from the world's big
The best science says depression is a social ill, not an individual flaw
Contrary to what we've been told for decades, depression isn't coming from inside our heads. This author and big thinker tells us that it's coming much more from the society we live in.
Johann Hari is the New York Times bestselling author of Chasing the Scream, which is being adapted into a feature film. He was twice named Newspaper Journalist of the Year by Amnesty International UK. He has written for many of the world’s leading newspapers and magazines, including the New York Times, Le Monde, the Guardian, the Los Angeles Times, the New Republic, the Nation, Slate, El Mundo, and the Sydney Morning Herald. He was a lead op-ed columnist for the Independent, one of Britain’s leading newspapers, for nine years. He is a regular panelist on HBO's Real Time with Bill Maher. His TED talk, “Everything You Think You Know About Addiction Is Wrong,” has more than 20 million views.
Johann Hari: I kept learning intellectually about what causes depression and anxiety.
And that it’s much deeper than the story I’d been told by my doctor—that it’s just a missing chemical in your brain.
But I think it really emotionally fell into place when I went and met an incredible South African psychiatrist called Derek Summerfield. So Derek was in Cambodia when chemical antidepressants were first introduced there. And the Cambodian doctors didn’t know what they were, right? They’d never heard of it. So he explained it to them and they said, “Oh, we don’t need them. We’ve already got antidepressants.”
And Derek said what do you mean?
He thought they were going to talk about some kind of herbal remedy or something.
Instead they told him a story. There was a farmer in their community who one day, a rice farmer, who one day had stood on a landmine and had his leg blown off. And so they gave him an artificial limb and he went back to work in the fields. But it’s apparently very painful to work in water when you’ve got an artificial limb. And I imagine it was quite traumatic—He’s going back to the fields where he was blown up.
And he started crying all day. He didn’t want to get out of bed. Classic depression, right? And so they said to Derek, “Well we gave him an antidepressant.” Derek said what did you do? They explained that they sat with him, they listened to his problems, they realized that his pain made sense. He was depressed for perfectly good reasons. They figured if we bought him a cow he could become a dairy farmer then he wouldn’t be so depressed. They bought him a cow. Within a few weeks his crying stopped, he felt fine.
They said to Derek, “You see, Doctor, that cow was an antidepressant.” Now if you’ve been raised to think about depression the way that we’ve been indoctrinated to, that it’s just the result of – there are real biological factors but it’s just the result of a chemical imbalance in your brain—that sounds like a joke, a bad joke. They gave the guy a cow as an antidepressant and he stopped being depressed?
But what those Cambodian doctors knew intuitively is what the World Health Organization has been trying to tell us for years. Depression is a response to things going wrong deep in our lives and our environments. Our pain makes sense.
As the World Health Organization put it, mental health is produced socially. It’s a social indicator. It requires social as well as individual solutions. It requires social change, right?
Now that is a very different way of thinking about depression and anxiety but it happens to fit with the best scientific evidence.
And it really required me to reassess how I’d felt about my own pain and how I tried to deal it unsuccessfully and open up a whole different way of responding to my depression and anxiety that worked for me.
And I think as the World Health Organization says and the UN says, if we talk less about chemical imbalances and more about power imbalances we will get more at the heart of depression and anxiety and we’ll find better solutions.
This was a—this was such a personal and difficult journey for me. There were these two mysteries that were really kind of haunting me, and it’s a sign of how afraid I was to look into them. I wanted to start doing this seven years ago and I figured it would actually be easier to do a book that required me to go and spend time with the hitmen for the Mexican drug cartels instead, which I then did.
And the first was: why was I still depressed? I’d gone to my doctor when I was a teenager and I’d explained I had this feeling like pain was kind of leaking out of me. I didn’t understand it. I couldn’t regulate it. I was very afraid of it. I was very ashamed of it.
And my doctor said, “We know why you feel this way. There’s a chemical called serotonin in people’s brains and it makes people feel good. Some people naturally lack it. You’re clearly one of them. We’ll give you these drugs. They’ll boost you back to a normal serotonin level.”
And I felt such relief when I was give that story and even more relief when I was given the drug. And for a few months I felt radically better.
And then this sense of pain started to kind of bleed back in. So I went back to the doctor and he said, “We didn’t give you a high enough dose.” I took a higher dose. Again—got relief again, and the pain came back. And I was really in that cycle until I was taking the maximum possible dose for 13 years. And at the end of it I still felt terrible.
The second mystery, and to me the much more important one, is: why are so many other people in our culture feeling such profound despair and anxiety? One in five Americans will take a psychiatric drug. One in four middle-aged women in the United States is taking a chemical antidepressant in any given year.
And I thought, I began to think, “Could it really be that just so many people are just mysteriously lacking a specific chemical in their brain? Why does it seem to be rising so much if that’s the cause?”
So I forced myself to go on this journey over 40,000 miles for my book Lost Connections.
I met the leading scientists in the world who studied the causes of depression and anxiety and the solutions. The first thing I learned is that story my doctor told me is not true.
Professor Andrew Scull at Princeton University says it is deeply misleading and unscientific to say that depression is just caused by low serotonin.
Dr. David Healy in Britain says you can’t even say that idea has been discredited because it was never credited.
There was never a time when half of the scientists in the field believed that. It doesn’t mean there’s no value to chemical antidepressants. There’s some value, but what I learned is actually I had been wrong about depression all my life.
Until I went to my doctor when I was a teenager I thought it was “all in my head,” meaning you’re weak, you’re just not tough enough.
And then for the next 13 years I thought it was “all in my head,” meaning it’s a chemical imbalance.
What I learned is: it’s largely not in our heads. There are real biological factors that can make it worse, but the main causes of depression and anxiety are in the way we’re living today.
For almost the past 100 years, some mental health professionals have told us that depression is purely caused by a chemical imbalance in the brain. However, there's a much more realistic theory that depression happens due to an imbalance happening outside of your cranium. Journalist and author Johann Hari believes that while for some people it is a chemical imbalance, for many people suffering from depression, the cause stems from societal issues. Hari offers some staggering statistics showing that antidepressants seem to be doing much more harm than good — among them, that one out of every four middle-aged women in the United States is taking a chemical antidepressant in any given year. If we want to get rid of modern-day depression, he says, we have to change society. Johann Hari's new book is Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions.
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Gender and sexual minority populations are experiencing rising anxiety and depression rates during the pandemic.
- Anxiety and depression rates are spiking in the LGBTQ+ community, and especially in individuals who hadn't struggled with those issues in the past.
- Overall, depression increased by an average PHQ-9 score of 1.21 and anxiety increased by an average GAD-7 score of 3.11.
- The researchers recommended that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders—even among those with no prior history of anxiety or depression.
Study findings<p>For the study, <a href="https://link.springer.com/article/10.1007/s11606-020-05970-4" target="_blank">published in the Journal of General Internal Medicine</a><em>, </em>Flentje and her team evaluated survey responses from nearly 2,300 individuals who identified as being in the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Most of the participants were white, while nearly 19 percent identified as a racial or ethnic minority. Multiple genders were represented with cisgender women (27.2 percent) and men (24.6 percent) making up a majority of the participants. Sixty-three percent had been assigned female at birth. For the most part, participants identified their sexual orientations as queer (40.3 percent), gay (36.5 percent), and bisexual (30.3 percent).</p><p>The JGIM study participants were recruited from the 18,000-participant <a href="https://pridestudy.org/" target="_blank">PRIDE Study</a> (Population Research in Identity and Disparities for Equality), which is the first large-scale, long-term national study focusing on American adults who identify as LGBTQ+. It conducts annual questionnaires to understand factors related to health and disease in this population. </p><p>Participants filled out an annual questionnaire (starting in June 2019) and a COVID-19 impact survey this past spring. Flentje noted that on an individual level, some people may not have experienced a big change in anxiety or depression levels, but for others there was. Overall, depression increased by a <a href="https://patient.info/doctor/patient-health-questionnaire-phq-9" target="_blank">PHQ-9 score</a> of 1.21, putting it at 8.31 on average. Anxiety went up by a <a href="https://www.mdcalc.com/gad-7-general-anxiety-disorder-7" target="_blank">GAD-7</a> score of 3.11 to an average of 8.89. Interestingly, the average PHQ-9 scores for those who screened positive for depression at the first 2019 survey decreased by 1.08. Those who screened negative for depression saw their PHQ-9 scores increase by 2.17 on average. As for anxiety, researchers detected no GAD-7 change among the study participants who screened positive for anxiety in the first survey, but did see an overall increase of 3.93 among those who had initially been evaluated as negative for the disorder. </p>
Risks among gender and sexual minorities<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="fc3fd1ae68b77bbbf58a6995638d6d65"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/EnUqDjCqg0A?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The LGBTQ+ community is a vulnerable population to mental health concerns because of their fear of stigmatization and previous discriminatory experiences.</p> <p>Previous research by the Human Rights Campaign has found "that LGBTQ Americans are more likely than the <a href="https://medicalxpress.com/tags/general+population/" target="_blank">general population</a> to live in poverty and lack access to adequate medical care, paid <a href="https://medicalxpress.com/tags/medical+leave/" target="_blank">medical leave</a>, and basic necessities during the pandemic," said researcher Tari Hanneman, director of the health and aging program at the campaign.</p> <p>"Therefore, it is not surprising to see this increase in anxiety and depression among this population," Hanneman said in the release. "This study highlights the need for <a href="https://medicalxpress.com/tags/health+care+professionals/" target="_blank">health care professionals</a> to support, affirm and provide <a href="https://medicalxpress.com/tags/critical+care/" target="_blank">critical care</a> for the LGBTQ community to manage and maintain their mental health, as well as their physical health, during this pandemic."</p>
What should health care providers do?<p>The authors of the study recommend that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders in members of that community—even among those with no prior history of anxiety or depression.</p><p>As cases of COVID-19 continue to mount, the sustained social distancing, potential isolation, economic precariousness, and personal illness, grief, and loss are bound to have increased and varied impacts on mental health. Effective treatments may include individual therapy and medications as well as more large-scale coronavirus support programs like peer-led groups and mindfulness practices. </p><p>"It will be important to find out what happens over time and to identify who is most at risk, so we can be sure to roll out public health interventions to support the mental health of our communities in the best and most effective ways," said Flentje.</p>
What we know about black holes is both fascinating and scary.
- When it comes to black holes, science simultaneously knows so much and so little, which is why they are so fascinating. Focusing on what we do know, this group of astronomers, educators, and physicists share some of the most incredible facts about the powerful and mysterious objects.
- A black hole is so massive that light (and anything else it swallows) can't escape, says Bill Nye. You can't see a black hole, theoretical physicists Michio Kaku and Christophe Galfard explain, because it is too dark. What you can see, however, is the distortion of light around it caused by its extreme gravity.
- Explaining one unsettling concept from astrophysics called spaghettification, astronomer Michelle Thaller says that "If you got close to a black hole there would be tides over your body that small that would rip you apart into basically a strand of spaghetti that would fall down the black hole."
The team caught a glimpse of a process that takes 18,000,000,000,000,000,000,000 years.
- In Italy, a team of scientists is using a highly sophisticated detector to hunt for dark matter.
- The team observed an ultra-rare particle interaction that reveals the half-life of a xenon-124 atom to be 18 sextillion years.
- The half-life of a process is how long it takes for half of the radioactive nuclei present in a sample to decay.
A new study looks at what would happen to human language on a long journey to other star systems.
- A new study proposes that language could change dramatically on long space voyages.
- Spacefaring people might lose the ability to understand the people of Earth.
- This scenario is of particular concern for potential "generation ships".