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

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