Depression as a mental illness is actually quite controversial. The psychiatric profession has agreed to attribute it on a chemical imbalance in the brain, although many question if this is the real cause of depression.
That is exactly what Johann Hari set out to investigate. His new book, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, shares his quest as he explores the question: What really causes depression and anxiety, and how can we really solve them?
Clearly, Hari discovered enough interesting information about the real cause of depression to fill a whole book. What I wanted to highlight in this article is Hari’s perspective on the medical establishment’s choice to categorize depression as a chemical imbalance.
The Grief Exemption
The term major depressive disorder was introduced by a group of US clinicians in the mid-1970s. It established the diagnostic criteria for depression based on patterns of nine possible symptoms.
In 1980, depression was incorporated into the Diagnostic and Statistical Manual (DSM). In this book, American psychiatrists include all the symptoms of different mental illnesses, so they could identify and treat these diseases in the same way.
After some time, psychiatrists started to questions if people who are bereaved also need pharmacological treatment. Hari writes:
If you lose someone, it turns out that these symptoms will come to you automatically. So, the doctors wanted to know, are we supposed to start drugging all the bereaved people in America?
This is when the grief exemption was created. The DSM authors updated the manual to exclude people who have lost somebody in the preceding year from the depression diagnosis, even if they showed depression symptoms.
The grief exception seemed to have blasted a hole in the claim that the causes of depression are sealed away in your skull.
The grief exception created too much debate in mainstream psychiatry. Doctors started asking if depressive symptoms where a logical and understandable response to other life circumstances, not just a death of a loved one. Eventually, DSM authors eventually did away with the exemption. Doctors were once again told to say that depression is, in fact, caused by a chemical imbalance in the brain.
Dr. Joanne Cacciatore, associate professor at Arizona State University, is a leading expert on the grief exception. In his book, Hari reveals Cacciatore’s perspective:
She told me this debate reveals a key problem with how we talk about depression, anxiety and other forms of suffering: we don’t, she said, “consider context”. We act like human distress can be assessed solely on a checklist that can be separated out from our lives, and labelled as brain diseases. If we started to take people’s actual lives into account when we treat depression and anxiety, Joanne explained, it would require “an entire system overhaul”. She told me that when “you have a person with extreme human distress, [we need to] stop treating the symptoms. The symptoms are a messenger of a deeper problem. Let’s get to the deeper problem.”
Are We Treating the Problem or the Symptoms?
Most typical mainstream doctors address symptoms associated with depression with anti-depressant drugs, such as Prozac. Cacciatore raises a very valid concern, that we may be treating the symptoms, but that a potential untreated problem is the actual cause of depression.
As a patient taking anti-depressants for many years, Hari asked:
“Why were so many other people across the western world feeling like me? Around one in five US adults are taking at least one drug for a psychiatric problem. In Britain, antidepressant prescriptions have doubled in a decade, to the point where now one in 11 of us drug ourselves to deal with these feelings. What has been causing depression and its twin, anxiety, to spiral in this way? I began to ask myself: could it really be that in our separate heads, all of us had brain chemistries that were spontaneously malfunctioning at the same time?”
To examine this question, Hari took at 40,000 mile journey around the world. Here are some of the findings he uncovered during his investigation.
They [drug companies] would fund huge numbers of studies, throw away all the ones that suggested the drugs had very limited effects, and then only release the ones that showed success. To give one example: in one trial, the drug was given to 245 patients, but the drug company published the results for only 27 of them. Those 27 patients happened to be the ones the drug seemed to work for.
Professor Andrew Scull of Princeton, writing in the Lancet, explained that attributing depression to spontaneously low serotonin is “deeply misleading and unscientific”.
Dr David Healy told me: “There was never any basis for it, ever. It was just marketing copy.”
Were Psychiatrists Wrong About the Cause of Depression?
Finding out the story fed to depressed patients may be no more than a marketing pitch, Hari researched further. He sought out to uncover the true cause of depression. He collected evidence that led him to believe that there are seven specific factors in the way we are living today that are causing depression to rise. In addition, two real biological factors (such as your genes) can combine with these forces to make things worse.
Here’s Hari’s thoughts:
It turns out that, in the same way, all humans have certain basic psychological needs. We need to feel we belong. We need to feel valued. We need to feel we’re good at something. We need to feel we have a secure future. And there is growing evidence that our culture isn’t meeting those psychological needs for many – perhaps most – people.
…the depression of many of my friends, even those in fancy jobs – who spend most of their waking hours feeling controlled and unappreciated – started to look not like a problem with their brains, but a problem with their environments.
Hari is not alone in claiming that our environment and power inequalities may be the real cause of depression.
In its official statement for World Health Day in 2017, the United Nations reviewed the best evidence and concluded that “the dominant biomedical narrative of depression” is based on “biased and selective use of research outcomes” that “must be abandoned”. We need to move from “focusing on ‘chemical imbalances’”, they said, to focusing more on “power imbalances”.
The complete findings about Hari’s investigation are presented in his book, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions. If you are struggling with depression and have found antidepressants an ineffective or undesirable treatment, it may be a worthwhile read.
If you are depressed and anxious, you are not a machine with malfunctioning parts. You are a human being with unmet needs. The only real way out of our epidemic of despair is for all of us, together, to begin to meet those human needs – for deep connection, to the things that really matter in life.
All quotes are extracted from Lost Connections: Uncovering the Real Causes of Depression – and th... by Johann Hari, published by Bloomsbury on 11 January 2018 and re-printed by The Guardian.
Read more articles by Anna Hunt.
About the Author
Anna Hunt is writer, yoga instructor, mother of three, and lover of healthy food. She’s the founder of Awareness Junkie, an online community paving the way for better health and personal transformation. She’s also the co-editor at Waking Times, where she writes about optimal health and wellness. Anna spent 6 years in Costa Rica as a teacher of Hatha and therapeutic yoga. She now teaches at Asheville Yoga Center and is pursuing her Yoga Therapy certification. During her free time, you’ll find her on the mat or in the kitchen, creating new kid-friendly superfood recipes.
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