Not Only the Depressed and Anxious Should Read This Book about Depression and Anxiety

Book Review: Lost Connections – Why You’re Depressed and How to Find Hope – by Johann Hari

Being English and Swiss, I occasionally take an unnatural, almost obsessive, interest in the work of Anglo-Swiss public intellectuals in England. Fortunately, as far as I’ve been able to establish, this is a small group of people of which Alain de Botton is one, and Johann Hari the other.

A few years ago I was greatly saddened when Hari’s high-flying journalistic career stalled due to some trouble concerning his journalistic integrity. I think he reported quotes from other people as if they had been given to him in conversation when in fact the subjects of his reporting had given them to someone else or published them somewhere else. To make things worse, Hari then attacked his critics by making critical edits to their pages on Wikipedia using a pseudonym. But he seems to have overcome that unfortunate episode. It probably explains why the brilliant books he’s written since are punctiliously backed up by documented evidence and audio recordings and littered with footnotes providing sources. I guess sometimes when a door shuts on being a prize-winning journalist writing for major British newspapers, another one opens to writing brilliant books – did I mention that his books are brilliant?

So this one is about depression and anxiety. And it’s among other things a personal journey for Hari. A journey from being told, and convincing himself, that his depression and anxiety were results of a chemical imbalance in the brain that could be addressed with ever increasing doses of pharmaceutical anti-depressants, to exploring the true roots of his depression and potential routes out of it.

At one point Hari worries that his book will be placed in the self-help shelves of bookstores. This is a worry because the very idea of self-help demonstrates how misguided our thinking on these matters is. As Hari says:

I’m conscious that in some bookstores, this book will be shelved in the Self-help section. But I now see that whole way of thinking is part of the problem. When I have felt down, up to now, most of the time, I tried to help myself. I turned to the self. I thought there was something wrong with the self, and the solution would come from repairing and aggrandizing the self. I puffed it up. But it turns out—the self isn’t the solution. The only answer lies beyond it.

The more serious worry, in my opinion, would be if this book were to be seen as a book only for those with depression and anxiety, a misconception that the subtitle “Why You’re Depressed and How to Find Hope” will only give rise to. I really hope it was forced on an unwilling Hari by the publisher’s marketing department. There are at least two reasons why this shouldn’t be the case:

Firstly, Hari writes about research that shows that there is a dose-response effect between the amount and strength of trauma that human beings experience and their depression and anxiety later in life. That is to say the more trauma, the greater a likelihood of depression and anxiety later. Put this together with the persuasive narrative that he constructs that depression is not a brain disease unrelated to the suffering and sadnesses in our lives, but on a continuum with these, exacerbated by a lack of connections that would help us cope better. As he puts it “depression, I realised, is itself a form of grief – for all the connections we need, but don’t have.” This I think would easily lead to a view that even non-depressive low-level dissatisfaction or occasional frustration could be alleviated by the connections Hari advocates (more about which shortly). In other words, if we all by virtue of being alive as human beings suffer some dose of trauma somewhere along the way, we all have as a result some level of suffering in our lives that could be alleviated by being more connected. That is what ancient Buddhist texts and modern Western mindfulness instructors like to refer to as dukka, I guess. This chimes with something from another great book I’ve just read. That book is “Maybe You Should Talk to Someone” by the psychologist and writer Lori Gottlieb who points out that “there’s no hierarchy of pain. Suffering shouldn’t be ranked because pain is not a contest.” Put this all together and you’ll find that Hari’s cures for depression should be of use to everyone.

Secondly, even if we were only interested in helping the clinically depressed, Hari’s point is that the solutions to their depression are not restricted to actions the individual should take. The causes of their depression are in things that are wrong with our world. They have no individual-based solutions, only societal, environmental, collective, economic and therefore political ones. The fact that some people are depressed is a problem all of us need to solve. Hari cites a British psychologist who “sometimes quotes the Eastern philosopher Jiddu Krishnamurti, who explained: ‘it is no measure of health to be well-adjusted to a sick society.'”

So what are the lost connections that cause depression according to Hari? They are: disconnection from meaningful work, from other people, from meaningful values, from childhood trauma, from status and respect, from the natural world and from a hopeful or secure future. In making this case, Hari describes his travels from Rio to Berlin and from Baltimore to East London visiting individuals and organisations who have provided a piece to this bigger picture.

This is the kind of non-fiction book that relies on tons of research findings. But Hari doesn’t sit in a library poring over journals to give us a dumbed down summary and original compilation of academic writings. He travels a lot. He goes to cities where communities have done things differently. He describes the geography of the places he goes to. He goes to meet the researchers and their research subjects. He talks to them. He describes the cafes where they meet. He describes the backstory of the researchers. 

So, the description of the anthropologist George Brown’s, work on the biographical and social causes of depression starts with an episode taking place just after the Second World War wherein a young woman – fresh from giving birth – walks through the ruins of the London suburb Kensal Rise to the Grand Canal to commit suicide by drowning herself in “its dust-choked waters.” This woman, it turns out had been a close neighbour of the teenage Brown and had looked after him for months when he had developed an infection. No one talked about her depression at the time. There was a sense of shame around it, Brown remembers more than seventy years later.

Whereas the researcher Isabel Behncke says she “will only explain to [Hari] how being cut off from the natural world can cause depression” if he agrees to climb Tunnel Mountain which towers over the Canadian town of Banff with her. Hari doesn’t like nature. He likes concrete, skyscrapers and bookshelves. But for an interview with Isabel he agrees to go. Surrounded by beautiful natural environment, he feels that he is looking at screensavers and is forced to confront his own fears of being in nature. Among other things, she describes that low status among primates has some of the same physical effects as depression in human beings but that it never gets as bad in nature, as it does in zoos.

And there are dozens of really fascinating findings in this book along similar lines:

For example, there’s the research that showed that obese people, even if helped to lose weight through a very severe diet, normally put it back on. When the researchers had the idea of looking at psychological factors, they found that in many cases, obesity was a kind of unconscious strategy for people who had suffered abuse or other traumatic experiences. Obesity protected them from the sexual interest of others, from the expectations of others (“people assume you are stupid, lazy”) and sometimes simply by adding a physical layer of protection.

But Hari also visits urban areas where people from vastly dissimilar outsider communities (eg. Turkish immigrants in Germany and members of the LGBTQ community), after years of ignoring each other, develop solidarity and friendships against rising rents and evictions and achieve real empowerment. Or he describes a bicycle business where people decided to run the business as a co-operative rather than just be exploited with low wages.

And Hari also cites the work by Michael Marmot as relevant who, in a famous study using the hierarchical system of the UK Civil Service as a massive group of test subjects, found that the highest levels of stress were caused by “work that is monotonous, boring, soul-destroying; [where] they die a little when they come to work each day, because their work touches no part of them that is them.” This kind of work also leads to the worst health outcomes – physical and mental – for those who do it.

Then there’s also the work of Tim Kasser who showed that people whose values are focussed on things to do with themselves, like material goods they could possess, or their looks, are less happy than people whose values are focussed on things outside themselves, such as the environment or their relationships with other people. And Hari backs this point up with descriptions of research where people in focussed discussions with each other managed to change their values from consumerist values to others. Then he goes to Rio and describes the effect it had when advertising was legally constrained in the city. And he also has the story of a Canadian town where an experiment was done that gave everyone a basic income.

It all adds up to an argument that the existence of anxiety and depression in some people is a massive warning to all of us that as a society we are way off the track that leads to a good life for human beings and that we would all be happier if we could changed things. The changes we would make, following Hari, would touch every aspects of our lives and would be social, economic, political and lifestyle changes. They would be nothing short of utopian. Realising the size of the project, Hari discusses his initial fears that a programme of this magnitude would never be taken seriously enough to get off the starting blocks. He decides not to be put off:

So I told myself: if you hear a thought in your head telling you that we can’t deal with the social causes of depression and anxiety, you should stop and realize—that’s a symptom of the depression and anxiety itself.

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Why Addiction Makes You Unhappy and Meditation Makes You Happy

Book Review: The Craving Mind: From Cigarettes to Smartphones to Love – Why We Get Hooked and How We Can Break Bad Habits – by Judson Brewer

I’ll admit it right at the start: There were times when I didn’t want to like this book. As I was reading it, I composed a snide and angry review in my mind. Some of that is below. But there’s something in there which makes the book great. It’s just hidden away in lots of other stuff.

So the things that annoyed me…

First, the foreword by Jon Kabat-Zinn: He is a great man. The great man of mindfulness meditation in the West. When he writes something new, people buy books and read them. But there is really very little that is new or exciting in this foreword other than an endorsement of the book’s author. At first I thought this was purely “clickbait,” a phenomenon Brewer helpfully describes later in the book as headlines or bits of text designed to “get us fired up, and our dopamine neurons firing, so that we will click the link to read the article.”

But on a second reading, I think I worked out what the point of Kabat-Zinn’s foreword is. It’s a bit complicated. Bear with me:

My theory is that the history of mindfulness meditation in the West has various waves. The first wave was the Tibetan Tulkus, Indian Yogis, Japanese Zen masters and other weird and wonderful creatures that literally went from the East to the United States to teach their philosophies and practices. The second were people like Kabat-Zinn who soaked up all those teachings, cleared out any religious content and made mindfulness clinical, not least so that they could get medical research grants to study and teach mindfulness. The third wave consists of people like Judson Brewer who make apps out of mindfulness. (They do literally make smartphone apps, but metaphorically they also package mindfulness as an application that can make you more effective professionally, healthier, free from your addictions, and so on.) Now, there is a slight embarrassment in selling (literally and metaphorically) mindfulness as an app: How do you square the attitude of non-doing, non-striving, non-purposive awareness of the present moment that constitutes mindfulness, with the idea of “doing this in order to get that”?

It appears that Kabat-Zinn is here not to explain this conundrum but to say he’s ok with it:

“Mindfulness as both a formal meditation practice and as a way of living has two interacting aspects, an instrumental dimension and a non-instrumental dimension. (…)

The non-instrumental dimension, a true complement to the instrumental dimension of mindfulness practice and absolutely essential to its cultivation and to freeing ourselves from craving-associated mind states, thoughts, and emotions, is that there is, at the very same time—and this is very hard to take in or talk about, which is why the phenomenon of flow plays such a large role in this book—no place to go, nothing to do, no special state to attain, and, ultimately, no one (in the conventional sense of a “you” or a “me”) to attain it.

Both of these dimensions of mindfulness are simultaneously true. Yes, you do need to practice, but if you try too hard or strive for some desired end point and its attendant reward, then you are simply shifting the craving to a new object or a new goal or a new attachment and a new or merely upgraded or revised “story of me.” Inside this tension between the instrumental and the non-instrumental lies the true extinguishing of craving, and of the “mis-taken” perceptions of yourself that the craving habit is grounded in.”

I’m not sure this is entirely successful as an explanation. The tension isn’t some kind of Zen riddle or paradox. It’s not the sound of one hand clapping. It stems from a further evolution of thinking about mindfulness that needs to be made explicit, brought out into the open and argued for. Otherwise it will remain a hard sell, even if Kabat-Zinn provides his blessing for the project.

The second thing that annoyed me about the book is Brewer’s attempt to adhere to all the hallmarks of a certain genre: The kind of popular science book – or “smart thinking” as some bookshops have come to call it – that is ubiquitous and has become so lame that it’s crying out for renewal. One of the most obvious genre markers is that, before a new discovery or concept is explained, the people working on the subject are introduced at length. Not necessarily just their academic career, or their intellectual journey, but how they dress in the morning before they go to their labs, what they eat for breakfast, their individual quirks and characteristics, as well as how happy they are to be friends of the author’s.  Tempting as it must be to copy ingredients of a recipe that sells so well I think this book and many others could do with less of that.

One egregious example of that feature is when Brewer talks about how the brain’s (the mind’s?) tendency to imagine various possible scenarios or outcomes. He imprecisely compares this process to Monte Carlo simulations, a statistical method to arrive at the relative likelihood of certain outcomes by running simulations thousands of times. Not only is the link between what the mind does and Monte Carlo simulations tenuous, but it is introduced with this entirely unnecessary backstory:

“I first came across Prasanta Pal in the neuroimaging analysis computer cluster at Yale. A compact and soft-spoken gentleman with a ready smile, he had just received his PhD in applied physics. When we met, he was using fMRI to measure turbulence in blood flow through the heart’s chambers. He had seen a paper of mine on brain activity during meditation, and over a cup of tea, he told me how he had grown up with meditation as part of his culture in India. Prasanta was excited to see that it was being researched seriously. In fact, he was interested in joining my lab and putting his particular skills to use.”

A third thing that was slightly irritating is that Brewer tries maybe too hard to show that his thinking about neurological and behaviouristic models of craving and addiction are not only presaged, but precisely present in the teachings of the Buddha himself. (“According to the Pali Canon, the Buddha was said to have been contemplating this idea on the night that he became enlightened. Maybe it was worth looking into further.”) At one point Brewer asks “Could [what the Pali canon refers to as] birth be what we now call memory?” Unlikely, right?

Ultimately though I found the book fascinating. It does a number of things really well:

  • It describes how addictions can come about based on very basic brain functions that allow animals to survive, e. g. by remembering where they can find food. Performing certain actions give us a short-term reward (mediated by dopamine in the brain) which makes us happy, but can also give us a craving for more.
  • It properly analyses certain kinds of social media and smartphone use as addictions. It describes the research that shows how people are getting addicted to presenting a certain image of themselves (their selfies) and being “liked” on social media. One fascinating study which Brewer describes links an increase in children’s accidents to parents being distracted by their phones.
  • It argues that other activities fit an addictive pattern, such as (obsessively) being in love, daydreaming or thinking. This is particularly so when they are really about the person in love, the daydreamer or the thinker themselves, rather than directed at someone or something else.
  • It also provides evidence that daydreaming, being lost in fantasies of pleasant scenarios actually makes us unhappy, rather than happy. (“A human mind is a wandering mind, and a wandering mind is an unhappy mind,” as the researchers of this phenomenon are quoted.)
  • It then describes the research by Brewer and others that implicates a certain pattern of activity in a specific area of the brain (the Default Mode Network) in addiction-style thinking about ourselves.
  • And of course the killer is that Brewer can then show that when we practice mindfulness meditation, this pattern of brain activity is absent. In other words meditation is the absence of an addictive activity to do with shoring up the self.
  • So every time we give in to a craving, we become more addicted. Every time we interject some mindfulness between craving and our next decision, we become less addicted. Giving in to addiction makes us unhappier, being mindful happier.

In Brewer’s words:

“In any type of addictive behavior, reactivity builds its strength through repetition—resistance training. Each time we look for our ‘likes’ on Facebook, we lift the barbell of ‘I am.’ Each time we smoke a cigarette in reaction to a trigger, we do a push-up of ‘I smoke.’ Each time we excitedly run off to a colleague to tell her about our latest and greatest idea, we do a sit-up of ‘I’m smart.’ That is a lot of work.”

And with this, Brewer has done something that is actually even more amazing than he explicitly says in his book. He has brought some issues that were far more present in the teachings of the first wave of meditation masters than they were for the later ones back to life. Those issues concern the role of the ego and the idea that less of it might be good for us. Through his scientific research, Brewer shows that shoring up the self is an activity that makes us unhappy and is linked to addictive behaviours. He also shows that meditation helps with that, not by a process of killing off or diminishing the ego, but simply by stopping the activity in the brain associated with self-referential thinking and doing something else for a while.