Friday, June 8, 2018

Lost Connections

Today seems like an apt day to finally write about Johann Hari’s recent book Lost Connections: Uncovering the Real Causes of Depression — and the Unexpected Solutions.

Like his earlier work, Chasing the Scream, the book had a big effect on me, and obviously on him as well. One thing I had wondered about in Chasing the Scream was that Hari seemed resistant to the idea that trauma contributes to self-medicating through illicit drug use.

In Lost Connections, I began to find out what may have motivated that one bit of illogic in his work. Hari himself lives with depression, and has taken medications for it over the years. In the book, he looks at his own attitudes about depression and medical treatments and talks to a range of scientists and psych researchers.

Medications are not the answer, he finds, though they can have real side effects. The idea that medical treatment is “restoring” the brain’s natural chemical balance is false and was created to manipulate our human weakness for naturalistic fallacies. Drug companies cooked the research “books” to meet standards:

All you have to do is produce two trials — anytime, anywhere in the world — that suggest some positive effect of the drug. If there are two, and there is some effect, that’s enough. [It could be that] 998 find the drug doesn’t work at all, and two find there is a tiny effect — and that means the drug will be making its way to your local pharmacy (page 31)
The placebo effect is real, though, and treatment with meds can appear to have a positive effect for a while, but it often tapers off. Then more or different meds are given, right?

So what does cause depression, if not a chemical imbalance? That’s the subject of the book. (Oh, and depression and anxiety are related disorders; Hari deals with both.)

“What if depression is, in fact, a form of grief — for our own lives not being as they should? What if it is a form of grief for the connections we have lost, yet still need?” (page 44)

Researchers have found that people with depression are more than three times as likely than those without to have experienced a major negative event in the previous year. They were also three times times more likely to be facing serious long-term stressors in their lives. Having both these factors accelerated the likelihood, of course. Positive stabilizing factors reduced the chances of developing depression, too.

Harry lists seven causes of depression and anxiety, but what holds them together is that they are all forms of disconnection. We are cut off from something we need but have lost:
  1. Disconnection from meaningful work. Based on a particular case study, he quotes one man who has found most of the important conclusions about this cause: “you have to be challenged in a healthy way” and “you have to know your voice counts.” Another case study describes British civl service workers: those with a higher degree of control over their work were a lot less likely to become depressed than others at the same pay grade and status, and even in the same office. Having no discretion in how the work gets done, learning to be passive, was deadening. “Disempowerment is at the heart of poor health,” according to that researcher.
  2. Disconnection from other people. Loneliness = stress. “Feeling lonely [research finds] caused your cortisol levels to absolutely soar — as much as some of the most disturbing things that can ever happen to you…as stressful as experiencing a physical attack” (page 74). And it has been established as a causal relationship, not just a correlation. One researcher has a hypothesis to explain this, based in our evolution: it’s a signal to us to bet back to the group or we will be more likely to die. “…every human instinct is honed not for life on your own, but for life…in a tribe” (page 77). Loneliness is the opposite of shared meaning and reciprocity, no matter what that is based on. It is “the sense that you’re not sharing anything that matters with anyone else…. you need to have a sense of ‘mutual aid and protection’” (page 83). Multiplayer games fit into this need perfectly, and compulsive Internet use (whether Facebook or gaming) is a “dysfunctional attempt to try to solve the pain” (page 88).
  3. Disconnection from meaningful values. This chapter focuses on the work of psychologist Tim Kasser, author of the graphic explainer Hypercapitalism. His research has found that “materialistic people, who think happiness comes from accumulating stuff and a superior status, had much higher levels of depression and anxiety” (page 94). Meeting extrinsic goals in general caused no increase in happiness. One cool summary of this section: “What you really need are connections. But what you are told you need…is stuff and a superior status, and in the gap between those two signals…depression and anxiety will grow as your real needs go unmet” (page 99). Kasser turned to the role of advertising, particularly to children, as a cause of message that permeates our culture. (Which reminds me of this recent Hidden Brain segment called This is Your Brain on Ads).
  4. Disconnection from childhood trauma. This chapter starts with a story about research on morbidly obese women who lost weight in a clinical trial. The trial found, however, that why they weighed what they did was not simple, but was often rooted in specific traumas they had experienced when young. That research led to the ACEs approach (Adverse Childhood Experiences, which I’ve mentioned once before). Answers to the 10 ACEs questions are highly predictive of depression. “If you had six categories of traumatic events in your childhood, you were five time more likely to become depressed…than somebody who didn’t have any. If you had seven…you were 3,100 percent [31 times] more likely to attempt…suicide as an adult” (page 111). And emotional abuse was the most likely to cause depression - more than physical abuse or sexual molestation.
  5. Disconnection from status and respect. This chapter starts with a primatologist studying baboons, who found that “our closest cousins are most stressed in two situations— when their status is threatened…and when their status is low” (page 119). The primatologist (Robert Sapolsky, who is also a neuroscientist) later found that depressed humans “are flooded with the same stress hormone that you find in low-ranking male baboons” (page 119). Hari says at this point he began to wonder if depression is partly “a response to the sense of humiliation the modern world inflicts on many of us” (page 120). And indeed, large-scale analyses of nations (and states within the U.S.) has found that more unequal places have significantly more mental illness than more equal societies, including depression.
  6. Disconnection from the natural world. Bonobos in the wild can be depressed, but ones in zoos sink significantly farther down into dysfunctional behaviors. Lots of other animals, too, which reminds me of the rat park, of course.
  7. Disconnection from a hopeful or secure future. “A sense of a positive future protects you. If life is bad today, you can think — this hurts, but it won’t hurt forever. But when it is taken away, it can feel like your pain will never go away” (page 138). Hari ties this disconnection in with a discussion of the precariat, and I have to add, what about living with climate change?
What are the solutions Hari proposes? He describes an amazing thing that happened in East Berlin after the Wall came down, in an area called Sudblock. This is a highly recommended chapter for anyone who despairs about people working together despite major differences. And it leads him to seven recommended forms of reconnection:
  1. Reconnection to other people. Evidence “suggests if we return to seeing our distress and our joy as something we share with a network of people all around us, we will feel different” (page 181). It’s not something you can do on your own, like taking a pill. The “desire for a solution that [is] private and personal… [is] in fact a symptom of the mindset” that causes depression and anxiety in the first place (page 183).
  2. Reconnection through social prescribing. A community garden plays a key role in the example here. And parties.
  3. Reconnection through meaningful work. In which we hear about worker co-ops (and I am reminded that I never wrote up the graphic explainer Parecomic about the work of Michael Alpert, some of which discusses what real worker co-ops would look like). Worker co-ops can count three soul-killing aspects of work: the feeling of being controlled, the knowledge that no one will notice anything you do, and the reality of being low in a hierarchy.
  4. Reconnection to meaningful values. In which we ban advertising to children (as they have Sweden and Greece). And that counter-programming can have an effect.
  5. Reconnection through sympathetic joy. This one involves meditation and a practice that’s literally called sympathetic joy (I will have to check that out) and the possibilities of psychedelics like psilocybin, which Michael Pollan has recently written about as well.
  6. Reconnection to our past to overcome childhood trauma. Just acknowledging that it happened can have an effect for some. Shame and humiliation play a big role in depression.
  7. Reconnection to a restored future. This chapter looks at research on the effects of universal basic income, and we learn about a Dutch economist who has published a book called Utopia for Realists.
In the final chapter, Hari puts it this way:
You are not suffering from a chemical imbalance in your brain. You are suffering from a social and spiritual imbalance in how we live…. your biology may make your distress worse…but it’s not the cause (page 257).
I'll end with some particularly salient details I found along the way:
  • A telling stat from the section on disconnection from meaningful work: A 2012 Gallup poll of a million workers, internationally, found just 13 percent said they were engaged in their jobs; 61 percent said they were not engaged, and 24 percent were actively disengaged, “undermin[ing] what their engaged co-workers accomplish… [they] are more or less out to damage their company” (page 64) That’s 87 percent of the workforce that’s not engaged, and with twice as many people hating their jobs as loving them.
  • One sad stat from the “disconnection from other people” section: Brain scans show that lonely people spot potential threats in 150 milliseconds, while socially connected people take 300 milliseconds for the same threats. This hyper-vigilance leads to even more social disconnection (pages 81-82).
  • Why do children think they are to blame for abuse they experience? “When you’re a child, you have very little power to change your environment…. So you have two choices. You can admit to yourself that you are powerless…. or you can tell yourself it’s your fault. If you do that, you actually gain some power—at least in your own mind…. You can become the powerful one. If it’s your fault, it’s under your control…. But that comes at a cost. If you were responsible for being hurt, then at some level, you have to think you deserved it” (page 114).
  • One concept from the disconnection from nature section that seemed counterintuitive to me: “Faced with a natural landscape, you have a sense that you and your concerns are very small, and the world is very big — and that sensation can shrink the ego down to a manageable size.” But since “Becoming depressed or anxious is a process of becoming a prisoner of your own ego,” that deflation can have a positive effect.
And really end with this as a motivator:

“I think we have many modern forms of captivity. Don’t be in captivity. Fuck captivity.” —Dr. Isabel Behncke, evolutionary biologist and bonobo researcher (page 131)

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