Uncovering the real causes of depression

Book: Lost Connections: Uncovering the Real Causes of Depression – and The Unexpected Solutions

Author: Johann Hari

Publisher Bloomsbury

Price Rs 469

Dr Avni S. Tiwari

Lost Connections – Uncovering the Real Causes of Depression and the Unexpected Solutions is a very engrossing read. It starts with a story about being diagnosed with depression and prescribed ‘pills’. The author very smartly avoids what he calls the ‘pain porn’ and then slips into a cliché about an exotic Asian town doctor providing life–changing insight! He also explains how that has motivated him to find the truth behind depression, the malady that affects millions yearly worldwide. We all have been through it or know someone who has. So yes, we want to find out more.

The book doesn’t bore at all despite the technical jargon that it contains. Author Johann Hari dwells on many medically well–known concepts, like neurotransmitters and placebo, explaining them in a simple and lucid manner. The research studies published in peer reviewed journals, which even the scientifically minded do not consider as light reading, have been covered briefly and clearly though the conclusions derived from it do seem contrived at times.

The author briefly touches on endogenous depression (that depends on one’s biology) vs. reactive depression (one triggered by external factors) and raises very pertinent observation of how usually anxiety symptoms co-occur with depressive symptoms.

The question that he raises is the one that has been asked innumerable times in the history of psychiatry — What is the cause of depression, brain going wrong or life going wrong?

After having cleared that he no longer believes in the big pharma hogwash of anti-depressants being the “be-all and end-all” answer to depression, he moves on to what he refers to as the real causes — disconnections — and this is where it really gets interesting. And good.

There are nine causes which he lists, seven of which he discusses in detail. Some of these are self-evident in title and beautifully illustrated with examples. Lack of meaningful work is the very first. Disconnection with other people resulting in loneliness the second. Both these are social disconnections. The third one relates to how our values are driven by what feels/is good and how intrinsic and extrinsic motives in conflict can lead us in wrong direction. Here he also points out how advertising is screwing with our self-esteem and talks about the materialistic and consumerist culture that is fostering a generation of inadequate beings. The fourth one is about adverse childhood experience that doesn’t invite any argument. It also has been one of the most discussed cause worldwide.

Causes 5, 6 and 7 are about lack of status and respect, being away from nature and not being able to visualise a hopeful or secure future. These are very important aspects not only for an individual but also for society at large. Immigration and urbanization are well known correlates of depression. The author gives example of bonobo apes to effectively point out the devastating effect of being away from your natural habitat.

The author rounds up with a chapter on last two causes, genetics and brain changes. And this is where he talks about 5HTT or the serotonin transporter though he refuses to actually attribute much importance to it.

The second half of the book is about solutions to these disconnections. The introductory chapters talk about finding new ways to tackle the problem. It sounds a lot like searching for a win-win situation. There’s also some talk of social activism to bring about the change you want and how the feeling of “you are not alone” can have you hoping for better.

In all, seven chapters discuss reconnections ─ about reconnecting with other people, finding meaningful work (finding meaning in work), changing junk values to meaningful ones, overcoming childhood trauma and restoring your future are in accordance with what is described while discussing causes.

The main highlight of the book is the chapter on Social Prescribing. It talks about reconnecting with nature, doing your bit, having patience and letting nature take its course. Imagine all these being actually prescribed by your mental health professional. Being told to turn a piece of waste land into garden can be therapeutic. This and other examples establish what the author actually wants you to change — go back a little, see what you had started and left or forgot in your hurry or struggle to get somewhere; pick up the pieces and restart; rebuild.

Another significant chapter is on Finding Sympathetic Joy. It talks about how “individualism” has exposed us up to the dangers of depression and how being happy for others can make us happy. The author then explains how ego is just a part of your personality and being accepted as you are, being important and being loved can be an antidote to depression. He also talks about meditation and the effects of psychedelics. He talks about the virtues of meditation and “the deep connection” experience that should be felt.

In the concluding chapters, however, the author does have some cautionary tales to tell. He acknowledges that milieu therapy (changing only environment) doesn’t have sustained effects. He also mentions how antidepressants are not all bad and shouldn’t be dismissed.

However, there are two very disconcerting things that jump up once you’re done reading it. First is very technical — the bio-psycho-social model that is one of the widely accepted models of mental illness. This model looks at a three-pronged approach to depression. The World Health Organization advocates it and most of the doctors believe in it. So while most of the measures discussed here are social, only a few of them are psychological and they are by no means exhaustive. It does not take into account personality factors or why two people with similar background react differently in the same situation. The twin studies, for example, are a good indicator of biological and psychological factors which seem to have been overlooked.

Secondly, biology and to some extent psychology remains similar world over. But the social and cultural milieu differs considerably. While the author is right in saying that biochemistry may cause the patient to bear the stigma of being “weak”, it can actually get the person to the door of a professional and get him some much needed help (either medicines or psychotherapy or even social prescribing advocated by the author). The social utopia that the author points to is surely something we all desire and yet negating the experience of millions of antidepressant users worldwide, specially in developing countries, may not be a very rational approach.

Johann Hari has written a self-help guide book. But there aren’t many straight instructions, there are, instead, observations derived from anecdotal evidence, few studies, some real life experiences. The author has outlined a lot of important approaches to tackle the menace that is increasingly climbing on disease and disability charts, not to mention the increasing rates of suicide world over. And he expects you to customise and apply them to your situation which can be a slightly daunting task.

Dr Avni S. Tiwari is a psychiatristbasedin Noida