What the best science really says about depression | Johann Hari | Big Think

What the best science really says about depression
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For almost the past 100 years, some mental health professionals have told us that depression is purely caused by a chemical imbalance in the brain. However, there's a much more realistic theory that depression happens due to an imbalance happening outside of your cranium. Journalist and author Johann Hari believes that while for some people it is a chemical imbalance, for many people suffering from depression, the cause stems from societal issues. Hari offers some staggering statistics showing that antidepressants seem to be doing much more harm than good — among them, that one out of every four middle-aged women in the United States is taking a chemical antidepressant in any given year. If we want to get rid of modern-day depression, he says, we have to change society. Johann Hari's new book is Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions.
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JOHANN HARI:

Johann Hari is the New York Times bestselling author of Chasing the Scream, which is being adapted into a feature film. He was twice named Newspaper Journalist of the Year by Amnesty International UK. He has written for many of the world’s leading newspapers and magazines, including the New York Times, Le Monde, the Guardian, the Los Angeles Times, the New Republic, the Nation, Slate, El Mundo, and the Sydney Morning Herald. He was a lead op-ed columnist for the Independent, one of Britain’s leading newspapers, for nine years. He is a regular panelist on HBO's Real Time with Bill Maher. His TED talk, “Everything You Think You Know About Addiction Is Wrong,” has more than 20 million views.
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TRANSCRIPT:

Johann Hari: I kept learning intellectually about what causes depression and anxiety.

And that it’s much deeper than the story I’d been told by my doctor—that it’s just a missing chemical in your brain.

But I think it really emotionally fell into place when I went and met an incredible South African psychiatrist called Derek Summerfield. So Derek was in Cambodia when chemical antidepressants were first introduced there. And the Cambodian doctors didn’t know what they were, right? They’d never heard of it. So he explained it to them and they said, “Oh, we don’t need them. We’ve already got antidepressants.”

And Derek said what do you mean?

He thought they were going to talk about some kind of herbal remedy or something.

Instead they told him a story. There was a farmer in their community who one day, a rice farmer, who one day had stood on a landmine and had his leg blown off. And so they gave him an artificial limb and he went back to work in the fields. But it’s apparently very painful to work in water when you’ve got an artificial limb. And I imagine it was quite traumatic—He’s going back to the fields where he was blown up.

And he started crying all day. He didn’t want to get out of bed. Classic depression, right? And so they said to Derek, “Well we gave him an antidepressant.” Derek said what did you do? They explained that they sat with him, they listened to his problems, they realized that his pain made sense. He was depressed for perfectly good reasons. They figured if we bought him a cow he could become a dairy farmer then he wouldn’t be so depressed. They bought him a cow. Within a few weeks his crying stopped, he felt fine.

They said to Derek, “You see, Doctor, that cow was an antidepressant.” Now if you’ve been raised to think about depression the way that we’ve been indoctrinated to, that it’s just the result of – there are real biological factors but it’s just the result of a chemical imbalance in your brain—that sounds like a joke, a bad joke. They gave the guy a cow as an antidepressant and he stopped being depressed?

But what those Cambodian doctors knew intuitively is what the World Health Organization has been trying to tell us for years. Depression is a response to things going wrong deep in our lives and our environments. Our pain makes sense.

As the World Health Organization put it, mental health is produced socially. It’s a social indicator. It requires social as well as individual solutions. It requires social change, right?

Now that is a very different way of thinking about depression and anxiety but it happens to fit with the best scientific evidence.

And it really required me to reassess how I’d felt about my own pain and how I tried to deal it unsuccessfully and open up a whole different way...

[shellieroman]

For myself, antidepressants are so helpful in giving me a boost so that I could go to therapy, so I could actually work on myself. After about 6 months, I didn't want them anymore. Behavioral therapy was working. I ended up changing my life with therapy. My mother and brother are both depressed and on medication, but refuse therapy. It makes me sad because, while medication helps, they still aren't enjoying their lives. I do wish more people would give behavioral therapy a shot. I don't believe we should tell people to not take medication if they feel it's beneficial, but other options should be more readily available

[MichaelColombo]

boy ya really left us hanging there...

[chasevivenzio]

Hello all, this is the hardest medical advice to pinpoint because all of our situations are different! But if you were as severely depressed as I was for over 15 years until 25 years old I would tell you that life is too short to be ashamed of who you REALLY are. Hopefully you are being HONEST with someone very close to you that loves you no matter who you were and where you’ve wandered. Telling someone that you are in deep deep pain and they feel that pain with you and tell you they love you is honestly the most freeing feeling. Honestly. Luckily I can just say “as long as my momma loves me, I’m okay with what’s happening.” And that will last forever :) thanks for reading everyone. I like to come back to these videos because they were a huge part of my life when I couldn’t figure anything out

[importantname]

Chemical imbalance is a great slogan for selling chemicals.

[davidmonroy]

Its three things, neurochemical, cognitive, and situational.

[DPK]

Great felt it when I was in a job I hated. I was working so much with no social life or hobbies. Once I found hobbies and began taking time for myself, things got much better. I eventually got a better job too, so that also helped.

[bluecedar]

The main causes, but not the only ones. Not all depression is trauma induced.

[betadryl]

These principles might help you on your way:

1. Be patient. No matter what.
2. Don't badmouth:
Assign responsibility, never blame.
Say nothing behind another's back you'd be
unwilling to say in exactly the same tone and
language, to his face.
3. Never assume the motives of others are, to them, less noble
than yours are to you
4. Expand your sense of the possible.
5. Don't trouble yourself with matters you truly cannot change
6. Expect no more of anyone than you yourself can deliver.
7. Tolerate ambiguity.
8. Laugh at yourself frequently.
9. Concern yourself with what is right rather than whom is
right.
10. Never forget that, no matter how certain, you might be
wrong.
11. Give up blood sports.
12. Remember that your life belongs to others as well. Do not
endanger it frivolously and never endanger the life of
another.
13. Never lie to anyone for any reason.
14. Learn the needs of those around you and respect them.
15. Avoid the pursuit of happiness. Seek to define your mission
and pursue that.
16. Reduce your use of the first personal pronoun.
17. Praise at least as often as you disparage.
18. Never let your errors pass without admission.
19. Become less suspicious of joy.
20. Understand humility.
21. Forgive.
22. Foster dignity.
23. Love memorably.
24. Love yourself.
25. Endure.

I don't expect the perfect attainment of these principles. However, I post them as a standard for my conduct as an adult. Should any of my friends or colleagues catch me violating any one of them, bust me.

1. stop doing the wrong things
2. make a schedule (one you like - negotiate with yourself)
3. clarify your thoughts
4. take the meaningful path
5. specify your goals
6. stop saying things that make you weak
7. adopt the mode of authentic being
8. learn from your errors
9. have a conversation with yourself
10. aim high (have your cake and eat it too)

[RodCornholio]

Huge. This gives victims something much needed and often ignored: validation. For someone - especially an authority - to make that judgement, that statement, that what happened to someone was not good...is huge. Not only is it meaningful and healing to the person, but what a great step forward for the degree of society's compassion. (NOTE: My comment is NOT about the efficacy of Johann Hari's ideas regarding treating depression).

[ShawnRavenfire]

I think the problem is that if people can't get over depression easily, they assume that it must be impossible to get over at all. A person can overcome almost any mental problem by a combination of change of lifestyle and force of will, but it takes time, just like building up a muscle.

[jettoscranda]

I was saying to a psychiatrist, it's not just a chemical imbalance. I have my reasons, I know exactly why I'm like this. It's because I am the consequence of my whole life. It's because I feel infinitely sad inside. Psychiatry has sure a long way to go, before they will learn a more meaningful side of the story. I have never felt like psychiatry can help. I tried anti-drepressive drugs. 3 months I used Wellbutrin. I felt nothing, no sadness, no joy, no creativity as an artistic person, I felt empty as hell. But at least I didn't feel depressed. However at some point I just stopped using them, cause I didn't feel them as a solution to my problems.

[ASMinor]

I am an avid #MentalHealthAwareness advocate and performer, and I love this so much. I travel the country trying to bring that awareness on stages, in classrooms, hospitals, and on my YouTube channel, so I get excited when I see other advocates. 💙❤

[SchmidyJustin]

After watching this video, dealing with what could be/could not be clinical depression, being on and off medications, talking with professional counselors, and then reading the comment section I felt like I should leave something nice.

I love all you Dr. Googles, you’re all so freakin’ adorable...

[dontdodrugs]

My experience with depression, intermittent explosive disorder, bipolar, chemical dependence, adhd, and an antisocial personality completely agrees with everything he stated. And he also stated that medication can help. And I would go as far as saying that medication shouldn't be depended on, just a helpful hand up. I have done deep internal change, increased my activity, actively volunteer, spiritually search, and meditate. And all of those DIAGNOSES that I have been repeatedly prescribed medication for, aren't near as much a factor as they were. I spent years in institutions. Received all types of care and told all types of things. And what changed me was all those things I stated as an active part of my life. No counselor, no therapy, no medication.

[carolnorton]

Nobody ever said situational depression was the same as chemical depression.
But sometimes you cant change the situation, e.g.deaths etc.

[weirdleftovers]

I have treatment resistant, reoccurring depression. I’ve tried all the alt stuff people talk about and it doesn’t work for me long-term. My anxiety just morphs through the years. I’ve had every type of anxiety listed in the DSM. I’ve been living with this since a small child. I do think there are various causes for depression and one man’s antidepressant is another mans placebo. I will most likely always have depression, and I’m okay with that. I’ve learned to live with the symptoms and keep it moving.

[pokeppokep]

"Less about chemical imbalances and more about power imbalances" thank you!

[sarahm]

I get what he's saying. I feel like I cant put that advice to my antenatal depression. I have never felt such a hormonal imbalance so deeply before. I don't feel like it's my life situation because I am happy about this pregnancy and am well supported. I truly feel my hormones change throughout the day and the deep depression coming on, so I feel like that is truly a chemical imbalance?

[steves]

I kind of agree with some of your points actually. I do believe this is down to part of the problem with doctors - in my experience (from the UK) they rarely have time to listen and analyse your symptoms/problems properly, and what's worse is that in my local doctor's clinic you are only allowed one problem per appointment - despite the fact that some seemingly disparate symptoms can have one major cause.
Giving a drug and saying it will do X is easy. Arranging counselling sessions and professional help is harder (and in the UK, subject to waiting lists).

That being said, in my experience, counsellors and psychiatrists are generally more on point about antidepressant medication; that is to say that drugs are a tool in the arsenal to be used to treat someone, not the be-all and end-all. By focusing on only one solution, as some doctors do, it's like a car mechanic trying to fix a car using only their favourite screwdriver!

The field of study into depression has also changed significantly in the last 40 years. Curiously in this time there has been a kind of U-turn and older style drugs (e.g. MAOIs) are making a comeback, albeit in safer forms. The relatively new assumption (about the time of the development of fluoxetine) that serotonin is the main cause of depression is also being challenged, and we now have agents that target noradrenaline, dopamine and even melatonin.

In short, I think it is dangerous to demonize antidepressant medication, they do have their place, but on the other hand we do need to think more about using every available tool rather than just sticking to "it's just low serotonin".

[CourteousCanine]

This video is a gift. Humans are social beings that are excessively forced into isolation and non social life styles. That is depressing. People suffering with mental illness need support and connections to others, yet they most often get the least support and often are totally isolated.