The Drugs Don’t Work: A Review of Lost Connections by Johann Hari
For many years, former Independent columnist Johann Hari not only took anti-depressants, but advocated their use. His columns would typically appear on a Monday: I remember reading it. In terms of the drugs, he’s now seen the light. Regretting his years of pro-drug treatment persuasion, Hari feels humility: he was wrong. Following much travelled research, the sum of his humility is Lost Connections, in which the biological case for depression is turned towards the way that people connect with one another or, in the case of the clinically depressed, fail to connect. Taken as a lone treatment, antidepressants do not give sufferers lasting relief from depression-related symptoms.
The typical anti-depressant is also called an SSRI: a selective serotonin reuptake inhibitor. When serotonin (the mood and status enhancer of the brain’s neurochemistry system) is low the individual feels anxious, depressed and experiences sleeping, eating and sexual problems. The SSRI apparently boosts the serotonin levels in synapses, thus elevating mood. For years Hari bought into this received wisdom, that anti-depressants are effective in alleviating low mood, but Lost Connections vigorously repudiates it. Hari cites experts who are highly sceptical of the benefits of SSRI drugs, although stops short of condemning their effectiveness entirely.
In the teaching profession, depression, anxiety and mood disorders are prescient topics for discussion and I would recommend Hari as a contributor on the issue. Surveys suggest that one in ten teachers are taking antidepressants. The narrative used to explain this alarming rate goes something like this: ever increasing workloads make teaching stressful and, as such, too many teachers do not enjoy a suitable work life balance. Anti-depressants have become a symptom of a stressed profession. The first question from Hari’s book is, do antidepressants have the desired effect? Secondly, if not, what can the sufferer do?
In Hari’s opinion, the answer to the first question is no. Having taught about anti-depressants and depression for a number of years in Psychology, I am already watching what I say when talking about these drugs in Psychology lessons. The notion that antidepressants are effective treatments is directly challenged by Hari as he cites several professors who claim, incredibly, that there never was convincing evidence that anti-depressants work. Although clinical trials of antidepressants are available under freedom of information, manufacturers are not obliged to publish all data. Naturally, points out Hari, they publish only the trials which show that drugs work, even though this could represent a minority of cases. Where drugs appear to be successful (as antidepressants seemed to be working for Hari) they represent little more than a placebo effect. As users gradually take higher doses of antidepressants, they experience some belief that they need drug therapy; crucially, after a few months, their depression symptoms catch up with them. It is one of the jaw-dropping moments of Hari’s book: the entire pharmaceutical industry promotes depression medication which is based on weak evidence.
For the sufferer, anti-depressants have effectively become like an asthmatic’s inhaler: get used to carrying it, for the rest of your life. Optimistically, Hari’s revelation paves the way for something treatment-wise which is encapsulated by the title of the book: we have stopped connecting to several things: nature, other people, meaningful work, to name a few.
One disconnection that might cause nods of agreement in teachers is the concept of “meaningful work”. Monotonous jobs, with poorly defined job descriptions, and seemingly mindless tasks, are part of the depressive’s experience all too often. Are ten per cent of teachers on antidepressants due to a chemical imbalance exclusively? Or are their symptoms created by the nature of the role? Hari’s book might signal an opportunity to review aspects of teaching that occur only due to received wisdom: tasks that actually do little for teaching and learning. Teachers, for instance, spend much time predicting grades, as though the performance of students in an exam is somehow foreseeable months before they sit them. At the risk of criticism, I have sometimes wondered whether the teaching holidays are as beneficial as they seem. Many teachers would suggest that the holidays are needed to recover from the term. But the relationship could be symbiotic – the promise of holidays justifies a more frenzied term. In order to feel that the holiday is justified, perhaps teachers unnecessarily run themselves into the ground.
Hari also promotes “sympathetic joy” as a reconnection point. If I have understood it correctly, sympathetic joy comes from appreciating what is around you, rather than falling into a trap of self-analysis and self-importance. Hari’s case in point comes from the experience of climbing a mountain and experiencing the wonder of nature: facetiously, his chapter could almost be simplified into, why not go for a walk in the park? He still points out, wisely I think, the paradox of mental illness: whilst it is fundamentally about internal feelings it is best resolved by facing outwards. When people have poor mental health they are probably better off connecting (to use Hari’s term) with art, nature, helping people or making something. The problem lies internally; the answer lies externally.
An advice book about mental illness is never going to be easy to write and Hari’s book sounds like a self-help guide. The chapters, specifically identifying each connection type, are written like a blog post. The implication is clear: you can do something about your illness; you have that agency. This doesn’t carry the tone of the “pull yourself together” or “man up” language, but it amounts to the same thing. If there is a difference, Hari suggests that depression can only be solved within group organisation, as the disconnection problems are too big for one person to solve alone. If nothing else Hari is an engaging storyteller and writer. He is also pretty well connected himself. The celebrity endorsements on the rear cover read like a guest list for a New Labour Millennium soiree.
Lost Connections: Uncovering The Real Causes Of Depression - And The Unexpected Solutions, by Johann Hari is published by Bloomsbury Circus