One of the books I have most enjoyed reading this past year is Lost Connections by Johann Hari. Hari, a writer and journalist, struggled with depression for many years. Like many depressed individuals seeking help, he was given medication along with the explanation that depression is caused by a biochemical imbalance in one’s brain. However, even after years of taking antidepressant medication, which supposedly corrects this imbalance, his depression never went away.
Hari’s personal experience with depression eventually led him on a quest to find the true causes depression along with potential solutions. Keep in mind the Hari is a writer, not a scientist. Nonetheless, in his quest to find the truth, he met with several prominent researchers and took a deep dive into the relevant literature.
What the biochemical model neglects are the ways that depression can be rooted in one’s life experience. Hari tells the story of a Cambodian farmer who lost a leg to a mine explosion. This farmer became very depressed and was constantly worried about the future. Instead of giving him antidepressants, the doctors met with him and his neighbors to explore his life situation and difficulties. After some discussion they saw that while he could no longer work in the rice paddies without significant pain and fear, he could work as a dairy farmer. They ended up buying him a cow, and the farmer’s depression lifted. The cow was the antidepressant!
During my college years I was deeply depressed. But this had nothing to do with my brain chemistry. It had everything to do with being gay at time when gay people were considered to be outcasts and less than fully human. While outwardly I was successful and came from a reasonably supportive family, at a deeper level I grew up thinking that the entire world was against me. Needing to hide who was from others, including from my own family, rendered relationships tenuous and undermined my self-esteem. What gave me hope and allowed some light to enter the darkness was the attention and care of a mentor who was able to see past my alienation and provide a genuine human connection.
Hari’s book emphasizes the role of missing or diminished connections in fostering depression. These connections can be with friends and community, with nature, with meaningful values and activities or even with oneself. Over the years I have observed a relationship between low self-esteem, social anxiety and depression. The isolation that sometimes accompanies social anxiety is fertile ground for the negative thoughts and painful mood states that make up depression.
We evolved in close connection with the natural world. Hari notes that animals held in captivity develop symptoms of despair. For instance, parrots may rip out their own feathers. Elephants may grind down their tusks into gnarled stumps. Hari also cites a study from the University of Essex that compared the experiences of those who moved from green rural areas to the city and those who moved in the opposite direction. The researchers found a significant drop in depression among those who moved to the countryside and large increase in depression in those who moved to the city. In my own experience and that of some of my friends, nothing lifts our spirits more than spending a day in nature.
Victor Frankl, an Austrian psychiatrist and Holocaust survivor, observed that his fellow prisoners in the concentration campus could survive most things except for the loss of meaning. We can find meaning in various ways — through relationships, spirituality and philosophy, creativity or community engagement, as well as through our activities and our work. I recall working with a student many years ago whose depression resolved once he changed his major to one that was better aligned with his personality, values and interests. Students who attend a university are relatively fortunate in that they typically have a choice about what to study, even if sometimes making a choice seems difficult and scary.
Those who are depressed are often caught up in negative ruminations. Ruminations are often some version of “the planet is dying” or “nobody can stand me,” etc. When we are depressed, everything can seem bleak and hopeless. We are cut off from a sense of purpose and a meaningful future. But the stories we tell ourselves about ourselves and the world are just stories. They are not reality. They are like a collection of snapshots on a photo page designed to create a certain impression. In the case of depression, the impression they create is a despairing one. Yet, the true reality is always more three-dimensional, more full of possibility than we imagine.
Hari tells the story of Kotti, a neighborhood in Berlin, where rising rents were driving people out of their homes. One woman in a wheel chair posted a note on her window that she was going to kill herself in a week’s time because she was going to be evicted. Soon neighbors she barely knew came to check on her. To make a long story short, people from the neighborhood, who previously had passed each other like ships in the night, began to gather in the street where they set up a protest camp. The camp brought together individuals who previously treated each other with skepticism and disdain — gay people and conservative Turkish Muslims, homeless people and German hipsters. Spending lots of time together in the camp, they came to know one another’s stories and developed compassion for one another. They felt empowered in their new sense of home. Not a home as a castle with a moat, but a home in a community, a home for the heart.
Depression is a state of constricted awareness. When our walls come down with other people and we stop filtering reality through a dark lens, we can start to discover and appreciate all that life has to offer. While we cannot completely eliminate pain and suffering, we can see that our worst experiences and thoughts do not define us and do not determine what life can be.
Since depression and a sense of separation go hand in hand, experiences that allow us to transcend our separation are potent antidepressants. This could be joining an affinity group or communing with nature, taking up a musical instrument or volunteering for a valued cause, diving into a major that you love or connecting deeply to a spiritual source. When we can drop our negative chatter and break through our self-made prisons, what is waiting to be noticed, appreciated and explored is nothing less than the entire world.
Mark Evans, Ph.D.
Senior Staff Psychologist