I recently finished reading the book Lost Connections: Uncovering the Real Causes of Depression–And the Unexpected Solutions by Johann Hari, an English journalist (the most recent edition has a different subtitle). Hari comes from an atheistic perspective, and part of his book is autobiographical, part is based on social, medical, and psychological research. Hari was in a dark place for a long time as a teenager, so much so that his friends started commenting that they didn't think his emotional state was normal. He went to a doctor, who asked him very few questions about his personal life, and instead told him he had a neurochemical imbalance in his brain and diagnosed him with depression. He put Hari on the depression medication Seroxat, which is known as Paxil in the United States (p. 7).
Hari remained on Seroxat for several years, but he noticed something strange. He would feel better for a little while, then a few months later, the sadness would be overwhelming again, he’d tell his doctor about it, the doctor would up his dose a little bit more, he'd feel another boost in his mood, but it seemed always to be temporary. There were negative side effects with that particular drug, like weight gain and sweating. This pattern of upping the dose and temporary relief continued for several years, but Hari’s therapist kept noticing that he was still very depressed and anxious in spite of years of taking an antidepressant. This started him on a journey of studying much of the latest research concerning depression, and it led him to challenge the story he had been given of depression only being a neurochemical imbalance.
While Hari still maintains that biology is a factor that can predispose people toward being more susceptible to sadness than others, he and the researchers he cites argue that social and psychological factors are often the most substantial triggers for depression. One of the more interesting parts of the book was his research into the data behind a lot of antidepressant medications, and how many of the findings in their trials are modest at best, yet pharmaceutical companies have at times cherry-picked the data and perpetuated the chemical imbalance narrative because it's profitable for them. He cites research done by people like Harvard professor Irving Kirsch, Dr. Joanna Moncrieff of the University College of London, Dr. Lucy Johnstone of University of West England, Bristol, and several others, all of whom would like to modify the prevailing explanation of and treatment for depression and anxiety. Some research even indicates worse long-term effects for people who stay on antidepressants compared to those who don't.
Hari weaned off Seroxat at the lead of his doctor, and made some intentional changes in his lifestyle in an effort to combat depression and pursue a healthier, happier life. He does not recommend getting off medicine as the solution for everyone, nor is he against taking medicine. He writes, "I want to stress–some reputable scientists still believe that these drugs genuinely work for a minority of people who take them, due to a real chemical effect. It's possible" (p. 37). But he precedes those words with this sentence: "To me, this seems like the most crucial piece of evidence about antidepressants of all: most people on these drugs, after an initial kick, remain depressed or anxious" (Ibid.). If depression is only a neurochemical imbalance, then why are so many people still depressed after taking the drugs that are supposed to correct the imbalance?
If Hari and his sources are correct, then in some ways this can be a further burden for those who are already burdened by depression and anxiety. It challenges the notion of the quick fix, the thought that if I just find the right pill, my life will be happier and my problems will go away without any other significant changes to my life. It puts the responsibility for our mental health back on us, and may require some hard work of us. Yet Hari notes that in another way, the neurochemical imbalance narrative is a disempowering story that puts your body at war with itself: Your mind is defective, your distress is a meaningless screwup in your brain tissue, and your only hope is to drug your body into normalcy. There's nothing you can do to help. If the drugs don't work, you're trapped (pp. 154-155). But what if sometimes your darkness is pointing out something wrong, either in society, or your past, or in how others have treated you, or in how you're living? What if we're grieving lost connections that all of us need to live a fulfilling life?
Hari broadens the definition of an antidepressant from being a pill you take to being anything that relieves your sorrow. Where I find his book most helpful is in his articulation of things we need to be connected to in order to pursue happiness and satisfaction. Honestly, I see a lot of his recommendations as being present within Scripture and in the Christian life. If we get disconnected from these things, they can be a source of sorrow in our lives. Here's a brief overview of some of those connections he explores in depth, with me throwing in the occasional Christian linkage:
- Connection to Other People (Friendship; Hebrews 10:24-25)
- Connection to Nature (Psalm 8:3-4; 19:1-2; Romans 1:20)
- Connection to Meaningful Work (Purpose; 1 Corinthians 12:4-31)
- Overcoming Trauma and Abuse (particularly if you were abused as a child)
- Connection to a Secure Future
- Prayer and Meditation (the chapter is strangely titled "Sympathetic Joy, and Overcoming the Addiction to Self," though it is mostly about meditation and guided psychotropic drug trips. I commend Hari for writing this chapter as an atheist.)
- Connection to Meaningful Values
Now in many ways I’m way out of my depth here–I'm not a psychologist or medical doctor, and I’ll let the experts in the academic community discern if Hari and his sources are right. There also are some things I wish he would've addressed. He doesn't mention postpartum depression, in which it seems like there's a strong possibility that a chemical imbalance is at work. Further, I wish he would've addressed depression in the elderly and in the dying. I think Hari's worldview is limited in its ability to provide much in the way of resources for facing death. I also know folks on antidepressants and anti-anxiety medication who say the medicine has helped in a big way. I am not going to dispute their stories.
But questions and quibbles aside, Hari provides a more thorough exploration of the causes of depression and more holistic solutions from which all who go through dark seasons can benefit. He has encouraged me to have a more comprehensive approach when it comes to counseling others who are in darkness. I’d encourage you to get the book if you’re curious–there's much more to his argument than I've written.
