This is the second of three posts based on the work of writer Johann Hari, whose search for answers about his own depression led to his book Lost Causes: Uncovering the Real Causes of Depression–and the Unexpected Solution. In the first post in this series, we looked at some problems with the idea that depression is mostly caused by low levels of serotonin in the brain. These problems include the six weeks it typically takes an SSRI to start working, selective publishing of research on the effectiveness of SSRIs, good results from cognitive behavioral therapy, and depression caused by events such as bereavement and job loss that are not attributed to a serotonin deficiency. This last aspect was of particular interest to Hari, whose own experience with depression led to ever higher doses of SSRIs but no lasting relief. In his research, Hari discovered there is quite a lot of evidence to support the idea that depression is more often about unmet psychological needs than it is about brain chemistry. The problem is that we typically only recognize acute causes of psychological distress, such as divorce, bereavement, or job loss, but chronically unmet psychological needs usually escape our notice. This may explain the increasing levels of depression and anxiety in the US and UK. It would be strange if our brains spontaneously started malfunctioning and producing insufficient serotonin at an increasingly higher rate–possible, but strange. However, society changes quickly, and never more quickly than in the past 100 years. Technological changes cause economic instability and cultural fragmentation. Demographics are shifting, creating fear and insecurity. Money and power is concentrated in fewer companies and institutions. This often leads to people working in jobs–often good jobs–that have too little meaning, autonomy, and security. Thus, one of the most important aspects of our lives–work–increasingly delivers more stress and less meaning. Hari cites a study done of UK civil service workers that found, surprisingly, that the most heart attacks and other stress-related illnesses didn’t occur among the higher ranks who bore the most public responsibility, but among the lower ranks who had the least freedom. Only about 13 percent of people say they enjoy their work or find meaning in it. The remaining 87 percent of people simply go through the motions or actively despise their jobs. Most people who suffer from depression and anxiety fall into the latter group. They feel stuck, yet vulnerable. They get no satisfaction or sense of purpose from how they spend most of their waking hours. More and more, workers, even highly paid knowledge workers are shrinking cogs in a growing machine. And that’s just one way in which the structure of society deprives people of psychological needs. Some studies have found that loneliness is also on the rise. Loneliness can be acutely distressing and lead to depression and increased risk of health problems. To be psychologically healthy, humans need to have certain needs met. No one would think it was strange if someone who was chronically cold and hungry was also anxious and depressed. We understand that having certain physical needs met is necessary for survival and happiness, but we often overlook the psychological needs that are essential to our wellbeing. These include positive social connection, a sense of purpose, feeling valued, and having a sense of self-efficacy. Very often, depression is not simply a malfunction of the brain, but rather a signal that some of our basic needs aren’t being met. Treating depression effectively means paying attention to our psychological needs. More on that in the next part.
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