Lost connections

That’s the title of the book by Johann Hari (Lost Connections) that I’m about to finish, and it’s what I want to talk to you about today. Like every book I recommend here, it’s an easy, approachable read. In it, Hari offers a new perspective on why people fall into depression. His points are common sense, yet they contradict the dominant view in our society about this disorder: that depression has a mainly biological cause and that if you suffer from it, it’s because “something isn’t right in your brain”. As he puts it in the book, “your brain is supposed to be broken and needs fixing”. I’ve talked to you about this in other articles, and since the research on it keeps getting stronger, I think it’s worth spreading the word. Remember that, according to the World Health Organization, depression affects around 280 million people worldwide, and that during the first year of the COVID-19 pandemic cases of anxiety and depression rose by more than 25%.

When a patient with depression comes to therapy and tells you things like “it’s just the way I am, my brain works differently from most people’s”, this has many more implications than it might seem at first. In my view, the most important one is that hope is lost, and with it the motivation to work on the problem. It’s completely understandable: if this is just the way I am, why would I bother trying to change a factory defect? If I thought the same, I’d lose my motivation too.

Two very important things about depression that the author reminds us of in his book:

1. The monoamine hypothesis (the supposed reason antidepressants work) has not been proven. What’s more, by now there are a great many studies whose results contradict it. Antidepressants do work for some people, yes, but the fact that they work doesn’t mean they do so because they fix the cause of the depressive state. Careful, that’s an important difference. If you’d like a refresher on the subject, you can read Do psychiatric medications really work?.

2. While it’s true that anxiety and depression have a certain hereditary component (not a single gene, but many genes, each with a very small effect; in fact, the studies that pointed to one specific depression gene haven’t been replicated), it’s also true that genes can be switched on (expressed) or switched off (not expressed) depending on the environment a person grows up in. So even if you inherited that predisposition, it would tend to show itself mainly in very stressful environments, ones with some traumatic component, for example. This means that, although a certain hereditary component has been shown for both anxiety and depression, the chances of that predisposition being expressed depend largely on context. In other words, inheriting those genes doesn’t determine whether you’ll suffer from anxiety and/or depression.

A lot of research questions whether the brains of people with depression are actually broken, and stresses instead that the changes need to be made in the context surrounding the individual. That is exactly what the book focuses on: lost connections as the main cause of depression. I’ll summarise them so you get an idea of the key points, and if you’re interested, you can get hold of the book to go deeper.

• Disconnection from meaningful work: work I enjoy, that motivates me, that makes me feel useful and gives me some sense of self-fulfilment, and that allows me a certain quality of life. A job with decent conditions on every level. Nowadays, having a job with good conditions that you feel motivated by is a real privilege. Many depressed people are in jobs where they don’t feel valued, fulfilled and sometimes not even respected. Jobs that leave them no time for a personal life of even minimal quality. According to the research, this has a big impact on people’s mood in general, contributing more than we think to a depressed mood.

• Disconnection from other people. Quite a few studies have shown that loneliness is a crucial factor in developing depression. It’s worth stressing that being alone is not the same as feeling lonely. You can be surrounded by people all the time, in both your personal and professional life, and feel lonely. On the other hand, you can live in isolation, like a hermit, far from the madding crowd, and not feel lonely at all. Loneliness is a feeling that depends not so much on how many people I interact with but above all on whether I feel connected to someone. And feeling disconnected for a long time from the people around you, feeling them far away… very far away, is a sure ticket to a depressed mood.

• Disconnection from meaningful values. We live in a consumer society that practically condemns us to feel permanently dissatisfied, whether with our body, our lifestyle, our house, our car, our clothes… the list is endless. I hardly need to tell you that advertising, in all its forms (with Instagram leading the way), is the main driver and sustainer of this constant dissatisfaction. How can I feel happy and satisfied if I’m constantly being pushed to need something more, something “better”? Of course it’s possible not to get swept along by the whole circus, but for most of us it’s harder.

• Disconnection from childhood trauma. Many people with depression carry a very heavy backpack from the past that remains unresolved. What tends to happen when we don’t take care of emptying that backpack (whether out of fear, because we think it isn’t that important, or perhaps even because it has been stored in our mind as a repressed memory) is that it shows up through various problems, be it depression on its own or alongside other disorders.

• Disconnection from status and respect. Perceiving that you hold a lower position on the social ladder than you’d like, and that you don’t get the respect you feel you deserve from others, are two more important factors that tend to coincide in depressed people. We live in a society where, although it may seem otherwise, the social hierarchy is very steep and there are big differences between its levels. So feeling a socioeconomic gap compared with those around us, with the sense of disadvantage that this brings for some people, is more common than we might think.

• Disconnection from the natural world. According to research, depressed people tend to be disconnected from nature. Depression makes the patient very focused on themselves, a heightened self-centredness (and not out of whim), and spending time connected with nature reminds us that we are part of a whole far more extraordinary and important than ourselves. Let’s say it takes us out of ourselves to reconnect us with the whole, helping us put things into perspective and feel connected to something much bigger than the individual.

• Disconnection from a hopeful and secure future. When you think your present moment is bad but temporary, it gives you some hope and peace of mind. The idea that something negative has an expiry date makes it more bearable, right? But when your perspective shifts and you can’t see any possibility of things getting better, you rob yourself of a future, of hope, of the prospect of something better. This seems to be another important factor in falling into depression. In my view it’s crucial, because if a person has lost faith in the possibility of change, why and what for would they even try?

I want to stress something I consider important. Often, when people think of someone with depression, they picture a person crying all day who can’t get out of bed. Sometimes that’s how it is, but at other times you can have serious depression, feel you’re falling into the deepest abyss and yet be a straight-A student, a superhero mum or dad, always look immaculate, have a busy social life, come across as outgoing and cheerful… and feel an enormous darkness inside, cry in secret, binge on food or drink more than you should when nobody notices… and countless other situations. I think it’s important to understand depression in all its forms, because stereotypes and labels sometimes blind us and stop us seeing when someone is crying out for help “because they don’t fit” what we have in mind about a depressed person.

To finish, as the author says, drawing on numerous studies and interviews with some of the leading international researchers in the field: perhaps the way forward lies not so much (or at least not only) in chemistry but in reconnecting with whatever each of us has become disconnected from along the way. Even if that means going through the uncomfortable process of exploring, acknowledging and changing part of our world.

Highly recommended reading. What’s more, the author has lived with depression for many years, so sensitivity and empathy are guaranteed.