👉 https://www.goodreads.com/book/show/34921573-lost-connections

Chapters

Part 1: The Crack in the old story (27)

The Wand (28)

With any drug there always comes a story:

But Irving was also one of the leading experts in the world in a field of science that began right back in Bath when John Haygarth first waved his false wand. At that time, the English doctor had realized that when you give a patient a medical treatment, you are really giving her two things. You are giving her a drug, which will usually have a chemical effect on her body in some way. And you are giving her a story—about how the treatment will affect her.

Prozac and some false research:

He learned right away that the drug companies had—for years—been selectively publishing research, and to a greater degree than he expected. For example, in one trial for Prozac, the drug was given to 245 patients, but the drug company published the results for only twenty-seven of them. Those twenty-seven patients9 were the ones the drug seemed to work

The Hamilton scale:

Scientists measure the depth of someone’s depression using something named the Hamilton scale, which was invented by a scientist named Max Hamilton in 1959. The Hamilton scale ranges from 0 (where you’re skipping along merrily) to 51 (where you’re jumping in front of trains). To give you a yardstick: you can get a six-point leap in your Hamilton score if you improve your sleeping patterns. What Irving found is that, in the real data that hadn’t been run through a PR filter, antidepressants do cause an improvement in the Hamilton score—*they do make depressed people feel better. It’s an improvement of 1.8 points*.

Irvin Kirsch:

When Irving Kirsch discovered that these serotonin-boosting drugs were not having the effects that everyone was being sold, he began—to his surprise—to ask an even more basic question. What’s the evidence, he began to wonder, that depression is caused primarily by an imbalance of serotonin, or any other chemical, in the brain? Where did it come from?

Imbalance (38)

After twenty years researching this at the highest level, Irving has come to believe that the notion depression is caused by a chemical imbalance is just “an accident of history,” produced by scientists initially misreading what they were seeing, and then drug companies selling that misperception to the world to cash in. And so, Irving says, the primary explanation for depression offered in our culture starts to fall apart. The idea you feel terrible because of a “chemical imbalance” was built on a series of mistakes and errors. It has come as close to being proved wrong, he told me, as you ever get in science. It’s lying broken on the floor, like a neurochemical Humpty Dumpty with a very sad smile.

The Grief Exception (50)

But this blasts a hole in the rudder of the boat the psychiatrists writing the DSM have been sailing in for so long. Suddenly, life—with all its complexity—starts to flood into diagnosing depression and anxiety. It can’t just be a matter of chemical imbalance, as verified by checklists of symptoms. It would have to be seen as a response to your circumstances.

Depression as a disconnection from ourselves, from others:

As she said this, I told her that in thirteen years of being handed ever higher doses of antidepressants, no doctor ever asked me if there was any reason why I might be feeling so distressed. She told me I’m not unusual—and it’s a disaster. The message my doctors gave me—*that our pain is simply a result of a malfunctioning brain—makes us, she told me, “disconnected from ourselves, which leads to disconnection from others*.”

Mental health should be become emotional health:

In most cases, Joanne says, we would have to stop talking about “mental health”—which conjures pictures of brain scans and defective synapses—and start talking about “emotional health.” “*Why do we call it mental health?” she asked me. “Because we want to scientize it. We want to make it sound scientific. But it’s our emotions.*”

Depression as a form of grief:

I was beginning to think there was something significant about the fact that grief and depression have identical symptoms. Then one day, after interviewing several depressed people, I asked myself: What if depression is, in fact, a form of grief—for our own lives not being as they should? What if it is a form of grief for the connections we have lost, yet still need?

The First Flag on the Moon (57)

Part 2: Disconnection: Nine Causes of Depression

Picking up the flag (69)

Cause one: Disconnection from meaningful work (71)

As a result of this research, and the science it opened up, “the notion of what constitutes stress at work has undergone a revolution,” Michael explains. The worst stress for people isn’t having to bear a lot of responsibility. It is, he told me, having to endure “work [that] is monotonous, boring, soul-destroying; [where] they die a little when they come to work each day, because their work touches no part of them that is them.” Joe, then, in his paint shop, by this real standard, had one of the most stressful jobs there is. “Disempowerment,” Michael told me, “is at the heart12 of poor health”—physical, mental, and emotional.

Cause two: Disconnection from other people (83)

On being “homesick”:

When we talk about home today, we mean just our four walls and (if we’re lucky) our nuclear family. But that’s never been what home has meant to any humans before us. To them, it meant a community—a dense web of people all around us, a tribe. But that is largely gone. Our sense of home has shriveled so far and so fast it no longer meets our need for a sense of belonging. So we are homesick even when we are at home.

Why people post on social media:

The comedian Marc Maron once wrote that “*every status update is a just a variation on a single request: ‘Would someone please acknowledge me?*’

There’s a quote from the biologist E. O. Wilson that John Cacioppo—who has taught us so much about loneliness—likes: “People must belong to a tribe.” Just like a bee goes haywire if it loses its hive, a human will go haywire if she loses her connection to the group.

Cause three: Disconnection from meaninful values (102)

Consumerism & work:

And the pressure, in our culture, runs overwhelmingly one way—*spend more; work more*. We live under a system, Tim says, that constantly “distracts us from what’s really good about life.” We are being propagandized to live in a way that doesn’t meet our basic psychological needs—*so we are left with a permanent, puzzling sense of dissatisfaction*.

Intrinsic vs extrinsic values:

“On Friday at four, I can stay [in my office] and work more—or I can go home and play with my kids,” he told me. “I can’t do both. It’s one or the other. If my materialistic values are bigger, I’m going to stay and work. If my family values are bigger, I’m going to go home and play with my kids.” It’s not that materialistic people don’t care about their kids—but “*as the materialistic values get bigger, other values are necessarily going to be crowded out,” he says, even if you tell yourself they won’t*.

Advertising makes us feel bad:

Tim suspected that advertising plays a key role in why we are, every day, choosing a value system that makes us feel worse. So with another social scientist named Jean Twenge,21 he tracked the percentage of total U.S. national wealth that’s spent on advertising, from 1976 to 2003—and he discovered that the more money is spent on ads, the more materialistic teenagers become. A few years ago, an advertising agency head named Nancy Shalek22 explained approvingly: “*Advertising at its best is making people feel that without their product, you’re a loser. Kids are very sensitive to that … You open up emotional vulnerabilities, and it’s very easy to do with kids because they’re the most emotionally vulnerable*.

Adertising and the ego:

When they talk among themselves, advertising people have been admitting since the 1920s that their job is to make people feel inadequate—and then offer their product as the solution to the sense of inadequacy they have created. Ads are the ultimate frenemy—they’re always saying: Oh babe, I want you to look/smell/feel great; it makes me so sad that that at the moment you’re ugly/stinking/miserable; here’s this thing that will make you into the person you and I really want you to be. Oh, did I mention you have to pay a few bucks? I just want you to be the person you deserve to be. Isn’t that worth a few dollars? You’re worth it.

One of his proudest moments was when one of his sons came home one day and said: “Dad, some kids at school are making fun of my sneakers.” They were not a brand name, or shiny-new. “Oh, what’d you say to them?” Tim asked. His son explained he looked at them and said: “*Why do you care?*” He was nonplussed—he could see that what they valued was empty, and absurd.

Problem with shopping malls:

“But I think part of why people are depressed is that our society is not set up in order to help people live lifestyles, have jobs, participate in the economy, [or] participate in their neighborhoods” in ways that support their intrinsic values. The change Tim saw happening in Florida as a kid—when the beachfronts were transformed into shopping malls and people shifted their attention there—has happened to the whole cultur

Cause four: Disconnection from childhood trauma (117)

Obesity and the real causes:

“When you look at a house burning down, the most obvious manifestation is the huge smoke billowing out,” he told me. It would be easy, then, to think that the smoke is the problem, and if you deal with the smoke, you’ve solved it. But “thank God that fire departments understand that the piece that you treat is the piece you don’t see—the flames inside, not the smoke billowing out. Otherwise, house fires would be treated by bringing big fans to blow the smoke away. [And that would] make the house burn down faster.” Obesity, he realized, isn’t the fire. It’s the smoke.

turned out that for every category of traumatic experience you went through as a kid, you were radically more likely to become depressed as an adult. If you had six categories of traumatic events in your childhood, you were five times9 more likely to become depressed as an adult than somebody who didn’t have any. If you had seven categories of traumatic events as a child, you were 3,100 percent more likely to attempt to commit suicide as an adult.

Depression and emotional abuse:

Curiously, it turned out emotional abuse was more likely to cause depression than any other kind of trauma—even sexual molestation. Being treated cruelly by your parents was the biggest driver of depression, out of all these categories.

Cause five: Disconnection from status and respect (128)

After I learned about this, I began to wonder—especially as I interviewed many depressed people—*if depression is, in part, a response to the sense of humiliation the modern world inflicts on many of us*. Watch TV and you’ll be told the only people who count in the world are celebrities and the rich—and you already know your chances of joining either group are vanishingly small. Flick through an Instagram feed or a glossy magazine, and your normal-shaped body will feel disgusting to you. Go to work and you’ll have to obey the whims of a distant boss earning hundreds of times more than you. Even when we are not being actively humiliated, even more of us feel like our status could be taken away at any moment. Even the middle class—even the rich—are being made to feel pervasively insecure. Robert had discovered that having an insecure status was the one thing even more distressing than having a low status.

Cause six: Disconnection from the natural world (136)

Cause seven: Disconnection from a hopeful or secure future (146)

Causes eight and nine: The real role of genes and brain changes (158)

Being depressed for a long time causes increased nervous activity in specific brain areas:

Because you are feeling intense pain for a long period, your brain will assume this is the state in which you are going to have to survive from now on—so it might start to shed the synapses that relate to the things that give you joy and pleasure, and strengthen the synapses that relate to fear and despair. That’s one reason why you can often start to feel you have become somehow fixed in a state of depression or anxiety even if the original causes of the pain seem to have passed. John

Genes and depression:

Yet there was a catch. We are all born with a genetic inheritance—but your genes are activated by the environment. They can be switched on, or off, by what happens to you. And Avshalom discovered—as Professor Robert Sapolsky explains—“that if you have a particular flavor of 5-HTT, you have a greatly increased risk of depression, but only in a certain environment.” If you carried this gene, the study showed, you were more likely to become depressed—but only if you had experienced a terribly stressful event, or a great deal of childhood trauma. (They didn’t test for most of the other causes of depression I’ve been talking about here, such as loneliness, so we don’t know if they also interact with genes in this way

Feminism in the 1950s:

Picture a 1950s housewife living before modern feminism.She goes to her doctor to say there is something terribly wrong with her. She says something like: “I have everything a woman could possibly want. I have a good husband who provides for me. I have a nice house with a picket fence. I have two healthy children. I have a car. I have nothing to be unhappy about. But look at me—I feel terrible. I must be broken inside. Please—can I have some Valium?” The feminist classics talk a lot about women like this. There were millions of women saying things just like it. And the women meant what they said. They were sincere. Yet now, if we could go back in a time machine and talk to these women, what we’d say is: You had everything a woman could possibly want by the standards of the culture. You had nothing to be unhappy about by the standards of the culture. But we now know that the standards of the culture were wrong. Women need more than a house and a car and a husband and kids. They need equality, and meaningful work, and autonomy. You aren’t broken, we’d tell them. The culture is.

It turns out that you were more likely to hurt somebody if you believed their mental illness was the result of their biochemistry than if you believed it was the result of what had happened to them in life. Believing depression was a disease didn’t reduce hostility. In fact, it increased it.

See depression as a reaction to the way we are living:

This experiment—like so much of what I had learned—hints at something. For a long time, we have been told there are only two ways of thinking about depression. Either it’s a moral failing—a sign of weakness—or it’s a brain disease. Neither has worked well in ending depression, or in ending its stigma. But everything I had learned suggests that there’s a third option—to regard depression as largely a reaction to the way we are living

“Things have changed in psychiatry,”24 he said—and he then explained to me two more crucial reasons why we are being told stories only about our brains and our genes. “Psychiatry has undergone a real constriction from this bio-psycho-social approach. While some people still pay lip service to it, mainstream psychiatry has become very biological.” He furrowed his brow. “It’s very problematic.” We have ended up with “a grossly oversimplified picture” of depression that he said “doesn’t look at social factors … But at a deeper level for me, it doesn’t look at basic human processes.” One reason why is that it is “much more politically challenging”25 to say that so many people are feeling terrible because of how our societies now work. It fits much more with our system of “neoliberal capitalism,” he told me, to say, “Okay, we’ll get you functioning more efficiently, but please don’t start questioning … because that’s going to destabilize all sorts of things.” This observation fits, he believes, with the other big key reason. “The pharmaceutical [companies] are major forces shaping a lot of psychiatry, because it’s this big, big business—billions of dollars,” he said. They pay the bills, so they largely set the agenda, and they obviously want our pain to be seen as a chemical problem with a chemical solution. The result is that we have ended up, as a culture, with a distorted sense of our own distress. He looked at me. The fact that “the entire program of psychiatric research should look like [this],” he said, “is really disturbing.”

Part 3: Reconnection; or, A different kind of antidepressant

The cow (172)

We built this city (177)

Reconnection one: To other people (192)

Reconnection two: Social prescribing (203)

Reconnection three: To meaningful work (215)

Reconnection four: To meaningful values (226)

Reconnection five: Sympathetic joy, and overcoming addiction to the self (234)

Reconnection six: Acknowledging and overcoming childhood trauma (257)

Reconnection seven: Restoring the future (262)

Conclusion: Homecoming (273)