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Lost Connections – Book Notes

Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions
Johann Hari

Some one in five4 U.S. adults is taking at least one drug for a psychiatric problem; nearly one in four5 middle-aged women in the United States is taking antidepressants at any given time; around one in ten6 boys at American high schools is being given a powerful stimulant to make them focus; and addictions to legal and illegal drugs are now so widespread that the life expectancy of white men is declining for the first time in the entire peacetime history of the United States.

You can’t escape it: when scientists test the water supply of Western countries, they always find it is laced with antidepressants, because so many of us are taking them and excreting them that they simply can’t be filtered out of the water we drink every day.9 We

What once seemed startling has become normal. Without talking about it much, we’ve accepted that a huge number of the people around us are so distressed that they feel they need to take a powerful chemical every day to keep themselves together.

Scientists measure the depth of someone’s depression using something named the Hamilton scale, which was invented by a scientist named Max Hamilton in 1959. The Hamilton scale ranges from 0 (where you’re skipping along merrily) to 51 (where you’re jumping in front of trains). To give you a yardstick: you can get a six-point leap in your Hamilton score if you improve your sleeping patterns. What Irving found is that, in the real data that hadn’t been run through a PR filter, antidepressants do cause an improvement in the Hamilton score—they do make depressed people feel better. It’s an improvement of 1.8 points.

Somebody once told me1 that giving a person a story about why they are in pain is one of the most powerful things you can ever do. Taking away the story for your pain is just as powerful: I felt like I was on a rocky ship and somebody had taken away the railings.

To get a diagnosis of depression, you have to show at least five out of nine symptoms nearly every day: for example, depressed mood, decreased interest in pleasure, or feelings of worthlessness.

They said that you are allowed to show the symptoms of depression and not be considered mentally ill in one circumstance and one circumstance only—if you have recently suffered the loss of somebody close to you.

As Joanne Cacciatore researched the grief exception in more detail, she came to believe it revealed a basic mistake our culture is making about pain, way beyond grief. We don’t, she told me, “consider context.”5 We act like human distress can be assessed solely on a checklist that can be separated out from our lives, and labeled as brain diseases.

As she said this, I told her that in thirteen years of being handed ever higher doses of antidepressants, no doctor ever asked me if there was any reason why I might be feeling so distressed. She told me I’m not unusual—and it’s a disaster.

The message my doctors gave me—that our pain is simply a result of a malfunctioning brain—makes us, she told me, “disconnected from ourselves, which leads to disconnection from others.”

Our approach today is, Joanne said, “like putting a Band-Aid on an amputated limb. [When] you have a person with extreme human distress, [we need to] stop treating the symptoms. The symptoms are a messenger of a deeper problem. Let’s get to the deeper problem.”

So the psychiatrists who wrote the fifth and most recent edition of the DSM, which was published in 2015, came up with a solution. They got rid of the grief exception. In the new version, it’s not there. There’s just the checklist of symptoms,6 followed by a vague footnote. So

And so the model is preserved. Depression is something you can find on a checklist. If you tick the boxes, you’re mentally ill. Don’t look for context. Look for symptoms. Don’t ask what is happening in the person’s life.

Thinking like this, Joanne told me, makes her believe that “we’re such an utterly disconnected culture, we just don’t get human suffering.” She looked at me, and I thought of everything she has gone through, and the wisdom it has given her. She blinked, and said: “We just don’t get it.”

What if depression is, in fact, a form of grief—for our own lives not being as they should? What if it is a form of grief for the connections we have lost, yet still need?

“clinical depression is an understandable response to adversity.”

As they crunched the numbers, George and Tirril had discovered people living in poverty were more likely to become depressed—but the data showed it was too crude to say the poverty caused the depression. No: something more subtle was happening. People in poverty were more likely to become depressed because on average they faced more long-term stress, and because more negative life events happened to them, and because they had fewer stabilizers. But the underlying lessons were true for everyone, rich, middle-class, or poor. We all lose some hope when we’re subjected to severe stress, or when something horrible happens to us, but if the stress or the bad events are sustained over a long period, what you get is “the generalization of hopelessness,” Tirril told me. It spreads over your whole life,16 like an oil slick, and you begin to want to give up.

The conversation shifted from figuring out what is making us so unhappy in our lives, to trying to block the neurotransmitters in the brain that allow us to feel it.

Nobody asked them—how do we do that? What environmental changes would reduce depression and anxiety? These questions seemed too big, too revolutionary, to process. They are still ignored today—although later, I began to explore what they could mean.

They are all forms of disconnection. They are all ways in which we have been cut off from something we innately need but seem to have lost along the way.

Before long, “I made sure I had them before I went to work, made sure I had enough with me at work to get through work, rationing them out,” he says. He would take some more when he got home with some beers, thinking: “I can deal with that bullshit at work knowing that when I come home, I get to do this.” And he shook more paint.

I wondered if this was because the Oxy made him as blank and empty as the job itself. It seemed to dissolve the conflict between his desire to make a difference and the reality of his life. When I started talking to Joe, he thought at first he was telling me a story about addiction. He had been told by the people he went to for help kicking the Oxy that he was “born an addict,” and that’s the story he told me at first.

“When you wake up in the morning, you look forward to your day. When I wake up, I don’t look forward to work … It’s just something I have to do.”

A common symptom of depression is something called “derealization”5—which is where you feel like nothing you are doing is authentic or real. That seems to me, as I read it, to describe Joe—and it didn’t sound irrational. It sounds like a normal human reaction to working at a job like Joe’s for your whole life.

“When work is enriching, life is fuller, and that spills over into the things you do outside work,” he said to me. But “when it’s deadening,” you feel “shattered at the end of the day, just shattered.”

“Disempowerment,” Michael told me, “is at the heart13 of poor health”—physical, mental, and emotional.

Despair often happens, he had learned, when there is a “lack of balance between efforts and rewards.”

“The stunning thing was that loneliness is not merely the result of depression,” he told me. “Indeed—it leads to depression.”

For example, social scientists have been asking a cross-section of U.S. citizens a simple question for years: “How many confidants do you have?” They wanted to know how many people you could turn to in a crisis, or when something really good happens to you. When they started doing the study several decades ago, the average number of close friends an American had was three. By 2004, the most common answer was none.18 It’s worth pausing on that: there are now more Americans who have no close friends than any other option.

I think I understand what was happening to her. When we talk about home today, we mean just our four walls and (if we’re lucky) our nuclear family. But that’s never been what home has meant to any humans before us. To them, it meant a community—a dense web of people all around us, a tribe. But that is largely gone. Our sense of home has shriveled so far and so fast it no longer meets our need for a sense of belonging. So we are homesick even when we are at home.

Protracted loneliness causes you to shut down socially, and to be more suspicious of any social contact, he found. You become hypervigilant. You start to be more likely to take offense where none was intended, and to be afraid of strangers. You start to be afraid of the very thing you need most. John calls this a “snowball” effect, as disconnection spirals into more disconnection.

To end loneliness, you need other people—plus something else. You also need, he explained to me, to feel you are sharing something with the other person, or the group, that is meaningful to both of you.

Loneliness isn’t the physical absence of other people, he said—it’s the sense that you’re not sharing anything that matters with anyone else.

To end loneliness, you need to have a sense of “mutual aid and protection,” John figured out, with at least one other person, and ideally many more.

Of all the people they’ve treated at this rehab center, Hilarie told me, there are certain things almost everyone has in common. They were all anxious or depressed before the compulsion began. For the patient, the Internet obsession was a way of “escaping his anxiety, through distraction,” she said. “That is their exact profile, ninety percent of the time.”

The comedian Marc Maron28 once wrote that “every status update is a just a variation on a single request: ‘Would someone please acknowledge me?’

The difference between being online and being physically among people, I saw in that moment, is a bit like the difference between pornography and sex: it addresses a basic itch, but it’s never satisfying.

But more than that—our obsessive use of social media is an attempt to fill a hole, a great hollowing, that took place before anyone had a smartphone. It is—like much of our depression and anxiety—another symptom of our current crisis.

There’s a quote from the biologist E. O. Wilson that John Cacioppo—who has taught us so much about loneliness—likes: “People must belong to a tribe.” Just like a bee goes haywire if it loses its hive, a human will go haywire if she loses her connection to the group.

John had discovered that we—without ever quite intending to—have become the first humans to ever dismantle our tribes. As a result, we have been left alone on a savanna we do not understand, puzzled by our own sadness.

In 1984, he voted for Ronald Reagan, but he was starting to think a lot about the question of authenticity. “I was stumbling around,” he told me. “I think I was questioning just about everything. I wasn’t just questioning these values. I was questioning lots about myself, I was questioning lots about the nature of reality and the values of society.” He feels like there were piñatas all around him and he was hitting chaotically at them all. He added: “I think I went through that phase for a long time, to be honest.”

Twenty-two different studies have,10 in the years since, found that the more materialistic and extrinsically motivated you become, the more depressed you will be.

Twelve different studies found that the more materialistic and extrinsically motivated you become, the more anxious you will be.

That is what your head starts to look like when you become more materialistic. If you are doing something not for itself but to achieve an effect, you can’t relax into the pleasure of a moment. You are constantly monitoring yourself. Your ego will shriek like an alarm you can’t shut off.

Materialism leaves you constantly vulnerable to a world beyond your control.

Tim suspected that advertising plays a key role in why we are, every day, choosing a value system that makes us feel worse. So with another social scientist named Jean Twenge,21 he tracked the percentage of total U.S. national wealth that’s spent on advertising, from 1976 to 2003—and he discovered that the more money is spent on ads, the more materialistic teenagers become.

When they talk among themselves, advertising people have been admitting since the 1920s that their job is to make people feel inadequate—and then offer their product as the solution to the sense of inadequacy they have created.

This logic radiates out through the culture, and we start to impose it on each other, even when ads aren’t there. Why did I, as a child, crave Nike air-pumps, even though I was as likely to play basketball as I was to go to the moon? It was partly because of the ads—but mostly because the ads created a group dynamic among everyone I knew. It created a marker of status, that we then policed. As adults, we do the same, only in slightly more subtle ways.

This system trains us, Tim says, to feel “there’s never enough. When you’re focused on money and status and possessions, consumer society is always telling you more, more, more, more. Capitalism is always telling you more, more, more. Your boss is telling you work more, work more, work more. You internalize that and you think: Oh, I’ve got to work more, because my self depends on my status and my achievement. You internalize that. It’s a kind of form of internalized oppression.”

We are all vulnerable to this, he believes. “The way I understand the intrinsic values,”24 Tim told me, is that they “are a fundamental part of what we are as humans, but they’re fragile. It’s easy to distract us from them … You give people social models of consumerism … and they move in an extrinsic way.” The desire to find meaningful intrinsic values is “there, it’s a powerful part of who we are, but it’s not hard to distract us.” And we have an economic system built around doing precisely that.

This couple has no vocabulary to understand why they feel so bad. They are doing what the culture has been priming them to do since we were infants—they are working hard and buying the right things, the expensive things. They are every advertising slogan made flesh.

“You’ve got to pull yourself out of the materialistic environments—the environments that are reinforcing the materialistic values,” he says, because they cripple your internal satisfactions. And then, he says, to make that sustainable, you have to “replace them with actions that are going to provide those intrinsic satisfactions, [and] encourage those intrinsic goals.”

By living without these polluting values, Tim has, he says, discovered a secret. This way of life is more pleasurable than materialism. “It’s more fun to play these games with your kids,” he told me. “It’s more fun to do the intrinsically motivated stuff than to go to work and do stuff you don’t necessarily want to do. It’s more fun to feel like people love you for who you are—instead of lov[ing] you because you gave them a big diamond ring.”

If you believe that your depression is due solely to a broken brain, you don’t have to think about your life, or about what anyone might have done to you. The belief that it all comes down to biology protects you, in a way, for a while. If you absorb this different story, though, you have to think about those things. And that hurts.

“When people have these kind of problems, it’s time to stop asking what’s wrong with them,” he said, “and time to start asking what happened to them.”

Robert had discovered that our closest cousins are most stressed in two situations—when their status is threatened (like Solomon, when Uriah struck), and when their status is low (like poor Job all the time).

“We’re extraordinarily sensitive to these things,”18 Richard said. When the status gap is too big, it creates “a sense of defeat that you can’t escape from.”

exercise significantly reduces depression and anxiety.

When scientists have compared people who run on treadmills in the gym12 with people who run in nature, they found that both see a reduction in depression—but it’s higher for the people who run in nature. So what are the other factors?

When you are depressed—as Isabel knows from her own experience—you feel that “now everything is about you.” You become trapped in your own story and your own thoughts, and they rattle around in your head with a dull, bitter insistence. Becoming depressed or anxious is a process of becoming a prisoner of your ego, where no air from the outside can get in. But a range of scientists have shown that a common reaction15 to being out in the natural world is the precise opposite of this sensation—a feeling of awe.

Faced with a natural landscape, you have a sense that you and your concerns are very small, and the world is very big—and that sensation can shrink the ego down to a manageable size.

“You’re always embedded in a network,” even when you don’t realize it; you are “just one more node” in this enormous tapestry.

The cruelest thing about depression, she said, is that it drains you of the desire to be as fully alive as this—to swallow experience whole. “We want to feel alive,” she said. We want it, and need it, so badly. Later, she said: “Obviously, we were facing death, but you felt alive, right? You might have been horrified—but you were not depressed.”

A sense of a positive future protects you. If life is bad today, you can think—this hurts, but it won’t hurt forever. But when it is taken away, it can feel like your pain will never go away.

There was a window when people on middle-class and working-class incomes had some sense of security and could plan for the future. That window has been closing, as a direct result of political decisions to free businesses from regulation and to make it very hard for workers to organize to protect their rights, and what we are losing is a predictable sense of the future. Angela didn’t know what was waiting for her. Working this way meant she couldn’t create a picture of herself in a few months, never mind in a few years, or a few decades.

It turns out that you were more likely to hurt somebody if you believed their mental illness was the result of their biochemistry than if you believed it was the result of what had happened to them in life. Believing depression was a disease didn’t reduce hostility. In fact, it increased it. This experiment—like so much of what I had learned—hints at something. For a long time, we have been told there are only two ways of thinking about depression. Either it’s a moral failing—a sign of weakness—or it’s a brain disease. Neither has worked well in ending depression, or in ending its stigma. But everything I had learned suggests that there’s a third option—to regard depression as largely a reaction to the way we are living. This way is better, Marc said, because if it’s an innate biological disease, the most you can hope for from other people is sympathy—a sense that you, with your difference, deserve their big-hearted kindness. But if it’s a response to how we live, you can get something richer: empathy—because it could happen to any of us. It’s not some alien thing. It’s a universal human source of vulnerability. The evidence suggests Marc is right—looking at it this way makes people less cruel, to themselves and to other people.

As I described before, for decades, psychiatrists have—in their training—been taught something called the bio-psycho-social model.22 They are shown that depression and anxiety have three kinds of causes:23 biological, psychological, and social. And yet almost nobody I know who has become depressed or severely anxious was told this story by their doctor—and most were not offered help for anything except their brain chemistry.

One reason why is that it is “much more politically challenging”25 to say that so many people are feeling terrible because of how our societies now work. It fits much more with our system of “neoliberal capitalism,” he told me, to say, “Okay, we’ll get you functioning more efficiently, but please don’t start questioning … because that’s going to destabilize all sorts of things.”

“It is no measure of health to be well-adjusted to a sick society.”

“You see, doctor, the cow was an analgesic, and antidepressant,” they told Derek. To them, an antidepressant wasn’t about changing your brain chemistry, an idea that seemed bizarre to their culture. It was about the community, together, empowering the depressed person to change his life.

We have been told depression is caused by a chemical imbalance, so the idea of a cow as an antidepressant seems almost like a joke.

You could fill an aircraft with the research that’s been conducted into the social causes of depression and anxiety. And you could fill a toy airplane with the research into reconnection.

But what I was being taught is—if you want to stop being depressed, don’t be you. Don’t be yourself.3 Don’t fixate on how you’re worth it. It’s thinking about you, you, you that’s helped to make you feel so lousy. Don’t be you. Be us. Be we. Be part of the group. Make the group worth it. The real path to happiness, they were telling me, comes from dismantling our ego walls—from letting yourself flow into other people’s stories and letting their stories flow into yours; from pooling your identity, from realizing that you were never you—alone, heroic, sad—all along.

No, don’t be you. Be connected with everyone around you. Be part of the whole. Don’t strive to be the guy addressing the crowd. Strive to be the crowd.

But once I knew about Brett’s research, I saw the error I had been making. Now, when I feel myself starting to slide down, I don’t do something for myself—I try to do something for someone else. I go to see a friend and try to focus very hard on how they are feeling and making them feel better. I try to do something for my network, or my group—or even try to help strangers who look distressed. I learned something I wouldn’t have thought was possible at the start. Even if you are in pain, you can almost always make someone else feel a little bit better. Or I would try to channel it into more overt political actions, to make the society better. When I applied this technique, I realized that it often—though not always—stopped the slide downward. It worked much more effectively than trying to build myself up alone.

They decided to plant daffodils, and key shrubs, and seasonal flowers. At first it was slow, and difficult. They realized “there’s something about nature,” Lisa told me. “You can’t change how nature is—because the weather will do that. The seasons will do that. So you can plant things, and either they’ll fail, or they’ll succeed. You have to learn how to do that. You have to learn to be patient. It’s not a quick fix. Creating a garden takes time and investment of energy and a commitment … You might not feel you’ve made much impact in one gardening session, but if you do that every week, over a period of time, you’ll see a change.” She was going to learn “it’s about commitment to something that might take a long time, and having the patience to do that.”

What he has learned is that when you can become connected to the people around you, “it’s restoring of human nature.”

When there is pollution in the air that makes us feel worse, we ban the source of the pollution: we don’t allow factories to pump lead into our air. Advertising, he says, is a form of mental pollution. So there’s an obvious solution. Restrict or ban mental pollution, just like we restrict or ban physical pollution.

Advertising is only the PR team for an economic system that operates by making us feel inadequate and telling us the solution is to constantly spend.

Often, the teenagers would say, they craved this stuff so badly because they wanted to belong—the branded clothes meant you were accepted by the group, or got a sense of status.

spending often isn’t about the object itself. It is about getting to a psychological state that makes you feel better.

She had been raised to constantly compete and compare, she said. “We’re highly individualistic,” she explained, and we’re constantly told that life is a “zero sum game. There’s only so many pieces of the pie, so if somebody else has success, or beauty, or whatever, somehow it leaves less for you. Or if you can get it, too, it’s less meaningful if all these other people have it.” We are trained to think that life is a fight for scarce resources—“even if it’s for something like intelligence, when there’s no limit to how much human intelligence can grow across the world.” If you become smarter, it doesn’t make me less smart—but we are primed to feel that it does.

She felt she was slowly realizing that the things she had been trained by the culture to envy were in fact the least valuable things we have: “Who’s envious of someone else’s good character? Who’s envious of somebody else’s wonderful treatment of their spouse? You’re not envious of that. You might admire that. You’re not envious of it. You’re envious of other shit: you’re envious of what people have materially, or status-wise.” As the meditation progressed across the years, Rachel began to see that even if she got those things, they wouldn’t make her happy. They’re not what matters.

The largest scientific study of using meditation as a treatment for depression found something really interesting. It turned out that depressed people were significantly more likely to recover from depression if they went into an eight-week meditation training program than people in a control group who didn’t.

It turned out if you’d done the loving-kindness meditation, you were almost twice as likely to help somebody else than the people who hadn’t. This is an early sign suggesting Rachel was right: you could double your compassion through doing this practice3 even for a short time. And that in turn would lead to greater connection to other people. It’s as though the loving-kindness meditation works a muscle that helps us resist and counteract the worst of our culture. It’s not so much what happens in those fifteen minutes—Rachel has come to feel that “you’re planting seeds during the meditation, [and] it flowers spontaneously during your day, and your life.”

Right at the start I talked about how the biological interventions we currently have—antidepressants—don’t do much for most of us.

Then, up to now, I’ve been talking about the environmental or social changes that might be able to help us. But what Rachel was teaching me was something different. She was proposing a psychological change.

Until I had this experience with Rachel, I had been wary about meditation. There were, I realized, two reasons. The first is that I was afraid of being still and alone with my thoughts—I associated that with depression and anxiety.

The second is that I found many of the reasons why meditation has been promoted over the past few years problematic. There are self-help gurus who have made a fortune telling people that meditation can make you a better little worker-bee, more able to cope with working constantly and being loaded with stress. This seemed to me to be just another individualistic “solution” that misses the point—why do so many people feel overloaded and stressed out in the first place, and how do we stop it happening?

But I now knew there are lots of different kinds of meditation. Rachel’s school of meditation is the opposite of this individualistic meditation that disturbed me. It’s not about dealing with the distress and strain of disconnection a little better. It’s about finding a way back to reconnection.

As he read through this, Roland noticed one thing in particular. The way people described feeling when they took psychedelics was strikingly similar to the way people said they felt if they had a deep, sustained program of meditation.

When he came back from that experience, Mark never quite felt like the same person again. He feels, he told me, that the experience made clear to him that people need a sense “of being accepted, to have some sense of importance, and to be loved. And I can give that to anyone at any time, and it’s that simple. It’s just paying attention. It’s just being with people. It’s loving.”

Fred Barrett, an assistant professor at Johns Hopkins, is running a study with Roland17 in which they give psilocybin to people who had been deep meditators for over a decade—people who had gone on months-long retreats and had meditated for at least an hour a day for years. He explained to me that people like Mark—who hadn’t meditated before and hadn’t used psychedelics—usually had no words (at least at first) to describe what they had experienced on the drug, and couldn’t think of any parallel in their lives. But the long-term meditators had plenty of words, because to them, the drug seemed to be bringing them, they said, to “the same place” that really deep meditation, at its highest peaks, could sometimes reach. “By and large,” Fred told me, “they’re saying that these places are, if not similar, identical.”

They both, he said, break our “addiction to ourselves.”

Our ego, our sense of self, always has both these qualities—protective, and imprisoning.

But what both deep meditation and psychedelic experiences teach us is the ability to see how much of that self—that ego—is constructed.

My friend Rachel could see that her envy was a way of protecting herself from sadness—and meditation enabled her to see she didn’t have to be that way: she could protect herself with positivity and love instead.

As Fred put it to me, these experiences teach you that “you don’t have to be controlled by your concept of yourself.”

“If meditation is the tried and true course for [discovering this],” Roland said, “psilocybin surely has to be the crash course.”

When you see a person under the influence of psychedelics, you see why we need an ego. Their ego is switched off—and they are literally defenseless; you wouldn’t leave them alone to walk down the street. Our egos protect us. They guard us. They are necessary. But when they grow too big, they cut us off from the possibility of connection. Taking them down, then, isn’t something to be done casually. To people who feel safe only behind walls, dismantling their walls won’t feel like a jail break; it will feel like an invasion.

“The value of the experience,” Andrew told me, is to “show you the possibility”—how connection can make you feel. Then, he says, “it’s up to you to find other ways to maintain the experience.” Its value is not as a drug experience but as a learning experience. And you need to keep practicing the lesson, one way or another.

“it’s not a trick of the mind. It’s an opening of the mind that allows you to see … [the] things that are inside you already.” “All it’s doing,” he said to me, looking back on this long journey, “is opening the gate” to what we have known—at some level—we needed all along.

This program does trigger a big change, he says—but not the one most people imagine. The biggest change, Rutger believes, will be in how people think about work.6

That means those employers will have to offer either better wages, or better working conditions. In one swoop, the worst jobs, the ones that cause the most depression and anxiety, will have to radically improve, to attract workers.

When people are free to say no, Rutger says, “I think the definition of work would [become] to add something of value—to make the world a little more interesting, or a bit more beautiful.”

every civilizing proposal started off as a utopian dream—from the welfare state, to women’s rights, to gay equality.

President Obama said it could happen in the next twenty years.

If we start to argue and campaign for it now—as an antidepressant; as a way of dealing with the pervasive stress that is dragging so many of us down—it will, over time, also help us to see one of the factors that are causing all this despair in the first place.

It’s a way, Rutger explained to me, of restoring a secure future to people who are losing the ability to see one for themselves; a way of restoring to all of us the breathing space to change our lives, and our culture.

When the book—Virtually Normal—came out a year later, Patrick died when it had only been in the bookstores for a few days, and Andrew was widely ridiculed for suggesting something so absurd as gay marriage.

It would have seemed like science fiction. But it happened. It’s not a small thing to overturn two thousand years of gay people being jailed and scorned and beaten and burned. It happened for one reason only. Because enough brave people banded together and demanded

Every single person reading this is the beneficiary of big civilizing social changes that seemed impossible when somebody first proposed them.

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. Yes, the changes we need now are huge. They’re about the size of the revolution in how gay people were treated. But that revolution happened.

There’s a huge fight ahead of us to really deal with these problems. But that’s because it’s a huge crisis. We can deny that—but then we’ll stay trapped in the problem. Andrew taught me: The response to a huge crisis isn’t to go home and weep. It’s to go big. It’s to demand something that seems impossible—and not rest until you’ve achieved it.

It’s a sign, Rutger says, of how badly off track we’ve gone, that having fulfilling work is seen as a freakish exception, like winning the lottery, instead of how we should all be living. Giving everyone a guaranteed basic income, he says “is actually all about making [it so we tell everyone]—‘Of course you’re going to do what you want to do. You’re a human being. You only live once. What would you want to do [instead]—something you don’t want to do?’ ”

wandered over and I stood in that doorway, and I remembered the story I had believed on that day, and for so long after. I had been told it by my doctor, and by Big Pharma, and by the bestselling books of the day: The problem is in your head. It’s a chemical imbalance. Your broken machinery needs to be fixed, and this is the answer.

The false story is the claim that depression is caused by a chemical imbalance in the brain and that the primary solution for most people is a chemical antidepressant. That story has made Big Pharma over $100 billion,1 which is one of the crucial reasons why it persists.

Depression and anxiety have three kinds of causes—biological, psychological, and social.

You are not suffering from a chemical imbalance in your brain. You are suffering from a social and spiritual imbalance in how we live.

Because you are being told depression and anxiety are misfirings of brain chemicals, you will stop looking for answers in your life and your psyche and your environment and how you might change them. You will become sealed off in a serotonin story.4 You will try to get rid of the depressed feelings in your head. But that won’t work unless you get rid of the causes of the depressed feelings in your life.

this pain isn’t your enemy, however much it hurts (and Jesus, I know how much it hurts). It’s your ally—leading you away from a wasted life and pointing the way toward a more fulfilling one.

Then I would tell him—you are at a fork in the road now. You can try to muffle the signal. That will lead you to many wasted years when the pain will persist. Or you can listen to the signal and let it guide you—away from the things that are hurting and draining you, and toward the things that will meet your true needs.

For decades, long before these new antidepressants were developed, we have been disconnecting—from each other, and from what matters. We have lost faith in the idea of anything bigger or more meaningful than the individual, and the accumulation of more and more stuff.

Margaret Thatcher said, “There’s no such thing as society, only individuals and their families”—and, all over the world, her viewpoint won. We believed it—even those of us who thought we rejected it.

But it turns out we are all still living in a society, even if we pretend we aren’t. The longing for connection never goes away.

Depression and anxiety might, in one way, be the sanest reaction you have.6 It’s a signal, saying—you shouldn’t have to live this way, and if you aren’t helped to find a better path, you will be missing out on so much that is best about being human.

Deep grief and depression, she explained to me, have identical symptoms for a reason. Depression, I realized, is itself a form of grief—for all the connections we need, but don’t have.

realized—just like it is an insult to Joanne to say that her ongoing grief for her daughter is a form of mental dysfunction, it was an insult to my teenage self to say that his pain was just the result of bad brain chemistry. It was an insult to what he had been through, and to what he needed.

I’ve radically cut back on social media, I’ve stopped watching any TV with advertising. Instead, I spend much more time face-to-face with the people I love, and pursuing causes I know really matter. I am more deeply connected—to other people, and to meaning—than I have ever been before.

I was able to make these changes because I am really fortunate.

This is why I believe we should not—must not—talk about solving depression and anxiety only through individual changes. To tell people that the solution lies solely or primarily in tweaking your own life would be a denial of so much of what I learned on this journey. Once you understand that depression is to a significant degree a collective problem caused by something that’s gone wrong in our culture, it becomes obvious that the solutions have to be—to a significant degree—collective, too. We have to change the culture so that more people are freed up to change their lives.

But if the problem doesn’t originate with them alone, it can’t be solved by them alone. As a group, together, we have to change our culture—to strip out the causes of depression and anxiety that are causing such deep unhappiness.

You’re not going to be able to deal with this problem alone. It’s not a flaw in you. The hunger for this change is out there all around you, waiting just beneath the surface.

If you stay broken up and isolated, you will likely stay depressed and anxious. But if you band together, you can change your environment.

You have to turn now to all the other wounded people around you, and find a way to connect with them,7 and build a home with these people—a place where you are bonded to one another and find meaning in your lives together.

All these depressed and anxious people, all over the world—they are giving us a message. They are telling us something has gone wrong with the way we live. We need to stop trying to muffle or silence or pathologize that pain. Instead, we need to listen to it, and honor it. It is only when we listen to our pain that we can follow it back to its source—and only there, when we can see its true causes, can we begin to overcome it.