This review contains discussion of antidepressants and their efficacy. Please do not make any changes to your medication without discussion and advice from a trained medical professional.
In his controversial book Hari delves into the world of depression and anxiety and questions whether we’re looking at the problem the right way. The world’s obsession with medication could be obscuring the root cause of a lot of people’s unhappiness. He walks you through nine possible causes of depression and anxiety (disconnections from meaningful work, other people, meaningful values, childhood trauma, status and respect, the natural world, a secure future, and the role of genes and brain changes). His focus is heavily on the role disconnection plays in the way we experience the world. He shares parts of his own journey with depression and comments on the enthusiasm to prescribe him medication without ever asking about what the rest of his life looked like. The latter part of the book considers ways we can create a more connected life, with the likely outcome being more positive mental health. Unfortunately, a lot of these solutions require societal change rather than individual change, and as a result this isn’t really a self help book so much as popular psychology. It is a fascinating, gripping read, but could be challenging for those currently receiving treatment for depression and anxiety.
The most shocking revelation for me reading this book was the claim that serotonin levels being the cause of depression has never been scientifically proven, or indeed credible enough to warrant disproving. Hari gives a fair amount of space to discussing studies that have been done around the efficacy of anti-depressants, and the split between experts on whether they are useful. It seems that although they might not do what we thought they did, they do still prove useful for some. There are others however who believe the effects to largely be placebo, whereas the negative side effects are very real, and we should therefore move away from our reliance on them. He carefully references all studies he refers to and encourages the reader to go to the source material and come to their own conclusions.
Hari looks further in to how depression is diagnosed, considering the fact the DSM checklist used to include a ‘grief exception’ which acknowledged that grief presents in similar ways to depression and would give someone a year after their loss before diagnosing them. This has now been removed. He wonders at why one specific circumstance was considered as reasonable to experience emotional challenges but other life events were not.
Hari believes that the modern world is set up in such a way as to damage our mental wellbeing. Community used to be central to the human experience but increasingly we are living isolated lives. The old adage of ‘it takes a village to raise a child’ is still bandied around but in practice parents are often on their own, or with support from their parents if they are lucky. There is not a broad support network for many, leading to further disconnection from the local environment and your neighbours. He also considers the impact of work that is found to be meaningless by those employed to do it, and the precarity of the job market meaning that people do not feel they have security. This naturally causes distress and feelings of hopelessness. Delving deeper still he considers why people don’t make the changes they need to improve their lives when they have the opportunity to.
Advertising culture has also had an impact on the way we feel about ourselves and our lives. We are constantly bombarded with messaging that tells us we should be thinner, more youthful, wealthier, that if we could just obtain x or y we would be happier and garner more respect. This is internalised and causes many people to constantly seek the short-lived dopamine hit of buying the latest gadget or most current fashion. Ultimately these things don’t bring us lasting happiness, but that truth doesn’t make people money, and so we are constantly encouraged to look for extrinsic validation through the possession of stuff.
It is a well acknowledged fact that spending time in nature, or indeed, just seeing it, can have a positive impact on our mood. Indeed, some doctors have begun prescribing activities that involve the outdoors, or the joining of groups that have a practical aim (gardening, painting, etc) which fulfil the need for community, purpose, and nature. These things are encouraging, both that the establishment is considering the wider circumstances that lead to good mental health, and also that we can make some changes to our lives to include these things on a personal level. However, there are many suggestions which are up to business and governments to change. Can working in a co-operative business boost wellbeing? Would Universal Basic Income have the incredible benefits that Hari claims?
Hari does not dismiss the fact that depression can have biological causes, or at the very least, biological pre-dispositions, but he questions why biology has been the main focus for so long. His examination of the things we need to be happy in life is thoughtful and important. He acknowledges his own privilege that has allowed him to implement some of these changes, with positive results. The book can be a little repetitive and, as already mentioned, most of the solutions are much bigger than one person can do, but it is an absolutely fascinating read. I couldn’t stop talking about it while I was reading it.