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Book Review: Lost Connections

On the recommendation of a loved one with depression, I have been reading Johann Hari’s Lost Connections. It’s a book that traces the journey of the author, a journalist who has been diagnosed with depression since he was a teenager, to uncover the causes of and solutions for depression that go beyond medication.  Hari explains that, as an 18-year-old in London, he seized on the easy answer that the pharmaceutical industry has promoted and society has often embraced—depression is a brain chemistry imbalance, often described as a lack of serotonin.

No Magic Pills

According to this story, the answer is a pill. But Hari found that the drugs had only a modest and temporary effect. His doctors kept increasing the dose, leading to health-threatening side effects like significant weight loss, and then prescribing other medications to counteract the side effect.

Hari’s story is that he ended up on a potent cocktail of drugs that left him worse off than he was at the outset. It is an experience I have heard many times. I do not in any way question people who find psychiatric medication helpful—they know their lives and brains—but I have yet to speak with anyone who describes experiencing a simple “magic pill” effect.

Hari’s book was therefore intriguing to me.  He lays out studies about factors other than brain chemistry that contribute to depression, and treatments that may be more effective than pills. His thesis is

“The primary cause of all this rising depression and anxiety is not in our heads. It is, I discovered, largely in the world, and the way we are living in it.”

Johann Hari, Lost Connections, p.13

While clinical depression is different from unhappiness, he says, they are connected.  “Depression and anxiety … are the sharpest edges of a spear that has been thrust into almost everyone in our culture.” (P.14).

Designing a Society for Everyone’s Life

Hari is not saying that clinical depression and anxiety are the same as ordinary unhappiness.  He is saying that some of the societal fixes to help people with those serious conditions will help everyone.  To me, this resonates with the way stair-free design, for example in subways, helps wheelchair users, but also help parents with strollers and tourists with luggage.   

Some of the social prescriptions that Hari describes could have come from the pages of Robert Putnam’s Bowling Alone, a book about the harms to U.S. society of the loss of community ties.I was particularly struck by the way that some of the prescriptions—for community integration and social prescribing—recall ADA rights

Hari’s review of studies of alternative treatments is helpful reading for any civil rights lawyer thinking about remedies for mental health disability rights violations.