Here on Democracy Now!, democracynow.org, I'm Amy Goodman with Nermeen Shaikh.
NERMEEN SHAIKH: We turn now to mental illness and its treatment in the United States.
According to the National Institutes of Health, the disease is widely prevalent: Almost 20
percent of adult Americans suffer from mental illness every year.
Anxiety disorders are the most common mental illness in the U.S., affecting 40 million
adults in the U.S., or 18 percent of the population, every year.
About 7 percent of adult Americans suffer from major depression.
According to the World Health Organization, the U.S. is one of the most depressed countries
in the world, and, globally, depression is the leading cause of ill health and disability.
Depression is also the major contributor to suicides worldwide, which number close to
800,000 a year.
The National Alliance on Mental Illness finds that more than half of Americans don’t receive
treatment for mental illness.
AMY GOODMAN: Well, we now turn to a new book that argues that people who do receive treatment
for depression and anxiety are not being treated adequately.
Author Johann Hari says too much emphasis is placed on brain chemistry, to the exclusion
of equally and often more important environmental causes.
He points specifically to what he calls, quote, “junk values,” writing, quote, “Junk
food has taken over our diets, and it is making millions of people physically sick.
A growing body of scientific evidence suggests that something similar is happening with our
minds—that they have become dominated by junk values, and this is making us mentally
sick, triggering soaring rates of depression and anxiety.”
Johann Hari has experienced mental illness himself, found he was still depressed after
having been on antidepressants for well over a decade, starting when he was a teenager.
In his research, Johann Hari found his experience was far from unique and that a staggering
65 to 80 percent of people on antidepressants continue to be depressed.
Well, Johann Hari joins us now from Washington, D.C.
He is a writer and a journalist.
His book on depression is called Lost Connections: Uncovering the Real Causes of Depression—and
the Unexpected Solutions.
His previous book, Chasing the Scream: The First and Last Days of the War on Drugs.
Johann, welcome back to Democracy Now!
Let’s start with the title, because I think that very much conveys what your underlying
thesis is: Lost Connections.
JOHANN HARI: Yeah.
So, everyone watching this knows that they have natural physical needs, right?
You need food, you need water, you need clean air, you need warmth.
If I took those away from you, things would go real wrong real fast.
One of the things I learned on the big journey I did for this book, over 40,000 miles, interviewing
the best experts in the world on what causes depression and anxiety and what solves them,
is there’s equally strong evidence that we have natural psychological needs.
You’ve got to feel you belong.
You’ve got to feel your life has meaning and purpose.
You’ve got to feel that people see you and value you.
You’ve got to feel you’ve got a future that makes sense.
And our culture is good at lots of things, but we’ve been getting less and less good
at meeting people’s deep, underlying psychological needs.
And that’s one of the key reasons why we have this exploding depression and anxiety
crisis.
So, that can sound a bit weird in the abstract, so I’ll give you a specific example.
I noticed that lots of the people I know who are depressed and anxious, their depression
and anxiety focuses around their work.
So I started to look at the evidence.
How do people feel about their work in our culture?
Turns out Gallup did the best research on this.
Thirteen percent of us like our work most of the time.
Sixty-three percent of us are what they called “sleepworking”—you don’t like it,
you don’t hate it.
Twenty-four percent of people hate their work.
So you think about that.
Eighty-seven percent of people don’t like the thing they’re doing most of their waking
lives.
I started to think, “Could that have some relationship to our mental health crisis?”
So, I discovered the incredible Australian social scientist called Professor Michael
Marmot, who discovered the core, in the 1970s, of what makes you depressed at work.
If you go to work and you feel you have low or no control, you are significantly more
likely to become depressed, or even more likely to have a heart attack.
That’s because human beings have a need to feel their life is meaningful.
And if you’re controlled, that disrupts your ability to create meaning.
And I started to think, chemical—so, I believe strongly that chemical antidepressants have
a real role, they give some relief to some people.
But I started to think, “What would be the antidepressant for that problem?”
Right?
Which is so prevalent in our culture.
And I learned there is one.
In Baltimore, not far from where I am now, I went and met a woman called Meredith Keogh.
Meredith used to go to bed every Sunday night just sick with anxiety about her work.
And one day, with her husband Josh, she did this quite bold thing.
Josh had worked in bike stores since he was a teenager, which is, you know, insecure,
controlled work.
And Josh and Meredith decided they were going to set up a bike store with their colleagues
that ran on a different principle.
It’s a democratic cooperative.
You might call it democracy now.
The way it works is they don’t have a boss.
They take all the big decisions together.
They share the profits, obviously.
They share out the good tasks and the less good tasks, so no one gets stuck with the,
you know, more depressing tasks.
And one of the things that was so fascinating, spending time with them, and in other democratic
cooperatives, is how many of them talked about how depressed and anxious they’d been in
their previous workplace, but they weren’t now, which is completely in line with Professor
Marmot’s findings.
And as Josh put it to me, there’s no reason why any workplace should operate like this.
We have a society that is putting in place all sorts of structures that are causing depression
and anxiety, yet we tell people this—so, your depression and anxiety, if you’re watching
this—I learned about these nine causes of depression and anxiety for which there is
scientific evidence.
Two are biological, and the rest are in the way we live.
If you’re depressed, if you’re anxious, you’re not crazy.
You’re not a machine with broken parts.
You’re a human being with unmet needs.
And there are ways we can change our society so that those needs are met and you won’t
be in such pain.
NERMEEN SHAIKH: Well, Johann Hari, I want to ask you about some of the criticism your
book has received.
In a Guardian piece headlined “As a psychiatrist, I know that Johann Hari is wrong to cast doubt
on antidepressants,” Carmine Pariante writes, quote, “[J]ust as knowing that you have
broken your legs in a car crash does not miraculously heal your broken bones, knowing the 'rational
reason' for being depressed does not make depression any less real, or the sufferer
any less in need of support and treatment.”
She [sic] disputes the argument in your book that depression and anxiety are treated only
as a chemical problem by the psychiatric community.
She goes on to say, quote, that your “suggesting that prescribing antidepressants to a patient
who suffers from clinical depression is the equivalent of treating them as a 'machine
with malfunctioning parts' is wrong, unhelpful and even dangerous.”
JOHANN HARI: Yeah, the—
NERMEEN SHAIKH: “Antidepressants are no cure-all, but demonising them plays into stigma
meaning that, tragically, more people will be held back from receiving help for a debilitating
condition.”
JOHANN HARI: Yeah, the individual you’re quoting—yeah.
NERMEEN SHAIKH: So, Johann Hari, can you respond to that, and specifically—
JOHANN HARI: Yeah.
NERMEEN SHAIKH: —the claim that she makes that your book demonizes an illness that’s
already demonized and stigmatized, and that people already hesitate to go on antidepressants
precisely because of this stigma?
JOHANN HARI: Yeah.
The individual you mentioned admits they’ve not read the book.
In the book, I’m very clear: I want to expand the menu of options for people with depression
and anxious people; I don’t want to take anything off the menu.
Some of the people I most love, some of my closest relatives take chemical antidepressants.
I’ve never urged them to stop.
Chemical antidepressants do give some relief to some people, which is really valuable.
They don’t solve the problem.
This isn’t just my position, this is the position of the World Health Organization.
World Health Organization explains, mental health is produced socially.
It is a social indicator.
It needs social as well as individual solutions.
So we need to be able to have a serious conversation about these causes that doesn’t just descend
into kind of ridiculous straw men.
Of course I’m not against chemical antidepressants.
I took them for 13 years.
Some of the people I most love take them.
But we have to be able to talk about the wider context that’s happening and how we deal
with that.
One thing that helped me really change how I think about this is when I went to interview
a professor called Derek Summerfield, amazing South African psychiatrist.
And he explained to me—he was in Cambodia when they first introduced chemical antidepressants,
right?
And the doctors there didn’t know what they were.
So he explained.
And they said, “Oh, we don’t need them.
We’ve already got antidepressants.”
And he said, “What do you mean?”
They explained.
They talked about a farmer in their community who worked in the rice fields, who one day
got blown up by a land mine.
They gave him an artificial limb.
He went back to work in the fields.
And he started just to become very depressed.
Apparently it’s very painful to work underwater with an artificial limb.
He—I imagine it’s pretty traumatic—starts just crying all day, didn’t want to get
out of bed.
They said, “We gave him an antidepressant.”
Derek said, “What did you do?”
They said, “We went.
We sat with him.
We listened to his problems.
We realized that his pain made sense.
We figured if we bought him a cow, he could become a dairy farmer, he wouldn’t be so
depressed.”
They bought him a cow.
Within a few weeks, his crying stopped.
Now, what those Cambodian doctors knew intuitively is what the World Health Organization has
been trying to tell us for years, that our depression makes sense.
Far from stigmatizing depressed people, I think this destigmatizes them.
There’s actually a really interesting experiment I go through in Lost Connections that demonstrates
this really powerfully.
Because what we’ve done up to now is we’ve told people an exclusively biological story
about their distress.
That’s what my doctor told me.
Now, there are real biological factors to depression, but most of the causes are in
the way we live.
And I think that’s much more powerfully destigmatizing.
It says it’s not you.
You’re actually surrounded by loads of people who feel this way.
You feel this way for perfectly understandable reasons.
And, of course, Dr. Pariante, who, to be fair to him—it’s a man, not woman—said he
agrees with me on these social causes and that we need to deal with these deeper social
causes.
I think part of the problem is we’ve been in this funk of pessimism where we think we
can’t change anything.
There are loads of experiments that have demonstrated that we can powerfully change them.
I’ll give you one example.
In Canada, in the 1970s—something that’s been covered by Democracy Now!
really well—in Canada, in the 1970s, they did an experiment.
They chose a town, at random, called Dauphin—it’s near Manitoba—and they gave a huge number
of people in this town a guaranteed basic income.
It was the equivalent of $15,000 a year.
They said to them, “We’re just going to give you this money in monthly installments.
There’s nothing you have to do in return for it, and there’s nothing you can do that
means we’ll take it away.”
And they followed what happened over the next three years.
The most powerful thing for me is, there was a massive fall in depression and anxiety.
Depression and anxiety that was so severe people had to be hospitalized fell by 9 percent.
Now, that tells us something.
It tells us the financial insecurity of neoliberalism, that guys document so brilliantly, is causing
a lot of that depression and anxiety.
Firstly, it’s very empowering to people to tell them, “Your depression is caused
by these factors in the way we’re living.
It’s not that just your brain is broken.”
There are factors in your brain going on, of course.
We are biological beings.
But that’s not the primary driver here.
And there are solutions that we can band together and fight for.
That’s much more destigmatizing and empowering, and it’s not a kind of straw man about saying
the drugs are bad.
Of course they’re not.
AMY GOODMAN: Johann, earlier this month, British Prime Minister Theresa May appointed a minister
for loneliness, following a year-long investigation which found 14 percent of the population in
the U.K. often or always feels lonely.
Can you talk about the connection between loneliness and depression?
And you have 20 seconds.
JOHANN HARI: Yeah, we are the loneliest society there’s ever been.
Professor John Cacioppo, with Chicago University, has shown that.
There are doctors that have started prescribing lonely people to take part in voluntary gardening
groups.
That is twice as effective as chemical antidepressants in reducing depression.
We’ve got to look at the wider solutions.
The book goes through the nine causes of depression and anxiety for which there is scientific
evidence, and seven different kinds of antidepressant that we should be utilizing, alongside chemical
antidepressants.
AMY GOODMAN: We’re going to do Part 2 of this discussion.
We’ll post it online at democracynow.org.
Johann Hari’s new book is out.
It is called Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected
Solutions.