of friends collectively quit their jobs to become equal partners in Baltimore Bike Works – a business modeled after the “cooperatives” that had been popular in the US prior to the late 1800s. They voted on important decisions at weekly meetings in a space that allowed anyone to raise an issue and voice their concerns. Everyone Hari spoke with at the bike shop reported feeling less anxious and depressed while working at the Bike Works than they had working in top-down jobs. Josh’s wife, Meredith, no longer had sleepless nights filled with feelings of dread and nervousness, which had plagued her during her career at a nine-to-five desk job.
Lost Connections Key Idea #5: The second cause of depression is a disconnect from other people, which can be solved by fostering mutually beneficial relationships.With the strong emphasis on individuality in both the US and UK, books that focus on “self-help” are incredibly popular and people are constantly sharing slogans on Facebook like “Only you can help you.” This strong sense of individualism, though, makes it so people often ignore the outside factors that affect our emotional states. One of these huge outside factors is our relationship with the people around us, which brings us to the second significant source of depression: a disconnect from others. Loneliness is a huge influencer on the feeling of stress and depression. Neuroscientist John Cacioppo studied how loneliness directly contributes to increased heart rates and higher levels of the stress-related hormone cortisol. In his studies during the 1990s, Cacioppo concluded that acute loneliness causes as much stress as being punched by a stranger! Loneliness is especially dangerous because it can make an already bad situation feel worse. We tend to close ourselves off when we’re sad, and the loneliness only adds to the anxiety. In order to reconnect with others, it’s important to take into account our inherent tribal nature and the want to be part of a mutually beneficial community based on sharing, helping, and protecting one another. One example of this type of mutually beneficial community is the Berlin neighborhood of Kotti, shortened from Kottbusser Tor, the name of the subway station after which the district is named. The community began in 2011 during a period in which the area’s rent was being raised. An elderly wheelchair user named Nuriye was facing eviction, so she posted a note stating her intentions to kill herself rather than lose her apartment. Her neighbors saw her note, and eventually barricaded the road in front of the apartment complex in protest for the rent increases. A diverse group of people consisting of conservative Turkish Muslims, gays, and punks all joined forces, calling their movement Kotti & Co. Once the movement was underway, the group figured out that rent control was just one area that would allow them to support each other. Before Kotti & Co., one high-schooler was at risk of flunking out of school, but after joining the protest, he met a neighbor who helped him with his homework, allowing him to get his grades under control. Also among the group’s members was a homeless Turkish man, Tuncai. There came a day when the group discovered that Tuncai had been taken to a psychiatric institution once again. Members of the group came together to get him out of the facility, since they all knew that his being a part of Kotti & Co. had given him purpose and allowed him to get better.
Lost Connections Key Idea #6: The third cause of depression is a disconnect from meaningful values, so it’s essential to keep the things that are most important to you in your sight.Recently, there was an ad campaign in London that featured a thin and tanned woman captioned with the phrase “Are you beach body ready?” People got so upset at the ad that the company discontinued it, and people even vandalized other ads with phrases like “Advertising shits in your head.” As it turns out, there has been a lot of studies that involve this idea, showing how the consumerist society we live in has made us feel disconnected from the things that mean the most to us, and, as a result, people are depressed. At the heart of this disconnect are two types of values: intrinsic and extrinsic. If you play piano for the joy you feel when you play, you’re motivated by intrinsic value. If you play the piano for the money you make playing shows, then you’re motivated by extrinsic value. Likewise, your goals in life can also be influenced by both types of values. Dozens of studies show how advertisements encourage motivation through extrinsic values, which have been proven to be less rewarding. Psychologist Tim Kasser has conducted multiple studies which show that the more driven by consumerism a person is and the more extrinsic-valued they are, the more depressed they become. Meanwhile, those who focus on intrinsic goals, such as helping others or becoming better musicians for the sheer joy of playing, saw a significant boost in their mood. Now, you may be thinking: “Wait a minute, buying a new iPhone does bring me joy!” It’s important to ask yourself one question: Why does this purchase make you happy? When we’re obsessed with buying new gadgets and other consumer goods, it usually comes from a want to appear cool and impressive in the eyes of other people. This means our happiness relies on outside factors and opinions, and this isn’t a stable or happy way to live. Likewise, when we’re motivated by promotions or higher pay, we’re usually thinking this way at the cost of more intrinsically meaningful things like relationships with loved ones. The key to reconnecting with meaningful values is to be aware of your motivations and to question where you’re spending your time and money. This will help you to focus on what’s truly meaningful to you. Tim Kasser has taken his own research to heart by finding a peaceful ten acres of land in Western Illinois where he and his family can focus on gardening, activism, volunteer work, and the things that enrich their lives.
Lost Connections Key Idea #7: The fourth cause of depression is a disconnection from childhood trauma.In recent years, there has been a lot of talk about the “obesity epidemic.” The discussion is usually focused around forming better nutritional habits and getting more exercise. What is usually overlooked, however, is the role that mental illness and trauma can play in both weight gain and therefore, depression. In the 1980s, Dr. Vincent Felitti conducted a remarkable study of obesity, which showed how a disconnect from our past traumas could lead to depression. Making this connection wasn’t Dr. Felitti’s original goal. Instead, his study involved the question of whether or not an extreme fasting diet could help a group of obese people lose weight quickly and safely. At first, the results were impressive: a woman named Susan quickly went from 408 pounds to 132 pounds. However, Dr. Felitti was surprised when Susan, and others, quickly put the weight back on. Dr. Felitti had a feeling that something bigger was happening with the patients, so he began talking to the participants about their lives. He was shocked to discover that 55 percent of them had instances of sexual abuse in their past and that, immediately following these events, they began putting on weight. For example, Susan started putting on weight after she’d been raped by her grandfather when she was 11 years old. But why was weight gain the result of this trauma? As some participants put it: “Overweight is overlooked.” That is, being physically larger made them feel protected from unwanted male attention. Dr. Felitti then expanded his research to include 17,000 people in the San Diego area, and the evidence showed that the more traumatic a person’s childhood was, the more likely they were to be depressed. According to the study, emotional abuse is the most influential factor – even more so than sexual abuse. These results surprised both medical journals and public health agencies since it reiterated the pushback against the widespread belief that depression was a dysfunction of the brain. The study also showed that instead of asking a person “What’s wrong?” it’s more affective to ask “What happened?” By acknowledging and talking about past trauma, people will be able to have a connection with their pasts, and therefore, move past them. The author is no stranger to trauma — he was abused and strangled with a cord as a child. Once he acknowledged that this happened, he was able to stop feeling like he was deserving of the bad things that had happened to him, and that he was the reason they’d happened.
Lost Connections Key Idea #8: A disconnect from status and respect is the fifth cause of depression, and the sixth is disconnection from nature.Scientists don’t study baboons and bonobos just because they’re fun to watch. Both of these animals are some of our closest relatives, so we have plenty to learn from them about our own human nature. Status and respect are very important to our well-being and a disconnect from these can lead to depression. Baboons live in a strict hierarchy: the alpha male is allowed to take food from whomever he pleases, number two can take food from number three, and so on until you get to the poor fellow at the bottom. By testing the cortisol levels in baboons, researcher Robert Sapolsky found that those on the bottom rung had extremely high levels of stress. It was also evident that the alpha male expressed large amounts of stress when another male challenged him. In humans, there is a lot that can make us feel inferior – including ads that make us feel like we’re nothing without lots of money or the perfect body. There’s also plenty of research to show that areas with greater economic gaps, such as the US, have higher levels of depression than places where there’s less of an economic gap, such as in Norway. Society is what decides whether we live in either a stressful and depressing environment with a strict hierarchy or one where status and respect are more evenly distributed amongst the people. Another cause of depression that we can observe in primates is a disconnect from nature. Since her 20s, Isabel Behncke has studied “the nature of human nature,” and has witnessed how bonobos in the wild cope with stress. It’s clear that they’re depressed when they stop grooming themselves and sit far apart from each other. When they’re taken out of their natural environment, things get much worse: they’ll scratch until they bleed, howl, and rock back and forth. Being close to nature is important for us too. Studies have shown that people who live in greener areas are generally less stressed, because immersion in nature reduces obsessive thoughts and boosts concentration.
Lost Connections Key Idea #9: The seventh reason for depression comes from a disconnect from a hopeful and secure future.If you’ve ever struggled with depression, there’s a good chance you felt like it was never going to end. This is one of the reasons depression is so powerful – you can’t see past it. This inability to see the future can lead to feeling disconnected from feelings of hope and security. One of the main causes for feeling hopeless about the future is a disconnection from a feeling of control over our own destiny. In Canadian Native American communities, there’s been an epidemic of unfortunate suicides. When psychologist Michael Chandler looked into this, it was evident that the suicides were mostly among residents of reservations controlled by the government – communities where the government is in charge of the schools, enforces the laws, and gives no control to the residents. Chandler was also able to see that some reservations had managed to regain claim over their land and in these communities, the Native Americans controlled the elections, police, health services, and could even revive their native languages by teaching them in schools. Chandler recognized that the people in these communities were in control of their destinies and suicide epidemics didn’t occur there. Feeling disconnected from a sense of security is another powerful factor that can influence our well-being. Here’s another example from Canada: In 1973, the Manitoba town of Dauphin was the base for an experiment that would provide people with an automatic minimum wage that equates to $19,000 a year in today’s money. It was canceled in 1979 by a new conservative government that didn’t approve of the concept, but 1800 boxes of data on this experiment still exist. From the data, we can see that in just three years, there was a 9-percent drop in people seeking medical help for mood disorders. People who lived in the area during this time state that the money acted as an insurance policy for the farming town since most of their income was based in canola crops. Once the automatic wages arrived, inhabitants were able to worry less about their children’s futures and were able to use the money to access the education they otherwise wouldn’t have been able to afford. Overall, the automatic minimum wage helped people to reconnect with their idea of the future and allowed for a connection with meaningful work.
Lost Connections Key Idea #10: While changes in the brain and genes arethe final cause of depression, their influence is quite limited.While there is a strong case against depression being caused by a chemical imbalance, this doesn’t mean that there aren’t any biological factors involved in depression. Your brain is always changing, which, in the sciences, is referred to as neuroplasticity. Because of this, it might be that the brain can actually change in a way that supports depression. There is a lot of evidence for neuroplasticity. For example, a London cab driver who has to memorize every road in the city, will grow in his skills related to the part of his brain that has to do with spatial recognition. Likewise, if a person spends more time focusing on thoughts of fear and negativity rather than joy and pleasure, the areas of the brain associated with positive feelings will weaken, while the ones associated with negative feelings will strengthen. It’s also a common idea that depression runs in the family, meaning that a person is predisposed to be depressed, just as past relatives were. However, this is grossly overstating the true nature of genetics. Research has shown that only 37 percent of depression cases come from genes. For perspective, height is 90 percent determined by your genes, but that percentage drops to zero when it comes to determining your language. So really, when it comes to depression, genetics plays a relatively small role. More specifically, researchers have found that there is a variant of a gene known as 5-HTT that can make you more susceptible to depression. This is similar to having a gene that can lead to weight gain – it’s not unrelated, but it isn’t causing the weight gain. According to research, there are plenty of reasons why people might latch onto this idea of genes being the cause of depression. For one, there’s still a stigma attached to depression and mental illness in general. So, when someone questions it, it’s often simpler and easier to attribute your suffering to biology rather than a combination of factors in your life.
Lost Connections Key Idea #11: A solution to get people to connect to one another and to meaningful work is a prescription for social interaction.We’ve already gone over the nine different causes of depression that Hari has discovered, and for most of these disconnections, there’s an obvious reconnection, allowing us to reconnect to other people, meaningful work, meaningful values, a hopeful future, and acknowledging and overcoming trauma. The last two ways to reconnect involve actively combatting depression. The first is through something called social prescribing. Lisa had already quit her job as a nurse in a London hospital before she met Dr. Everington. After she complained that her fellow nurses were mistreating the patients in the psychiatric ward, Lisa’s co-workers turned on her, making her job unbearable. She’d grown up in a household of constant bullying, so she couldn’t handle being picked on at work. This lead her to simply stop showing up one day. Around this time, Lisa began a prescription of Prozac, which lead to weight gain. For the next seven years, she felt horrible about herself and only left the house to buy junk food. Eventually, she worked up the courage go with her doctor’s advice and visit an East London clinic run by Dr. Sam Everington. Instead of giving her more drugs to try, Dr. Everington gave Lisa a social prescription, which meant she would be working with a small group of other disconnected people on turning an abandoned piece of London wasteland into a healthy garden. At first, the people involved were a little guarded around each other, but they’d all agreed to take on the challenge, and together they learned the basics of gardening and worked to fix up the abandoned lot. Through working together, they were able to open up to each other, which lead them to learn that they actually had a lot in common. Lisa would never have guessed she would have such a similar life to an elderly Asian man, but it turned out that he too had been bullied at work. It was incredibly satisfying getting to watch their garden bloom and receiving thanks from people in the neighborhood. Eventually, Lisa was able to get off Prozac, allowing her to drop 62 pounds. She then moved to Wales to open her own gardening center. None of this would have happened had she not received that social prescription from Dr. Everington.
Lost Connections Key Idea #12: Psychedelic drugs and meditation can allow people to let go of their egos and therefore, find sympathetic joy.Psychologist Fred Barrett identifies one of the main symptoms of depression as “an addiction to ourselves.” It’s hard to see a way out because we’re blinded by our own ego– or sense of self-importance. Something that can help you to dissolve this ego, and start seeing situations differently is a different type of drug: psychedelics. At John Hopkins University, psychologist Bill Richards has been testing the effects of psilocybinon depression. Psilocybin is a psychedelic found in many species of mushroom. The results from his research have been uniformly promising. After three sessions of Bill guiding his patients through the experience, 80 percent of patients found the experience to be one of the five most important in their lives. The results show that psilocybin assisted in the acknowledgement of past trauma, allowing them to overcome it. It also helped them to connect with nature, let go of their ego, see past their problems, and gain a peek into a better future filled with possibility. Sounds pretty great, right? Well, all drugs can come with downsides. One problem is you need to sustain the benefits of the treatment, meaning that when people return to day-to-day life, they can lose sight of the advantages listed above. A less risky, yet still effective approach involves meditation. Many of the same benefits people have gained from the psilocybin tests, have been gained by others through deep meditation. Although meditation takes discipline and practice, it can help you cultivate sympathetic joy– another solution to depression. Sympathetic joy is about being happy for others, which allows you to rid yourself of jealousy and envy, opening you up to joy by cultivating these feelings about the people around you. It’s possible to achieve this through meditating regularly in sessions wherein you imagine yourself having the same joy and compassion for strangers as you do for your close family. You’re then able to start feeling happy for people you dislike, or even feel envious of. With some training and repetition, you’ll find yourself able to experience a greater sense of joy and peace.
In Review: Lost Connections Book SummaryThe key message in this book summary: There is a common myth spread by pharmaceutical companies that depression is caused by a chemical imbalance in the brain, however research shows little evidence to support this claim. There are nine main causes for depression, ranging from trauma and loneliness to disconnections from meaningful values and nature. Contrary to these disconnections, there are also seven reconnections, through which we can heal ourselves. These include acknowledging our disconnections and rethinking our values. Actionable advice: Practice the sympathetic joy meditation. Close your eyes and imagine something wonderful happening to you, like falling in love. Let that joy overflow within you. Next, imagine that same feeling happening to someone you care deeply about and let the joy flow. Now, imagine this happening to someone you don’t know very well, and let the joy flow. Imagine now that this happening to someone you don’t like, and let the joy flow. Finally, imagine this happening to someone you really don’t like, perhaps someone who’s a source of envy for you, and let the joy flow. Doing this for 15 minutes every day, will allow feelings of jealousy to start to dissipate, allowing a new capacity for joy to flourish inside you.
Suggested further reading: Find more great ideas like those contained in this summary in this article we wrote on Depression