What's the angle?
Hari is a journalist and writer, and most of his book is built on interviews with psychologists and sociologists and stories about their work. Like Rottenberg (The Depths), he weaves in some of his own experience with depression.
His general conclusion is well expressed by a quote he includes from the World Health Organization, "mental health is produced socially: the presence or absence of mental health is above all a social indicator and therefore requires social, as well as individual, solutions."
Disconnection and re-connection - this was his key metaphor for the problem and solution of depression. "Only connect!" I'm surprised he didn't riff on that famous line from Howards End. Maybe he thought it overplayed? However if I remember correctly, "only connect" doesn't always work so well for the Schlegel sisters. Or did it? I can't remember. I guess they connect some dots, just maybe not all the dots they hope to.
What causes depression?
He writes that most mental health guidelines recognize interlocking biological, psychological, and social causes of depression (the bio-psycho-social model). Hari summarizes all his findings as Disconnection. Hari breaks it down into nine areas.
1. Disconnection from Meaningful Work. He cites a 2011-2012 Gallup poll across 147 countries that really struck me. Only 13% of people reported being engaged in their work (looking forward to it and positive). 63% reported being not engaged (like, going through the motions or apathetic). And 23% reported being actively disengaged (like, hatred). Snap.
2. Disconnection from Other People. Loneliness, alienation, isolation. And technologically simulated connections aren't helping much, rather they may be hindering the kinds of tribal or "mutual aid and protection" connections that we need.
3. Disconnection from Meaningful Values. Basically, we are way too materialistic. Most of this chapter focused on the study of intrinsic vs extrinsic motivations and values. Intrinsic values would be the "deep" stuff like love, respect, power, pleasure, security. Extrinsic values are things or goals that (sometimes) help us attain those intrinsic things. The diagnosis is that we're tangled up in a knot of extrinsic values. We're really good at convincing each other that we can't be happy or adequate with out this or that product.
4. Disconnection from Childhood Trauma. In this section he tells the story of Vincent Felitti, who began to study obesity at the request of an insurance company, and found a trail all the way back to childhood trauma. He and others created and, through the same insurance provider, deployed the ACE survey, Adverse Childhood Experiences, the seminal study in the effects of childhood trauma on adult physical and mental health.
5. Disconnection from Status and Respect. Generally speaking, the lower status you have in a hierarchy, the more your risk for anxiety and depression. And insecure status is an even bigger risk factor. Another study found that highly unequal societies have greater levels of depression.
6. Disconnection from the Natural World. We have a natural "biophilia" and need to act on that love.
7. Disconnection from a Hopeful or Secure Future. Here he works backwards from the observation that depressed patients often have a difficult time thinking about the future, making plans, imagining change. Hari also cites a Canadian study that found a close correlation between the level of autonomy for First Nations and their rates of depression and suicide. The more self-governance, the less depression.
8 & 9. Genes and Brain. Your genes and brain can make you more or less susceptible to depression. That's pretty certain.
And it's probable that for some people, depression is mostly caused by a chemical or biological glitch. Like, your neurotransmitter system starts tripping up. But based on Hari's interviews and investigation, that is a small slice of the depressed population.
How do people recover from depression?
I assumed Hari would simply mirror each disconnection chapter with a reconnection chapter, but he takes a slightly different tack. First he uses two fulcrum chapters to display multiple reconnections in action at once.
He tells the story of a doctor and a depressed man, in a Cambodian rice farming region, whose leg had been blown off by an old land mine. Together they found a way to reconnect him to his community and to meaningful work by raising money to buy a cow, so that he could become a dairy farmer.
Then, in his longest chapter, he tells the story of the Kotti neighborhood in Berlin, which rallied around an elderly Turkish immigrant who'd become suicidal when faced with her continuing isolation and potential eviction, then rallied around other vulnerable members of their community, and ultimately managed to organize long enough and well enough to protect their community from displacement.
1. Reconnection to Other People. You have a better chance of being happy if you think of, and pursue, happiness as essentially a shared experience, rather than something you can achieve for yourself.
2. Social Prescribing. Here he describes the work at the Bromley-by-Bow Center in East London, where the core of their treatment is connecting patients to social programs, volunteering, support groups, nature excursions, "one of over a hundred ways to reconnect."
3. Reconnection to Meaningful Work. He explores how the same work can be more or less meaningful depending on how the workplace is structured. He advocates for more democratic work environments.
4. Reconnection to Meaningful Values. In surveys of "what's most important to you," relationships and personal growth most often score at the top of the list. It takes effort but groups working together can resist being over-saturated in extrinsic values.
5. Sympathetic Joy, and Overcoming the Addiction to the Self. This is mostly about meditation, altruism, and loosening the grip of ego. Spiritual stuff. He writes about Roland Griffith, who, in an effort to understand the effects of meditation, recently resurrected the study of psychedelics.
6. Acknowledging and Overcoming Childhood Trauma. Children are quick to blame themselves and hold on to that shame and guilt into adulthood. However trauma can be addressed and worked through. Adverse childhood experiences are risk factors but not determinants.
7. Restoring the Future. Here he advocates for a universal basic income as a way to decrease inequality, increase security, and balance the power of ownership with more leverage (stability and choice) for workers.
_ _ _ _ _ _ _ _ _ _
Notes
- depression and anxiety "like cover versions of the same song by different bands"
- depression and anxiety "are only the sharpest edges of a spear that has been thrust into almost everyone in our culture
- when giving a medical treatment, you are giving the treatment, but also a story about how the treatment works
- proportion of people on antidepressants who continue to be depressed is b/w 65-80 percent
- all want a story about why we are in pain
- the grief exception, or dilemma, in the DSM
- Joanne Cacciatore - call it emotional health
- depression as grief over our own lives
- biopsycosocial model
- "disconnection"
- broad Gallup poll, 147 countries, 13% engaged in work, 63% not engaged, 23% actively not engaged (hatred)
- derealization - feeling like nothing you do is real or authentic
- disconnection at work can carry over into home life, and vice versa
- loneliness raises cortisol levels
- loneliness, "an adverse state that helps us to reconnect"
- "micro-awakenings" during sleep happen more when people feel lonely or anxious (or depressed)
- to end loneliness, you need to have a sense of "mutual aid and protection"
- difference b/w being on social media and being physically present is similar difference b/w pornography and sex
- intrinsic vs extrinsic motives and values
- materialism associated with depression
- high satisfaction in "flow states"
- ad angle - make people feel and believe they need something; make them feel inadequate without your product
- a "vocabulary to understand why they feel so bad"
- relationships and personal growth - usu the top two on surveys about what people value most
- ACE Study (started with interviews about obesity, then led to study early trauma)
- being treated cruelly by parents biggest driver of depression
- dose-response effect of trauma
- big social stressors: low status and insecure status
- the more unequal you society, the more prevalent all forms of mental illness
- depression and anxiety in animals held in captivity
- e.o. wilson - humans have natural biophilia
- all over world, people show preference to images of savanna
- depression - lose sense of future
- from proletariat to "precariat"
- suicide lower in first nations with more autonomy
- a brain scan is a snapshot of a moving picture
- "ask not what's inside your head...ask what you head's inside of"
- "it's no measure of health to be well-adjusted to a sick society" Krishnamurti
- a different kind of antidepressant
- Kotti neighborhood in Berlin, powerful story
- Brett Ford, "the more you think happiness is a social thing, the better off you are"
- altruism as antidepressant
- social prescribing, Bromley-by-Bow Center in east london
- ask less, "what's the matter with you?" and more "what matter's to you"
- average american exposed to up to five thousand ad impressions a day
- sympathetic joy mediation (you plant seeds during your meditation, and it flowers throughout the day)
- depression as a constricted consciousness
- psilocybin and mediation (connection, walls of ego dissolve)
- humiliation, shame, childhood trauma
- WHO - "mental health is produced socially: the presence or absence of mental health is above all a social indicator and therefore requires social, as well as individual, solutions"
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