Kobus Cilliers | On 14, Aug 2019

Darrell Mann

This month’s book choice fits into the psychology end of the innovation story. It’s also about the Big Pharma industry and how their urge to sell drugs rather than cure patients ends up creating far bigger problems than the ones being solved. As is so often the case when we’re looking for big ideas, the book does its job by looking at extreme situations. In this case, ‘Lost Connections’ by Johann Hari, is all about the true causes of depression. And more to the point – skin-in-the-game – his depression.

Hari was 18 when he took his first antidepressant. That morning he had visited a doctor and explained how, ever since he was small, he had battled with feelings of overwhelming sadness. When he wasn’t taking himself off to cry quietly, an anxious monologue would be running in his head. “Get over it,” it would say, “stop being so weak.” The doctor was reassuring, explaining that these feelings were to be expected since Hari was one of many people whose brain had depleted levels of serotonin. And so he prescribed some pills that would restore the balance. As Hari swallowed his first tablet, he says, “it felt like a chemical kiss”.

It wasn’t until he was in his 30s that he thought of all the questions the doctor didn’t ask, such as: what was his life like? What was making him sad? What changes could be made to make life more tolerable? The push and pull between “reactive” depression (the kind that relates to our environment and life experience) and “endogenous” depression (where something goes wrong in the brain) forms the basis of Lost Connections, an eye-opening, highly detailed though sometimes frustrating investigation into the causes and cures of depression.

The book is part personal odyssey, in which Hari gets to grips with the flaws in his own treatment, and part scholarly reflection, where he sifts through the varying perspectives of scientists, psychologists and people with depression. In the first half, he examines the social and psychological factors that can cause reactive depression, which include hardship, trauma, loneliness, lack of fulfilment, absence of status and disconnection from nature. He casts a damning eye on the research practices of the Big Pharma industry, which has a clear investment in the endogenous argument, and deftly debunks the popular notion that depression stems from faulty genes.

It’s no surprise that Hari is meticulous in revealing his methods, given his past misdemeanours while working at the Independent newspaper. In 2011 it emerged that he had been using quotes from his interviewees’ books, and from previous press interviews, as if they had been given to him. Thus, to (over-)compensate there are copious notes at the back of Lost Connections containing websites, journals and books consulted, while his interview recordings have been made available online.

As well as sifting through hundreds of academic papers, Hari has talked directly to people who have made great strides in understanding depression. He meets a junkie-turned-neuroscientist in Sydney, climbs a mountain with a primatologist outside Banff in Canada, visits a rehabilitation centre for gaming addicts in Washington state and observes an Amish community in Indiana. So, it’s somewhat baffling, given the legwork put in, how little his interviewees actually get to say. In London he meets George Brown and Tirril Harris, authors of a groundbreaking study of the social causes of depression that saw them going into the community and interviewing women about their lives. He makes clear the importance of their work and spends 10 pages telling their story, but quotes just a few sentences from each. It’s a recurring theme: Hari crisscrosses the globe to meet prominent thinkers only to tell their stories on their behalf, throwing in a couple of quotes if they are lucky. (He does, at least, give his case studies a louder voice; his conversations with those dealing with depression are extremely moving.)

The research is thorough, however, and his ability to locate a narrative in what one might fairly assume to be bone-dry source material is undeniable. The lazy, oversimplified and unimaginative attitudes of the medical establishment to anxiety and depression laid out here beggar belief. You could argue that finding fault in the current system isn’t that hard – it’s the solutions that present the real challenge. But Hari is clear about the difficulties of the task ahead and, in offering new ways of thinking, presents not surefire solutions, but, he says, “an alternative direction of travel … points on a compass”. Put in the broadest terms, his argument is that if our current malaise lies in disconnection from vital human requirements such as neighbourliness, professional fulfilment, acknowledgment of trauma and so on, then we need to find ways to reconnect.

Hari discusses nine causes of depression and anxiety in all. He doesn’t think to try and (irony alert) connect them all, but that’s probably because he didn’t have the tools. Or an understanding of the importance of mapping the ‘betweens’ when dealing with complex siutations like depression. Here’s what happened when I made my own attempt at doing the ‘between’ mapping job with his nine causes:

Which suggests to me that the vicious cycle is the place to start if there’s a desire to genuinely address the depression epidemic currently engulfing many parts of the West. One thing’s for certain: there’s little or no place for drugs in the remedy story. If you take away nothing else from this book, it’s a vivid re-affirmation of the power of the body (or should that be mind) to self-repair. In that context, the Big Pharma industry – and their sinister role in the growing distrust of ‘experts’ – has a lot to be ashamed of.

Hari is by no means the first writer to call for a compassionate, common-sense approach to depression and anxiety, or to point out how medical and societal attitudes have fallen short. But his book brings with it an urgency and rigour that will, with luck, encourage the authorities to sit up and take note. Plus, where else are you going to find a book endorsed by Hillary Clinton, Naomi Klein, Brian Eno and Russell Brand?