The US suicide rate has risen nearly 30 percent since 1999. The rate in 2017 was the highest it has been in at least 50 years. Why are more Americans suffering from depression?
Johan Hari interviewed prominent researchers in the field to find the answer. An award-winning journalist and best selling author, Hari suffered from depression, which ran in his family. He took antidepressants in progressively stronger doses, but inevitably the sadness returned.
Hari noticed a tremendous increase in the American use of antidepressants over several decades. Today about one in four middle-aged women in the United States is taking antidepressants. His book explains why are so many more people apparently feeling depressed and severely anxious. Something changed. Hari came to understood that depression is not caused by a defective brain. Instead, anxiety and depression are reactions to how we are living.
What are environmental factors causing anxiety? In a word, the cause is disconnection -- from meaningful work, from other people, from meaningful values, from nature, from a secure future.
Gallup finds that 87 percent of workers are either not engaged or are actively disengaged from their jobs. Nearly twice as many people hate their jobs as love their jobs. Depression among British civil servants correlates with their rank, with higher ranked bureaucrats suffering less depression than those lower on the totem pole. The degree of control a worker has over his job is the key factor, even among workers with the same ranking.
"More people say they feel lonely than ever before," and research shows that loneliness leads to depression. In most cases in one five-year study, loneliness preceded depressive symptoms.
Humans evolved in tribes, and being part of a tribe was necessary for survival. "Loneliness isn’t just some inevitable human sadness, like death. It’s a product of the way we live now." Highly social groups such as the Amish and the Hutterites have very low rates of loneliness.
In his book Bowling Alone, Robert Putnam of Harvard meticulously documented the sharp decline in community involvement in the US since the 1960s. Putnam also found we do fewer activities with our families, such as eating meals or watching tv together.
Americans have been polled for decades about how many close friends they have; at one time the answer was three, but today the most common answer is none. In short, there has been an unprecedented social crash, which prevents us from fulfilling our desire for belonging.
Cyberspace connection doesn't fill the void. The inordinate amount of time young people spend on smartphones further reduces the time they spend in face-to-face interaction.
"Online connection is a pale imitation of face-to-face connection that we social animals crave. The difference between being online and being physically among people is a bit like the difference between pornography and sex: it addresses a basic itch, but it’s never satisfying. Social media can’t compensate us psychologically for what we have lost—social life."
Another cause of depression is the loss of status and respect. Among baboons, the lowest ranking members of the troop have the highest levels of stress hormones, although having an insecure status was the one thing even more distressing than having a low status. In other words, stress is highest when status is low or is threatened. Depressed humans have the same stress hormone found in low-ranking male baboons. Human depression and anxiety are responses to the constant status anxiety many of us live with today.
Research by Wilkinson and Picket finds that the more unequal the society, the more prevalent all forms of mental illness are. The higher the inequality, the higher the depression, which strongly suggests that something about inequality seems to be driving up depression and anxiety. This doesn’t affect only people at the bottom; in a highly unequal society, everyone has to think about their status a lot, and whether they are in danger of falling into lower status.
What role do genes play in depression? The best research on identical twins reveals that 37 percent of depression is inherited, while for severe anxiety, it is between 30 and 40 percent. "So genes increase your sensitivity, sometimes significantly, but they aren’t—in themselves—the cause. Experts agree that depression caused solely by internal brain malfunction is rare or nonexistent, with the exception of bipolar or manic depressive disorders where genes play a bigger role.
If Hari is right that depression is not a brain disease, then pills are not the appropriate treatment for most people. So what is? Hari says treatment would change if doctors called depression disconnection. "If disconnection is the main driver of our depression and anxiety, we need to find ways to reconnect." The Amish have low rates of depression because they have a dense community network that provides a profound sense of belonging and meaning.
Alienated workers need to become reconnected to meaningful work. They need to overcome the feelings of being controlled and having no say and little status. An alternative to the corporation is the democratic cooperative, which better engages partner/workers than the hierarchical corporate structure. Partners are happier, less anxious, and less depressed than they had been working in the kind of top-down organizations that dominate our society. People are less anxious where they feel they have some control and input, as opposed to just being given orders.
Finally, he would address anxiety related to low income by having government provide a guaranteed basic income. Studies of this policy show recipients have less stress, a reduced sense of financial insecurity, fewer doctor visits for anxiety and depression, and more time with their kids.
Lost Connections reads like a series of stories rather than an academic journal. Hari's interviews with researchers and formerly depressed people make the book more interesting and readable. Some of his contentions are debatable, but he certainly persuades readers to rethink what we know about depression. ###
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I am leaving a one star review not because I did not enjoy the book- I have so far, but I've only gotten to page 148- because the book I received is MISSING pages 149-164?? It seems I may be too late to return or exchange it, but I will reach out to customer service anyway...UPDATE: I reached out to customer service and was issued a refund for defective book. I'll be glad to see what I missed in those missing pages. I'm sure it was just a faulty manufacturing blip since I haven't seen any other reviewers have the same problem.
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