Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions

“I had my story. In fact, I realize now, it came in two parts. The first was about what causes depression: it’s a malfunction in the brain, caused by serotonin deficiency or some other glitch in your mental hardware. The second was about what solves depression: drugs, which repair your brain chemistry. I liked this story. It made sense to me. It guided me through life.”

Hari says that antidepressants were not just a medicine for him, but the basis for how he understood himself and his depression. He thought of his depression as a medical disorder, and didn’t consider the social and personal reasons for his depression. Hari uses short, declarative sentences, which slow down the pace and encourage readers to linger.

“First, I scoffed; [Dr. Irving Kirsch’s] claims seemed absurd, and contrary to my own direct experience in all sorts of ways. And then I became angry. He seems to be kicking away the pillars on which I had built a story about my own depression. He was threatening what I knew about myself.”

Hari has bult a sense of identity around his depression, a narrative of how depression works based on it being a medical problem that can be solved through drugs. Hari is frustrated when Kirsch challenges this narrative, subverting Hari’s sense of self.

“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.”

At the heart of Lost Connections is the argument that chemical antidepressants are not as effective as they are widely believed to be and as many doctors claim. Despite the powerful marketing of antidepressants, Hari argues the scientific evidence of their efficacy is weak.

“The grief exception revealed something that the authors of the DSM—the distillation of mainstream psychiatric thinking—were deeply uncomfortable with. They had been forced to admit, in their own official manual, that it’s reasonable—and perhaps even necessary—to show the symptoms of depression, in one set of circumstances.”

The grief exception is important to Hari’s argument of how depression can be from environmental and not biological factors. It also represents how diagnoses of clinical depression do not consider problems in the patient’s life. Instead, depression is seen as mostly stemming from nature, or biology, rather than nurture, or environment.

“They had proved that depression is—in fact—to a significant degree a problem not with your brain, but with your life.”

This refers to the work of George Brown and Tirril Harris (57-63). Their work supports Hari’s claims about depression, specifically that depression is rooted in a person’s situation or trauma, and not a biological dysfunction.

“It was only a long time talking with these social scientists that I realized every one of the social and psychological causes of depression and anxiety they have discovered has something in common. They are all forms of disconnection. They are all ways in which we have been cut off from something we innately need but seem to have lost along the way.”

Hari presents the social and economic causes of depression as “disconnection.” Depressed individuals are separated from things like community, Purpose and Meaning in their work, and hope for the future. These lines set up the idea that truly effective cures for depression are “reconnections.” 

“The Greek woman who came to Michael [Marmot] saying she was crying all day and didn’t know how to stop didn’t have a problem with her brain; she had a problem with her life. But the hospital gave her a few tablets they knew were just a placebo, and sent her on her way.”

This passage represents two ways that Hari supports his arguments. First, he cites medical authorities and researchers like Michael Marmot and their work. Secondly, he uses anecdotes taken from his own life or from those of the experts he interviews, like the story of the Greek patient.

“Loneliness isn’t the physical absence of other people, [John Cacciopo] said—it’s the sense that you’re not sharing anything that matters with anyone else.”

Hari’s concept of disconnection is layered. It does not just mean disconnection from one’s community and loved ones. It may also encompass internal disconnection from one’s own values and goals.

“Twelve different studies found that the more materialistic and extrinsically motivated you become, the more anxious you will be.”

This is a key part of Hari’s arguments against materialism, or “junk values.” As Hari argues, materialism means “chasing a way of life that does a bad job of meeting […] needs” (119).

“I saw now they aren’t just suffering from the absence of something, such as meaningful work, or community. They are also suffering from the presence of something—an incorrect set of values telling them to seek happiness in all the wrong places, and to ignore the potential human connections that are right in front of them.”

Hari’s idea of disconnection affects both one’s relationships and way of thinking. Disconnection means not pursuing what will improve one’s life as well as pursuing the wrong things, like material goods. It also means that individuals with “junk values” will compare themselves to others who are more materially successful and find themselves lacking. They will be haunted by an internal value system, even if they don’t act.

“If you believe that your depression is due solely to a broken brain, you don’t have to think about your life, or about what anyone might have done to you.”

This calls back to Hari’s view that the idea of clinical depression as an imbalance of brain chemistry gave him a “story” that was difficult to challenge (10). Here, Hari suggests that this belief keeps one from having to address difficult realities about society and their own lives.

“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.”

The best approach to depression may be societal solutions, Hari argues. Hari sees depression as a societal problem, whether it be the lack of regulation around drug companies or the use of advertisements that worsen anxiety and depression.

“When you have a stable picture of yourself in the future, [Angela] explained, what it gives you is ‘perspective—doesn’t it? You are able to say—‘Okay, I’m having a shitty day. But I’m not having a shitty life.’ She never expected, she says, to be partying with Jay-Z, or to own a yacht. But she did expect to be able to plan on an annual vacation. She did expect—by the time she got into her late thirties—to know who her employer would be next week, and the week after that.”

Some of the causes of depression stem from current trends in society. One of the major ones that Hari discusses is work, particularly the lack of fulfilling or stable jobs. Depression is also caused by an inability to project beyond the current moment—especially if that moment is bad. Angela, in working an unstable, low-paying job, can’t envision a future. Hari uses repetition to create tension—“She did expect.”

“[…] it is ‘much more politically challenging’ 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 destabilizing all sorts of things.’”

Part of the problem with addressing depression’s real causes is that drug companies promote the idea that depression is purely biological in order to sell chemical antidepressants (37-39). Here, Hari argues that society is geared to work toward the benefits of profit-seeking companies, and as a result, its priority is in making sure employees are subservient to their employers. By examining the role society plays in depression, individuals risk subverting the status quo, which those in power find threatening.

“People living in Kotti who had been totally cut off before—scuttling from home to work, avoiding people’s gaze—started making eye contact.”

Kotti represents Hari’s idea of a community that achieves connection. The residents of Kotti got involved in society-changing protests, but they also reconnected by simply getting to know each other.

“I don’t want to abandon the modern world and go back to a mythical past that was more connected in many ways but more brutal in many more.”

This is Hari’s response to a potential criticism of Lost Connections. Would sacrificing modern individualism mean a loss of modern rights and freedoms? Hari answers that we should strive for a compromise.

“Sam [Everington]’s plan—working with a group of like-minded people—had been simple. He believed that something was going wrong for his depressed patients not primarily in their brains or their bodies, but in their lives, and if he wanted to help make them better, he had to help his patients change their lives. What they needed was to reconnect.”

The passage summarizes the argument behind Lost Connections. Treatments for depression must focus more on the social causes of depression, and as a result, solutions more ambitious than drugs must be found. People must be encouraged to reconnect—with their community, with intrinsic values, with what gives them Purpose and Meaning.

“I realized that this recipe for mental health could be distilled down to the three words that everyone in our culture instinctively understands: Elect Your Boss. Work wouldn’t be an ordeal that’s done to you, something to endure.”

This illustrates Hari’s political understanding of problems underpinning contemporary society, namely that employers have too much power. For Hari, problems with employment are inseparable from depression.

“In our culture, Nathan was starting to believe, we end up on a materialistic autopilot. We are constantly bombarded with messages that we will feel better (and less stinky, and less disgustingly shaped, and less all-around worthless) only if we buy some specific product; and then buy something more; and buy again, and on and on, until finally your family buy your coffin.”

Hari uses repetition to create tension (emphasis added): “and less stinky, and less disgustingly shaped, and less all-around worthless.” He also repeats “buy.” These lines feature polysyndeton, where words are separated by a conjunction, in this case “and” (emphasis added): “and less stinky, and less disgustingly shaped, and less all-around worthless […] only if we buy some specific product; and then buy something more; and buy again, and on and on […]” This creates a feeling of urgency and breathlessness.

“If you have this intense experience [using psychedelics], and then return to disconnection, it won’t last. But if you use it to build a deeper, longer sense of connection—beyond materialism and ego—it might. It shows you what we’ve lost, and what we still need.”

Even psychedelics, which Hari believes are more effective than chemical antidepressants, are not enough to combat depression. Any kind of short-term drug treatment needs to be coupled with what Hari sees as reconnection.

“It’s hard to join a big struggle when it feels like a struggle to make it to the end of the day. Asking people to take on more—when they’re already run down—feels like a taunt.”

Wide and deeply rooted social and economic problems cause depression and anxiety in many people. Even though Hari argues for different methods of reconnection that can help, improvements cannot be made in some cases without ambitious social and political reforms.

“Much more than you’ve been told up to now, it’s not serotonin; it’s society. It’s not your brain; it’s your pain. Your biology can make your distress worse, for sure. But it’s not the cause. It’s not the driver. It’s not the place to look for the main explanation, or the main solution.”

In Hari’s words to his past self, he lays out the central argument of Lost Connections—biology is not the culprit behind depression. Hari uses repetition—“it’s not”—for emphasis. He writes in short, punchy sentences—"But it’s not the cause. It’s not the driver”—to underscore his point.

“So instead of seeing your depression and anxiety as a form of madness, I would tell my younger self—you need to see the sanity in this sadness. You need to see that it makes sense. Of course it is excruciating. I will always dread that pain returning, every day of my life. But that doesn’t mean the pain is insane, or irrational. […] Depression and anxiety might, in one way, be the sanest reaction you have. It’s a signal, saying—you shouldn’t have to live this way, and if you aren’t helped to find a better path, you will be missing out on so much that is best about being human.”

This passage refers back to the Prologue, where Johann Hari recounts when a doctor told him that his nausea was a “message” from his body (4). Likewise, depression and anxiety are also messages hinting toward deeper problems.