A new book on the roots of depression, and the routes out of it, is one that should be read with great care. There's lots in it, but it's not for everybody.
We’ve not been in the habit of writing book reviews, nor do we intend to get into one. But since reviewing books is our day job and our experience with depression—our own and others’—is extensive and informed from many angles, we’re coming out from behind our anonymity because we think it’s important.
Hi, my name is Tim Pfaff, and I’m a journalist, something less easy to admit these days than “I’m an alcoholic.” I’ve been reviewing books and other stuff for more than 40 years, for newspapers including Financial Times and the San Francisco Examiner (back in the days when it was an actual newspaper with committed arts coverage), and a string of national and international magazines. Now I just write.
Today, January 23, is the official U.S. publication date of the book in question, Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions by Johann Hari (Bloomsbury). It’s been out in Europe, also from Bloomsbury, since January 11.
Hari is a journalist who is open about having experienced depression since childhood and having taken antidepressants (SSRIs) from the age of 18, for 13 more years. He is the author of New York Times best-seller Chasing the Scream: The First and Last Days of the War on Drugs. His Amazon bio further identifies him as “one of the top-rated TED talkers of all time.”
Hari’s new book has already collected pre-publication plaudit blurbs from Hillary Clinton, Elton John, Naomi Klein, and Matt Haig—and the first gusts of blowback, which go as far as accusing him of anti-science, willful misunderstanding and misrepresentation of science, and plagiarism, not only in the new book but in the past. It bears noting that in the loudest claim to that last end is by Joe Muggs, who scrupulously adds, “Now I haven’t read the book, and I'm fucking not going to.”
It’s a touchy subject, and already we have evidence that cooler heads are not prevailing. What we don’t want to do here is fan the flames. Rather, we want to take as measured a look as we can at a book we have read and, thanks to publisher-supplied final .pdf files, been able to live with for months, and digest.
No, that’s not my judgment of Hari, or his book. But, rather like the Bible, it’s how Hari’s book starts. By one of those coincidences that periodically afflict those who notice things, Hari was, in his opening anecdote, staying at the Very Charming Hanoi Hotel, albeit 15 years after I had.
Hari bought a large, delicious-looking, suspiciously expensive red apple late one night, and took it back to his room. One bite made it clear the fruit was contaminated, but, in another eerie echo of the Biblical myth, Hari ate half against his awakened better judgment.
In a hospital I can instantly envision, he was eventually informed that he had been poisoned by commonly used agricultural insecticides that can’t be eliminated by washing, only by peeling the fruit as well. There’s mention of “knowing laughs” from the treatment staff.
But it’s more than a colorful story, it’s a good, useful one—one I had to learn much earlier, on a train in Mexico, where once my hunger overrode the sage advice of a doctor uncle in Mexico City who said, “At the first sign that your body doesn’t want something, spit it out and clean you mouth as thoroughly as you can.” Apparently, my bad apple was a dog tortilla.
To say that shit happens is both to say the obvious, and the least—and to miss the wisdom that was Hari’s take-away “moral” of his story:
“Although I couldn’t understand why, all through the time I was working on this book, I kept thinking of something that doctor said to me that day, during my unglamorous hour of poisoning.
“You need your nausea. It is a message. It will tell us what is wrong with you.”
So to lay one hand of cards on the table, I’m not just sympathetic but also empathetic with Hari’s story and its take-away. Not unlike me—but not wholly like me, either—the horror in Hanoi not only did not curtail his travels. It sent him on some 40,000 miles of travel to consult with individuals of many cultures to inquire and listen to their ideas of the causes of depression and its proper treatment.
An edited excerpt from Hari’s book in the UK newspaper, The Guardian, gets no farther than its third sentence before the author is taking whacks at the Diagnostic and Statistical Manual, the “Bible” of psychiatric diagnosis whose successive editions show movement, if not always evolution.
I, too, have witnessed first-hand its casualties, but count them at their worst no more grave than those of Freud’s Studies on Hysteria and the “talking cure” it coughed up. But I’ve also found the DSM helpful, including to my own understanding of myself, if only because I’ve not seen it as other than a thick red book and not the Diagnostic and Satanic Manual.
It’s entirely possible that my own passage into adulthood began the ground-shaking, deeply disillusioning day I realized that something was not true because it was in a book. Also, that printed materials accompanied by advertisements are sure to have biases.
Now, in the full flower of maturity, I have come to see that in any two words put down in sequence (and sometimes in a single word, or even letter) there is bias. Choice of a subjective if not necessarily conscious kind has been made. Since Hari keeps his focus on solutions, I’ll tell you mine: I read more than ever, everything I can get my hands on. If The Truth lay in any one place, we’d all do less gossiping and surely eat less.
Hari’s gift for writing—I loved reading his book—includes a rhetorical device I mostly associate with Edgar Allan Poe: foreshadowing. You feel the criminal, or ghost, creeping up on you long before you have the kind of evidence the police would require, but though you can’t see it, you can feel it, and it most assuredly is there.
Hari’s bugaboos—his scarecrows—are, in some order of escalating evil: drugs, anti-depressants (mostly emphatically including SSRIs), the companies who make and market them, and the physicians who order them. As a reader, there you are, looking along with him at a strange Gaudi cathedral in Barcelona, when rising out of the same sentence like a putrid boil comes—Paxil!
Vastly oversimplified, his problem with the drugs is that in his own case, the need for escalating doses of medications, the intermittent need for a change of medication, and the—Unfair!—persistence of some aspects of depression, is the bad apple back in Hanoi. A degree of nausea Sartre knew. Existential.
The paraphrase: Not only are chemicals not the answer—hell, they’re insecticides—they mask the problem like the apple-seller’s wax. The real problem lies in the disconnection of our authentic selves with the nearly ubiquitous horrors of life on Earth as we know it.
Instead of dosing away our symptoms, we should be looking, tirelessly, and because life depends on it, finding the meaning in depression. Then remaking the connections, re-attaching our haywire wiring with the wisdom at our fingertips, not at the pharmacists.
Who could argue?
Well, the list is long and includes scientists, physicians, and drug-makers with a great deal more worldly power, wealth, and influence than my own. But in the ways I think matter most deeply to Hari, I couldn’t agree with him more.
So solid are his analyses that I don’t think they’re trivialized even by reducing what in his book are whole chapters to bullet points. Re the Disconnections, here we go:
The “different kind of antidepressant”—reconnection—is not hard to divine:
One possibility, and for me a temptation, is to say Yes, Yes, a thousand times Yes.
My very own story—which would merely be a further digression here—bears out those very same diagnoses and treatments, to use language Hari would and does shun. My personal inclination is to find meaning in everything, from why the sky is blue to why buses come late in threes. Not all meanings are created equal.
Nor are the seekers. Every adult step I’ve taken in Hari’s reconnection scheme—which is to say all of them—has come with the cost of a willingness to jeopardize my personal safety in a myriad of ways. Every single one of them has been accompanied by a willingness to walk away from false securities and live with bank balances that would put most of my actuarial fellows on life support.
Sympathetic joy, and overcoming addiction to the self
Yes, that. But it’s been my own accumulated experience that for those priceless things there is no how-to book, no one how-to book, anyway. That would include Johann Hari’s Lost Connections, a book that in my view should be read with care in every sense of the word.
Most days I think the biggest task in getting over myself and finding sympathetic joy is in realizing, and reminding myself all damn day long, that not everyone is looking for meaning. Or capable of making the search, let alone the discovery. Or—and I know I’m going out on a limb here—knowing that there’s such a thing as connection to have, let alone to re-establish in a more meaningful way.
And they’re people too. And they're as deserving of help as I am and as right in refusing help, known about or otherwise, as I am lustful and greedy for it. And some of them, probably millions of them, are better off with medications, what you could call “the usual culprits” except that they save lives. Including mine.
It was in my impressionable years that R.D. Laing and his crowd were, hardly without reason, decrying psychiatry and advocating for self-awareness, one path to which might include hallucinogens. My extremely limited experience of those drugs did not, let’s say, “work for me.”
But nor would I now, if there were some safe way to do it, not explore treating my psyche with monitored micro-doses of laboratory-pure versions of whatever the hell I took that made me do watercolors in three-dimensional blacks.
Despite what I now see as depression dating back to childhood, my first experience with antidepressants came at age 45, with the very Prozac that “the best minds of the day” were already talking back to, at least in books. After 18 months on it, I was off it, and its counterparts, for 18 years—successfully, judging by the fact that I did not, during those nearly two decades, commit suicide as often as I considered it.
I’m back on, probably for life, and perfectly accepting of that. At my age it’s the difference between being vertical and ambulatory and working and having a shot at happiness—and not. Almost nothing externally changes these days, and I’m happy when I want to be, which is most of the time, and I’m never short on meaning.
Since what has been anything but the Constitutionally ordained “orderly transfer of power” in my own country—where I do not live but whose citizen I am every minute—my spells of depression, on the same, realiable medication, are deeper, more frequent, and intermittently terrifying and even defeating. But by having made the very reconnections Hari “prescribes,” I’m good—and I’m also “good to go.”
And it’s how lucky I consider myself to be able to say that—deservedly and not; I’ve been blessed; I do the work; I’m happiest when I’m working, but I screw up there and elsewhere with regularity—that I think that Lost Connections should be read with great care by everyone who picks it up—and probably should not be picked up by a portion of the world Johann Hari would probably find dismayingly large.
Here’s my not-by-Christopher-Isherwood Berlin story: I once had a valued spiritual advisor who urged—and urged and urged—me not to go back on antidepressants because it would “bring me to closer God.” It almost got me all the way there. When I said I no longer had to strength to do without, she conceded that neither did she. So there you have it.
So, lots of good stuff in your book, Johann Hari. And some of us do better on medication.
Hari, Johann, Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions by Johann Hari (Bloomsbury)