Top Quotes: “Lost Connections: Uncovering the Real Causes of Depression — and the Unexpected Solutions” — Johann Hari
Introduction
“And so it continued, all through my late teens; and all through my twenties. I would preach the benefits of these drugs; after a while, the sadness would return; so I would be given a higher dose; 30 milligrams became 40; 40 became 50; until finally I was taking two big blue pills a day, at 60 milligrams. Every time, I got fatter; every time, I sweated more; every time, I knew it was a price worth paying.”
“Everything that causes an increase in depression also causes an increase in anxiety, and the other way around. They rise and fall together.”
“Unhappiness and depression are totally different things. There is nothing more infuriating to a depressed person than to be told to cheer up, or to be offered jolly little solutions as if they were merely having a bad week. It feels like being told to cheer yourself up by going out dancing after you’ve broken both your legs.
But as I studied the evidence, I noticed something that I couldn’t ignore.
The forces that are making some of us depressed and severely anxious are, at the same time, making even more people unhappy. It turns out there is a continuum between unhappiness and depression. They’re still very different – in the same way that losing a finger in a car accident is different from losing an arm, and falling over in the street is different from falling off a cliff. But they are connected. Depression and anxiety, I was going to learn, are only the sharpest edges of a spear that has been thrust into almost everyone in our culture.”
“At the start of my research for this book, I spent a long time reading the scientific debate about antidepressants that has been playing out in medical journals for more than two decades now. I was surprised to discover that nobody seems to know quite what these drugs do to us, or why — including the scientists who most strongly support them. There is a huge argument among scientists, and no consensus.”
“They split the people taking part into three groups. If you are in the first group, they tell you they are giving you a chemical antidepressant — but in fact, they simply give you a placebo. If you are in the second group, you are told you were being given a chemical antidepressant — and you actually get one. And if you are in the third group, you aren’t given anything — no drug, and no sugar pill; you are just followed over time.
The third group, Irving says, is really important — although almost all studies leave it out. “Imagine,” he explains, “that you are investigating a new remedy for colds.” You give people either a placebo or a drug. Over time, everyone gets better. The success rate seems amazing. But then you remember: lots of people with a cold recover within a few days anyway. If you don’t factor that in, you’ll get a really misleading impression about how well a cold remedy works — it would look like the drug was curing people who were just recovering naturally. You need the third group to test the rate that people will simply get better on their own, without any help.”
“When they added up the figures from all the publicly available scientific studies on antidepressants, what they found baffled them.
The numbers showed that 25 percent of the effects of antidepressants were due to natural recovery, 50 percent were due to the story you had been told about them, and only 25 percent to the actual chemicals.”
“This is called “publication bias.” Of all the studies drug companies carry out, 40 percent are never released to the public, and lots more are only released selectively, with any negative findings left on the cutting room floor.”
“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 patients were the ones the drug seemed to work for.”
“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.
Irving furrowed his brow. That’s a third less than getting better sleep. It was absolutely startling.”
“The side effects of the drugs, by contrast, were very real. They make many people gain weight, or develop sexual dysfunction, or start to sweat a lot.”
“During the clammy summer of 1952, some patients began to dance uncontrollably down a hospital corridor. A new drug named Marsilid had come along that doctors thought might help TB patients. It turned out it didn’t have much effect on TB — but the doctors noticed it did something else entirely. They could hardly miss it. It made the patients gleefully, joyfully euphoric — some began to dance frenetically.
So it wasn’t long before somebody decided, perfectly logically, to try to give it to depressed people — and it seemed to have a similar effect on them, for a short time. Not long after that, other drugs came along that seemed to have similar effects (also for short periods) — ones named Ipronid and Imipramine. So what, people started to ask, could these new drugs have in common? And whatever it was — could it hold the key to unlocking depression?
Nobody really knew where to look, and so for a decade the question hung in the air, tantalizing researchers. And then in 1965, a British doctor called Alec Coppen came up with a theory. What if, he asked, all these drugs were increasing levels of serotonin in the brain? If that were true, it would suggest that depression might be caused by low levels of serotonin. “It’s hard to overstate” just how far out on a limb these scientists were climbing,” Dr. Gary Greenberg, who has written the history of this period, explains. “They really had no idea what serotonin was doing in the brain.” To be fair to the scientists who first put forward the idea, he says, they put it forward tentatively — as a suggestion. One of them said it was “at best a reductionist simplification,” and said it couldn’t be shown to be true “on the basis of data currently available.”
But a few years later, in the 1970s, it was finally possible to start testing these theories. It was discovered that you can give people a chemical brew that lowers their serotonin levels. So if this theory was right — if low serotonin caused depression — what should happen? After taking this brew, people should become depressed.
So they tried it. They gave people a drug to lower their serotonin levels and watched to see what would happen. And-unless they had already been taking powerful drugs — they didn’t become depressed. In fact, in the vast majority of patients, it didn’t affect their mood at all.
I went to see one of the first scientists to study these new antidepressants in Britain, Professor David Healy, in his clinic in Bangor, a town in the north of Wales. He has written the most detailed history of antidepressants we have. When it comes to the idea that depression is caused by low serotonin, he told me: “There was never any basis for it, ever. It was just marketing copy. At the time the drugs came out in the early 1990s, you couldn’t have got any decent expert to go on a platform and say, Look, there’s a lowering of serotonin in the brains of people who are depressed…There wasn’t ever any evidence for it.” It hasn’t been discredited, he said, because “it didn’t ever get ‘credited,’ in a sense. There wasn’t ever a point in time when 50 percent of the field actually believed it.” In the biggest study of serotonin’s effects on humans, it found no direct relationship? with depression. Professor Andrew Skull of Princeton has said attributing depression to low serotonin is “deeply misleading and unscientific.”
“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.”
““There’s no evidence that there’s a chemical imbalance” in depressed or anxious people’s brains, Professor Joanna Moncrieffs — one of the leading experts on this question — explained to me bluntly in her office at the University College of London. The term doesn’t really make any sense, she said: we don’t know what a “chemically balanced” brain would look like. People are told that drugs like antidepressants restore a natural balance to your brain, she said, but it’s not true — they create an artificial state. The whole idea of mental distress being caused simply by a chemical imbalance is “a myth,” she has come to believe, sold to us by the drug companies.”
“I discussed this with one of the leading scientists in this field, Professor John loannidis, who the Atlantic Monthly has said “may be one of the most influential scientists, alive.” He says it is not surprising that the drug companies could simply override the evidence and get the drugs to market anyway, because in fact it happens all the time. He talked me through how these antidepressants got from the development stage to my mouth. It works like this: “The companies are often running their own trials on their own products,” he said. That means they set up the clinical trial, and they get to decide who gets to see any results. So “they are judging their own products. They’re involving all these poor researchers who have no other source of funding … [and who] have little control over … how the [results] will be written up and presented.” Once the scientific evidence is gathered; it’s not even the scientists who write it up much of the time. “Typically, it’s the company people who write up the [published scientific] reports.”
This evidence then goes to the regulators, whose job is to decide whether to allow the drug onto the market. But in the United States, 40 percent of the regulators’ wages are paid by the drug companies (while in Britain, it’s 100 percent). When a society is trying to figure out which drug is safe to put on the market, there are meant to be two teams: the drug company making the case for it, and a referee working for us, the public, figuring out if it properly works. But Professor Ioannidis was telling me that in this match, the referee is paid by the drug company team, and that team almost always wins.
The rules they have written are designed to make it extraordinarily easy to get a drug approved. All you have to do is produce two trials — any time, anywhere in the world — that suggest some positive effect of the drug. If there are two, and there is some effect, that’s enough. So you could have a situation in which there are one thousand scientific trials, and 998 find the drug doesn’t work at all, and two find there is a tiny effect — and that means the drug will be making its way to your local pharmacy.”
““In young people, [these chemical antidepressants] increase the risk of suicide. There’s a new Swedish study showing that it increases the risk of violent criminal behavior,” Irving continued. “In older people it increases the risk of death from all causes, increases the risk of stroke. In everybody, it increases the risk of type 2 diabetes. In pregnant women, it increases the risk of miscarriage [and] of having children born with autism or physical deformities. So all of these things are known.” And if you start experiencing these effects, it can be hard to stop — about 20 percent of people experience serious withdrawal symptoms.”
“Since Irving published his early results, and as he has built on them over the years, the reaction has been similar. Nobody denies that the drug companies’ own data, submitted to the FDA, shows that antidepressants have only a really small effect over and above placebo. Nobody denies that my own drug company admitted privately that the drug I was given, Paxil, was not going to work for people like me, and they had to make a payout in court for their deception.”
“Some reputable scientists still believe that these drugs genuinely work for a minority of people who take them, due to a real chemical effect. It’s possible. Chemical antidepressants may well be a partial solution for a minority of depressed and anxious people — I certainly don’t want to take away anything that’s giving relief to anyone. If you feel helped by them, and the positives outweigh the side effects, you should carry on. (And if you are going to stop taking them, then it’s essential that you don’t do it overnight, because you can experience severe physical withdrawal symptoms and a great deal of panic as a result. I gradually reduced my dose very slowly, over six months, in consultation with my doctor.”
“As she treated many people who had gone through experiences like hers, she noticed something peculiar. Very soon after they went through the death of a loved one, lots of her patients were being diagnosed by psychiatrists with clinical depression, and being given very powerful psychiatric drugs. This was becoming routine. So if (say) your child was murdered, you were told you were clinically unwell and needed to have your brain chemistry fixed. For example, one of her patients, whose child had died recently, told her doctor that she sometimes felt her child was speaking to her. It didn’t distress her; she felt mildly comforted by it. Yet the patient was immediately diagnosed with psychosis, and given anti-psychotic drugs.”
“To get a diagnosis of depression, you have to show at least five out of nine symptoms nearly every day: for example, depressed mood, decreased interest in pleasure, or feelings of worthlessness.
But as doctors first started to apply this checklist, they discovered something awkward. Almost everybody who is grieving, it turns out, matches the clinical criteria for depression. If you simply use the checklist, virtually anyone who has lost someone should be diagnosed as having a clear mental illness.
This made many doctors and psychiatrists feel uncomfortable. So the authors of the DSM invented a loophole, which became known as “the grief exception.”They said that you are allowed to show the symptoms of depression and not be considered mentally ill in one circumstance and one circumstance only — if you have recently suffered the loss of somebody close to you. After you lose (say) a baby, or a sister, or a mother, you can show these symptoms for a year before you are classed as mentally ill. But if you continued to be profoundly distressed after this deadline, you will still be classified as having a mental disorder. As the years passed and different versions of the DSM were published, the time limit changed: it was slashed to three months, one month, and eventually just two weeks.”
“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.
But once you’ve conceded that, it invites an obvious follow-up question. Why is a death the only event that can happen in life where depression is a reasonable response? Why not if your husband has left you after thirty years of marriage? Why not if you are trapped for the next thirty years in a meaningless job you hate? Why not if you have ended up homeless and you are living under a bridge? If it’s reasonable in one set of circumstances, could there also be other circumstances where it is also reasonable?”
“This tension unsettled lots of people. It begged too many questions. People like Joanne could use it to force debates onto the table that many people didn’t want to have.
So the psychiatrists who wrote the fifth and most recent edition of the DSM, which was published in 2015, came up with a solution. They got rid of the grief exception. In the new version, it’s not there. There’s just the checklist of symptoms, followed by a vague footnote. So now if your baby dies and you go to the doctor the next day and you’re in extreme distress, “you can be diagnosed immediately,” Joanne explained to me.
And so the model is preserved. Depression is something you can find on a checklist. If you tick the boxes, you’re mentally ill. Don’t look for context. Look for symptoms. Don’t ask what is happening in the person’s life.”
“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?”
“Among the women who didn’t develop depression, some 20 percent had experienced a significant negative event in the preceding year. Among the women who did develop depression, some 68 percent of them had experienced a significant negative experience in the year before the depression set in.
It was a gap of 48 percent — far more than could be caused by chance. This showed that experiencing something really stressful can cause depression.
But this was only the first of their findings. It turned out depressed women were three times more likely to be facing serious long-term stressors in their lives in the year before they developed their depression than women who didn’t get depressed. It wasn’t just a bad event that caused depression — it was also long-term sources of stress. And if you had some positive stabilizing things in your life, that massively reduced the chances of developing depression. For every good friend you had, or if your partner was more supportive and caring, it reduced depression by a remarkable amount.
So George and Tirril had discovered that two things make depression much more likely — having a severe negative event, and having long-term sources of stress and insecurity in your life. But the most startling result was what happened when these factors were added together. Your chances of becoming depressed didn’t just. combine: they exploded. For example — if you didn’t have any friends, and you didn’t have a supportive partner, your chances of developing depression when a severe negative life event came along were 75 percent. It was much more likely than not.
It turned out that every bad thing that happened to you, every source of stress, every lack of support — each one accelerated the risks of depression more and more. It was like putting a fungus in a place that’s dark and wet. It wouldn’t just grow more than it would in a place that was just dark, or in a place that was just wet. It would balloon bigger than both combined.”
“Years later, Tirril used the same techniques to carry out a study of anxiety — and found similar results. It wasn’t just a problem caused by the brain going wrong. It was caused by life going wrong.”
Nine Causes of Depression & Anxiety
“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 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.”
Cause One: Disconnection from Meaningful Work
“They studied millions of workers across 142 countries. They found that 13 percent of us say we are “engaged” in our jobs — which means they are “enthusiastic about, and committed to their work and contribute to their organization in a positive manner.”
Against them, 63 percent say they are “not engaged,” which is defined as “sleepwalking through their workday, putting time — but not energy or passion — into their work.”
And a further 24 percent are “actively disengaged.” They, Gallup explained, “aren’t just unhappy at work; they’re busy acting out their unhappiness. Every day, these workers undermine what their engaged co-workers accomplish … Actively disengaged employees are more or less out to damage their company.””
“After years of intensive interviewing, Michael and the team added up the results. It turned out the people at the top of the civil service were four times less likely to have a heart attack than the people at the bottom of the Whitehall ladder. The truth was the opposite of what everyone had expected.”
“If you worked in the civil service and you had a higher degree of control over your work, you were a lot less likely to become depressed or develop severe emotional distress than people working at the same pay level, with the same status, in the same office, as people with a lower degree of control over their work.”
“The higher up you went in the civil service, he found, the more friends and social activity you had after work. The lower you went, the more that tapered off — the people with boring, low-status jobs just wanted to collapse in front of the television when they got home. Why would that be? “When work is enriching, life is fuller, and that spills over into the things you do outside work,” he said to me.”
“If these tax inspectors worked really hard and gave it their best, nobody noticed. And if they did a lousy job, nobody noticed, either. Despair often happens, he had learned, when there is lack of balance between efforts and rewards. It was the same for Joe in his paint shop. Nobody ever noticed how much effort he put in. The signal you get from the world, in that situation, is — you’re irrelevant. Nobody cares what you do.
So Michael explained to the tax office bosses that a lack of control and a lack of balance between efforts and rewards were causing such severe depression that it was leading their staff to suicide.”
Cause Two: Disconnection from Other People
“Feeling lonely, it turned out, caused your cortisol levels to absolutely soar — as much as some of the most disturbing things that can ever happen to you. Becoming acutely lonely, the experiment found, was as stressful as experiencing a physical attack. It’s worth repeating. Being deeply lonely seemed to cause as much stress as being punched by a stranger.”
“A professor named Sheldon Cohen, he learned, had carried out a study in which he took a bunch of people and recorded how many friends and healthy social connections each of them had. He then took them into a lab and deliberately exposed them — with their knowledge — to the cold virus. What he wanted to know was — would the isolated people get sicker than the connected people? It turned out that they were three times more likely to catch the cold than people who had lots of close connections to other people.
Another scientist, Lisa Berkman, had followed both isolated and highly connected people over nine years, to see whether one group was more likely to die than the other. She discovered that isolated people were two to three times more likely to die during that period. Almost everything became more fatal when you were alone: cancer, heart disease, respiratory problems.
Loneliness itself, John was slowly discovering as he pieced together the evidence, seemed to be deadly. When they added up the figures, John and other scientists found that being disconnected from the people around you had the same effect on your health as being obese — which was, until then, considered the biggest health crisis the developed world faced.”
“It turned out that — for the initial five years of data that have been studied so far — in most cases, loneliness preceded depressive symptoms. You became lonely, and that was followed by feelings of despair and profound sadness and depression. And the effect was really big. Picture the range of loneliness in our culture as a straight line. At one end, you are 0 percent lonely. At the other end, you are 100 percent lonely. If you moved from being in the middle — 50 percent — to being at 65 percent, your chances of developing depressive symptoms increased eight times.
The fact he has discovered this through two very different kinds of study — and a great deal more research he has done — led John to a key conclusion, one that has been gathering in scientific support: loneliness, he concluded, is causing a significant amount of the depression and anxiety in our society.”
“Social scientists have been asking a cross-section of U.S. citizens a simple question for years: “How many confidants do you have?” They wanted to know how many people you could turn to in a crisis, or when something really good happens to you. When they started doing the study several decades ago, the average number of close friends an American had was three. By 2004, the most common answer was none.”
“It’s not that we turned inward to our families. The research he gathered showed across the world we’ve stopped doing stuff with them, too. We eat together as families far less; we watch TV together as families far less; we go on vacation together far less. “Virtually all forms of family togetherness,” Putnam shows with a battery of graphs and studies, “became less common over the last quarter of the twentieth century.” There are similar figures for Britain and the rest of the Western world.
We do things together less than any humans who came before us. Long before the economic crash of 2008, there was a social crash, in which we found ourselves alone and lonely far more of the time. The structures for looking out for each other — from the family to the neighborhood — fell apart. We disbanded our tribes. We embarked on an experiment — to see if humans can live alone.”
“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.”
“As John was proving how this effect plays out in humans, other scientists were investigating it in other animals. For example, Professor Martha McClintock separated out lab rats. Some were raised in a cage, alone. Others were raised in groups. The isolated rats developed eighty-four times the number of breast cancer tumors as the rats who had a community.”
“When he put lonely people into brain-scanning machines, he noticed something. They would spot potential threats within 150 milliseconds, while it took socially connected people twice as long, 300 milliseconds, to notice the same threat. What was happening?
Protracted loneliness causes you to shut down socially, and to be more suspicious of any social contact, he found. You become hypervigilant. You start to be more likely to take offense where none was intended, and to be afraid of strangers. You start to be afraid of the very thing you need most. John calls this a “snowball” effect, as disconnection spirals into more disconnection.
Lonely people are scanning for threats because they unconsciously know that nobody is looking out for them, so no one will help them if they are hurt. This snowball effect, he learned, can be reversed — but to help a depressed or severely anxious person out of it, they need more love, and more reassurance, than they would have needed in the first place.
The tragedy, John realized, is that many depressed and anxious people receive less love, as they become harder to be around. Indeed, they receive judgment, and criticism, and this accelerates their retreat from the world. They snowball into an ever colder place.”
“Before the Internet addiction, they had felt lost and isolated in the world. Then the online world offered these young people things that they craved but that had vanished from the environment — such as a goal that matters to you, or a status, or a tribe. “The highly popular games,” she says, “are the multiplayer games, where you get to be part of a guild — which is a team — and you get to earn your status in that guild. The positive side of that, these guys would say, is — I’m a team player. I know how to cooperate with my guys. It’s tribalism at its core.” Once you have that, Hilarie says, “you can immerse yourself in an alternate reality and completely lose track of where you are. You feel rewarded by the challenges of it, by the opportunity for cooperation, by the community that you’re in, and have status in — and [you] have much more control over than the real world.”
I thought a lot about this — about how the depression or anxiety preceded the compulsive Internet use for everyone here. The compulsive Internet use, she was saying, was a dysfunctional attempt to try to solve the pain they were already in, caused in part by feeling alone in the world. What if that applies not only to the people here, I wondered, but to many more of us?”
“The Internet was born into a world where many people had already lost their sense of connection to each other. The collapse had already been taking place for decades by then. The web arrived offering them a kind of parody of what they were losing — Facebook friends in place of neighbors, video games in place of meaningful work, status updates in place of status in the world.”
Cause Three: Disconnection from Meaningful Values
“Tim’s first tentative piece of research was to give this survey to 316 students. When the results came back and were all calculated out, Tim was struck by the results: materialistic people, who think happiness comes from accumulating stuff and a superior status, had much higher levels of depression and anxiety.
This was, he knew, just a primitive first shot in the dark. So Tim’s next step was – as part of a larger study – to get a clinical psychologist to assess 140 eighteen-year-olds in depth, calculating where they were on the Aspiration Index and if they were depressed or anxious. When the results were added up, they were the same: the more the kids valued getting things and being seen to have things, the more likely they were to be suffering from depression and anxiety.
Was this something that happened only with young people? To find out, Tim measured one hundred citizens of Rochester in upstate New York, who came from a range of age groups and economic backgrounds. The result was the same. But how could he figure out what was really happening – and why?
Tim’s next step was to conduct a more detailed study, to track how these values affect you over time. He got 192 students to keep a detailed mood diary in which, twice a day, they had to record how much they were feeling nine different emotions, such as happiness or anger, and how much they were experiencing any of nine physical symptoms, such as backache. When he calculated out the results, he found – again – higher depression among the materialistic students; but there was a result more important than that. It really did seem that materialistic people were having a worse time, day by day, on all sorts of fronts. They felt sicker, and they were angrier. “Something about a strong desire for materialistic pursuits,” he was starting to believe, “actually affected the participants’ day-to-day lives, and decreased the quality of their daily experience.” They experienced less joy, and more despair.”
“People who achieved their extrinsic goals didn’t experience any increase in day-to-day happiness — none. They spent a huge amount of energy chasing these goals, but when they fulfilled them, they felt the same as they had at the start. Your promotion? Your fancy car? The new iPhone? The expensive necklace? They won’t improve your happiness even one inch.
But people who achieved their intrinsic goals did become significantly happier, and less depressed and anxious. You could track the movement. As they worked at it and felt they became (for example) a better friend — not because they wanted anything out of it but because they felt it was a good thing to do — they became more satisfied with life. Being a better dad? Dancing for the sheer joy of it? Helping another person, just because it’s the right thing to do? They do significantly boost your happiness.
Yet most of us, most of the time, spend our time chasing extrinsic goals — the very thing that will give us nothing. Our whole culture is set up to get us to think this way. Get the right grades. Get the best-paying job.”
“They found that the more materialistic you become, the shorter your relationships will be, and the worse their quality will be. If you value people for how they look, or how they impress other people, it’s easy to see that you’ll be happy to dump them if someone hotter or more impressive comes along. And at the same time, if all you’re interested in is the surface of another person, it’s easy to see why you’ll be less rewarding to be around, and they’ll be more likely to dump you, too. You will have fewer friends and connections, and they won’t last as long.”
“If you are doing something not for itself but to achieve an effect, you can’t relax into the pleasure of a moment. You are constantly monitoring yourself. Your ego will shriek like an alarm you can’t shut off.”
“When you are extremely materialistic, Tim said to me, “you’ve always kind of got to be wondering about yourself — how are people judging you?” It forces you to “focus on other people’s opinions of you, and their praise of you — and then you’re kind of locked into having to worry what other people think about you, and if other people are going to give you those rewards that you want. That’s a heavy load to bear, instead of walking around doing what it is you’re interested in doing, or being around people who love you just for who you are.” If “your self-esteem, your sense of self-worth, is contingent upon how much money you’ve got, or what your clothes are like, or how big your house is,” you are forced into constant external comparisons, Tim says. “There’s always somebody who’s got a nicer house or better clothes or more money.””
“What you really need are connections. But what you are told you need, in our culture, is stuff and a superior status, and in the gap between those two signals — from yourself and from society — depression and anxiety will grow as your real needs go unmet.
You have to picture all the values that guide why you do things in your life, Tim said, as being like a pie. “Each value” you have, he explained, “is like a slice of that pie. So you’ve got your spirituality slice, and your family slice, and your money slice, and your hedonism slice. We’ve all got all the slices.” When you become obsessed with materialism and status, that slice gets bigger. And “the bigger one slice gets, the smaller other slices have to get.” So if you become fixated on getting stuff and a superior status, the parts of the pie that care about tending to your relationships, or finding meaning, or making the world better have to shrink, to make way.
““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.”
“There’s an experiment, by a different group of social scientists, that gives us one early clue.” In 1978, two Canadian social scientists got a bunch of four- and five-year-old kids and divided them into two groups. The first group was shown no commercials. The second group was shown two commercials for a particular toy. Then they offered these four- or five-year-old kids a choice. They told them: You have to choose, now, to play with one of these two boys here. You can play with this little boy who has the toy from the commercials — but we have to warn you, he’s not a nice boy. He’s mean. Or you can play with a boy who doesn’t have the toy, but who is really nice.
If they had seen the commercial for the toy, the kids mostly chose to play with the mean boy with the toy. If they hadn’t seen the commercial, they mostly chose to play with the nice boy who had no toys.
In other words, the advertisements led them to choose an inferior human connection over a superior human connection — because they’d been primed to think that a lump of plastic is what really matters.
Two commercials — just two — did that. Today, every person sees way more advertising messages than that in an average morning. More eighteen-month-olds can recognize the McDonald’s arch than know their own surname. By the time an average child is thirty-six months old, she already knows a hundred brand logos.
Tim suspected that advertising plays a key role in why we are, every day, choosing a value system that makes us feel worse.”
“He believes it also explains why junk values lead to such an increase in anxiety. “You’re always thinking — Are they going to reward me? Does the person love me for who I am, or for my handbag? Am I going to be able to climb the ladder of success?” he said. You are hollow, and exist only in other people’s reflections. “That’s going to be anxiety-provoking.””
“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.”
“I had been puzzled back in Philadelphia about why Joe didn’t leave the job he hated at the paint company and go become a fisherman in Florida, when he knew life in the Sunshine State would make him so much happier. It seemed like a metaphor for why so many of us stay in situations we know make us miserable.
I think I see why now. Joe is constantly bombarded with messages that he shouldn’t do the thing that his heart is telling him would make him feel calm and satisfied. The whole logic of our culture tells him to stay on the consumerist treadmill, to go shopping when he feels lousy, to chase junk values. He has been immersed in those messages since the day he was born. So he has been trained to distrust his own wisest instincts.”
Cause Four: Disconnection from Childhood Trauma
“One woman started to rapidly put on weight when she was twenty-three. What happened then? She was raped. She looked at the ground after she confessed this, and said softly: “Overweight is overlooked,” and that’s the way I need to be.”
“I was incredulous,” he told me when I sat with him in San Diego. “It seemed every other person; I was asking was acknowledging such a history. I kept thinking — it can’t be. People would know if this was true. Somebody would’ve told me. Isn’t that what medical school is for?” When five of his colleagues came in to conduct further interviews, it turned out some 55 percent of the patients in the program had been sexually abused — far more than people in the wider population. And even more, including most of the men, had had severely traumatic childhoods.”
“It 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 times 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.”
Cause Five: Disconnection from Status and Respect
“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.”
“The more unequal your society, the more prevalent all forms of mental illness are. Other social scientists then broke this down to look at depression specifically — and found the higher the inequality, the higher the depression. This is true if you compare different countries, and if you compare different states within the United States. It strongly suggested that something about inequality seems to be driving up depression and anxiety.
When you have a society with huge gaps in income and status, Richard told me, it creates the sense that “some people seem supremely important, and others seem of no importance at all.” This doesn’t affect only people at the bottom. In a highly unequal society, everyone has to think about their status a lot. Am I maintaining my position? Who’s threatening me? How far can I fall? Just asking these questions — as you have to when inequality grows — loads more and more stress into our lives.
This means that more people will unconsciously respond to this stress by offering a response from deep in our evolutionary history —we put our head down. We feel defeated.”
Cause Six: Disconnection from the Natural World
“She was especially impressed when she saw one of the female bonobos make a dildo. “She was given food one day in a bucket that was kind of cut in half — a blue bucket,” and she rolled it up, and “she took it wherever she went and she would just use it to masturbate. Amazing!”
Cause Seven: Disconnection from a Hopeful or Secure Future
““In the last decades, indigenous groups have tried to reassemble control of their own lives.” Some have been able to reclaim control of their traditional lands, revive their own languages, and get control of their own schools, health services, and police so they can elect and run them for themselves. In some places, the authorities have given in to organizing by First Nations peoples and conceded some freedoms, and in others they haven’t.
That means there’s a big gap between those First Nations groups that are still totally controlled and at the mercy of whatever decisions are made by the Canadian government about them, and other indigenous nations who have been able to achieve some freedom to rebuild a culture that makes sense to them — to try to build a world where, in their terms, something happens.
So Michael and his colleagues spent years carefully gathering and studying the statistics. They developed nine ways to measure the control a tribal group had, and slowly, over time, they plotted this against the suicide statistics. What they wanted to know was: Is there any relationship?
Then they compiled the results. It turned out the communities with the highest control had the lowest suicide; and the communities with the lowest control had the highest suicide. If you plotted these two factors on a graph, across these 196 tribal groups, it was a remarkably straight line — you could very often predict the rate of at some profound level, Michael had discovered, extremely depressed people have become disconnected from a sense of the future, in a way that other really distressed people have not. From this early research, though, it was hard to tell if these kids’ symptoms were a cause or an effect. It could go either way. Maybe losing a sense of the future makes you suicidal — or maybe being extremely depressed makes it hard to think about the future. How, he wondered, could he figure this out?
The research into First Nations Canadians, he came to believe, gives you an answer. If you live in a First Nations community with no control over its own destiny, it’s hard to construct a picture of a hopeful or stable future in your mind. You’re at the mercy of alien forces that have destroyed your people many times before. But if you live in a First Nations community that does have control over its destiny, you can easily construct a vision of a hopeful future — because, together, you’ll be deciding it.
It was, he concluded, the loss of the future that was driving the suicide rates up. A sense of a positive future protects you. If life is bad today, you can think — this hurts, but it won’t hurt forever. But when it is taken away, it can feel like your pain will never go away.”
Causes Eight and Nine: The Real Role of Genes and Brain Changes
“If you raise a baby in total darkness, the baby will shed the synapses that relate to eyesight — the brain has figured out he won’t need them and that it’s better to deploy that brainpower somewhere else.”
“When I told Marc that I had been given antidepressants for thirteen years and had always been told that all my distress had been caused by a problem inside my brain, he said: “It’s crazy. It’s always related to your life and your personal circumstances.” The seven social and psychological factors I had been investigating, Marc believes, have the capacity to physically change the brains of millions of people. If learning the map of London changes your brain, then being lonely, or isolated, or grossly materialistic — these things change your brain, too. And, crucially, reconnection can change it back. We have been thinking too simplistically, he says. You couldn’t figure out the plot of Breaking Bad by dismantling your TV set. In the same way, you can’t figure out the root of your pain by dismantling your brain. You have to look at the signals the TV, or your brain, is receiving to do that.”
“Imagine, he told me, that “your marriage just broke up, and you lost your job, and you know what? Your mother just had a stroke. It’s pretty overwhelming.” 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.”
“What the leading scientists found-according to the National Institutes of Health overview of the best twin research — is that for depression, 37 percent of it is inherited, while for severe anxiety, it is between 30 and 40 percent.”
“If those bad things hadn’t happened to you, even if you had the gene that related to depression, you were no more likely to become depressed than anyone else.”
“The way we have resisted this form of nastiness is to say that depression is a disease. You wouldn’t hector a person with cancer to pull themselves together, so it’s equally cruel to do it to somebody with the disease of depression or severe anxiety. The path away from stigma has been to explain patiently that this is a physical illness like diabetes or cancer.”
“We have come to believe that the only route out of stigma is to explain to people that this is a biological disease with purely biological causes. So — based on this positive motive — we have scrambled to find the biological effects, and held them up as evidence to rebut the sneerers.”
Reconnection. Or, a Different Kind of Antidepressant
“It turned out there was no obvious translation for the word “antidepressant” into the Khmer language. It was an idea that seemed to puzzle them.
Derek tried to explain it. Depression is, he said, a profound sense of sadness that you can’t shake off. The Cambodians thought about this carefully and said, yes, we do have some people like that. They gave an example: a farmer whose left leg was blown off by a land mine, who came to the doctors for medical help and got fitted with a new limb but didn’t recover. He felt constantly anxious about the future and was filled with despair.
They then explained that they didn’t need these newfangled antidepressants, because they already had antidepressants for people like this in Cambodia. Derek was intrigued, so he asked them to explain more.
When they realized this man was despondent, the doctors and his neighbors sat with him, and talked through his life and his troubles. They realized that even with his new artificial limb, his old job – working in the rice paddies – was just too difficult, and he was constantly stressed and in physical pain, and that was making him want to just stop living, and give up.
So they had an idea. They believed that he would be perfectly capable of being a dairy farmer, and that would involve less painful walking on his false leg and fewer disturbing memaries. So they bought him a cow.
In the months and years that followed, his life changed. His depression – which had been profound – went away, “You see, doctor, the cow was an analgesic, and antidepressant,” they told Derek. To them, an antidepressant wasn’t ahout changing your brain chemistry, an idea that seemed bizarre to their culture. It was about the community, together, empowering the depressed person to change his life.”
“Here’s the thing. That Cambodian farmer did cease to be depressed when his social circumstances were changed. This wasn’t an individualistic solution — they weren’t telling him the problem was all in his head and to pull his socks up or swallow a pill. It was a collective solution. He could never have gotten that cow on his own; the solution couldn’t have come from him alone, because he was too distressed, and anyway he didn’t have the cash. Yet it did solve his problem, and that solved his despair.”
“On the day the wall came down, Taina was pushing her baby son in a buggy when she saw a couple of East German punks crawling through a hole in the wall. “Where’s the nearest record shop?” they asked her. “We want to buy punk records.” She replied: “There’s one very near, but I don’t think you have the money.” They asked her the price, and when she told them, their faces fell.
Taina had almost no money at that time, but she opened her purse and gave them everything she had. “Hey, people,” she said. “Go. Go buy a punk record.””
Reconnection One: To Other People
“If you decide to pursue happiness in the United States or Britain, you pursue it for yourself – because you think that’s how it works. You do what I did most of the time: you get stuff for yourself, you rack up achievement for yourself, you build up your own ego. But if you consciously pursue happiness in Russia or Japan or China, you do something quite different. You try to make things better for your group – for the people around you. That’s what you think happiness means, so it seems obvious to you. These are fundamentally conflicting visions of what it means to become happier. And it turns out – for all the reasons I described earlier – that our Western version of happiness doesn’t actually work – whereas the collectivist vision of happiness does.”
“Now, when I feel myself starting to slide down, I don’t do something for myself — I try to do something for someone else. I go to see a friend and try to focus very hard on how they are feeling and making them feel better. I try to do something for my network, or my group — or even try to help strangers who look distressed. I learned something I wouldn’t have thought was possible at the start. Even if you are in pain, you can almost always make someone else feel a little bit better. Or I would try to channel it into more overt political actions, to make the society better.”
“[The Amish] speak a language that’s a variant of German as their mother tongue.”
“You were always with the family. Often, “spending time with the family was going out and working in the fields or milking the cows.” Other times, it meant the constant family time of eating and social events. An Amish family isn’t like an English family, he explained. It’s not just your mom and dad and siblings. It’s a big interconnected tribe of about 150 people — all the Amish, in fact, who live within walking or buggy distance of your home. There’s no physical church for the Amish. You take turns gathering in different people’s homes for the Sunday service. There’s no permanent hierarchy at all — people also take turns serving as pastor, and it’s allocated randomly.”
“When they turn sixteen, all Amish have to go on a journey — one that makes them curiously well equipped to comment on our culture. They have to go and live in the “English” world for a few years. It’s called going on Rumspringa, and out there, they don’t follow the strict Amish rules for an average of two years. They get drunk, they go to strip clubs (at least, Freeman Lee did), they use phones and the Internet. (Lee told me he always thought somebody should launch a brand of rum named Rumspringa.) And then — at the end of their youth spurt— they have to make a choice. Do you want to leave all that behind and come home to join the Amish Church — or do you want to stay out in the world? If you stay out in the world, you can still come back and visit, but you’ll never be an Amish. Around 80 percent choose to join the Church. This experience of freedom is one of the reasons why the Amish are never regarded as a cult. It is a genuine choice.”
“A major scientific study carried out on Amish mental health in the 1970s found that they have significantly lower levels of depression than other Americans. Several smaller studies since have backed up this finding.
It was in Elkhart-LaGrange that I felt I could see most clearly what we have lost in the modern world — and, at the same time, what we have gained. The Amish had a profound sense of belonging and meaning. But I could also see that it would be absurd to see the way they lived as a panacea. Jim and I spent an afternoon with an Amish woman who begged the community to help her when her husband was violently abusing her and their sons. The church elders told her it is the job of an Amish woman to submit to her husband, no matter what. She continued to be violently abused for years, before she finally left — scandalizing many in the community.
The group was united in ways that were inspiring — but it was also united by an often extreme and brutal theology. Women are subordinated; gay people are treated appallingly; the beating of children is seen as a good thing.”
Reconnection Two: Social Prescribing
“When you went to see your doctor, you didn’t just get pills. You were prescribed one of over a hundred different ways to reconnect — with the people around you, with the society, and with values that really matter.
What Lisa was prescribed was something that seems almost stupidly modest from the outside. Around the corner from the medical center was an ugly scratch of scrub and concrete that the locals dubbed “Dog Shit Alley” — a messy place that contained nothing but weeds and a broken bandstand and (as the name suggests) dog shit. One of the programs Sam helped set up was to turn this ugly wasteland into a garden, full of flowers and vegetables. They had one member of the staff to coordinate, but otherwise it was up to a group of around twenty volunteer-patients who were depressed or suffering from other forms of distress. It’s yours, they said. Help us to make it beautiful.”
Reconnection Three: To Meaningful Work
“Here, he said, it works differently. At Baltimore Bicycle Works, they have a meeting every Thursday morning to discuss together the decisions they have to make as a business. They’ve divided the work of the business into seven different chunks — from marketing to servicing broken bikes — and everyone takes joint responsibility for at least two of them. If anyone has an idea for how to do something better, or to stop doing something that’s failing, they can propose it at that meeting. If somebody seconds it, they discuss it as a group, and then they vote on it. So-for example — if somebody wants to start carrying a new brand of bicycles, that’s the process they go through.
There are six full partners in the business, who all share the proceeds, and when I was there, there were also three apprentices who were spending a year as part of the process and — if everyone felt they were a good fit— would then become full partners. At the end of each year, everyone does an annual review on everyone else. The goal is for everyone to feel equally committed to the cooperative, and able to find a way to make the best contribution they possibly can to it.”
“A major study by scientists at Cornell University investigated 320 small businesses. Half had top-down control, and half let the workers set their own agenda in a model that was closer to the democratic system at Baltimore Bicycle Works. The businesses closer to the democratic model grew, on average, four times more than the others.”
“I learned there are tens of thousands of democratic workplaces like Baltimore Bicycle Works, all over the world.”
Reconnection Four: To Meaningful Values
“When there is pollution in the air that makes us feel worse, we ban the source of the pollution: we don’t allow factories to pump lead into our air. Advertising, he says, is a form of mental pollution. So there’s an obvious solution. Restrict or ban mental pollution, just like we restrict or ban physical pollution.
This isn’t an abstract idea. It has already been tried in many places. For example, the city of São Paulo, in Brazil, was being slowly smothered by billboards. They covered every possible space — gaudy logos and brands dominated the skyline wherever you looked. It had made the city look ugly, and made people feel ugly, by telling them everywhere they looked that they had to consume.
So in 2007 the city’s government took a bold step — they banned all outdoor advertising: everything. They called it the Clean City Law. As the signs were removed one by one, people began to see beautiful old buildings that had long been hidden. The constant ego-irritation of being told to spend was taken away, and was replaced with works of public art.”
“We could take this insight and go further. Several countries, including Sweden and Greece, have banned advertising directed at children.”
“The average American is exposed to up to five thousand advertising impressions a day — from billboards to logos on T-shirts to TV advertisements. It is the sea in which we swim.”
Reconnection Five: Sympathetic Joy, and Overcoming Addiction to the Self
“It is, she says, quite simple. Sympathetic joy is a method for cultivating “the opposite of jealousy or envy … It’s simply feeling happy for other people.” Rachel guided me through how it works.
You close your eyes and picture yourself. You imagine something good happening to you — falling in love, or writing something you’re proud of. You feel the joy that would come from that. You let it flow through you.
Then you picture somebody you love, and you imagine something wonderful happening for them. You feel the joy from that, and you let that, too, flow through you.
So far, so easy. Then you picture somebody you don’t really know — say, the clerk who serves you in the grocery store. You imagine something wonderful happening to her. And you try to feel joy for her — real joy.
Then it gets harder. You picture somebody you don’t like, and you try to imagine something good happening for that person. And you try to feel joy for that person.
You try to feel the same joy you’d feel for yourself, or for somebody you love. You imagine how good they’d feel, and how moved they’d be.”
“You do this every day, for fifteen minutes. For the first few weeks, Rachel thought it felt pointless. Nothing changed. But then she started to notice, over time, “I don’t feel that same churning punch in the gut. It’s just not there.” She felt the toxic feelings slowly abate. Envy wasn’t puncturing her several times a day in the same way. The longer she did it, the more these feelings ebbed.”
““It’s almost like people become your children. That same tender, warm happiness you have for your child when they’re having fun and they’re happy or they get something they like, you can feel that for a complete stranger, and it’s quite incredible. It’s almost like looking at them through the eyes of a loving parent that just wants someone they love to be happy and have good things, and there’s a tenderness to it for me.”
“Depressed people were significantly more likely to recover from depression if they went into an eight-week meditation training program than people in a control group who didn’t. Some 58 percent of the control group became depressed again, while only 38 percent of the newly trained meditators did — a huge gap. Other studies have found that meditation is similarly helpful for people with anxiety. One different study honed this effect a little and found that meditation works particularly well for people who’ve developed depression as a result of abusive childhoods — they have a 10 percent higher improvement rate than others.”
“It turned out if you’d done the loving-kindness meditation, you were almost twice as likely to help somebody else than the people who hadn’t.”
“A team that works with Roland at Johns Hopkins wanted to see what would happen if you gave psilocybin to long-term smokers who had been trying to quit for many years without success. After just three sessions — like Mark — 80 percent of them quit, and were still off cigarettes six months later. That’s a higher success rate than any comparable technique anywhere. A team working at University College London gave psilocybin to people who had severe depression and hadn’t been helped by any other form of treatment. It was only a preliminary study, so we shouldn’t overstate it, but they found that nearly 50 percent of patients saw their depression go away entirely for the three-month period of the trial.”
Reconnection Six: Acknowledging and Overcoming Childhood Trauma
“What if, when a patient checked that they had suffered a trauma in childhood, the doctor waited until they next came in for health care of any kind, and asked the patient about it? Would that make any difference?
So they began an experiment. Every doctor providing help to a Kaiser Permanente patient — for anything from hemorrhoids to eczema to schizophrenia — was told to look at the patient’s trauma questionnaire, and if the patient had suffered a childhood trauma, the doctors were given a simple instruction. They were told to say something like: “I see you had to survive X or Y in your childhood. I’m sorry that happened to you — it shouldn’t have. Would you like to talk about those experiences?” If the patient said she did, the doctor was told to express sympathy, and to ask: Do you feel it had negative long-term effects on you?’ Is it relevant to your health today?
The goal was to offer the patient two things at the same time. The first was an opportunity to describe the traumatic experience — to craft a story about it, so the patient could make sense of it. As this experiment began, one of the things they discovered almost immediately is that many of the patients had literally never before acknowledged what happened to them to another human being.
The second — just as crucial — was to show them that they wouldn’t be judged. On the contrary, as Vincent explained to me, the purpose was for them to see that an authority figure, who they trusted, would offer them real compassion for what they’d gone through.
So the doctors started to ask the questions. While some patients didn’t want to talk about it, many of them did. Some started to explain about being neglected, or sexually assaulted, or beaten by their parents. Most, it turned out, had never asked themselves if these experiences were relevant to their health today. Prompted in this way, they began to think about it.”
“Finally, the figures came in? In the months and years that followed, the patients who had their trauma compassionately acknowledged by an authority figure seemed to show a significant reduction in their illnesses— they were 35 percent less likely to return for medical help for any condition.”
“In a smaller pilot study, after being asked these questions, the patients were given the option of discussing what had happened in a session with a psychoanalyst. Those patients were 50 percent less likely to come back to the doctor saying they felt physically ill, or seeking drugs, in the following year.
So it appeared that they were visiting the doctor less because they were actually getting less anxious, and less unwell. These were startling results. How could that be?
The answer, Vincent suspects, has to do with shame. “In that very brief process,” he told me, “one person tells somebody else who’s important to them … something [they regard as] deeply shameful about themselves, typically for the first time in their life. And [she] comes out of that with the realization — still seem to be accepted by this person. It’s potentially transformative.”
What this suggests is it’s not just the childhood trauma in itself that causes these problems, including depression and anxiety — it’s hiding away the childhood trauma. It’s not telling anyone because you’re ashamed. When you lock it away in your mind, it festers, and the sense of shame grows.”
“Closeted gay men, during the AIDS crisis, died on average two to three years earlier than openly gay men, even when they got health care at the same point in their illness. Sealing off a part of yourself and thinking it’s disgusting poisons your life. Could the same dynamic be at work here?”
Reconnection Seven: Restoring the Future
“It is a well-established fact that the poorer you are, the more likely you are to become depressed or anxious — and the more likely you are to become sick in almost every way. In the United States, if you have an income below $20,000, you are more than twice as likely to become depressed as somebody who makes $70,000 or more. And if you receive a regular income from property you own, you are ten times less likely to develop an anxiety disorder than if you don’t get any income from property.”
“This had been a conservative farming community, and one of the biggest changes was how women saw themselves. Evelyn met with one woman who had taken her [UBI] check and used it to become the first female in her family to get a postsecondary education. She trained to be a librarian and rose to be one of the most respected people in the community. She showed Evelyn pictures of her two daughters graduating, and she talked about how proud she was she had been able to become a role model for them.”
“Evelyn went through the medical records of the people taking part — and she found that, as she explained to me, there were “fewer people showing up at their doctor’s [office] complaining about mood disorders.” Depression and anxiety in the community fell significantly. When it came to severe depression and other mental health disorders that were so bad the patient had to be hospitalized, there was a drop of 9 percent in just three years.
Why was that? “It just removed the stress — or reduced the stress — that people dealt with in their everyday lives,” Evelyn concludes. You knew you’d have a secure income next month, and next year, so you could create a picture of yourself in the future that was stable.”
“In the Great Smoky Mountains, there’s a Native American tribal group of eight thousand people who decided to open a casino. But they did it a little differently. They decided they were going to split the profits equally among everyone in the group — they’d all get a check for (as it turned out) $6,000 a year, rising to $9,000 later. It was, in effect, a universal basic income for everyone. Outsiders told them they were crazy. But when the program was studied in detail by social scientists, it turned out that this guaranteed income triggered one big change. Parents chose to spend a lot more time with their children, and because they were less stressed, they were more able to be present with their kids. The result? Behavioral problems like ADHD and childhood depression fell by 40 percent. I couldn’t find any other instance of a reduction in psychiatric problems in children by that amount in a comparable period of time. They did it by freeing up the space for parents to connect with their kids.”
“In 1993, the journalist Andrew Sullivan was diagnosed as HIV-positive. It was the height of the AIDS crisis. Gay men were dying all over the world. There was no treatment in sight.
Not long after, he left his job as editor of one of the leading magazines in the United States, the New Republic. His closest friend, Patrick, was dying of AIDS — the fate Andrew was now sure awaited him.
So Andrew went to Provincetown, the gay enclave at the tip of Cape Cod in Massachusetts, to die. That summer, in a small house near the beach, he began to write a book. He knew it would be the last thing he ever did, so he decided to write something advocating a crazy, preposterous idea — one so outlandish that nobody had ever written a book about it before. He was going to propose that gay people should be allowed to get married, just like straight people. He thought this would be the only way to free gay people from the self-hatred and shame that had trapped Andrew himself. It’s too late for me, he thought, but maybe it will help the people who come after me.
When the book — Virtually Normal — came out a year later, Patrick died when it had only been in the bookstores for a few days, and Andrew was widely ridiculed for suggesting something so absurd as gay marriage. Andrew was attacked not just by right-wingers, but by many gay left-wingers, who said he was a sellout, a wannabe heterosexual, a freak, for believing in marriage. A group called the Lesbian Avengers turned up to protest at his events with his face in the crosshairs of a gun. Andrew looked out at the crowd and despaired. This mad idea — his last gesture before dying — was clearly going to come to nothing.”
Conclusion: Homecoming
“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.”
“I thought a lot about what one of the women at Kotti said to me. She had grown up in a village in Turkey, and she thought of the whole village as her home. But when she came to Europe, she learned that you are supposed to think of home as just your own apartment, and she felt alone there. But when the protest began, she started to think of the whole housing project and everyone in it as her home. She realized she had felt homeless for more than thirty years, and now she had a home once again.
Many of us are homeless in the West today. It only took a small impetus — a moment of connection — for the people at Kotti to see that, and to find a way to fix it. But it required somebody to be the first to reach out.”
