Depression

This could be why you’re depressed or anxious | Johann Hari

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Transcript

00:13
For a really long time,
00:14
I had two mysteries that were hanging over me.
00:18
I didn’t understand them
00:20
and, to be honest, I was quite afraid to look into them.
00:24
The first mystery was, I’m 40 years old,
00:27
and all throughout my lifetime, year after year,
00:31
serious depression and anxiety have risen,
00:34
in the United States, in Britain,
00:37
and across the Western world.
00:39
And I wanted to understand why.
00:43
Why is this happening to us?
00:45
Why is it that with each year that passes,
00:48
more and more of us are finding it harder to get through the day?
00:51
And I wanted to understand this because of a more personal mystery.
00:55
When I was a teenager,
00:56
I remember going to my doctor
00:58
and explaining that I had this feeling, like pain was leaking out of me.
01:03
I couldn’t control it,
01:04
I didn’t understand why it was happening,
01:06
I felt quite ashamed of it.
01:09
And my doctor told me a story
01:10
that I now realize was well-intentioned,
01:12
but quite oversimplified.
01:14
Not totally wrong.
01:15
My doctor said, “We know why people get like this.
01:18
Some people just naturally get a chemical imbalance in their heads —
01:22
you’re clearly one of them.
01:24
All we need to do is give you some drugs,
01:26
it will get your chemical balance back to normal.”
01:28
So I started taking a drug called Paxil or Seroxat,
01:30
it’s the same thing with different names in different countries.
01:34
And I felt much better, I got a real boost.
01:36
But not very long afterwards,
01:37
this feeling of pain started to come back.
01:39
So I was given higher and higher doses
01:41
until, for 13 years, I was taking the maximum possible dose
01:45
that you’re legally allowed to take.
01:47
And for a lot of those 13 years, and pretty much all the time by the end,
01:50
I was still in a lot of pain.
01:52
And I started asking myself, “What’s going on here?
01:55
Because you’re doing everything
01:56
you’re told to do by the story that’s dominating the culture —
02:00
why do you still feel like this?”
02:02
So to get to the bottom of these two mysteries,
02:05
for a book that I’ve written
02:06
I ended up going on a big journey all over the world,
02:09
I traveled over 40,000 miles.
02:10
I wanted to sit with the leading experts in the world
02:13
about what causes depression and anxiety
02:15
and crucially, what solves them,
02:17
and people who have come through depression and anxiety
02:19
and out the other side in all sorts of ways.
02:21
And I learned a huge amount
02:23
from the amazing people I got to know along the way.
02:26
But I think at the heart of what I learned is,
02:29
so far, we have scientific evidence
02:32
for nine different causes of depression and anxiety.
02:35
Two of them are indeed in our biology.
02:38
Your genes can make you more sensitive to these problems,
02:41
though they don’t write your destiny.
02:43
And there are real brain changes that can happen when you become depressed
02:46
that can make it harder to get out.
02:48
But most of the factors that have been proven
02:50
to cause depression and anxiety
02:52
are not in our biology.
02:55
They are factors in the way we live.
02:58
And once you understand them,
02:59
it opens up a very different set of solutions
03:02
that should be offered to people
03:04
alongside the option of chemical antidepressants.
03:07
For example,
03:09
if you’re lonely, you’re more likely to become depressed.
03:12
If, when you go to work, you don’t have any control over your job,
03:15
you’ve just got to do what you’re told,
03:17
you’re more likely to become depressed.
03:19
If you very rarely get out into the natural world,
03:22
you’re more likely to become depressed.
03:23
And one thing unites a lot of the causes of depression and anxiety
03:27
that I learned about.
03:28
Not all of them, but a lot of them.
03:30
Everyone here knows
03:32
you’ve all got natural physical needs, right?
03:34
Obviously.
03:35
You need food, you need water,
03:38
you need shelter, you need clean air.
03:40
If I took those things away from you,
03:42
you’d all be in real trouble, real fast.
03:44
But at the same time,
03:46
every human being has natural psychological needs.
03:50
You need to feel you belong.
03:52
You need to feel your life has meaning and purpose.
03:55
You need to feel that people see you and value you.
03:57
You need to feel you’ve got a future that makes sense.
04:00
And this culture we built is good at lots of things.
04:03
And many things are better than in the past —
04:05
I’m glad to be alive today.
04:07
But we’ve been getting less and less good
04:09
at meeting these deep, underlying psychological needs.
04:13
And it’s not the only thing that’s going on,
04:16
but I think it’s the key reason why this crisis keeps rising and rising.
04:20
And I found this really hard to absorb.
04:24
I really wrestled with the idea
04:26
of shifting from thinking of my depression as just a problem in my brain,
04:31
to one with many causes,
04:32
including many in the way we’re living.
04:34
And it only really began to fall into place for me
04:36
when one day, I went to interview a South African psychiatrist
04:40
named Dr. Derek Summerfield.
04:41
He’s a great guy.
04:43
And Dr. Summerfield happened to be in Cambodia in 2001,
04:46
when they first introduced chemical antidepressants
04:50
for people in that country.
04:51
And the local doctors, the Cambodians, had never heard of these drugs,
04:55
so they were like, what are they?
04:56
And he explained.
04:58
And they said to him,
04:59
“We don’t need them, we’ve already got antidepressants.”
05:02
And he was like, “What do you mean?”
05:04
He thought they were going to talk about some kind of herbal remedy,
05:07
like St. John’s Wort, ginkgo biloba, something like that.
05:11
Instead, they told him a story.
05:14
There was a farmer in their community who worked in the rice fields.
05:18
And one day, he stood on a land mine
05:20
left over from the war with the United States,
05:22
and he got his leg blown off.
05:23
So they him an artificial leg,
05:25
and after a while, he went back to work in the rice fields.
05:28
But apparently, it’s super painful to work under water
05:30
when you’ve got an artificial limb,
05:32
and I’m guessing it was pretty traumatic
05:34
to go back and work in the field where he got blown up.
05:36
The guy started to cry all day,
05:39
he refused to get out of bed,
05:40
he developed all the symptoms of classic depression.
05:44
The Cambodian doctor said,
05:45
“This is when we gave him an antidepressant.”
05:47
And Dr. Summerfield said, “What was it?”
05:50
They explained that they went and sat with him.
05:53
They listened to him.
05:56
They realized that his pain made sense —
05:59
it was hard for him to see it in the throes of his depression,
06:01
but actually, it had perfectly understandable causes in his life.
06:05
One of the doctors, talking to the people in the community, figured,
06:09
“You know, if we bought this guy a cow,
06:11
he could become a dairy farmer,
06:13
he wouldn’t be in this position that was screwing him up so much,
06:16
he wouldn’t have to go and work in the rice fields.”
06:18
So they bought him a cow.
06:20
Within a couple of weeks, his crying stopped,
06:22
within a month, his depression was gone.
06:24
They said to doctor Summerfield,
06:25
“So you see, doctor, that cow, that was an antidepressant,
06:28
that’s what you mean, right?”
06:30
(Laughter)
06:31
(Applause)
06:34
If you’d been raised to think about depression the way I was,
06:37
and most of the people here were,
06:38
that sounds like a bad joke, right?
06:40
“I went to my doctor for an antidepressant,
06:42
she gave me a cow.”
06:43
But what those Cambodian doctors knew intuitively,
06:46
based on this individual, unscientific anecdote,
06:49
is what the leading medical body in the world,
06:53
the World Health Organization,
06:55
has been trying to tell us for years,
06:57
based on the best scientific evidence.
07:00
If you’re depressed,
07:02
if you’re anxious,
07:05
you’re not weak, you’re not crazy,
07:08
you’re not, in the main, a machine with broken parts.
07:12
You’re a human being with unmet needs.
07:15
And it’s just as important to think here about what those Cambodian doctors
07:19
and the World Health Organization are not saying.
07:21
They did not say to this farmer,
07:23
“Hey, buddy, you need to pull yourself together.
07:26
It’s your job to figure out and fix this problem on your own.”
07:29
On the contrary, what they said is,
07:31
“We’re here as a group to pull together with you,
07:35
so together, we can figure out and fix this problem.”
07:40
This is what every depressed person needs,
07:44
and it’s what every depressed person deserves.
07:47
This is why one of the leading doctors at the United Nations,
07:50
in their official statement for World Health Day,
07:53
couple of years back in 2017,
07:54
said we need to talk less about chemical imbalances
07:57
and more about the imbalances in the way we live.
08:00
Drugs give real relief to some people —
08:02
they gave relief to me for a while —
08:05
but precisely because this problem goes deeper than their biology,
08:09
the solutions need to go much deeper, too.
08:12
But when I first learned that,
08:15
I remember thinking,
08:16
“OK, I could see all the scientific evidence,
08:19
I read a huge number of studies,
08:20
I interviewed a huge number of the experts who were explaining this,”
08:23
but I kept thinking, “How can we possibly do that?”
08:26
The things that are making us depressed
08:28
are in most cases more complex than what was going on
08:30
with this Cambodian farmer.
08:32
Where do we even begin with that insight?
08:34
But then, in the long journey for my book,
08:38
all over the world,
08:39
I kept meeting people who were doing exactly that,
08:42
from Sydney, to San Francisco,
08:44
to São Paulo.
08:45
I kept meeting people who were understanding
08:48
the deeper causes of depression and anxiety
08:50
and, as groups, fixing them.
08:52
Obviously, I can’t tell you about all the amazing people
08:55
I got to know and wrote about,
08:57
or all of the nine causes of depression and anxiety that I learned about,
09:00
because they won’t let me give a 10-hour TED Talk —
09:03
you can complain about that to them.
09:04
But I want to focus on two of the causes
09:06
and two of the solutions that emerge from them, if that’s alright.
09:10
Here’s the first.
09:12
We are the loneliest society in human history.
09:15
There was a recent study that asked Americans,
09:18
“Do you feel like you’re no longer close to anyone?”
09:21
And 39 percent of people said that described them.
09:25
“No longer close to anyone.”
09:26
In the international measurements of loneliness,
09:28
Britain and the rest of Europe are just behind the US,
09:31
in case anyone here is feeling smug.
09:33
(Laughter)
09:34
I spent a lot of time discussing this
09:36
with the leading expert in the world on loneliness,
09:38
an incredible man named professor John Cacioppo,
09:40
who was at Chicago,
09:42
and I thought a lot about one question his work poses to us.
09:44
Professor Cacioppo asked,
09:47
“Why do we exist?
09:48
Why are we here, why are we alive?”
09:50
One key reason
09:53
is that our ancestors on the savannas of Africa
09:56
were really good at one thing.
09:58
They weren’t bigger than the animals they took down a lot of the time,
10:01
they weren’t faster than the animals they took down a lot of the time,
10:04
but they were much better at banding together into groups
10:07
and cooperating.
10:09
This was our superpower as a species —
10:11
we band together,
10:13
just like bees evolved to live in a hive,
10:15
humans evolved to live in a tribe.
10:17
And we are the first humans ever
10:22
to disband our tribes.
10:24
And it is making us feel awful.
10:27
But it doesn’t have to be this way.
10:29
One of the heroes in my book, and in fact, in my life,
10:31
is a doctor named Sam Everington.
10:33
He’s a general practitioner in a poor part of East London,
10:36
where I lived for many years.
10:38
And Sam was really uncomfortable,
10:40
because he had loads of patients
10:41
coming to him with terrible depression and anxiety.
10:44
And like me, he’s not opposed to chemical antidepressants,
10:46
he thinks they give some relief to some people.
10:49
But he could see two things.
10:50
Firstly, his patients were depressed and anxious a lot of the time
10:54
for totally understandable reasons, like loneliness.
10:57
And secondly, although the drugs were giving some relief to some people,
11:01
for many people, they didn’t solve the problem.
11:03
The underlying problem.
11:05
One day, Sam decided to pioneer a different approach.
11:08
A woman came to his center, his medical center,
11:11
called Lisa Cunningham.
11:12
I got to know Lisa later.
11:14
And Lisa had been shut away in her home with crippling depression and anxiety
11:18
for seven years.
11:20
And when she came to Sam’s center, she was told, “Don’t worry,
11:23
we’ll carry on giving you these drugs,
11:25
but we’re also going to prescribe something else.
11:28
We’re going to prescribe for you to come here to this center twice a week
11:31
to meet with a group of other depressed and anxious people,
11:34
not to talk about how miserable you are,
11:37
but to figure out something meaningful you can all do together
11:41
so you won’t be lonely and you won’t feel like life is pointless.”
11:44
The first time this group met,
11:47
Lisa literally started vomiting with anxiety,
11:49
it was so overwhelming for her.
11:51
But people rubbed her back, the group started talking,
11:54
they were like, “What could we do?”
11:55
These are inner-city, East London people like me,
11:58
they didn’t know anything about gardening.
12:00
They were like, “Why don’t we learn gardening?”
12:02
There was an area behind the doctors’ offices
12:04
that was just scrubland.
12:05
“Why don’t we make this into a garden?”
12:07
They started to take books out of the library,
12:09
started to watch YouTube clips.
12:11
They started to get their fingers in the soil.
12:13
They started to learn the rhythms of the seasons.
12:16
There’s a lot of evidence
12:18
that exposure to the natural world
12:19
is a really powerful antidepressant.
12:21
But they started to do something even more important.
12:25
They started to form a tribe.
12:27
They started to form a group.
12:29
They started to care about each other.
12:31
If one of them didn’t show up,
12:32
the others would go looking for them — “Are you OK?”
12:35
Help them figure out what was troubling them that day.
12:38
The way Lisa put it to me,
12:39
“As the garden began to bloom,
12:42
we began to bloom.”
12:44
This approach is called social prescribing,
12:46
it’s spreading all over Europe.
12:48
And there’s a small, but growing body of evidence
12:50
suggesting it can produce real and meaningful falls
12:53
in depression and anxiety.
12:55
And one day, I remember standing in the garden
12:59
that Lisa and her once-depressed friends had built —
13:01
it’s a really beautiful garden —
13:03
and having this thought,
13:04
it’s very much inspired by a guy called professor Hugh Mackay in Australia.
13:08
I was thinking, so often when people feel down in this culture,
13:12
what we say to them — I’m sure everyone here said it, I have —
13:15
we say, “You just need to be you, be yourself.”
13:19
And I’ve realized, actually, what we should say to people is,
13:22
“Don’t be you.
13:24
Don’t be yourself.
13:26
Be us, be we.
13:28
Be part of a group.”
13:30
(Applause)
13:33
The solution to these problems
13:36
does not lie in drawing more and more on your resources
13:39
as an isolated individual —
13:41
that’s partly what got us in this crisis.
13:43
It lies on reconnecting with something bigger than you.
13:45
And that really connects to one of the other causes
13:48
of depression and anxiety that I wanted to talk to you about.
13:51
So everyone knows
13:53
junk food has taken over our diets and made us physically sick.
13:56
I don’t say that with any sense of superiority,
13:59
I literally came to give this talk from McDonald’s.
14:01
I saw all of you eating that healthy TED breakfast, I was like no way.
14:04
But just like junk food has taken over our diets and made us physically sick,
14:10
a kind of junk values have taken over our minds
14:14
and made us mentally sick.
14:16
For thousands of years, philosophers have said,
14:19
if you think life is about money, and status and showing off,
14:23
you’re going to feel like crap.
14:25
That’s not an exact quote from Schopenhauer,
14:27
but that is the gist of what he said.
14:29
But weirdly, hardy anyone had scientifically investigated this,
14:32
until a truly extraordinary person I got to know, named professor Tim Kasser,
14:36
who’s at Knox College in Illinois,
14:38
and he’s been researching this for about 30 years now.
14:40
And his research suggests several really important things.
14:43
Firstly, the more you believe
14:47
you can buy and display your way out of sadness,
14:51
and into a good life,
14:53
the more likely you are to become depressed and anxious.
14:56
And secondly,
14:58
as a society, we have become much more driven by these beliefs.
15:02
All throughout my lifetime,
15:04
under the weight of advertising and Instagram and everything like them.
15:08
And as I thought about this,
15:10
I realized it’s like we’ve all been fed since birth, a kind of KFC for the soul.
15:16
We’ve been trained to look for happiness in all the wrong places,
15:19
and just like junk food doesn’t meet your nutritional needs
15:22
and actually makes you feel terrible,
15:25
junk values don’t meet your psychological needs,
15:28
and they take you away from a good life.
15:30
But when I first spent time with professor Kasser
15:33
and I was learning all this,
15:35
I felt a really weird mixture of emotions.
15:37
Because on the one hand, I found this really challenging.
15:40
I could see how often in my own life, when I felt down,
15:43
I tried to remedy it with some kind of show-offy, grand external solution.
15:49
And I could see why that did not work well for me.
15:52
I also thought, isn’t this kind of obvious?
15:55
Isn’t this almost like banal, right?
15:57
If I said to everyone here,
15:58
none of you are going to lie on your deathbed
16:01
and think about all the shoes you bought and all the retweets you got,
16:04
you’re going to think about moments
16:06
of love, meaning and connection in your life.
16:08
I think that seems almost like a cliché.
16:10
But I kept talking to professor Kasser and saying,
16:12
“Why am I feeling this strange doubleness?”
16:15
And he said, “At some level, we all know these things.
16:18
But in this culture, we don’t live by them.”
16:21
We know them so well they’ve become clichés,
16:23
but we don’t live by them.
16:24
I kept asking why, why would we know something so profound,
16:27
but not live by it?
16:29
And after a while, professor Kasser said to me,
16:32
“Because we live in a machine
16:35
that is designed to get us to neglect what is important about life.”
16:39
I had to really think about that.
16:40
“Because we live in a machine
16:42
that is designed to get us to neglect what is important about life.”
16:46
And professor Kasser wanted to figure out if we can disrupt that machine.
16:50
He’s done loads of research into this;
16:51
I’ll tell you about one example,
16:53
and I really urge everyone here to try this with their friends and family.
16:57
With a guy called Nathan Dungan, he got a group of teenagers and adults
17:00
to come together for a series of sessions over a period of time, to meet up.
17:04
And part of the point of the group
17:06
was to get people to think about a moment in their life
17:09
they had actually found meaning and purpose.
17:12
For different people, it was different things.
17:14
For some people, it was playing music, writing, helping someone —
17:18
I’m sure everyone here can picture something, right?
17:21
And part of the point of the group was to get people to ask,
17:24
“OK, how could you dedicate more of your life
17:26
to pursuing these moments of meaning and purpose,
17:29
and less to, I don’t know, buying crap you don’t need,
17:32
putting it on social media and trying to get people to go,
17:35
‘OMG, so jealous!'”
17:36
And what they found was,
17:38
just having these meetings,
17:39
it was like a kind of Alcoholics Anonymous for consumerism, right?
17:43
Getting people to have these meetings, articulate these values,
17:46
determine to act on them and check in with each other,
17:49
led to a marked shift in people’s values.
17:52
It took them away from this hurricane of depression-generating messages
17:56
training us to seek happiness in the wrong places,
17:59
and towards more meaningful and nourishing values
18:02
that lift us out of depression.
18:05
But with all the solutions that I saw and have written about,
18:08
and many I can’t talk about here,
18:11
I kept thinking,
18:12
you know: Why did it take me so long to see these insights?
18:16
Because when you explain them to people —
18:18
some of them are more complicated, but not all —
18:21
when you explain this to people, it’s not like rocket science, right?
18:24
At some level, we already know these things.
18:26
Why do we find it so hard to understand?
18:29
I think there’s many reasons.
18:31
But I think one reason is that we have to change our understanding
18:35
of what depression and anxiety actually are.
18:39
There are very real biological contributions
18:41
to depression and anxiety.
18:44
But if we allow the biology to become the whole picture,
18:47
as I did for so long,
18:49
as I would argue our culture has done pretty much most of my life,
18:53
what we’re implicitly saying to people is, and this isn’t anyone’s intention,
18:57
but what we’re implicitly saying to people is,
19:00
“Your pain doesn’t mean anything.
19:02
It’s just a malfunction.
19:03
It’s like a glitch in a computer program,
19:06
it’s just a wiring problem in your head.”
19:10
But I was only able to start changing my life
19:13
when I realized your depression is not a malfunction.
19:18
It’s a signal.
19:20
Your depression is a signal.
19:23
It’s telling you something.
19:24
(Applause)
19:29
We feel this way for reasons,
19:31
and they can be hard to see in the throes of depression —
19:34
I understand that really well from personal experience.
19:37
But with the right help, we can understand these problems
19:40
and we can fix these problems together.
19:43
But to do that,
19:44
the very first step
19:46
is we have to stop insulting these signals
19:48
by saying they’re a sign of weakness, or madness or purely biological,
19:53
except for a tiny number of people.
19:55
We need to start listening to these signals,
19:58
because they’re telling us something we really need to hear.
20:02
It’s only when we truly listen to these signals,
20:07
and we honor these signals and respect these signals,
20:11
that we’re going to begin to see
20:13
the liberating, nourishing, deeper solutions.
20:19
The cows that are waiting all around us.
20:23
Thank you.
20:24
(Applause)