Book Reviews

Author: Johann Hari 

Category: Health & Wellness, Community 

Rating: 7/10 

Check it out on Amazon.com

Summary:

Depression and isolation are running rampant. And, what we have believed to be “cures,” antidepressants, aren’t solving the issue like we thought they would. While there may be some short term relief, most taking the prescriptions find themselves still depressed. People struggling with depression and loneliness can do all that modern medicine is prescribing they should do, but even still, they can’t find relief. Why is this? — Problem of the book.

• 1) How are people still depressed while taking antidepressants? How can they still be depressed even though they are doing everything modern medicine is prescribing?
• 2) Why are so many people feeling depressed and anxious? What has changed over time?
• 3) “Could something other than bad brain chemistry” be causing depression in people? If so—what is it?

Depression and anxiety are misunderstood, overmedicated and misrepresented (depression is not unhappiness). Through attempting to really understand, 1) Why people are still depressed even while taking antidepressants, 2) Why so many people are feeling depressed and anxious and what has changed over time, and 3) What other than brain chemistry and biology could be causing depression in people, we may be able to find real and long-term solutions. In fact, from Hari’s research (and personal experience) he came to find 9 proven causes of depression and anxiety, and their potential antidotes.

Questions & Implications:

• Studies have shown that the effects of antidepressants are marginal—the majority of their effect on “recovery” were in someway related to placebo, being either a natural recovery cycle or the story the patient had been told about the medication. Getting better sleep can have more of a meaningful impact on a patient’s status than taking antidepressants. Not to mention, the side effects on antidepressants are/have been real; gaining weight, sexual dysfunction, etc.
  • Antidepressants aren’t as effective as has been promised. And the percentage of people on antidepressants who continue to be depressed is high—between 65 and 80 percent.
  • Antidepressants don’t work like we’ve been told to believe, so…we can assume there’s a story we have told about them that is untrue — why the inaccurate story? And what’s the incentive for the inaccuracy?

Actions & Takeaways:

• “…depression is—in fact—to a significant degree a problem not with your brain, but with your life.” (51)
  • Highly stressful events and long term stressors present in life can dramatically increased your likelihood of becoming depressed. On the inverse, stabilizing forces in your life; supportive friends and partner can reduce the probability.
  • Living in poverty, were long term stressors among those.
• Causes of Depression are disconnections from things we innately need.
  • 1) Disconnection from Meaningful Work
    • 2011 and 2012 — Gallup poll of millions of workers across 142 countries concluded that “13 percent of us say we are “engaged” in our jobs—which means they are “enthusiastic about, and committed to their work and contribute to their organization in a positive manner.”” (64)
      • “63 percent say they are “not engaged,” which is defined as “sleepwalking through their workday, putting time—but not energy or passion—into their work.” (64)
      • “…24 percent are “actively disengaged.” They, Gallup explained, “aren’t just unhappy at work; they’re busy acting out their unhappiness. Every day, these workers undermine what their engaged co-workers accomplish…Actively disengaged employees are more or less out to damage their company.” (64)
      • “Nearly twice as many people hate their jobs as loves their jobs.” (64)
    • Your position in the work hierarchy plays a very close relationship to your likelihood of becoming depressed…(the higher you are, the less likely, the lower, the more likely).
      • “If you worked in the civil service and you had a higher degree of control over your work, you were a lot less likely to become depressed or develop severe emotional distress than people working at the same pay level, with the same status, in the same office as people with a lower degree of control over the work.” (68) — It would seem that the missing component in workplace satisfaction was/is autonomy.
  • 2) Disconnection from Other People
    • Studies have shown that “loneliness preceded depressive symptoms. You became lonely, and that was followed by feelings of despair and profound sadness and depression.” (77)
      • Why does loneliness cause depression and anxiety so much?
        • A primal argument is made — all our instincts were honed not for life on our own, but life within a tribe. Loneliness can be thought of like a thirst for water. It’s an emotional reaction letting us know that we need to reconnect.
      • As societies, statistics are showing that we are trending away from “active involvement in community organizations,” between 1985 and 1994, this involvement dropped by 45 percent. (79)
      • Study asking a simple question, “How many confidants [people you could turn to in crisis] do you have?”
        • In 2004, the most common answer was 0. Several decades ago, the most common answer was three.
        • The sense of community and close friendships has only dropped. It’s more common that Americans believe themselves to have no close friends.
      • Difficulty is, that the more lonely people become, often the more difficult they are to spend time around. Likewise, lonely people are often skeptical of others, because they don’t feel they have anyone looking out for them. (82) — This is a snowball effect of loneliness — Strangely enough, it’s a situation where the thing we most need (connection) becomes harder to obtain. The thing we need most, we don’t want?
    • How do you end loneliness?
      • Studies have found that “to end loneliness, you need other people—plus something else. You also need…to feel you are sharing something with the other person, or the group, that is meaningful to both of you.” (83)
        • “A one-way relationship can’t cure loneliness. Only two-way (or more) relationships can do that.” (83)
        • You need “mutual aid and protection.”
          • Responsibility — A sense of connection is limited with one person feeling like they are being taken care of?
  • 3) Disconnection from Meaningful Values
    • It seems as if this is a large battle between intrinsic and extrinsic values.
      • Thinking extrinsically poisons your relationships with people.
      • Extrinsically focused people experience far fewer flow states. — Far less enjoyment of doing things for the sake of doing them.
      • You are always worrying and wondering what other people are thinking about you.
      • Materialistic people are chasing values that don’t fill our basic needs (of connection)
    • Key definitions:
      • Intrinsic motives — “…things you do purely because you value them in and of themselves, not because of anything you get out of them.” (95)
      • Extrinsic motives — “…things you do not because you actually want to do them, but because you’ll get something in return—whether it’s money, or admiration, or sex, or superior status.” (95)
    • Intrinsic Goals vs. Extrinsic Goals (96)
      • Achieving extrinsic goals doesn’t correlate to any increase in day to day happiness.
      • Achieving intrinsic goals does make people significantly happier—less depressed and anxious.
    • Values can change over time though…so when are people materialistic?
      • Coercion? Like advertising!
    • You have to escape the circumstances where you environment is encouraging materialism, these cripple your internal satisfactions — you have to then replace these environments with actions that will provide the internal satisfaction and encourage intrinsic goals. (103)
    • How to re-connect to the meaningful values
      • Start with your own values
      • Ask yourself if you are setting yourself up for success!
      • “Am I setting up my life so I can have a chance of succeeding at my intrinsic values? Am I hanging out with the right people, who are going to make me feel loved, as opposed to making me feel like I made it?…” (104)
  • 4) Disconnection from Childhood Trauma
    • “The greater the trauma, the greater your risk of depression, anxiety or suicide.” (112)
  • 5) Disconnection from Status and Respect
    • “The more unequal your society, the more prevalent all forms of mental illness are. Other social scientists then brok this down to look at depression specifically—and found the higher the inequality, the higher the depression.” (121) — Inequality & mental health, what might this imply for a country like the United States? Is capitalism, at least how it currently is, a recipe for mental illness amongst the people?
    • In unequal societies, people are questioning their own status. “Am I maintaining my position? Who’s threatening me? How far can I fall? Just asking these questions—as you have to when inequality grows—loads more and more stress into our lives.” (121)
  • 6) Disconnection from the Natural World
    • “…people who moved to green areas saw a big reduction in depression, and the people who moved away from green areas saw a big increase in depression.” (126)
    •  How might you remedy?
      • Nature walks, — studies conducted that had people in cities take walks in nature showed that moods improved as did concentration. For people who were depressed, “…their improvement was five times greater than the improvement for other people.” (127)
      • Exercise — significantly reduces depression and anxiety.
    • Biophilia — “…an innate love for the landscapes in which humans have lived for most of our existence, and for the natural web of life that surrounds us and makes our existence possible.” (128)
  • 7) Disconnection from a Hopeful or Secure Future
    • At direct contrast with various modern trends
      • Gig economy — These are inherently insecure, unstable jobs.
      • Lacking regulations of businesses, making it difficult for workers to organize and protect their rights.
      • What is reasonable security? What is security for the entrepreneur? Creating value
  • 8 & 9) The Real Role of Genes
    • “…genes increase your sensitivity, sometimes significantly. But they aren’t—in themselves—the cause.” (148)
    • The snowball effect comes into play here — the more lonely you are/feel, the more your brain continues to change.
    • The experience of being lonely, isolated and materialistic all change your brain—as does the healing from that. (145)
    • 37 percent of depression is inherited, severe anxiety between 30 and 40 percent. (Height is 90 percent inherited for perspective) (147)
• Curing Depression is about Connection — Hari calls these “Reconnections”
  • 1) To Other People
    • Does trying consciously to make yourself happier actually work? (180) — The topic of SELF-HELP. Instead: How can I make my community better?
      • “If you deliberately try to become happy, you will not become happier—if you live in the United States. But if you live in Russia, Japan, or Taiwan, you will become happier.” (180)
      • In the West, our way of looking at life is more individualistic. In Asia, it’s more collective. “If you decide to pursue happiness in the United States or Britain, you pursue it for yourself—because you think that’s how it works. You do what I did most of the time: you get stuff for yourself, you rack up achievement for yourself, you build up your own ego.” (181)
        • Pursuing happiness in Russia, Japan or China is done by trying “…to make things better for your group—for the people around you. That’s what you think happiness means, so it seems obvious to you.” (181)
      • And, the data shows, the Western version of happiness doesn’t work…the more you believe happiness to be a social thing, the better off you are. (181) “…if we return to seeing our distress and our joy as something we share with a network of people all around us, we will feel different.” (181)
        • Community! — The role of community in personal well-being. Thinking we versus I.
      • The search for individual solutions is a trap. We dive further into our own egos.
  • 2) Social Prescribing
    • Wasn’t sure as to the difference here between connections to others and social prescribing.
      • However, seems to stress more social programs. Used an example of “dog shit alley,” where a group of depressed patients worked together to take this run down, dirty alley and turn it into a community garden.
  • 3) To Meaningful Work
    • Fact is, most people dislike their work. “…87 percent of us feel either disengaged or enraged by our jobs. You are twice as likely to hate your job as love it, and once you factor in e-mails, those work hours are spreading over more and more of our lives—fifty, sixty hours a week.” (201) — Work satisfaction
    • Example of a democratic cooperative — Baltimore Bicycle Works
      • Six full partners, all share the proceeds — at the time of Hari’s visit, there were 3 apprentices who spent a year training, working, etc.  who would then be evaluated after a year to become full partners if they were seen as a good fit. — Importance of Equity & Ownership
        • “The goal is for everyone to feel equally committed to the cooperative, and able to find a way to make the best contribution they possibly can to it.” (206)
      • This style of work provides a “reconnection,” because you feel your are choosing it, you directly benefit from it, you have a respected status or status isn’t at play at all, and you are connected to evaluating the future. You know where you could be working 5 years from now — no pressure or insecurity. (208)
    • “A major study by scientists at Cornell University investigated 320 small businesses. Half had top-down control, and half let the workers set their own agenda in a model that was closer to the democratic system at Baltimore Bicycle Works. The businesses closer to the democratic model grew, on average, for times more than the others.” (209)
  • 4) To Meaningful Values
    • Decipher between what our your values and values that have been placed upon you, or expected of you from society.
    • This might be where a sorting of your personal philosophy may come to benefit. What do you believe? Are you acting in accordance with those values?
  • 5) Sympathetic Joy & Overcoming Addiction to the Self
    • Sympathetic Joy is a method for cultivating “the opposite of jealousy or envy…It’s simply feeling happy for other people.” (220)
      • The practice (220-221):
        • 1) Close your eyes and picture yourself. You imagine something good happening to you—falling in love, or writing something you’re proud of. You feel the joy that would come from that. You let it flow through you.
        • 2) Then you picture somebody you love, and you imagine something wonderful happening for them. You feel the joy from that, and you let that, too, flow through you.
        • 3) Then you picture somebody you don’t really know—say, the clerk who serves you in the grocery store. You imagine something wonderful happening to her. And you try to feel joy for her—real joy.
        • 4) You picture somebody you don’t like, and you try to imagine something good happening for that person. And you try to feel joy for that person.
        • 5) Then you picture somebody you really dislike, or someone you really envy
        • Do this everyday for fifteen minutes.
    • Psychedelics — Psilocybin experiment — Role in overcoming the addiction to the self / “breaking our addiction to ourselves”
      • “Some 80 percent of people who were given the highest dose of psilocybin said, two months later, that it was one of the five most important things that had ever happened to them.” (233)
      • Psilocybin & Smokers — “After just three session…80 percent of them quit, and were still off cigarettes six months later. That’s a higher success rate than any comparable technique anywhere.” (234)
      • Study — University College London, Psilocybin and treating Depression — (only a preliminary study), “…but they found that nearly 50 percent of patients saw their depression go away entirely for the three-month period of the trial.” (234)
        • These results were dependent on one thing, “Your likelihood of recovering from depression or addiction was dependent on how intense a spiritual experience you had during the drug experience. The more intense the spiritual experience, the better the outcomes afterward.” (234)
      • “…what both deep meditation and psychedelic experiences teach us is the ability to see how much of that self—that ego—is constructed.” (235)
      • “…these substances most often leave people with a profound sense of connection—to other people, to nature and to a deeper sense of meaning.” (236)
        • “They’ve recognized the connection between themselves and others…They feel more motivated to connect to others. They feel more motivated to care for themselves in healthy ways, rather than destructive ways.” (236)
  • 6) Acknowledging and Overcoming Childhood Trauma
  • 7) Restoring the Future
    • “It is a well-established fact that the poorer you are, the more likely you are to become sick in almost everyday. In the United Status, if you have an income below $20,000, you are more than twice as likely to become depressed as somebody who makes $70,000 or more. And if you received a regular income from property you own, you are ten times less likely to develop an anxiety disorder than if you don’t get any income from property.” (247)
      • Wealth, Mental Health, & Inequality — Poverty & Well-Being
      • If something like a Universal Basic Income was to help provide people with some sort of foundation…$12,000 a year even, would that then bring more people out of these “depression risk sector?” What’s the difference between complacency, and desperation? Would $12,000 a year, take people out of desperation? Or would it really turn us into more complacent people?
    • Canadian Basic Income Experiment — Dauphin (rural community in Manitoba) — Universal Basic Income 1970s (245 –
      • $19,000 (in U.S. dollars) per year by the govt. guarantee
      • 3 years into the experiment a conservative government took power in Canada and shut down the experiment.
      • What were the results?
        • Students stayed at school longer and performed better
        • Number of low-birth-weight babies declined as more women delayed having children until they were ready.
        • Parents with newborn babies stayed at home longer to care for them and didn’t rush back to work.
        • Depression and anxiety in the community fell significantly
          • Drop of 9 percent in serious mental health disorders and severe depression (in 3 years)
    • Great Smoky Mountains — Native American tribal group & Casino (250)
      • Everyone received $6,000 a year rising to $9,000 later
        • “Behavioral problems like ADHD and childhood depression fell by 40 percent.” (251)
    • Universal Basic Income
      • Implications, workers are empowered to say “no” to substandard jobs. Employers have to react with improving work conditions, increasing wages, etc.

Key Points, Quotes & Definitions:

• What has led to the depression, anxiety and antidepressant circumstance to be as it is?
  • Early trials & placebos —
    • 25 percent of the effects of antidepressants were due to natural recovery, 50 percent were due to the story you had been told about them, and only 25 percent to the actual chemicals. — Irving Kirsch — The impact of antidepressants was much lower than anticipated.