The key ideas

Lost Connections: Why You're Depressed and How to Find Hope

Johann Hari, 2018

Why does a pill help some people and not others, and rarely all the way? Journalist Johann Hari lived with depression for years, then set out to find its causes by talking to scientists around the world. He found nine causes and seven ways to rebuild the connections we have lost. Most of the causes lie in the way we live.

Who it is for

For anyone who feels low for no clear reason: after a move, after a breakup, when the things that used to bring joy no longer do. And for anyone who wants to understand where depression and anxiety come from, looking beyond brain chemistry.

You are not a machine with broken parts. You are an animal whose needs are not being met.

The pill and the serotonin story

Eighteen-year-old Johann Hari sits in a doctor's office and hears a simple explanation for his misery. His brain is short of a chemical called serotonin, and that is why he feels so bad. The doctor prescribes an antidepressant, and within a few weeks the pain really does lift. Then it comes back. The dose goes up, the pain lifts again, and again it comes back. This goes on for more than ten years.

Hari is a British journalist. One day he asked himself a question he had been putting off for a long time: if it is all about chemistry, why had depression and anxiety risen in Britain and across the Western world almost every year of his life? To find out, he travelled some forty thousand miles. He visited labs in Baltimore, an Amish community in Indiana and a protest square in Berlin, and he questioned dozens of scientists.

The book's central idea sounds unfamiliar. In Hari's view, depression and anxiety are not only a fault in the head. Often they are a signal that a person is missing something they cannot live without. Hari counted nine causes. Two are about the body: genes and changes in the brain. The other seven lie in the way we live today: in our work, in loneliness, in our values, in childhood wounds, in a lack of respect, in our disconnection from nature and in a lost belief in the future.

This book is for anyone starting life over: after a move, after a breakup, after the things that used to bring you joy suddenly stopped doing so. You will see where this kind of pain can come from, and you will learn seven ways to rebuild the connections you have lost. Hari found these ways among people all over the world. Along the way, you will find out why a farmer in Cambodia who could not climb out of despair was given a cow instead of pills.

The pill was weaker than the chemistry story promised

The first person to shake Hari's certainty was Irving Kirsch, a researcher of the placebo effect. A placebo is a dummy pill with no medicine in it, which a person takes believing they are being treated. Kirsch set out to test how much stronger antidepressants are than a placebo. He gathered the trial data that drug companies had submitted to the American regulator, including trials that were never published.

In these trials, depression is measured on a scale devised by the psychiatrist Max Hamilton, running from zero, when a person feels fine, up to fifty-one. By Kirsch's calculations, antidepressants on average scored 1.8 points better than the dummy pill. For comparison, Hari gives another number: if a person simply starts sleeping better, their score on the same scale can improve by about six points.

What troubled Hari even more was the serotonin story itself. The scientists he spoke to explained that the simple idea of “low serotonin means depression” was never backed by solid evidence. It was a handy way to tell patients what was happening to them, but it could not explain why the pills do not work for everyone.

What Hari does not say matters too. He does not claim antidepressants are useless: he writes that some people get real relief from them. Many doctors and researchers dispute Kirsch's conclusions, and this is a journalist's book, not a medical verdict. Hari's question is a different one: if the pill does not explain everything, where is the rest?

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About the author

Johann Hari is a British journalist and the author of Stolen Focus. He lived with depression for many years, and this book grew out of his effort to understand his own pain.

All books by this author: Johann Hari

Terms from the book

  • Placebo
  • Ford
  • Serotonin
  • Neuroplasticity
  • Biophilia
  • Hamilton
  • cooperative
  • Harris
  • Gallup
  • Brown
  • Marmot
  • antidepressant: A medicine prescribed for depression. Hari criticises the way these drugs are explained and how widely they are used, but he writes that some people get real relief from them.
  • Amish: A religious community in the United States that lives apart from the wider world, with almost no modern technology, in large families and close-knit communities.
  • Kirsch: Irving Kirsch, an American researcher of the placebo effect, associated with Harvard Medical School. He analysed the data from antidepressant trials.
  • Camberwell: A working-class area of south London where Brown and Harris carried out their study.
  • Cacciatore: Joanne Cacciatore, an American researcher of grief and loss, who talked with Hari about the grief exception in the diagnosis of depression.
  • 5-HTT: A gene that controls the serotonin transporter in the brain. It comes in a short and a long version, and their link to stress has been studied in depression research.
  • Summerfield: Derek Summerfield, a South African psychiatrist who worked in Cambodia. He told Hari the story of the farmer and the cow.
  • Cacioppo: John Cacioppo, an American neuroscientist at the University of Chicago who studied loneliness for many years.
  • Kotti: What Berliners call Kottbusser Tor, a square in the Kreuzberg district where, in 2012, neighbours built a protest camp against rising rents.
  • Cengiz: Nuriye Cengiz, an elderly Berliner of Turkish origin who was facing eviction. The protest at Kotti began with her trouble.
  • Kasser: Tim Kasser, an American psychologist who has spent many years studying how materialistic values relate to mood and well-being.
  • Dungan: Nathan Dungan, an American financial adviser who created programmes that help teenagers and adults rethink their relationship with money and shopping.
  • Felitti: Vincent Felitti, an American doctor and one of the authors of a large study on how hard experiences in childhood affect adult health.
  • Anda: Robert Anda, an American epidemiologist at the Centers for Disease Control and Prevention, and Felitti's co-author on the study of childhood trauma.
  • Sapolsky: Robert Sapolsky, an American neuroscientist at Stanford who spent many years observing baboons in Kenya and studying stress.
  • sympathetic joy: A meditation from the Buddhist tradition in which you learn to feel genuine joy at other people's good fortune, including the people you envy.
  • Behncke: Isabel Behncke, a Chilean primatologist who studies animal behaviour. She told Hari how animals behave when taken out of their natural surroundings.
  • Bromley by Bow: A medical and community centre in East London where patients are offered not only treatment but also a part in shared projects.
  • Everington: Sam Everington, a British family doctor at the Bromley by Bow Centre and one of the people championing social prescribing.
  • social prescribing: An approach in which a doctor refers a patient not only to medication but also to a group, a club or a shared project with other people.
  • Cunningham: Lisa Cunningham, a patient at the Bromley by Bow Centre whose story Hari tells.
  • Chandler: Michael Chandler, a Canadian psychologist who studied suicide among young people in the Indigenous communities of British Columbia.
  • Dauphin: A small town in the Canadian province of Manitoba where a guaranteed income experiment took place in the 1970s.
  • Mincome: A Canadian experiment in the 1970s that guaranteed low-income families a basic payment.
  • Forget: Evelyn Forget, a Canadian economist at the University of Manitoba who, decades later, studied the archives of the Mincome experiment.

All terms

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