Like many people suffering from depression, Johann Hari spent many years taking the antidepressant drug Seroxat, a Selective Serotonin Reuptake Inhibitor, or SSRI. Received wisdom held that “endogenous” depression was caused by a chemical imbalance in the brain; antidepressants were supposed to solve the problem by restoring the brain’s natural balance. By contrast, “reactive” depression was caused by external events such as bereavement, trauma or some other adversity.
In Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions, Hari interrogates this dubious taxonomy. He cites research indicating that, in many cases of so-called "endogenous" depression, the depressed person had suffered some kind of serious emotional distress in the year before the onset of their depression. The notion that depression occurs because of some intrinsic flaw divorced from social context – a biological problem requiring a biomedical solution – doesn't seem to hold true in most cases.
Far from being a defect, Hari argues that depression is actually a rational and self-preservatory response to the fragmentation of community life in the contemporary world. “Loneliness,” he writes, “hovers over our culture today like a thick smog.” Meaningful contact is something we are innately designed to crave – it’s in our very DNA – but our socio-economic system is predicated on individualism.
Reflecting on an American study indicating a sharp fall in active involvement in community organisations between the mid-1980s and mid-1990s, Hari observes that “across the Western world, we stopped banding together . . . and found ourselves shut away in our own homes”. Changes in working life – the so-called “gig economy” of zero-hours contracts and precarious labour – have exacerbated a sense of isolation and insecurity. (Paradoxically, “emotional labour” has become increasingly paramount: in a services-based economy, it’s no longer enough just to put a shift in. You have to visibly enjoy it.) People feel disempowered and disconnected from one another, and this state of affairs is fundamentally unnatural.
How, then, should we go about reconnecting? Hari insists that we can “find practical ways to dismantle hierarchies and create a more equal place, where everybody feels they have a measure of respect and status”. He presents a range of heartwarming real-life stories about people banding together: these include a housing project in Berlin, where the community mobilised collectively to stave off rent increases; a therapeutic horticulture group in east London; a bunch of bike mechanics in Baltimore who successfully set up a workers’ cooperative; and a short-lived Canadian government trial whereby every citizen was given a guaranteed universal basic income. All of these initiatives are shown to have alleviated people’s emotional distress in one way or another.
For those whose depression has its roots in childhood trauma, Hari advocates shedding the culture of shame as a first step to working through unresolved issues. It might sound wishful, but much of the available evidence suggests that talking therapies are at least as effective as antidepressants, if not more. The answers, in short, have been hiding in plain sight all along.
Grating style
Unsurprisingly for a book at the intersection of self-help and popular science, Lost Connections is written in a twee register that some may find grating. Addressing your readers as though they were a simpleton is a hallmark of the genre; it's how you reach the broadest possible audience. We know, from his earlier career as a political columnist, that Hari is capable of writing poised, accomplished prose; here he is playing the game with tactical nous. His recommendations are bound to meet resistance, not least from depressed people themselves, not just the minority for whom drugs have had demonstrably salutary effects, but also a significant number who have grown habitually dependent upon them despite their inefficacy.
As for his advocacy of talking therapies, the elephant in the room is, of course, cost: at a time when healthcare resources are stretched, the idea of replacing every antidepressant prescription with counselling or cognitive behavioural therapy seems unimaginable.
Book’s relevance
None of this should detract from the relevance of the book’s message. In linking the spiritual malaise of Western society to the rise of the chauvinistic populisms that culminated in Brexit and the election of Donald Trump, Hari makes a salient and timely point. “One of the most important slogans of the past few years has been ‘Take back control’,” he observes. “People are right to connect with this slogan – they have lost control, and they long to regain it – but that slogan has been used by political force . . . that will give them even less control.” Indeed, supporters of Brexit and Trump often articulate their disaffection by reference to a feeling that the social fabric is disintegrating, and that there is less of a sense of community than there used to be. Immigrants and other minorities are scapegoats for a phenomenon that has been decades in the making, and the causes of which are profoundly political.
It is puzzling, then, to see that Lost Connections has received a hearty endorsement from Hillary Clinton. Either she hasn't really read it, or she hasn't understood it. For Hari's critique of the atomisation of social life under neoliberalism advances a political radicalism that is way to the left of anything Clinton has hitherto espoused. And therein lies the nub: if the medicalisation of mental illness has been, in some measure, a self-serving deception on the part of the pharmaceutical industry, its politicisation will require a willingness to step outside our comfort zone and embrace ways of thinking that have resided, for the past 40-odd years, beyond the fringes of the mainstream.
