I never had serious problems with my mental health before the coronavirus hit. But over the past few weeks, I’ve found myself struggling: the constant sinking feeling in my stomach, difficulty falling asleep at night, crippling mental and physical fatigue out of nowhere. I had heard all of these symptoms described to me by depressed and anxious friends before, but this is the first time in my life I’ve truly felt them for extended periods of time. And I’m not the only one. Usage of mental health apps and chatbots has gone up in recent weeks, as have mental health-related social media posts — and dozens of friends and colleagues have relayed similar experiences.
Through it all, the book that’s been at the front of my mind is Lost Connections: Why You’re Depressed and How to Find Hope (audiobook) by Johann Hari. Drawing on interviews with dozens of neuroscientists, biologists, and social scientists, the book advances an argument that is both radical and obvious: Depression and anxiety are more than just chemical imbalances in the brain; they are also products of our distinct social environments — social environments that have left our core psychological needs unmet.
Over the last few weeks, there have been — and will continue to be — some fundamental shifts in the social landscape within which we live our lives. Unemployment applications have reached record highs. Small businesses are shuttering by the day. Entire cities are being told to “shelter in place.” Social distancing has become the new normal. And there’s no telling when any of it will end.
I wanted to speak to Hari about what these changes in our social environment could mean for our mental health, whether reactions like mine are normal, how our hyper-individualistic culture could be contributing to our collective angst, why policies like UBI should be considered antidepressants, and much more.
But there’s an important caveat I want to make first. In no way is this conversation intended to deny either that depression and anxiety have distinct biological components or that chemical antidepressants are extremely important for some people — it does and they are. While the direct social causation of mental health issues is fairly clear in the context of coronavirus, that logic does not necessarily apply to all cases.
I spoke with Hari over the phone. A transcript of our conversation, lightly edited for clarity and length, follows.
The premise of your book is that depression and anxiety can be a reflection of social conditions, and thus problems we individualize often demand collective solutions. Can you walk me through that argument at a high level?
There are biological causes of depression and anxiety, like your genes, which can make you more sensitive to these problems. There are psychological causes like trauma and how you think about yourself. And there are social causes in our environment like loneliness or financial insecurity. All of these factors are real and they interact in complex ways in any depressed or anxious individual. The problem is we often ignore the social ones.
It helps to think of it like this: Everyone knows they have natural physical needs — obviously you need food, water, shelter. If I took those things away from you, you’d be in real trouble real fast. But there’s equally strong evidence that all human beings have natural psychological needs. You need to feel you belong. You need to feel your life has meaning and purpose. You need to interact with the natural world. You need to feel that people see you and value you. You need to feel you’ve got a future that makes sense.
I think in a twisted way that insight is easier to see today than it was two weeks ago. It would be odd for someone who was anxious or depressed today in response to what’s just happened to all of us to think they are suffering from a purely biological problem. Today, it’s far easier to see that these issues are a reaction to the environment. For instance, we’ve had a big increase in financial insecurity in the United States and there’s been a huge increase in anxiety and depression in response.
I think it’s really problematic to say that those people are experiencing a disorder. If you are really financially insecure, it’s not a disorder for you to be anxious. In fact, it would be a disorder if you weren’t anxious. The solution isn’t to tell everyone they’ve got an individual pathology in their brain — although some of them will have some biological components that make them more vulnerable to it. The solution is for us to deal with that financial insecurity.
I think that’s a good jumping-off point to talk about coronavirus. Almost overnight, huge swaths of the American workforce have been thrown into a precarious financial situation. Unemployment has risen to unprecedented levels. Local businesses are in dire straits. How should we be thinking about these changes from a mental health perspective?
It massively depends on what political action happens. I’m very frustrated that whenever I turn on the news and they’re talking about what people should do about anxiety and depression, you have these mental health professionals who exclusively say things like “meditate” and “turn off the news.”
Now, that’s all fine — I’m doing that stuff. But the single biggest thing that will affect people’s anxiety is not knowing if you’re going to be thrown out of your home next month or how you’re going to feed your children. And I think there’s an element of cruel optimism in telling a country of people living paycheck to paycheck that they should be responding to the anxiety they’re experiencing this moment primarily by meditating and switching off the news. That’s not going to solve the problem. The single most important thing that has to be done to deal with people’s depression and anxiety is to deal with the financial insecurity they’re facing.
And this isn’t some pie in the sky thing. El Salvador, one of the poorest countries in the world, has canceled everyone’s utility bills and canceled their rent for the next three months. If El Salvador can do it, America can do it.
What you’re saying is that these shouldn’t just be thought of as economic policies, but mental health policies as well?
Yes. We need to radically expand our idea of what an antidepressant is. Anything that reduces depression and anxiety should be regarded as an antidepressant. For some people, that includes chemical antidepressants, but we need to radically expand that menu. I would argue that a high minimum wage is an antidepressant. A universal basic income (UBI) is an antidepressant. In one of the first UBI experiments ever in Dauphin, Canada, you saw an 8.5 percent decrease in hospitalizations due to mental health issues over three years — you won’t find any drug with that kind of effect.
Some of the other social causes of depression that you discuss in the book don’t have quite as clear and immediate policy solutions. You have entire chapters on the importance of things like nature and human-to-human connection, but being disconnected from nature and other human beings is essential to meeting the public health crisis we face. So where does that leave us?
Depression and anxiety are signals telling us that our needs are not being met, and I would say the single most helpful thing we can do going forward is to allow ourselves to hear the signal. What we’ve done for a really long time in our culture is either insult those signals by saying depressed and anxious people are just weak or feeble. Or we’ve pathologized the signals by saying they’re purely biological malfunctions. What we need to do is hear and respect the signal.
Once you hear the signal and you respect it, you’ll start to think differently. First, it means that your pain makes sense. So don’t judge yourself. Don’t shame yourself. There is nothing “wrong” with you.
And secondly, it means that when we begin to rebuild after coronavirus, we’ll have learned something really valuable about the kind of society we want. How could we redesign our education system with the understanding that nature is of the utmost importance to mental health? How could we redesign the health care system with the understanding that loneliness poses huge health risks? We can learn positive lessons about how to redesign our society to reduce depression and anxiety going forward if we allow ourselves to hear this signal.
I think that’s such an important point. And it makes me wonder if the extent to which our culture places responsibility and blame solely on individuals amplifies our depression problem. If we are individually responsible for everything that happens to us, then there’s no reason to change the social conditions around us. This myth of the solitary individual seems central to why we feel so depressed and helpless to do anything about it.
One of the things that really I found most revolutionary in my research was something discovered by Dr. Brett Ford, a psychologist now at the University of Toronto. She and her colleagues wanted to answer a simple question: If you try consciously to make yourself happier, will you actually become happier? They studied this in four countries: the United States, Russia, Taiwan, and Japan. They found that in the United States, those who consciously tried to make themselves happier didn’t become happier on average. But in the other countries, those who tried to make themselves happier did become happier
How could this be? When they did more analysis, they discovered that in the United States, when you try to make yourself happier, you generally do something for yourself: you work harder to get a promotion, you treat yourself by buying something — we could all think of a list of things. In the other countries, when you try to make yourself happy, you do something for someone else: your friends, your family, your community.
We have an instinctively individualistic definition of what happiness means; many other cultures have an instinctively collectivist definition of what happiness means. And it turns out individualism just doesn’t work very well — we’re not that species. A species of individualists would have died out on the savannas of Africa. We survived as a species because we banded together into tribes and cooperated. So there’s a reason we get anxious and depressed when we are separated from the tribe — we couldn’t survive that way. We only make sense socially.
I think that the lesson of human interdependence is one we’re learning very painfully right now because of coronavirus.
When I was a child, Margaret Thatcher famously said, “There’s no such thing as society.” And I think one of the reasons we have been so blind to the overwhelming evidence that there are huge social causes of depression and anxiety is because Margaret Thatcher won. Those ideas have become part of the common sense of our culture.
One of the things we’re going to learn in this crisis is that there is such a thing as society —and there always was. We are a social species. We stand or fall together. A viral outbreak in Wuhan, China, can lead to the Strip in Las Vegas being shut down. You can tell yourself that you’re John Wayne riding across the horizon if you want, but you’re just as vulnerable to the effects of social transformations as anyone else.
Here’s my last question: What would you say to people who are feeling depressed and anxious right now? What advice do you have for them?
In a society where people are not heard, the greatest gift you can give is to actually genuinely listen to someone and be present with them. Now, we can’t go and physically see each other at the moment, but you can show up digitally and you can listen and be present and let people know that you care. And, paradoxically, that is the single best thing you can do for yourself.
One of the things that correlates very tightly with depression is a lack of a sense of agency. If you feel there’s nothing you can do, you’re much more likely to become depressed. People need to know there’s a lot we can do to support each other in these circumstances. There’s a lot we can do at the political level as citizens and there’s a lot we can do at the personal level to support each other and love each other. It’s going to be hard but we absolutely have agency and power.