Because I tend to read a lot of wellbeing related articles, I tend to get sent a lot of wellbeing related articles (now that Google and everyone else are tracking me).
I had a rush of articles last week mentioning this guy – Johann Hari – a Swiss-British journalist and writer. A Google News search of his name will yield all the different articles.
He has been doing the rounds of all the various media outlets because he has a new book out – Lost Connections – Uncovering the real causes of depression and the unexpected solutions. You can read an extract of the book here.
Hari’s central thesis (and I am basing this on the interviews, not the book itself) is that the pervasive view that depression is an ‘illness’ with a genetic and chemical basis (e.g. imbalance of serotonin) is wrong. People aren’t getting depressed cause their brain chemicals are out of whack. People are getting depressed because some aspects of their life, or the society in which they live have become toxic.
We don’t have meaning or purpose. We are lonely and alienated. We are unable to work. We aren’t connected to nature. We don’t have security. Essentially, we aren’t having our basic psychological needs met (i’ve talked about fundamental needs previously).
The book is getting good reviews and celebrity endorsements (always a bonus) and looks on track to become a “best-seller”. Nice work Johann. I wish you the best.
But some people aren’t too happy.
A couple of articles – one here at the Guardian and one here at the Independent – have taken issue with some of Johann’s ideas. Not all, but some.
Here’s where they agree with him:
- Depression is common and debilitating and a worldwide problem. The World Health Organisation (WHO) reports its the leading cause of ill health and disability worldwide.
- We need to be drawing attention to depression and the people experiencing it, and ensure they receive the right help.
- Depression is often the consequence of stressful, traumatic or uncontrollable life events.
- Connecting people to the things that really matter (e.g. relationships, meaning, nature) is how to improve our mental health.
Here’s where they take umbrage (annoyance, offense, displeasure)
- Johann is sceptical antidepressants work and thinks too many people have been prescribed them. Critics argue that probably not enough people have been prescribed them, given the rates of depression around the world. The literature suggests they do work, but not for everyone, not all the time, and not as a complete treatment. Drugs have a place in the treatment of depression, but certainly not as the only approach.
- Related to this, Johann paints a picture of depression treatment as relying solely on medication. Myself and many other mental health professionals would feel this grossly misrepresents the work we are trying to do or the evidence-base. In addition to drugs, there are psychological treatments, online programs/forums, dietary approaches, self-help resources etc. The range of approaches being used is varied and growing.
- Johann’s uncovering of factors like childhood adversity and autonomy and their links to depression are made to seem like revelations, whereas as health professionals we’ve known about these links for ages. However, just understanding these links doesn’t necessarily help immediately with treatment. Depression, whilst arising from experience, makes changes to the brain, structural and chemical. Anti-depressants can help address or reverse these changes. Therapy can as well.
From my perspective, Johann’s ideas have opened up a debate that is really valuable and highlighted some things I’d like to explore and achieve in this blog.
- Informing individuals that there are options, in addition to medications, for managing depression, including behavioural activation, dietary approaches.
- Exploring the role that purpose and meaning, and meaningful work play in depression.
- Arming individuals with depression with a working knowledge of other approaches to treatment, so they can ask their treating professional if they are getting the full range of options
- Thinking about aspects of how our society and culture is structured that might make people depressed – e.g. social media, income inequality.
- Alerting you to mental health services in the community that emphasise different aspects of treatment than simply medications or therapy.
In summary, I am not recommending or dissuading you from reading Johann’s book. I am however pleased that the public discussion about the causes of depression (and hence how to address it) is expanding to new areas.
If you are, or suspect you are depressed, speak to one of our GPs or counsellors. Remember also, that there are treatment options in addition to medications that can be helpful.
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