Merle

This is an important book that has the potential to change the way many people see the world. It’s about depression, but depression on a continuum that includes the sort of unhappiness that most people in the modern world experience – which makes it not just a book for people with depression but a book for anyone who cares about their own mental health. It’s essentially a research-based popular science book on what makes a good life.

It’s a fairly short book that’s packed with a lot of information, but essentially, it turns out the notion that depression arises spontaneously from biological malfunctions has never been proven and probably isn’t true, though it’s been pushed hard by the pharmaceutical industry. The theory that it’s caused by serotonin levels was a hypothesis that wasn’t actually borne out in research. And in fact, the utility of antidepressants hasn’t been proven either: at best they provide a small improvement for a small number of people (though they’re noticeably less effective than improving your sleep, for one), once you control for the placebo effect and people who would have gotten better regardless. But in the meanwhile, they have real, negative side effects.

Research actually links depression first to bad things happening to people, and second to a number of factors that could be summed up as “modern life” and that the author refers to as “lost connections.” There’s the fact that people are increasingly isolated from one another; the fact that many people find their work meaningless, have little to no control at work and get no recognition for doing a good job; the fact that people are constantly bombarded with the message that the way to a better life is through spending; and more. Living in a society with a large wealth disparity and being far removed from nature have also been proven to increase rates of depression. Some have criticized the book for not saying much that was new to them, but all of this was new to me. I’d always assumed people who said things like “we don’t have depression in our country” were like people who say nobody in their country is gay, that rates of depression and anxiety are uniform and the most developed societies were the lucky ones because people get treatment. But actually, people in traditional societies are less likely to have mental illnesses, and have better outcomes.

There’s too much information for me to summarize here, and I wouldn’t anyway because I think everyone should read this. That said, the book isn’t perfect. It’s sometimes also about anxiety, which tends to occur alongside depression, but sometimes not; the effectiveness of medication for anxiety isn’t discussed. It doesn’t discuss the impacts of physical health (diet, sleep, exercise, illness) on mental health, which seemed like an oversight. Its discussion of the positive impacts of spending time in nature is simplistic, perhaps because the author has done little of this in his life. It spends very little time, perhaps because it’s not the point of the book, on depression caused by specific events in people’s lives (there are a couple of short chapters labeled as discussing childhood trauma, though it’s pretty clear from the discussion itself that trauma in adulthood causes depression too).

My final concern doesn’t speak to the quality of the book, but to the effect it might have on someone who reads it at the wrong time. As the author acknowledges – having suffered from depression himself, and wanting for years to believe that medication was the answer – many of these problems are huge. About 100 pages are about solutions, so it’s hardly a hopeless book, but these solutions require real lifestyle changes, and some require political and social change. It’s all a lot more daunting than taking a pill, and I would be concerned about people with depression reading this and concluding that their situation is hopeless. Hari’s argument that depression shouldn’t be pathologized, but is instead a sign of a sick society, may be empowering to some, but I suspect there are many people out there who need the placebo and the hope that comes with it.

At any rate, this is a book that caused me to do a lot of thinking. It’s well-researched and comes with extensive citations, while also being very readable and compelling. With the caveat above, I would recommend it to anyone, and think that virtually everyone would get something out of it.