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BASIC INCOME AND DEPRESSION. Restoring the Future – Johann Hari.

Giving people back time, and a sense of confidence in the future.

The point of a welfare state is to establish a safety net below which nobody should ever be allowed to fall. The poorer you are, the more likely you are to become depressed or anxious, and the more likely you are to become sick in almost every way.

There is a direct relationship between poverty and the number of mood-altering drugs that people take, the antidepressants they take just to get through the day. If we want to really treat these problems, we need to deal with poverty.

Instead of using a net to catch people when they fall, Basic Income raises the floor on which everyone stands.

The world has changed fundamentally. We won’t regain security by going backward, especially as robots and technology render more and more jobs obsolete, but we can go forward, to a basic income for everyone.

There was one more obstacle hanging over my attempts to overcome depression and anxiety, and it seemed larger than anything I had addressed up to now. If you’re going to try to reconnect in the ways I’ve been describing, if you’re going to (say) develop a community, democratize your workplace, or set up groups to explore your intrinsic values, you will need time, and you need confidence.

But we are being constantly drained of both. Most people are working all the time, and they are insecure about the future. They are exhausted, and they feel as if the pressure is being ratcheted up every year. It’s hard to join a big struggle when it feels like a struggle to make it to the end of the day. Asking people to take on more -when they’re already run down, seems almost like a taunt.

But as I researched this book, I learned about an experiment that is designed to give people back time, and a sense of confidence in the future.

In the middle of the 1970s, a group of Canadian government officials chose, apparently at random, a small town called Dauphin in the rural province of Manitoba. It was, they knew, nothing special to look at. The nearest city, Winnipeg, was a four-hour drive away. It lay in the middle of the prairies, and most of the people living there were farmers growing a crop called canola. Its seventeen thousand people worked as hard as they could, but they were still struggling. When the canola crop was good, everyone did well, the local car dealership sold cars, and the bar sold booze. When the canola crop was bad, everyone suffered.

And then one day the people of Dauphin were told they had been chosen to be part of an experiment, due to a bold decision by the country’s Liberal government. For a long time, Canadians had been wondering if the welfare state they had been developing, in fits and starts over the years, was too clunky and inefficient and didn’t cover enough people. The point of a welfare state is to establish a safety net below which nobody should ever be allowed to fall: a baseline of security that would prevent people from becoming poor and prevent anxiety. But it turned out there was still a lot of poverty, and a lot of insecurity, in Canada. Something wasn’t working.

So somebody had what seemed like an almost stupidly simple idea. Up to now, the welfare state had worked by trying to plug gaps, by catching the people who fell below a certain level and nudging them back up. But if insecurity is about not having enough money to live on, they wondered, what would happen if we just gave everyone enough, with no strings attached? What if we simply mailed every single Canadian citizen, young, old, all of them, a check every year that was enough for them to live on? It would be set at a carefully chosen rate. You’d get enough to survive, but not enough to have luxuries. They called it a universal basic income. Instead of using a net to catch people when they fall, they proposed to raise the floor on which everyone stands.

This idea had even been mooted by right-wing politicians like Richard Nixon, but it had never been tried before. So the Canadians decided to do it, in one place. That’s how for several years, the people of Dauphin were given a guarantee: Each of you will be unconditionally given the equivalent of $19,000 US. (in today’s money) by the government. You don’t have to worry. There’s nothing you can do that will take away this basic income. It’s yours by right. And then they stood back to see what would happen.

At that time, over in Toronto, there was a young economics student named Evelyn Forget, and one day, one of her professors told the class about this experiment. She was fascinated. But then, three years into the experiment, power in Canada was transferred to a Conservative government, and the program was abruptly shut down. The guaranteed income vanished. To everyone except the people who got the checks, and one other person, it was quickly forgotten.

Thirty years later, that young economics student, Evelyn, had become a professor at the medical school of the University of Manitoba, and she kept bumping up against some disturbing evidence. It is a well-established fact that the poorer you are, the more likely you are to become depressed or anxious, and the more likely you are to become sick in almost every way. In the United States, if you have an income below $20,000, you are more than twice as likely to become depressed as somebody who makes $70,000 or more. And if you receive a regular income from property you own, you are ten times less likely to develop an anxiety disorder than if you don’t get any income from property. “One of the things I find just astonishing,” she told me, “is the direct relationship between poverty and the number of mood-altering drugs that people take, the antidepressants they take just to get through the day.” If you want to really treat these problems, Evelyn believed, you need to deal with these questions.

And so Evelyn found herself wondering about that old experiment that had taken place decades earlier. What were the results? Did the people who were given that guaranteed income get healthier? What else might have changed in their lives? She began to search for academic studies written back then. She found nothing. So she began to write letters and make calls. She knew that the experiment was being studied carefully at the time, that mountains of data were gathered. That was the whole point: it was a study. Where did it go?

After a lot of detective work, stretching over five years, she finally got an answer. She was told that the data gathered during the experiment was hidden away in the National Archives, on the verge of being thrown in the trash. “I got there, and found most of it in paper. It was actually sitting in boxes,” she told me. “There were eighteen hundred cubic feet. That’s eighteen hundred bankers’ boxes, full of paper.” Nobody had ever added up the results. When the Conservatives came to power, they didn’t want anyone to look further, they believed the experiment was a waste of time and contrary to their moral values.

So Evelyn and a team of researchers began the long task of figuring out what the basic income experiment had actually achieved, all those years before. At the same time, they started to track down the people who had lived through it, to discover the Iong-term effects.

The first thing that struck Evelyn, as she spoke to the people who’d been through the program, was how vividly they remembered it. Everyone had a story about how it had affected their lives. They told her that, primarily, “the money acted as an insurance policy. It just sort of removed the stress of worrying about whether or not you can afford to keep your kids in school for another year, whether or not you could afford to pay for the things that you had to pay for.”

This had been a conservative farming community, and one of the biggest changes was how women saw themselves. Evelyn met with one woman who had taken her check and used it to become the first female in her family to get a postsecondary education. She trained to be a librarian and rose to be one of the most respected people in the community. She showed Evelyn pictures of her two daughters graduating, and she talked about how proud she was she had been able to become a role model for them.

Other people talked about how it lifted their heads above constant insecurity for the first time in their lives. One woman had a disabled husband and six kids, and she made a living by cutting people’s hair in her front room. She explained that the universal income meant for the first time the family had “some cream in the coffee” small things that made life a little better.

These were moving stories, but the hard facts lay in the number crunching. After years of compiling the data, here are some of the key effects Evelyn discovered:

  • Students stayed at school longer, and performed better there.
  • The number of low-birth-weight babies declined, as more women delayed having children until they were ready.
  • Parents with newborn babies stayed at home longer to care for them, and didn’t hurry back to work.
  • Overall work hours fell modestly, as people spent more time with their kids, or learning.

But there was one result that struck me as particularly important.

Evelyn went through the medical records of the people taking part, and she found that, as she explained to me, there were “fewer people showing up at their doctor’s office complaining about mood disorders.” Depression and anxiety in the community fell significantly. When it came to severe depression and other mental health disorders that were so bad the patient had to be hospitalized, there was a drop of 9 percent in just three years.

Why was that? “It just removed the stress, or reduced the stress, that people dealt with in their everyday lives,” Evelyn concludes. You knew you’d have a secure income next month, and next year, so you could create a picture of yourself in the future that was stable.

It had another unanticipated effect, she told me. If you know you have enough money to live on securely, no matter what happens, you can turn down a job that treats you badly, or that you find humiliating. “It makes you less of a hostage to the job you have, and some of the jobs that people work just in order to survive are terrible, demeaning jobs,” she says. It gave you “that little bit of power to say, I don’t need to stay here.” That meant that employers had to make work more appealing. And over time, it was poised to reduce inequality in the town, which we would expect to reduce the depression caused by extreme status differences.

For Evelyn, all this tells us something fundamental about the nature of depression. “If it were just a brain disorder,” she told me, “if it was just a physical ailment, you wouldn’t expect to see such a strong correlation with poverty,” and you wouldn’t see such a significant reduction from granting a guaranteed basic income. “Certainly,” she said, “it makes the lives of individuals who receive it more comfortable, which works as an antidepressant.”

As Evelyn looks out over the world today, and how it has changed from the Dauphin of the mid-1970s, she thinks the need for a program like this, across all societies, has only grown. Back then, “people still expected to graduate from high school and to go get a job and work at the same company [or] at least in the same industry until they’d be sixty-five, and then they’d be retired with a nice gold watch and a nice pension.” But “people are struggling to find that kind of stability in labor today, I don’t think those days are ever coming back. We live in a globalized world. The world has changed, fundamentally.” We won’t regain security by going backward, especially as robots and technology render more and more jobs obsolete, but we can go forward, to a basic income for everyone. As Barack Obama suggested in an interview late in his presidency, a universal income may be the best tool we have for recreating security, not with bogus promises to rebuild a lost world, but by doing something distinctively new.

Buried in those dusty boxes of data in the Canadian national archives, Evelyn might have found one of the most important antidepressants for the twenty-first century.

I wanted to understand the implications of this more, and to explore my own concerns and questions about it, so I went to see a brilliant Dutch economic historian named Rutger Bregman. He is the leading European champion of the idea of a universal basic income. We ate burgers and inhaled caffeinated drinks and ended up talking late into the night, discussing the implications of all this. “Time and again,” he said, “we blame a collective problem on the individual. So you’re depressed? You should get a pill. You don’t have a job? Go to a job coach, we’ll teach you how to write a résumé or [to join] LinkedIn. But obviously, that doesn’t go to the root of the problem. Not many people are thinking about what’s actually happened to our labor market, and our society, that these [forms of despair] are popping up everywhere.”

Even middle-class people are living with a chronic “lack of certainty” about what their lives will be like in even a few months’ time, he says. The alternative approach, a guaranteed income, is partly about removing this humiliation and replacing it with security. It has now been tried in many places on a small scale, as he documents in his book Utopia for Realists. There’s always a pattern, he shows. When it’s first proposed, people say, what, just give out money? That will destroy the work ethic. People will just spend it on alcohol and drugs and watching TV. And then the results come in.

For example, in the Great Smoky Mountains, there’s a Native American tribal group of eight thousand people who decided to open a casino. But they did it a little differently. They decided they were going to split the profits equally among everyone in the group, they’d all get a check for (as it turned out) $6,000 a year, rising to $9,000 later. It was, in effect, a universal basic income for everyone. Outsiders told them they were crazy. But when the program was studied in detail by social scientists, it turned out that this guaranteed income triggered one big change. Parents chose to spend a lot more time with their children, and because they were less stressed, they were more able to be present with their kids. The result? Behavioral problems like ADHD and childhood depression fell by 40 percent. I couldn’t find any other instance of a reduction in psychiatric problems in children by that amount in a comparable period of time. They did it by freeing up the space for parents to connect with their kids.

All over the world, from Brazil to India, these experiments keep finding the same result. Rutger told me: “When I ask people, ‘What would you personally do with a basic income?’ about 99 percent of people say, ‘I have dreams, I have ambitions, I’m going to do something ambitious and useful.’” But when he asks them what they think other people would do with a basic income, they say, oh, they’ll become lifeless zombies, they’ll binge-watch Netflix all day.

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. When Rutger asks people what they actually do at work, and whether they think it is worthwhile, he is amazed by how many people readily volunteer that the work they do is pointless and adds nothing to the world. The key to a guaranteed income, Rutger says, is that it empowers people to say no. For the first time, they will be able to leave jobs that are degrading, or humiliating, or excruciating. Obviously, some boring things will still have to be done. 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.

People will be free to create businesses based on things they believe in, to run projects to improve their community, to look after their kids and their elderly relatives. Those are all real work, but much of the time, the market doesn’t reward this kind of work. 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.”

This is, we have to be candid, an expensive proposal, a real guaranteed income would take a big slice of the national wealth of any developed country. At the moment, it’s a distant goal. But 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.

I was conscious, as I thought back over these seven provisional hints at solutions to our depression and anxiety, that they require huge changes, in ourselves, and in our societies. When I felt that way, a niggling voice would come into my head. It said, nothing will ever change. The forms of social change you’re arguing for are just a fantasy. We’re stuck here. Have you watched the news? You think positive changes are a-coming?

When these thoughts came to me, I always thought of one of my closest friends.

In 1993, the journalist Andrew Sullivan was diagnosed as HIV-positive. It was the height of the AIDS crisis. Gay men were dying all over the world. There was no treatment in sight. Andrew’s first thought was: I deserve this. I brought it on myself. He had been raised in a Catholic family in a homophobic culture in which, as a child, he thought he was the only gay person in the whole world, because he never saw anyone like him on TV, or on the streets, or in books. He lived in a world where if you were lucky, being gay was a punchline, and if you were unlucky, it got you a punch in the face.

So now he thought, ‘I had it coming. This fatal disease is the punishment I deserve.’

For Andrew, being told he was going to die of AIDS made him think of an image. He had once gone to see a movie and something went wrong with the projector, and the picture went all wrong, it displayed at a weird, unwatchable angle. It stayed like that for a few minutes. His life now, he realized, was like sitting in that cinema, except this picture would never be right again.

Not long after, he left his job as editor of one of the leading magazines in the United States, the New Republic. His closest friend, Patrick, was dying of AlDS, the fate Andrew was now sure awaited him.

So Andrew went to Provincetown, the gay enclave at the tip of Cape Cod in Massachussetts, to die. That summer, in a small house near the beach, he began to write a book. He knew it would be the last thing he ever did, so he decided to write something advocating a crazy, preposterous idea, one so outlandish that nobody had ever written a book about it before. He was going to propose that gay people should be allowed to get married, just like straight people. He thought this would be the only way to free gay people from the self-hatred and shame that had trapped Andrew himself. It’s too late for me, he thought, but maybe it will help the people who come after me.

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. Andrew was attacked not just by right-wingers, but by many gay left-wingers, who said he was a sellout, a wannabe heterosexual, a freak, for believing in marriage. A group called the Lesbian Avengers turned up to protest at his events with his face in the crosshairs of a gun. Andrew looked out at the crowd and despaired. This mad idea, his last gesture before dying, was clearly going to come to nothing.

When I hear people saying that the changes we need to make in order to deal with depression and anxiety can’t happen, I imagine going back in time, to the summer of 1993, to that beach house in Provincetown, and telling Andrew something:

Okay, Andrew, you’re not going to believe me, but this is what’s going to happen next. Twenty-five years from now, you’ll be alive. I know; it’s amazing; but wait, that’s not the best part. This book you’ve written, it’s going to spark a movement. And this book, it’s going to be quoted in a key Supreme Court ruling declaring marriage equality for gay people. And I’m going to be with you and your future husband the day after you receive a letter from the president of the United States telling you that this fight for gay marriage that you started has succeeded in part because of you. He’s going to light up the White House like the rainbow flag that day. He’s going to invite you to have dinner there, to thank you for what you’ve done. Oh, and by the way, that president? He’s going to be black.

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 it.

Every single person reading this is the beneficiary of big civilizing social changes that seemed impossible when somebody first proposed them. Are you a woman? My grandmothers weren’t even allowed to have their own bank accounts until they were in their forties, by law. Are you a worker? The weekend was mocked as a utopian idea when labor unions first began to fight for it. Are you black, or Asian, or disabled? You don’t need me to fill in this list.

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.

Every now and then, Rutger, the leading European campaigner for a universal basic income, will read a news story about somebody who has made a radical career choice. A fifty-year-old man realizes he’s unfulfilled as a manager so he quits, and becomes an opera singer. A forty-five-year-old woman quits Goldman Sachs and goes to work for a charity. “It is always framed as something heroic,” Rutger told me, as we drank our tenth Diet Coke between us. People ask them, in awe: “Are you really going to do what you want to do?” Are you really going to change your life, so you are doing something that fulfills you?

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?’”

. . .

from

Lost Connections. Uncovering the Real Causes of Depression and the Unexpected Solutions

by Johann Hari

get it at Amazon.com

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ADVERTISING SHITS IN YOUR HEAD. Reconnecting to Meaningful Values * JUNK VALUES. Consumerism literally is depressing – Johann Hari.

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

We are constantly bombarded with messages that we will feel better only if we buy some specific product; and then buy something more; and buy again, and on and on, until finally your family buys your coffin.

Can we turn off the autopilot, and take back control for ourselves?

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

When there is pollution in the air that makes us feel worse, we ban the source of the pollution.

Advertising is a form of mental pollution.

When I was trying to apply everything I had learned to change, in order to be less depressed, I felt a dull, insistent tug on me. I kept getting signals that the way to be happy is simple. Buy stuff. Show it off. Display your status. Acquire things. These impulses called to me, from every advertisement, and from so many social interactions. I had learned from Tim Kasser that these are junk values, a trap that leads only to greater anxiety and depression. But what is the way beyond them? I could understand the arguments against them very well. I was persuaded. But there they were, in my head, and all around me, trying to pull me back down.

But Tim, I learned, has been proposing two ways, as starters, to wriggle free. The first is defensive. And the second is proactive, a way to stir our different values.

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.

This isn’t an abstract idea. It has already been tried in many places. For example, the city of Sao Paulo, in Brazil, was being slowly smothered by billboards. They covered every possible space, gaudy logos and brands dominated the skyline wherever you looked. It had made the city look ugly, and made people feel ugly, by telling them everywhere they looked that they had to consume.

So in 2007 the city’s government took a bold step, they banned all outdoor advertising: everything. They called it the Clean City Law. As the signs were removed one by one, people began to see beautiful old buildings that had long been hidden. The constant ego-irritation of being told to spend was taken away, and was replaced with works of public art. Some 70 percent of the city’s residents say the change has made it a better place. I went there to see it, and almost everyone says the city seems somehow psychologically cleaner and clearer than it did before.

We could take this insight and go further. Several countries, including Sweden and Greece, have banned advertising directed at children. While I was writing this book, there was a controversy after a company marketing diet products put advertisements in the London Underground asking, ARE YOU BEACH BODY READY? next to a picture of an impossibly lithe woman. The implication was that if you are one of the 99.99 percent of humans who look less buff than this, you are not “ready” to show your flesh on the beach. There was a big backlash, and the posters were eventually banned. It prompted a wave of protests across London, where people defaced ads with the words “Advertising shits in your head.”

It made me think: Imagine if we had a tough advertising regulator who wouldn’t permit ads designed to make us feel bad in any way. How many ads would survive? That’s an achievable goal, and it would clear a lot of mental pollution from our minds.

This has some value in itself, but I think the fight for it could spur a deeper conversation. 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. My hunch is that, if we start to really talk about how this affects our emotional health, we will begin to see the need for more radical changes.

There was a hint of how this might start in an experiment that tried to go deeper, not just to block bad messages that divert our desires onto junk, but to see if we can draw out our positive values. This led to the second, and most exciting, path back that Tim has explored.

The kids were telling Nathan Dungan one thing, over and over again. They needed stuff. They needed consumer objects. And they were frustrated, outright angry, that they weren’t getting them. Their parents were refusing to buy the sneakers or designer clothes or latest gadgets that they needed to have, and it was throwing them into an existential panic. Didn’t their parents know how important it is to have all this?

Nathan didn’t expect to be having these conversations. He was a middle-aged man who had worked in financial services in Pennsylvania for years, advising people on investments. One day, he was talking to an educator at a middle school and she explained that the kids she was working with, middle-class, not rich, had a problem. They thought satisfaction and meaning came from buying objects. When their parents couldn’t afford them, they seemed genuinely distressed. She asked, could Nathan come in and talk to the kids about financial realities?

He agreed cautiously. But that decision was going to set him on a steep learning curve, and lead him to challenge a lot of what he took for granted.

Nathan went in believing his task was obvious. He was there to educate the kids, and their parents, about how to budget, and how to live within their financial means. But then he hit this wall of need, this ravenous hunger for stuff. To him, it was baffling. Why do they want it so badly? What’s the difference between the sneakers with the Nike swoosh and the sneakers without? Why would that gap be so significant that it would send kids into a panic?

He began to wonder if he should be talking not about how to budget, but why the teenagers wanted these things in the first place. And it went deeper than that. There was something about seeing teenagers craving apparently meaningless material objects that got Nathan to think, as adults, are we so different?

Nathan had no idea how to start that conversation, so he began to wing it. And it led to a striking scientific experiment, where he teamed up with Tim Kasser.

A short time later, in a conference room in Minneapolis, Nathan met with the families who were going to be the focus of his experiment. They were a group of sixty parents and their teenage kids, sitting in front of him on chairs. He was going to have a series of long sessions with them over three months to explore these issues and the alternatives. (At the same time, the experiment followed a separate group of the same size who didn’t meet with Nathan or get any other help. They were the experiment’s control group.)

Nathan started the conversation by handing everyone worksheets with a list of open-ended questions. He explained there was no right answer: he just wanted them to start to think about these questions. One of them said: “For me, money is …” and you had to fill in the blank.

At first, people were confused. They’d never been asked a question like this before. Lots of the participants wrote that money is scarce. Or a source of stress. Or something they try not to think about. They then broke into groups of eight, and began to contemplate their answers, haltingly. Many of the kids had never heard their parents talk about money worries before.

Then the groups began to discuss the question, why do I spend? They began to list the reasons why they buy necessities (which are obvious: you’ve got to eat), and then the reasons why they buy the things that aren’t necessities. Sometimes, people would say, they bought nonessential stuff when they felt down. 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.

As they explored this in the conversation, it became clear quite quickly, without any prompting from Nathan, that spending often isn’t about the object itself. It is about getting to a psychological state that makes you feel better. These insights weren’t deeply buried. People offered them quite quickly, although when they said them out loud, they seemed a little surprised. They knew it just below the surface, but they’d never been asked to articulate that latent feeling before.

Then Nathan asked people to list what they really value, the things they think are most important in life. Many people said it was looking after your family, or telling the truth, or helping other people. One fourteen-year-old boy wrote simply “love,” and when he read it out, the room stopped for a moment, and “you could hear a pin drop,” Nathan told me. “What he was speaking to was, how important is it for me to be connected?”

Just asking these two questions, “What do you spend your money on?” and “What do you really value?”, made most people see a gap between the answers that they began to discuss. They were accumulating and spending money on things that were not, in the end, the things that they believed in their heart mattered. Why would that be?

Nathan had been reading up on the evidence about how we come to crave all this stuff. He learned that the average American is exposed to up to five thousand advertising impressions a day, from billboards to logos on T-shirts to TV advertisements. It is the sea in which we swim. And “the narrative is that if you [buy] this thing, it’ll yield more happiness, and so thousands of times a day you’re just surrounded with that message,” he told me. He began to ask: “Who’s shaping that narrative?” It’s not people who have actually figured out what will make us happy and who are charitably spreading the good news. It’s people who have one motive only, to make us buy their product.

In our culture, Nathan was starting to believe, we end up on a materialistic autopilot. We are constantly bombarded with messages that we will feel better (and less stinky, and less disgustingly shaped, and less all-around worthless) only if we buy some specific product; and then buy something more; and buy again, and on and on, until finally your family buys your coffin. What he wondered is, if people stopped to think about this and discussed alternatives, as his group was doing, could we turn off the autopilot, and take back control for ourselves?

At the next session, he asked the people in the experiment to do a short exercise in which everyone had to list a consumer item they felt they had to have right away. They had to describe what it was, how they first heard about it, why they craved it, how they felt when they got it, and how they felt after they’d had it for a while. For many people, as they talked this through, something became obvious. The pleasure was often in the craving and anticipation. We’ve all had the experience of finally getting the thing we want, getting it home, and feeling oddly deflated, only to find that before long, the craving cycle starts again.

People began to talk about how they had been spending, and they were slowly seeing what it was really all about. Often, not always, it was about “filling a hole. It fills some sort of loneliness gap.” But by pushing them toward that quick, rapidly evaporating high, it was also nudging them away from the things they really valued and that would make them feel satisfied in the long run. They felt they were becoming hollow.

There were some people, both teens and adults, who rejected this fiercely. They said that the stuff made them happy, and they wanted to stick with it. But most people in the group were eager to think differently.

They began to talk about advertising. At first, almost everyone declared that ads might affect other people but didn’t hold much sway over them. “Everyone wants to be smarter than the ad,” Nathan said to me later. But he guided them back to the consumer objects they had longed for. Before long, members of the group were explaining to each other: “There’s no way they’re spending billions of dollars if it’s not having an impact. They’re just not doing that. No company is going to do that.”

So far, it had been about getting people to question the junk values we have been fed for so long.

But then came the most important part of this experiment.

Nathan explained the difference that I talked about before between extrinsic and intrinsic values. He asked people to draw up a list of their intrinsic values, the things they thought were important, as an end in themselves and not because of what you get out of it. Then he asked: How would you live differently if you acted on these other values? Members of the groups discussed it.

They were surprised. We are constantly encouraged to talk about extrinsic values, but the moments when we are asked to speak our intrinsic values out loud are rare. Some said, for example, they would work less and spend more time with the people they loved. Nathan wasn’t making the case for any of this. Just asking a few open questions took most of the group there spontaneously.

Our intrinsic motivations are always there, Nathan realized, lying “dormant. It was brought out into the light,” he said. Conversations like this, Nathan was realizing, don’t just happen “in our culture today. We don’t allow space or create space for these really critical conversations to take place, so it just creates more and more isolation.”

Now that they had identified how they had been duped by junk values, and identified their intrinsic values, Nathan wanted to know: could the group choose, together, to start to follow their intrinsic goals? Instead of being accountable to advertising, could they make themselves accountable to their own most important values, and to a group that was trying to do the same thing? Could they consciously nurture meaningful values?

Now that each person had figured out his or her own intrinsic goals, they would report back at the next series of meetings about what they’d done to start moving toward them. They held each other accountable. They now had a space in which they could think about what they really wanted in life, and how to achieve it. They would talk about how they had found a way to work less and see their kids more, for example, or how they had taken up a musical instrument, or how they had started to write.

Nobody knew whether all this would have any real effect, though. Could these conversations really reduce people’s materialism and increase their intrinsic values?

Independent social scientists measured the levels of materialism of the participants at the start of the experiment, and they measured them again at the end. As he waited for the results, Nathan was nervous. This was a small intervention, in the middle of a lifetime of constant consumerist bombardment. Would it make any difference at all?

When the results came through, both Nathan and Tim were thrilled. Tim had shown before that materialism correlates strongly with increased depression and anxiety. This experiment showed, for the first time, that it was possible to intervene in people’s lives in a way that would significantly reduce their levels of materialism. The people who had gone through this experiment had significantly lower materialism and significantly higher selfesteem. It was a big and measurable effect.

It was an early shot of proof that a determined effort to reverse the values that are making us so unhappy works.

The people who took part in the study could never have made these changes alone, Nathan believes. “There was a lot of power in that connection and that community for people, removing the isolation and the fear. There’s a lot of fear around this topic.” It was only together, as a group, that they there were able to “peel those layers away, so you could actually get to the meaning, to the heart: their sense of purpose.”

I asked Nathan if we could integrate this into our ordinary lives, if we all need to form and take part in a kind of Alcoholics Anonymous for junk values, a space where we can all meet to challenge the depression-generating ideas we’ve been taught and learn to listen instead to our intrinsic values. “I would say, without question,” he said. Most of us sense we have been valuing the wrong things for too long. We need to create, he told me, a “counter-rhythm” to the junk values that have been making us mentally sick.

From his bare conference room in Minneapolis, Nathan has proven something, that we are not imprisoned in the values that have been making us feel so lousy for so long. By coming together with other people, and thinking deeply, and reconnecting with what really matters, we can begin to dig a tunnel back to meaningful values.

Also on TPPA = CRISIS

JUNK VALUES. CONSUMERISM LITERALLY IS DEPRESSING

Johann Hari

Just as we have shifted en masse from eating food to eating junk food, we have also shifted from having meaningful values to having junk values.

All this mass-produced fried chicken looks like food, and it appeals to the part of us that evolved to need food; yet it doesn’t give us what we need from food, nutrition. Instead, it fills us with toxins.

In the same way, all these materialistic values, telling us to spend our way to happiness, look like real values; they appeal to the part of us that has evolved to need some basic principles to guide us through life; yet they don’t give us what we need from values, a path to a satisfying life.

Studies show that materialistic people are having a worse time, day by day, on all sorts of fronts. They feel sicker, and they are angrier. Something about a strong desire for materialistic pursuits actually affects their day-to-day lives, and decreases the quality of their daily experience. They experienced less joy, and more despair.

For thousands of years, philosophers have been suggesting that if you overvalue money and possessions, or if you think about life mainly in terms of how you look to other people, you will be unhappy.

Modern research indicates that materialistic people, who think happiness comes from accumulating stuff and a superior status, have much higher levels of depression and anxiety. The more our kids value getting things and being seen to have things, the more likely they are to be suffering from depression and anxiety.

The pressure, in our culture, runs overwhelmingly one way, spend more; work more. We live under a system that constantly distracts us from what’s really good about life. We are being propagandized to live in a way that doesn’t meet our basic psychological needs, so we are left with a permanent, puzzling sense of dissatisfaction.

The more materialistic and extrinsically motivated you become, the more depressed you will be.

JUNK VALUES. CONSUMERISM LITERALLY IS DEPRESSING – Johann Hari

. . .

from

Lost Connections. Uncovering the Real Causes of Depression and the Unexpected Solutions

by Johann Hari

get it at Amazon.com

DEPRESSION. It’s what’s Inside Your Head? – Johann Hari.

“Ask not what’s inside your head, ask what your head’s inside of” W. M. Mace.

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

How does your brain change when you are deeply distressed? Do those changes make it harder to recover? The real role of genes and brain changes.

The distress caused by the outside world, and the changes inside your brain come together. If the world keeps causing you deep pain, of course you’ll stay trapped there for a long time, with the snowball growing, your genes are activated by the environment. They can be switched on, or off, by what happens to you.

Genes increase your sensitivity, sometimes significantly. But they aren’t, in themselves, the cause of depression. Your genes can certainly make you more vulnerable, but they don’t write your destiny.

Marc Lewis’s friends thought he was dead.

It was the summer of 1969, and this young student in California was desperate to block out his despair any way he could. He had swallowed, snorted, or injected any stimulant he could find for a week now.

After he had been awake for thirty-six hours straight, he got a friend to inject him with heroin, so he could finally crash.

When Marc regained consciousness, he realized his friends were trying to figure out where they could find a bag big enough to dump his body in.

When Marc suddenly began to talk, they were freaked out. His heart, they explained to him, had stopped beating for several minutes.

About ten years after that night, Marc left drugs behind, and started to study neuroscience. He became a leading figure in the field, and a professor in the Netherlands.

He wanted to know: How does your brain change when you are deeply distressed? Do those changes make it harder to recover?

If you look at a brain scan of a depressed or highly anxious person it will look different from the brain scan of somebody without these problems. The areas that relate to feeling unhappy, or to being aware of risk, will be lit up like Christmas tree lights. They will be bigger, and more active.

Fifteen years ago, if you had shown me a diagram of my brain and described what it was like, I and most people, would have thought: that’s me, then. If the parts of the brain that relate to being unhappy, or being frightened, are more active, then I’m fixed as a person who is always going to be more unhappy, or more frightened. You might have short legs, or long arms; I have a brain with more active parts related to fear and anxiety; that’s how it is.

Wrong. To understand why we have to grasp a crucial concept called neuroplasticity.

Your brain changes according to how you use it. Neuroplasticity is the tendency for the brain to continue to restructure itself based on experience. Your brain is constantly changing to meet your needs. It does this mainly in two ways: by pruning the synapses you don’t use, and by growing the synapses you do use.

For as long as you live, this neuroplasticity never stops, and the brain is always changing.

A brain scan is a snapshot of a moving picture. You can take a snapshot of any moment in a football game, it doesn’t tell you what’s going to happen next, or where the brain is going. The brain changes as you become depressed and anxious, and it changes again when you stop being depressed and anxious. It’s always changing in response to signals from the world.

Social and psychological factors have the capacity to physically change your brain. Being lonely, or isolated, or grossly materialistic, these things change your brain, and, crucially, reconnection can change it back.

We have been thinking too simplistically. You couldn’t figure out the plot of Breaking Bad by dismantling your TV set. In the same way, you can’t figure out the root of your pain by dismantling your brain. You have to look at the signals the TV, or your brain, is receiving to do that.

They, the distress caused by the outside world, and the changes inside the brain come together.

Once this process begins, it, like everything else that happens to us, causes real changes in the brain, and they can then acquire a momentum of their own that deepens the effects from the outside world.

Imagine that your marriage just broke up, and you lost your job, and you know what? Your mother just had a stroke. It’s pretty overwhelming. Because you are feeling intense pain for a long period, your brain will assume this is the state in which you are going to have to survive from now on, so it might start to shed the synapses that relate to the things that give you joy and pleasure, and strengthen the synapses that relate to fear and despair. That’s one reason why you can often start to feel you have become somehow fixed in a state of depression or anxiety even if the original causes of the pain seems to have passed.

While it’s wrong to say the origin of these problems is solely within the brain, it would be equally wrong to say that the responses within the brain can’t make it worse. They can. The pain caused by life going wrong can trigger a response that is so powerful that the brain tends to stay there, in a pained response, for a while, until something pushes it out of that corner, into a more flexible place.

And if the world keeps causing you deep pain, of course you’ll stay trapped there for a long time, with the snowball growing.

How much of depression is carried in your genes?

I had assumed I inherited it in my genes. I sometimes thought of depression as a lost twin, born in the womb alongside me.

Scientists haven’t identified a specific gene or set of genes that can, on their own, cause depression and anxiety, but we do know there is a big genetic factor.

Scientists studying the genetic basis for depression and anxiety have concluded that it’s real, but it doesn’t account for most of what is going on. There is, however, a twist here.

A group of scientists led by a geneticist named Avshalom Caspi did one of the most detailed studies of the genetics of depression ever conducted. For twenty-five years, his team followed a thousand kids in New Zealand from being babies to adulthood. One of the things they were trying to figure out was which genes make you more vulnerable to depression.

Years into their work, they found something striking. They discovered that having a variant of a gene called 5-HTT does relate to becoming depressed.

Yet there was a catch. We are all born with a genetic inheritance, but your genes are activated by the environment. They can be switched on, or off, by what happens to you.

If you have a particular flavor of 5-HTT, you have a greatly increased risk of depression, but only in a certain environment. If you carried this gene, the study showed, you were more likely to become depressed, but only if you had experienced a terribly stressful event, or a great deal of childhood trauma.

If those bad things hadn’t happened to you, even if you had the gene that related to depression, you were no more likely to become depressed than anyone else.

So genes increase your sensitivity, sometimes significantly. But they aren’t, in themselves, the cause of depression.

This means that if other genes work like 5-HTT, and it looks as if they do, then nobody is condemned to be depressed or anxious by their genes.

Your genes can certainly make you more vulnerable, but they don’t write your destiny.

For example, we know that even if you are genetically more prone to put on weight, you still have to have lots of food in your environment for your genetic propensity to put on weight to kick in. Stranded in the rain forest or the desert with nothing to eat, you’ll lose weight whatever your genetic inheritance is.

Depression and anxiety, the current evidence suggests, are a little like that. The genetic factors that contribute to depression and anxiety are very real, but they also need a trigger in your environment or your psychology. Your genes can then supercharge those factors, but they can’t create them alone.

Endogenous Depression?

Is there some group of depressed people whose pain really is caused in just the way my doctor explained to me, by their brain wiring going wrong, or some other innate flaw? If it exists, how common is it?

It used to be thought that some depressions are caused by what happened to us in our lives, and then there is another, purer kind of depression that is caused by something going badly wrong in your brain. The first kind of depression was called “reactive,” and the second, purely internal kind was called “endogenous.”

Scientists have studied people who had been hospitalized for reactive depressions and compared them to people who had been classed as having endogenous depressions. It turned out that their circumstances were exactly the same: they had had an equal amount of things happen to them to trigger their despair. The distinction seemed, to them at that time, based on their evidence, to be meaningless.

There’s no agreement and scant evidence that endogenous depression actually exists, but researchers generally agree that if it exists at all, it’s a tiny minority of depressed people. This means that telling all depressed people a story that focuses only on these physical causes is a bad idea.

There are however situations, in addition to manic depression and bipolar disorder where we know that a biological change can make you more vulnerable. People with glandular fever, or underactive thyroids, are significantly more likely to become depressed.

It is foolish to deny there is a real biological component to depression and anxiety, and there may be other biological contributions we haven’t identified yet, but it is equally foolish to say they are the only causes.

Why then do we cling to the idea these problems are caused only by our brains.

Junk Values. You can have everything a person could possibly need by the standards of our culture, but those standards can badly misjudge what a human actually needs in order to have a good or even a tolerable life. Our culture creates a picture of what you “need” to be happy, through all the junk values we have been taught, that doesn’t fit with what we actually need.

Get a Grip. For a long time, depressed and anxious people have been told their distress is not real, that it is just laziness, or weakness, or self-indulgence.

The right-wing British pundit Katie Hopkins said depression is “the ultimate passport to self-obsession. Get a grip, people,” and added that they should just go out for a run and get over their moaning.

The way we have resisted this form of nastiness is to say that depression is a disease. You wouldn’t hector a person with cancer to pull themselves together, so it’s equally cruel to do it to somebody with the disease of depression or severe anxiety. The path away from stigma has been to explain patiently that this is a physical illness like diabetes or cancer.

We have come to believe that the only route out of stigma is to explain to people that this is a biological disease with purely biological causes. So, based on this positive motive, we have scrambled to find the biological effects, and held them up as evidence to rebut the sneerers.
“See! Even you admit it’s not a disease like cancer. So pull yourself together!”

But does saying something is a disease really reduce stigma?
Everybody knew, right from the start, that AIDS was a disease. It didn’t stop people with AIDS from being horribly stigmatized. People with AIDS are still stigmatized, greatly stigmatized. Nobody ever doubted leprosy was a disease, and lepers were persecuted for millennia.

Professor Sheila Mehta set up an experiment to figure out whether saying that something is a disease makes people kinder to the sufferer, or crueller.

Believing depression was a disease didn’t reduce hostility. In fact, it increased it.

“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.

Pills Pay Big

For decades, psychiatrists have, in their training, been taught something called the bio-psycho-social model. They are shown that depression and anxiety have three kinds of causes: 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.

Why? CASH!

It is much more politically challenging 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 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.”

The pharmaceutical companies are major forces shaping a lot of psychiatry, because it’s this big, big business, billions of dollars.

They pay the bills, so they largely set the agenda, and they obviously want our pain to be seen as a chemical problem with a chemical solution. The result is that we have ended up, as a culture, with a distorted sense of our own distress.

Just defective tissue!?

Telling people their distress is due mostly or entirely to a biological malfunction has several dangerous effects on them.

You leave the person disempowered, feeling they’re not good enough, because their brain’s not good enough.

Secondly: it pitches us against parts of ourselves. It says there is a war taking place in your head. On one side there are your feelings of distress, caused by the malfunctions in your brain or genes. On the other side there’s the sane part of you. You can only hope to drug the enemy within into submission, forever.

But it does something even more profound than that. It tells you that your distress has no meaning, it’s just defective tissue.

This is the biggest division between the old story about depression and anxiety and the new story. The old story says our distress is fundamentally irrational, caused by faulty apparatus in our head. The new story says our distress is, however painful, in fact rational, and Sane.

You’re not crazy to feel so distressed. You’re not broken.

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

from

Lost Connections. Uncovering the Real Causes of Depression and the Unexpected Solutions

by Johann Hari

get it at Amazon.com

JUNK VALUES. CONSUMERISM LITERALLY IS DEPRESSING – Johann Hari.

Just as we have shifted en masse from eating food to eating junk food, we have also shifted from having meaningful values to having junk values.

All this mass-produced fried chicken looks like food, and it appeals to the part of us that evolved to need food; yet it doesn’t give us what we need from food, nutrition. Instead, it fills us with toxins.

In the same way, all these materialistic values, telling us to spend our way to happiness, look like real values; they appeal to the part of us that has evolved to need some basic principles to guide us through life; yet they don’t give us what we need from values, a path to a satisfying life.

Studies show that materialistic people are having a worse time, day by day, on all sorts of fronts. They feel sicker, and they are angrier. Something about a strong desire for materialistic pursuits actually affects their day-to-day lives, and decreases the quality of their daily experience. They experienced less joy, and more despair.

For thousands of years, philosophers have been suggesting that if you overvalue money and possessions, or if you think about life mainly in terms of how you look to other people, you will be unhappy.

Modern research indicates that materialistic people, who think happiness comes from accumulating stuff and a superior status, have much higher levels of depression and anxiety. The more our kids value getting things and being seen to have things, the more likely they are to be suffering from depression and anxiety.

The pressure, in our culture, runs overwhelmingly one way, spend more; work more. We live under a system that constantly distracts us from what’s really good about life. We are being propagandized to live in a way that doesn’t meet our basic psychological needs, so we are left with a permanent, puzzling sense of dissatisfaction.

The more materialistic and extrinsically motivated you become, the more depressed you will be.

When I was in my late twenties, I got really fat. It was partly a side effect of antidepressants, and partly a side effect of fried chicken. I could still, from memory, talk you through the relative merits of all the fried chicken shops in East London that were the staples of my diet, from Chicken Cottage to Tennessee Fried Chicken (with its logo of a smiling cartoon chicken holding a bucket of fried chicken legs: who knew cannibalism could be an effective marketing tool?). My own favorite was the brilliantly named Chicken Chicken Chicken. Their hot wings were, to me, the Mona Lisa of grease.

One Christmas Eve, I went to my local branch of Kentucky Fried Chicken, and one of the staff behind the counter saw me approaching and beamed. “Johann!” he said. “We have something for you!” The other staff turned and looked at me expectantly. From somewhere behind the grill and the grizzle, he took out a Christmas card. I was forced, by their expectant smiles, to open it in front of them. “To our best customer,” it said, next to personal messages from every member of the staff.

I never ate at KFC again.

Most of us know there is something wrong with our physical diets. We aren’t all gold medalists in the consumption of lard like I was, but more and more of us are eating the wrong things, and it is making us physically sick. As I investigated depression and anxiety, I began to learn something similar is happening to our values, and it is making many of us emotionally sick.

This was discovered by an American psychologist named Tim Kasser, so I went to see him, to learn his story.

As a little boy, Tim arrived in the middle of a long stretch of swampland and open beaches. His dad worked as a manager at an insurance company, and in the early 1970s, he was posted to a place called Pinellas County, on the west coast of Florida. The area was mostly undeveloped and had plenty of big, broad outdoor spaces for a kid to play, but this county soon became the fastest growing in the entire United States, and it was about to be transformed in front of Tim’s eyes. “By the time I left Florida,” he told me, “it was a completely different physical environment. You couldn’t drive along the beach roads anymore and see the water, because it was all condos and high-rises. Areas that had been open land with alligators and rattlesnakes became subdivision after subdivision after shopping mall.”

Tim was drawn to the shopping malls that replaced the beaches and marshes, like all the other kids he knew. There, he would play Asteroids and Space Invaders for hours. He soon found himself longing for stuff, the toys he saw in ads.

It sounds like Edgware, where I am from. I was eight or nine when its shopping mall, the Broadwalk Centre, opened, and I remember wandering around its bright storefronts and gazing at the things I wanted to buy in a thrilled trance. I obsessively coveted the green plastic toy of Castle Grayskull, the fortress where the cartoon character He-Man lived, and Care-a-Lot, the home in the clouds of some animated creatures called the Care Bears. One Christmas, my mother missed my hints and failed to buy me Care-a-Lot, and I was crestfallen for months. I ached and pined for that lump of plastic.

Like most kids at the time, I spent at least three hours a day watching TV, usually more, and whole days would pass in the summer when my only break from television would be to go to the Broadwalk Centre and back again. I don’t remember anyone ever telling me this explicitly, but it seemed to me then that happiness meant being able to buy lots of the things on display there. I think my nine-year-old self, if you had asked him what it meant to be happy, would have said: somebody who could walk through the Broadwalk Centre and buy whatever he wanted. I would ask my dad how much each famous person I saw on television earned, and he would guess, and we would both marvel at what we would do with the money. It was a little bonding ritual, over a fantasy of spending.

I asked Tim if, in Pinellas County where he grew up, he ever heard anyone talking about a different way of valuing things, beyond the idea that happiness came from getting and possessing stuff. “Well, I think, not growing up. No,” he said. In Edgware, there must have been people who acted on different values, but I don’t think I ever saw them.

When Tim was a teenager, his swim coach moved away one summer and gave him a small record collection, and it included albums by John Lennon and Bob Dylan. As he listened to them, he realized they seemed to be expressing something he didn’t really hear anywhere else. He began to wonder if there were hints of a different way to live lying in their lyrics, but he couldn’t find anyone to discuss it with.

It was only when Tim went to study at Vanderbilt University, a very conservative college in the South, at the height of the Reagan years, that it occurred to him, slowly, to think more deeply about this. 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 pinatas 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.”

When he went to graduate school, he started to read a lot about psychology. It was around this time that Tim realized something odd.

For thousands of years, philosophers had been suggesting that if you overvalue money and possessions, or if you think about life mainly in terms of how you look to other people, you will be unhappy, that the values of Pinellas County and Edgware were, in some deep sense, mistaken. It had been talked about a lot, by some of the finest minds who ever lived, and Tim thought it might be true. But nobody had ever conducted a scientific investigation to see whether all these philosophers were right.

This realization is what launched him on a project that he was going to pursue for the next twenty-five years. It led him to discover subtle evidence about why we feel the way we do, and why it is getting worse.

It all started in grad school, with a simple survey.

Tim came up with a way of measuring how much a person really values getting things and having money compared to other values, like spending time with their family or trying to make the world a better place. He called it the Aspiration Index, and it is pretty straightforward. You ask people how much they agree with statements such as “It is important to have expensive possessions” and how much they agree with very different statements such as “It is important to make the world a better place for others.” You can then calculate their values.

At the same time, you can ask people lots of other questions, and one of them is whether they are unhappy or if they are suffering (or have suffered) from depression or anxiety. Then, as a first step, you see if they match.

Tim’s first tentative piece of research was to give this survey to 316 students. When the results came back and were all calculated out, Tim was struck by the results: materialistic people, who think happiness comes from accumulating stuff and a superior status, had much higher levels of depression and anxiety.

This was, he knew, just a primitive first shot in the dark. So Tim’s next step was, as part of a larger study, to get a clinical psychologist to assess 140 eighteen-year-olds in depth, calculating where they were on the Aspiration Index and if they were depressed or anxious. When the results were added up, they were the same: the more the kids valued getting things and being seen to have things, the more likely they were to be suffering from depression and anxiety.

Was this something that happened only with young people? To find out, Tim measured one hundred citizens of Rochester in upstate New York, who came from a range of age groups and economic backgrounds. The result was the same.

But how could he figure out what was really happening, and why?

Tim’s next step was to conduct a more detailed study, to track how these values affect you over time. He got 192 students to keep a detailed mood diary in which, twice a day, they had to record how much they were feeling nine different emotions, such as happiness or anger, and how much they were experiencing any of nine physical symptoms, such as backache. When he calculated out the results, he found, again, higher depression among the materialistic students; but there was a result more important than that. It really did seem that materialistic people were having a worse time, day by day, on all sorts of fronts. They felt sicker, and they were angrier. “Something about a strong desire for materialistic pursuits,” he was starting to believe, “actually affected the participants’ day-to-day lives, and decreased the quality of their daily experience.” They experienced less joy, and more despair.

Why would this be? What could be happening here? Ever since the 1960s, psychologists have known that there are two different ways you can motivate yourself to get out of bed in the morning. The first are called intrinsic motives, they are the things you do purely because you value them in and of themselves, not because of anything you get out of them. When a kid plays, she’s acting totally on intrinsic motives, she’s doing it because it gives her joy. The other day, I asked my friend’s five-year-old son why he was playing. “Because I love it,” he said. Then he scrunched up his face and said “You’re silly!” and ran off, pretending to be Batman. These intrinsic motivations persist all through our lives, long after childhood.

At the same time, there’s a rival set of values, which are called extrinsic motives. They’re the things you do not because you actually want to do them, but because you’ll get something in return, whether it’s money, or admiration, or sex, or superior status. Joe, who you met two chapters ago, went to work every day in the paint shop for purely extrinsic reasons, he hated the job, but he needed to be able to pay the rent, buy the Oxy that would numb his way through the day, and have the car and clothes that he thought made people respect him. We all have some motives like that.

Imagine you play the piano. If you play it for yourself because you love it, then you are being driven to do it by intrinsic values. If you play in a dive bar you hate, just to make enough cash to ensure you don’t get thrown out of your apartment, then you are being driven to do it by extrinsic values.

These rival sets of values exist in all of us. Nobody is driven totally by one or the other.

Tim began to wonder if looking into this conflict more deeply could reveal something important. So he started to study a group of two hundred people in detail over time. He got them to lay out their goals for the future. He then figured out with them if these were extrinsic goals, like getting a promotion, or a bigger apartment, or intrinsic goals, like being a better friend or a more loving son or a better piano player. And then he got them to keep a detailed mood diary.

What he wanted to know was, Does achieving extrinsic goals make you happy? And how does that compare to achieving intrinsic goals?

The results, when he calculated them out were quite startling. People who achieved their extrinsic goals didn’t experience any increase in day-to-day happiness, none. They spent a huge amount of energy chasing these goals, but when they fulfilled them, they felt the same as they had at the start, Your promotion? Your fancy car? The new iPhone? The expensive necklace? They won’t improve your happiness even one inch.

But people who achieved their intrinsic goals did become significantly happier, and less depressed and anxious. You could track the movement. As they worked at it and felt they became (for example) a better friend, not because they wanted anything out of it but because they felt it was a good thing to do, they became more satisfied with life. Being a better dad? Dancing for the sheer joy of it? Helping another person, just because it’s the right thing to do? They do significantly boost your happiness.

Yet most of us, most of the time, spend our time chasing extrinsic goals, the very thing that will give us nothing. Our whole culture is set up to get us to think this way. Get the right grades. Get the best-paying job. Rise through the ranks. Display your earnings through clothes and cars. That’s how to make yourself feel good.

What Tim had discovered is that the message our culture is telling us about how to have a decent and satisfying life, virtually all the time, is not true. The more this was studied, the clearer it became! Twenty-two different studies have 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. Similar studies, inspired by Tim’s work and using similar techniques, have now been carried out in Britain, Denmark, Germany, India, South Korea, Russia, Romania, Australia, and Canada-and the results, all over the world, keep coming back the same.

Just as we have shifted en masse from eating food to eating junk food, Tim has discovered, in effect, that we have shifted from having meaningful values to having junk values. All this mass-produced fried chicken looks like food, and it appeals to the part of us that evolved to need food; yet it doesn’t give us what we need from food, nutrition. Instead, it fills us with toxins.

In the same way, all these materialistic values, telling us to spend our way to happiness, look like real values; they appeal to the part of us that has evolved to need some basic principles to guide us through life; yet they don’t give us what we need from values, a path to a satisfying life. Instead, they fill us with psychological toxins. Junk food is distorting our bodies. Junk values are distorting our minds.

Materialism is KFC for the soul.

When Tim studied this in greater depth, he was able to identify at least four key reasons why junk values are making us feel so bad.

The first is that thinking extrinsically poisons your relationships with other people. He teamed up again with another professor, Richard Ryan, who had been an ally from the start, to study two hundred people in depth, and they found that the more materialistic you become, the shorter your relationships will be, and the worse their quality will be. If you value people for how they look, or how they impress other people, it’s easy to see that you’ll be happy to dump them if someone hotter or more impressive comes along. And at the same time, if all you’re interested in is the surface of another person, it’s easy to see why you’ll be less rewarding to be around, and they’ll be more likely to dump you, too. You will have fewer friends and connections, and they won’t last as long.

Their second finding relates to another change that happens as you become more driven by junk values. Let’s go back to the example of playing the piano. Every day, Tim spends at least half an hour playing the piano and singing, often with his kids. He does it for no reason except that he loves it, it makes him, on a good day, feel satisfied, and joyful. He feels his ego dissolve, and he is purely present in the moment. There’s strong scientific evidence that we all get most pleasure from what are called “flow states” like this, moments when we simply lose ourselves doing something we love and are carried along in the moment. They’re proof we can maintain the pure intrinsic motivation that a child feels when she is playing.

But when Tim studied highly materialistic people, he discovered they experience significantly fewer flow states than the rest of us. Why would that be?

He seems to have found an explanation. Imagine if, when Tim was playing the piano every day, he kept thinking: Am I the best piano player in Illinois? Are people going to applaud this performance? Am l going to get paid for this? How much? Suddenly his joy would shrivel up like a salted snail. Instead of his ego dissolving, his ego would be aggravated and jabbed and poked.

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.

This leads to a third reason why junk values make you feel so bad. When you are extremely materialistic, Tim said to me, “you’ve always kind of got to be wondering about yourself, how are people judging you?” It forces you to “focus on other people’s opinions of you, and their praise of you, and then you’re kind of locked into having to worry what other people think about you, and if other people are going to give you those rewards that you want. That’s a heavy load to bear, instead of walking around doing what it is you’re interested in doing, or being around people who love you just for who you are.”

If “your self-esteem, your sense of self-worth, is contingent upon how much money you’ve got, or what your clothes are like, or how big your house is,” you are forced into constant external comparisons, Tim says. “There’s always somebody who’s got a nicer house or better clothes or more money.” Even if you’re the richest person in the world, how long will that last? Materialism leaves you constantly vulnerable to a world beyond your control.

And then, he says, there is a crucial fourth reason. It’s worth pausing on this one, because I think it’s the most important.

All of us have certain innate needs, to feel connected, to feel valued, to feel secure, to feel we make a difference in the world, to have autonomy, to feel we’re good at something. Materialistic people, he believes, are less happy, because they are chasing a way of life that does a bad job of meeting these needs.

What you really need are connections. But what you are told you need, in our culture, is stuff and a superior status, and in the gap between those two signals, from yourself and from society, depression and anxiety will grow as your real needs go unmet.

You have to picture all the values that guide why you do things in your life, Tim said, as being like a pie. “Each value” you have, he explained, “is like a slice of that pie. So you’ve got your spirituality slice, and your family slice, and your money slice, and your hedonism slice. We’ve all got all the slices.” When you become obsessed with materialism and status, that slice gets bigger. And “the bigger one slice gets, the smaller other slices have to get.” So if you become fixated on getting stuff and a superior status, the parts of the pie that care about tending to your relationships, or finding meaning, or making the world better have to shrink, to make way.

“On Friday at four, I can stay [in my office] and work more, or I can go home and play with my kids,” he told me. “I can’t do both. It’s one or the other. If my materialistic values are bigger, I’m going to stay and work. If my family values are bigger, I’m going to go home and play with my kids.” It’s not that materialistic people don’t care about their kids, but “as the materialistic values get bigger, other values are necessarily going to be crowded out,” he says, even if you tell yourself they won’t.

And the pressure, in our culture, runs overwhelmingly one way, spend more; work more. We live under a system, Tim says, that constantly “distracts us from what’s really good about life.” We are being propagandized to live in a way that doesn’t meet our basic psychological needs, so we are left with a permanent, puzzling sense of dissatisfaction.

For millennia, humans have talked about something called the Golden Rule. It’s the idea that you should do unto others as you would have them do unto you. Tim, I think, has discovered something we should call the I-Want-Golden-Things Rule. The more you think life is about having stuff and superiority and showing it off, the more unhappy, and the more depressed and anxious, you will be.

But why would human beings turn, so dramatically, to something that made us less happy and more depressed? Isn’t it implausible that we would do something so irrational? In the later phase of his research, Tim began to dig into the question.

Nobody’s values are totally fixed. Your level of junk values, Tim discovered by following people in his studies, can change over your lifetime. You can become more materialistic, and more unhappy; or you can become less materialistic, and less unhappy. So we shouldn’t be asking, Tim believes, “Who is materialistic?” We should be asking: “When are people materialistic?” Tim wanted to know: What causes the variation?

There’s an experiment, by a different group of social scientists, that gives us one early clue. In 1978, two Canadian social scientists got a bunch of four and five year old kids and divided them into two groups. The first group was shown no commercials. The second group was shown two commercials for a particular toy. Then they offered these four or five year old kids a choice. They told them: You have to choose, now, to play with one of these two boys here. You can play with this little boy who has the toy from the commercials, but we have to warn you, he’s not a nice boy. He’s mean. Or you can play with a boy who doesn’t have the toy, but who is really nice.

If they had seen the commercial for the toy, the kids mostly chose to play with the mean boy with the toy. If they hadn’t seen the commercial, they mostly chose to play with the nice boy who had no toys.

In other words, the advertisements led them to choose an inferior human connection over a superior human connection, because they’d been primed to think that a lump of plastic is what really matters.

Two commercials, just two, did that. Today, every person sees way more advertising messages than that in an average morning. More eighteen-month-olds can recognize the McDonald’s M than know their own surname. By the time an average child is thirty-six months old she aIready knows a hundred brand logos.

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 he tracked the percentage of total US. 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.

A few years ago, an advertising agency head named Nancy Shalek explained approvingly: “Advertising at its best is making peopie feel that without their product, you’re a loser. Kids are very sensitive to that. You open up emotionaI vulnerabilities, and it’s very easy to do with kids because they’re the most emotionally vulnerable.”

This sounds harsh, until you think through the logic. Imagine if I watched an ad and it told me, Johann, you’re fine how you are. You look good. You smell good. You’re likable. People want to be around you. You’ve got enough stuff now. You don’t need any more. Enjoy life.

That would, from the perspective of the advertising industry, be the worst ad in human history, because I wouldn’t want to go out shopping, or lunge at my laptop to spend, or do any of the other things that feed my junk values. It would make me want to pursue my intrinsic values, which involve a whole lot less spending, and a whole lot more happiness.

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. Ads are the ultimate frenemy, they’re always saying: Oh babe, I want you to look/smell/feel great; it makes me so sad that at the moment you’re ugly/ stinking/miserable; here’s this thing that will make you into the person you and I really want you to be. Oh, did I mention you have to pay a few bucks? I just want you to be the person you deserve to be. Isn’t that worth a few dollars? You’re worth it.

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.”

He believes it also explains why junk values lead to such an increase in anxiety. “You’re always thinking: Are they going to reward me? Does the person love me for who I am, or for my handbag? Am I going to be able to climb the ladder of success?” he said. You are hollow, and exist only in other people’s reflections. “That’s going to be anxiety-provoking.”

We are all vulnerable to this, he believes. “The way I understand the intrinsic values,” 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.

As I sat with Tim, discussing all this for hours, I kept thinking of a middle-class married couple who live in a nice semidetached house in the suburbs in Edgware, where we grew up. They are close to me; I have known them all my life; I love them.

If you peeked through their window, you’d think they have everything you need for happiness, each other, two kids, a good home, all the consumer goods we’re told to buy. Both of them work really hard at jobs they have little interest in, so that they can earn money, and with the money they earn, they buy the things that we have learned from television will make us happy, clothes and cars, gadgets and status symbols. They display these things to people they know on social media, and they get lots of likes and comments like “OMG, so jealous!” After the brief buzz that comes from displaying their goods, they usually find they become dissatisfied and down again. They are puzzled by this, and they often assume it’s because they didn’t buy the right thing. So they work harder, and they buy more goods, display them through their devices, feel the buzz, and then slump back to where they started.

They both seem to me to be depressed. They alternate between being blank, or angry, or engaging in compulsive behaviors. She had a drug problem for a long time, although not anymore; he gambles online at least two hours a day. They are furious a lot of the time, at each other, at their children, at their colleagues, and, diffusely, at the world, at anyone else on the road when they are driving, for example, who they scream and swear at. They have a sense of anxiety they can’t shake off, and they often attach it to things outside them, she obsessively monitors where her teenage son is at any moment, and is afraid all the time that he will be a victim of crime or terrorism.

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.

Like the kids in the sandbox, they have been primed to lunge for objects and ignore the prospect of interaction with the people around them.

I see now they aren’t just suffering from the absence of something, such as meaningful work, or community. They are also suffering from the presence of something, an incorrect set of values telling them to seek happiness in all the wrong places, and to ignore the potential human connections that are right in front of them.

When Tim discovered all these facts, it didn’t just guide his scientific work. He began to move toward a life that made it possible for him to live consistent with his own findings, to go back, in a sense, to something more like the beach he had discovered joyfully in Florida as a kid. “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.”

So, with his wife and his two sons, he moved to a farmhouse on ten acres of land in Illinois, where they live with a donkey and a herd of goats. They have a small TV in the basement, but it isn’t connected to any stations or to cable, it’s just to watch old movies on sometimes. They only recently got the Internet (against his protestations), and they don’t use it much. He works part time, and so does his wife, “so we could spend more time with our kids, and be in the garden more and do volunteer work and do activism work and I could write more”, all the things that give them intrinsic satisfaction. “We play a lot of games. We play a lot of music. We have a lot of family conversations.” They sing together.

Where they live in western Illinois is “not the most exciting place in the world,” Tim says, “but I have ten acres of land, I have a twelve-minute commute with one flashing light and three stop signs on my way to my office, and we afford that on one [combined full-time] salary.”

I ask him if he had withdrawal symptoms from the materialistic world we were both immersed in for so long. “Never,” he says right away. “People ask me that: “Don’t you miss this? Don’t you wish you had that?” No, I don’t, because I am never exposed to the messages telling me that I should want it. I don’t expose myself to those things, so no, I don’t have that.”

One of his proudest moments was when one of his sons came home one day and said: “Dad, some kids at school are making fun of my sneakers.” They were not a brand name, or shiny-new. “Oh, what’d you say to them?” Tim asked. His son explained he looked at them and said: “Why do you care?” He was nonplussed, he could see that what they valued was empty, and absurd.

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 loving you because you gave them a big diamond ring.”

Most people know all this in their hearts, he believes. “At some level I really believe that most people know that intrinsic values are what’s going to give them a good life,” he told me. When you do surveys and ask people what’s most important in life, they almost always name personal growth and relationships as the top two. “But I think part of why people are depressed is that our society is not set up in order to help people live lifestyles, have jobs, participate in the economy, or participate in their neighborhoods” in ways that support their intrinsic values. The change Tim saw happening in Florida as a kid, when the beachfronts were transformed into shopping malls and people shifted their attention there, has happened to the whole culture.

Tim told me people can apply these insights to their own life, on their own, to some extent. “The first thing is for people to ask themselves, Am I setting up my life so I can have a chance of succeeding at my intrinsic values? Am I hanging out with the right people, who are going to make me feel loved, as opposed to making me feel like I made it? Those are hard choices sometimes.” But often, he says, you will hit up against a limit in our culture. You can make improvements, but often “the solutions to the problems that I’m interested in can’t be easily solved at the individual person level, or in the therapeutic consulting room, or by a pill.” They require something more, as I was going to explore later.

When I interviewed Tim, I felt he solved a mystery for me. I had been puzzled back in Philadelphia about why Joe didn’t leave the job he hated at the paint company and go become a fisherman in Florida, when he knew life in the Sunshine State would make him so much happier. It seemed like a metaphor for why so many of us stay in situations we know make us miserable.

I think I see why now. Joe is constantly bombarded with messages that he shouldn’t do the thing that his heart is telling him would make him feel calm and satisfied. The whole logic of our culture tells him to stay on the consumerist treadmill, to go shopping when he feels lousy, to chase junk values. He has been immersed in those messages since the day he was born. So he has been trained to distrust his own wisest instincts.

When I yelled after him “Go to Florida!” I was yelling into a hurricane of messages, and a whole value system, that is saying the exact opposite.

from

Lost Connections. Uncovering the Real Causes of Depression and the Unexpected Solutions

by Johann Hari

get it at Amazon.com

DEPRESSION, THE CHEMICAL IMBALANCE MYTH – Johann Hari * THE EMPEROR’S NEW DRUGS – Irving Kirsch.

There is a problem with what everyone knows about antidepressant drugs. It isn’t true. The whole idea of mental distress being caused simply by a chemical imbalance is “a myth,”, sold to us by the drug companies.

In the United States, 40 percent of the regulators’ wages are paid by the drug companies, and in Britain, it’s 100 percent. The rules they have written are designed to make it extraordinarily easy to get a drug approved.

“There was never any basis for it, ever. It was just marketing copy. At the time the drugs came out in the early 1990s, you couldn’t have got any decent expert to go on a platform and say, ‘Look, there’s a lowering of serotonin in the brains of people who are depressed’ There wasn’t ever any evidence for it.” It hasn’t been discredited, because “it didn’t ever get ‘credited.” We don’t know what a “chemically balanced” brain would look like. The effects of these drugs on depression itself are in reality tiny. No matter what chemical you tinker with, you get the same outcome. Antidepressants are little more than active placebos, drugs with very little specific therapeutic benefit, but with serious side effects.

What do the people taking these different drugs actually have in common? Only one thing: the belief that the drugs work, because you believe you are being looked after and offered a solution. Clever marketing over solid empirical evidence.

The serotonin theory “is a lie. I don’t think we should dress it up and say, ‘Oh, well, maybe there’s evidence to support that.’ There isn’t.” Most people on these drugs, after an initial kick, remain depressed or anxious. The belief that antidepressants can cure depression chemically is simply wrong.

The year after I swallowed my first antidepressant, Tipper Gore, the wife of Vice President Al Gore, explained to the newspaper USA Today why she had recently become depressed. “It was definitely a clinical depression, one that I was going to have to have help to overcome,” she said. “What I learned about is your brain needs a certain amount of serotonin and when you run out of that, it’s like running out of gas.” Tens of millions of people, including me, were being told the same thing.

When Irving Kirsch discovered that these serotonin boosting drugs were not having the effects that everyone was being sold, complete/nonfiltered FDA drug company study/research records show that the effects of these drugs on depression itself are in reality tiny, he began, to his surprise, to ask an even more basic question.

What’s the evidence, he began to wonder, that depression is caused primarily by an imbalance of serotonin, or any other chemical, in the brain? Where did it come from?

The serotonin story began, Irving learned, quite by accident in a tuberculosis ward in New York City in the clammy summer of 1952, when some patients began to dance uncontrollably down a hospital corridor. A new drug named Marsilid had come along that doctors thought might help TB patients. It turned out it didn’t have much effect on TB, but the doctors noticed it did something else entirely. They could hardly miss it. It made the patients gleefully, joyfully euphoric, some began to dance frenetically.

So it wasn’t long before somebody decided, perfectly logically, to try to give it to depressed people, and it seemed to have a similar effect on them, for a short time. Not long after that, other drugs came along that seemed to have similar effects (also for short periods), ones named Ipronid and Imipramine. So what, people started to ask, could these new drugs have in common? And whatever it was, could it hold the key to unlocking depression?

Nobody really knew where to look, and so for a decade the question hung in the air, tantalizing researchers. And then in 1965, a British doctor called Alec Coppen came up with a theory. What if, he asked, all these drugs were increasing levels of serotonin in the brain? If that were true, it would suggest that depression might be caused by low levels of serotonin.

“It’s hard to overstate just how far out on a limb these scientists were climbing,” Dr. Gary Greenberg, who has written the history of this period, explains. “They really had no idea what serotonin was doing in the brain.” To be fair to the scientists who first put forward the idea, he says, they put it forward tentatively, as a suggestion. One of them said it was “at best a reductionist simplification,” and said it couldn’t be shown to be true “on the basis of data currently available.”

But a few years later, in the 1970s, it was finally possible to start testing these theories. It was discovered that you can give people a chemical brew that lowers their serotonin levels. So if this theory was right, if low serotonin caused depression, what should happen? After taking this brew, people should become depressed. So they tried it. They gave people a drug to lower their serotonin levels and watched to see what would happen. And, unless they had already been taking powerful drugs they didn’t become depressed. In fact, in the vast majority of patients, it didn’t affect their mood at all.

I went to see one of the first scientists to study these new antidepressants in Britain, Professor David Healy, in his clinic in Bangor, a town in the north of Wales. He has written the most detailed history of antidepressants we have. When it comes to the idea that depression is caused by low serotonin, he told me: “There was never any basis for it, ever. It was just marketing copy. At the time the drugs came out in the early 1990s, you couldn’t have got any decent expert to go on a platform and say, ‘Look, there’s a lowering of serotonin in the brains of people who are depressed’ There wasn’t ever any evidence for it.” It hasn’t been discredited, he said, because “it didn’t ever get ‘credited,’ in a sense. There wasn’t ever a point in time when 50 percent of the field actually believed it.” In the biggest study of serotonin’s effects on humans, it found no direct relationships with depression. Professor Andrew Skull of Princeton has said attributing depression to low serotonin is “deeply misleading and unscientific.“

It had been useful in only one sense. When the drug companies wanted to sell antidepressants to people like me and Tipper Gore, it was a great metaphor. It’s easy to grasp, and it gives you the impression that what antidepressants do is restore you to a natural state, the kind of balance that everyone else enjoys.

Irving learned that once serotonin was abandoned by scientists (but certainly not by drug company PR teams) as an explanation for depression and anxiety, there was a shift in scientific research. Okay, they said: if it’s not low serotonin that’s causing depression and anxiety, then it must be the lack of some other chemical. It was still taken for granted that these problems are caused by a chemical imbalance in the brain, and antidepressants work by correcting that chemical imbalance. If one chemical turns out not to be the psychological killer, they must start searching for another one.

But Irving began to ask an awkward question. If depression and anxiety are caused by a chemical imbalance, and antidepressants work by fixing that imbalance, then you have to account for something odd that he kept finding. Antidepressant drugs that increase serotonin in the brain have the same modest effect, in clinical trials, as drugs that reduce serotonin in the brain. And they have the same effect as drugs that increase another chemical, norepinephrine. And they have the same effect as drugs that increase another chemical, dopamine. In other words, no matter what chemical you tinker with, you get the same outcome.

So Irving asked: What do the people taking these different drugs actually have in common? Only, he found, one thing: the belief that the drugs work. It works, Irving believes, largely for the same reason that John Haygarth’s wand worked: because you believe you are being looked after and offered a solution.

After twenty years researching this at the highest level, Irving has come to believe that the notion depression is caused by a chemical imbalance is just “an accident of history,” produced by scientists initially misreading what they were seeing, and then drug companies selling that misperception to the world to cash in.

And so, Irving says, the primary explanation for depression offered in our culture starts to fall apart. The idea you feel terrible because of a “chemical imbalance” was built on a series of mistakes and errors. It has come as close to being proved wrong, he told me, as you ever get in science. It’s lying broken on the floor, like a neurochemical Humpty Dumpty with a very sad smile.

I had traveled a long way with Irving on his journey but I stopped there, startled. Could this really be true? I am trained in the social sciences, which is the kind of evidence that I’ll be discussing in the rest of this book. I’m not trained in the kind of science he is a specialist in. I wondered if I was misunderstanding him, or if he was a scientific outlier. So I read all that I could, and I got as many other scientists to explain it to me as possible. “There’s no evidence that there’s a chemical imbalance” in depressed or anxious people’s brains, Professor Joanna Moncrieff, one of the leading experts on this question-explained to me bluntly in her office at the University College of London. The term doesn’t really make any sense, she said: we don’t know what a “chemically balanced” brain would look like. People are told that drugs like antidepressants restore a natural balance to your brain, she said, but it’s not true-they create an artificial state. The whole idea of mental distress being caused simply by a chemical imbalance is “a myth,” she has come to believe, sold to us by the drug companies.

The clinical psychologist Dr. Lucy Johnstone was more blunt still. “Almost everything you were told was bullshit,” she said to me over coffee. The serotonin theory “is a lie. I don’t think we should dress it up and say, ‘Oh, well, maybe there’s evidence to support that.’ There isn’t.”

Yet it seemed wildly implausible to me that something so huge, one of the most popular drugs in the world, taken by so many people all around me, could be so wrong. Obviously, there are protections against this happening: huge hurdles of scientific testing that have to take place before a drug gets to our bathroom cabinets. I felt as if I had just landed in a flight from JFK to LAX, only to be told that the plane had been flown by a monkey the whole way. Surely there are procedures in place to stop something like this from happening? How could these drugs have gotten through the procedures in place, if they were really as limited as this deeper research suggested?

I discussed this with one of the leading scientists in this field, Professor John Ioannidis, who the Atlantic Monthly has said “may be one of the most influential scientists alive.” He says it is not surprising that the drug companies could simply override the evidence and get the drugs to market anyway, because in fact it happens all the time. He talked me through how these antidepressants got from the development stage to my mouth.

It works like this: “The companies are often running their own trials on their own products,” he said. That means they set up the clinical trial, and they get to decide who gets to see any results. So “they are judging their own products. They’re involving all these poor researchers who have no other source of funding, and who have little control over how the results will be written up and presented.” Once the scientific evidence is gathered, it’s not even the scientists who write it up much of the time. “Typically, it’s the company people who write up the published scientific reports.”

This evidence then goes to the regulators, whose job is to decide whether to allow the drug onto the market. But in the United States, 40 percent of the regulators’ wages are paid by the drug companies, and in Britain, it’s 100 percent. When a society is trying to figure out which drug is safe to put on the market, there are meant to be two teams: the drug company making the case for it, and a referee working for us, the public, figuring out if it properly works. But Professor Ioannidis was telling me that in this match, the referee is paid by the drug company team, and that team almost always wins.

The rules they have written are designed to make it extraordinarily easy to get a drug approved. All you have to do is produce two trials, any time, anywhere in the world, that suggest some positive effect of the drug. If there are two, and there is some effect, that’s enough. So you could have a situation in which there are one thousand scientific trials, and 998 find the drug doesn’t work at all, and two find there is a tiny effect, and that means the drug will be making its way to your local pharmacy.

“I think that this is a field that is seriously sick,” Professor Ioannidis told me. “The field is just sick and bought and corrupted, and I can’t describe it otherwise.” I asked him how it made him feel to have learned all of this. “It’s depressing,” he said. That’s ironic, I replied. “But it’s not depressing,” he responded, “to the severe extent that I would take SSRIs [antidepressants].”

I tried to laugh, but it caught in my throat.

Some people said to Irving, so what? Okay, so say it’s a placebo effect. Whatever the reason, people still feel better. Why break the spell? He explained: the evidence from the clinical trials suggests that the antidepressant effects are largely a placebo, but the side effects are mostly the result of the chemicals themselves, and they can be very severe.

“Of course,” Irving says, there’s “weight gain.” I massively ballooned, and saw the weight fall off almost as soon as I stopped. “We know that SSRIs [the new type of antidepressants] in particular contribute to sexual dysfunction, and the rates for most SSRIs are around 75 percent of treatment-engendered sexual dysfunction,” he continued. Though it’s painful to talk about, this rang true for me, too. In the years I was taking Paxil, I found my genitals were a lot less sensitive, and it took a really long time to ejaculate. This made sex painful and it reduced the pleasure I took from it. It was only when I stopped taking the drug and I started having more pleasurable sex again that I remembered regular sex is one of the best natural antidepressants in the world.

“In young people, these chemical antidepressants increase the risk of suicide. There’s a new Swedish study showing that it increases the risk of violent criminal behavior,” Irving continued. “In older people it increases the risk of death from all causes, increases the risk of stroke. In everybody, it increases the risk of type 2 diabetes. In pregnant women, it increases the risk of miscarriage and of having children born with autism or physical deformities. So all of these things are known.” And if you start experiencing these effects, it can be hard to stop, about 20 percent of people experience serious withdrawal symptoms.

So, he says, “if you want to use something to get its placebo effect, at least use something that’s safe.” We could be giving people the herb St. John’s Wort, Irving says, and we’d have all the positive placebo effects and none of these drawbacks. Although, of course, St. John’s Wort isn’t patented by the drug companies, so nobody would be making much profit off it.

By this time, Irving was starting, he told me softly, to feel “guilty” for having pushed those pills for all those years.

In 1802, John Haygarth revealed the true story of the wands to the public. Some people are really recovering from their pain for a time, he explained, but it’s not because of the power in the wands. It’s because of the power in their minds. It was a placebo effect, and it likely wouldn’t last, because it wasn’t solving the underlying problem.

This message angered almost everyone? Some felt duped by the people who had sold the expensive wands in the first place, but many more felt furious with Haygarth himself, and said he was clearly talking rubbish. “The intelligence excited great commotions, accompanied by threats and abuse,” he wrote. “A counterdeclaration was to be signed by a great number of very respectable persons”, including some leading scientists of the day, explaining that the wand worked, and its powers were physical, and real.

Since Irving published his early results, and as he has built on them over the years, the reaction has been similar. Nobody denies that the drug companies’ own data, submitted to the FDA, shows that antidepressants have only a really small effect over and above placebo. Nobody denies that my own drug company admitted privately that the drug I was given, Paxil, was not going to work for people like me, and they had to make a payout in court for their deception.

But some scientists, a considerable number, do dispute many of Kirsch’s wider arguments. I wanted to study carefully what they say. I hoped the old story could still, somehow, be saved. I turned to a man who, more than anyone else alive, successfully sold antidepressants to the wider public, and he did it because he believed it: he never took a cent from the drug companies.

In the 1990s, Dr. Peter Kramer was watching as patient after patient walked into his therapy office in Rhode Island, transformed before his eyes after they were given the new antidepressant drugs. It’s not just that they seemed to have improved; they became, he argued, “better than well”, they had more resilience and energy than the average person. The book he wrote about this, Listening to Prozac, became the bestselling book ever about antidepressants. I read it soon after I started taking the drugs. I was sure the process Peter described so compellingly was happening to me. I wrote about it, and I made his case to the public in articles and interviews.

So when Irving started to present his evidence, Peter, by then a professor at Brown Medical School, was horrified. He started taking apart Irving’s critique of antidepressants at length, in public, both in books and in a series of charged public debates.

His first argument is that Irving is not giving antidepressants enough time. The clinical trials he has analyzed, almost all the ones submitted to the regulator, typically last for four to eight weeks. But that isn’t enough. It takes longer for these drugs to have a real effect.

This seemed to me to be an important objection. Irving thought so, too. So he looked to see if there were any drug trials that had lasted longer, to find their results. It turns out there were two, and in the first, the placebo did the same as the drug, and in the second, the placebo did better.

Peter then pointed to another mistake he believed Irving had made. The antidepressant trials that Irving is looking at lump together two groups: moderately depressed people and severely depressed people. Maybe these drugs don’t work much for moderately depressed people, Peter concedes, but they do work for severely depressed people. He’s seen it. So when Irving adds up an average for everyone, lumping together the mildly depressed and the severely depressed, the effect of the drugs looks small, but that’s only because he’s diluting the real effect, as surely as Coke will lose its flavor if you mix it with pints and pints of water.

Again, Irving thought this was a potentially important point, and one he was keen to understand, so he went back over the studies he had drawn his data from. He discovered that, with a single exception, he had looked only at studies of people classed as having very severe depression.

This then led Peter to turn to his most powerful argument. It’s the heart of his case against Irving and for antidepressants.

In 2012, Peter went to watch some clinical trials being conducted, in a medical center that looked like a beautiful glass cube, and gazed out over expensive houses.

When the company there wants to conduct trials into antidepressants, they have two headaches. They have to recruit volunteers who will swallow potentially dangerous pills over a sustained period of time, but they are restricted by law to paying only small amounts: between $40 and $75. At the same time, they have to find people who have very specific mental health disorders, for example, if you are doing a trial for depression, they have to have only depression and no other complicating factors. Given all that, it’s pretty difficult for them to find anyone who will take part, so they often turn to quite desperate people, and they have to offer other things to tempt them. Peter watched as poor people were bused in from across the city to be offered a gorgeous buffet of care they’d never normally receive at home, therapy, a whole community of people who’d listen to them, a warm place to be during the day, medication, and money that could double their poverty-level income.

As he watched this, he was struck by something. The people who turn up at this center have a strong incentive to pretend to have any condition they happen to be studying there, and the for-profit companies conducting the clinical trials have a strong incentive to pretend to believe them. Peter looked on as both sides seemed to be effectively bullshitting each other. When he saw people being asked to rate how well the drugs had worked, he thought they were often clearly just giving the interviewer whatever answer they wanted.

So Peter concluded that the results from clinical trials of antidepressants, all the data we have, are meaningless. That means Irving is building his conclusion that their effect is very small (at best) on a heap of garbage, Peter declared. The trials themselves are fraudulent.

It’s a devastating point, and Peter has proved it quite powerfully. But it puzzled Irving when he heard it, and it puzzled me. The leading scientific defender of antidepressants, Peter Kramer, is making the case for them by saying that the scientific evidence for them is junk.

When I spoke to Peter, I told him that if he is right (and I think he is), then that’s not a case for the drugs. It’s a case against them. It means that, by law, they should never have been brought to market.

When I started to ask about this, in a friendly tone Peter became quite irritable, and said even bad trials can yield usable results. He soon changed the subject. Given that he puts so much weight on what he’s seen with his own eyes, I asked Peter what he would say to the people who claimed that John Haygarth’s wand worked, because they, too, were just believing what they saw with their own eyes. He said that in cases like that, “the collection of experts isn’t as expert or as numerous as what we’re talking about here. I mean, this would be [an] orders-of-magnitude bigger scandal if these were [like] just bones wrapped in cloth.”

Shortly after, he said: “I think I want to cut off this conversation.”

Even Peter Kramer had one note of caution to offer about these drugs. He stressed to me that the evidence he has seen only makes the case for prescribing antidepressants for six to twenty weeks. Beyond that, he said, “I think that the evidence is thinner, and my dedication to the arguments is less as you get to long-term use. I mean, does anyone really know about what fourteen years of use does in terms of harm and benefit? I think the answer is we don’t really know.” I felt anxious as he said that, I had already told him that I used the drugs for almost that long. Perhaps because he sensed my anxiety, he added: “Although I do think we’ve been reasonably lucky. People like you come off and function.”

Very few scientists now defend the idea that depression is simply caused by low levels of serotonin, but the debate about whether chemical antidepressants work for some other reason we don’t fully understand, is still ongoing. There is no scientific consensus. Many distinguished scientists agree with Irving Kirsch; many agree with Peter Kramer. I wasn’t sure what to take away from all of this, until Irving led me to one last piece of evidence. I think it tells us the most important fact we need to know about chemical antidepressants.

In the late 1990s, a group of scientists wanted to test the effects of the new SSRI antidepressants in a situation that wasn’t just a lab, or a clinical trial. They wanted to look at what happens in a more everyday situation, so they set up something called the Star-D Trial. It was pretty simple. A normal patient goes to the doctor and explains he’s depressed. The doctor talks through the options with him, and if they both agree, he starts taking an antidepressant. At this point, the scientists conducting the trial start to monitor the patient. If the antidepressant doesn’t work for him, he’s given another one. If that one doesn’t work, he’s given another one, and on and on until he gets one that feels as though it works. This is how it works for most of us out there in the real world: a majority of people who get prescribed antidepressants try more than one, or try more than one dosage, until they find the effect they’re looking for.

And what the trial found is that the drugs worked. Some 67 percent of patients did feel better, just like I did in those first months.

But then they found something else. Within a year, half of the patients were fully depressed again. Only one in three of the people who stayed on the pills had a lasting, proper recovery from their depression. (And even that exaggerates the effect, since we know many of those people would have recovered naturally without the pills.)

It seemed like my story, played out line by line. I felt better at first; the effect wore off; I tried increasing the dose, and then that wore off, too. When I realized that antidepressants weren’t working for me any more, that no matter how much I jacked up the dose, the sadness would still seep back through, I assumed there was something wrong with me.

Now I was reading the Star-D Trial’s results, and I realized I was normal. My experience was straight from the textbook: far from being an outlier, I had the typical antidepressant experience.

This evidence has been followed up several times since, and the proportion of people on antidepressants who continue to be depressed is found to be between 65 and 80 percent.

To me, this seems like the most crucial piece of evidence about antidepressants of all: most people on these drugs, after an initial kick, remain depressed or anxious.

I want to stress, some reputable scientists still believe that these drugs genuinely work for a minority of people who take them, due to a real chemical effect. It’s possible. Chemical antidepressants may well be a partial solution for a minority of depressed and anxious people, I certainly don’t want to take away anything that’s giving relief to anyone. If you feel helped by them, and the positives outweigh the side effects, you should carry on. (And if you are going to stop taking them, then it’s essential that you don’t do it overnight, because you can experience severe physical withdrawal symptoms and a great deal of panic as a result. I gradually reduced my dose very slowly, over six months, in consultation with my doctor, to prevent this from happening.)

But it is impossible, in the face of this evidence, to say they are enough, for a big majority of depressed and anxious people.

I couldn’t deny it any longer: for the vast majority we clearly needed to find a different story about what is making us feel this way, and a different set of solutions. But what, asked myself, bewildered, could they be?

The Emperor’s New Drugs

Irving Kirsch

Everyone knows that antidepressant drugs are miracles of modern medicine. Professor Irving Kirsch knew this as well as anyone. But, as he discovered during his research, there is a problem with what everyone knows about antidepressant drugs. It isn’t true.

How did antidepressant drugs gain their reputation as a magic bullet for depression? And why has it taken so long for the story to become public? Answering these questions takes us to the point where the lines between clinical research and marketing disappear altogether.

Using the Freedom of Information Act, Kirsch accessed clinical trials that were withheld, by drug companies, from the public and from the doctors who prescribe antidepressants. What he found, and what he documents here, promises to bring revolutionary change to the way our society perceives, and consumes, antidepressants.

The Emperor’s New Drugs exposes what we have failed to see before: depression is not caused by a chemical imbalance in the brain; antidepressants are significantly more dangerous than other forms of treatment and are only marginally more effective than placebos; and, there are other ways to combat depression, treatments that don’t only include the empty promise of the antidepressant prescription.

This is not a book about alternative medicine and its outlandish claims. This is a book about fantasy and wishful thinking in the heart of clinical medicine, about the seductions of myth, and the final stubbornness of facts.

Irving Kirsch is a lecturer in medicine at the Harvard Medical School and a professor of psychology at Plymouth University, as well as professor emeritus of psychology at the University of Hull, and the University of Connecticut. He has published eight books and numerous scientific articles on placebo effects, antidepressant medication, hypnosis, and suggestion. His work has appeared in Science, Science News, New Scientist, New York Times, Newsweek, and BBC Focus and many other leading magazines, newspapers, and television documentaries.

Like most people, I used to think that antidepressants worked. As a clinical psychologist, I referred depressed psychotherapy clients to psychiatric colleagues for the prescription of medication, believing that it might help. Sometimes the antidepressant seemed to work; sometimes it did not. When it did work, I assumed it was the active ingredient in the antidepressant that was helping my clients cope with their psychological condition.

According to drug companies, more than 80 per cent of depressed patients can be treated successfully by antidepressants. Claims like this made these medications one of the most widely prescribed class of prescription drugs in the world, with global sales that make it a $19-billion-a-year industry. Newspaper and magazine articles heralded antidepressants as miracle drugs that had changed the lives of millions of people. Depression, we were told, is an illness a disease of the brain that can be cured by medication. I was not so sure that depression was really an illness, but I did believe that the drugs worked and that they could be a helpful adjunct to psychotherapy for very severely depressed clients. That is why I referred these clients to psychiatrists who could prescribe antidepressants that the clients could take while continuing in psychotherapy to work on the psychological issues that had made them depressed.

But was it really the drug they were taking that made my clients feel better? Perhaps I should have suspected that the improvement they reported might not have been a drug effect. People obtain considerable benefits from many medications, but they also can experience symptom improvement just by knowing they are being treated. This is called the placebo effect. As a researcher at the University of Connecticut, I had been studying placebo effects for many years. I was well aware of the power of belief to alleviate depression, and I understood that this was an important part of any treatment, be it psychological or pharmacological. But I also believed that antidepressant drugs added something substantial over and beyond the placebo effect.

As I wrote in my first book, ‘comparisons of antidepressive medication with placebo pills indicate that the former has a greater effect, the existing data suggest a pharmacologically specific effect of imipramine on depression’. As a researcher, I trusted the data as it had been presented in the published literature. I believed that antidepressants like imipramine were highly effective drugs, and I referred to this as ‘the established superiority of imipramine over placebo treatment’.

When I began the research that I describe in this book, I was not particularly interested in investigating the effects of antidepressants. But I was definitely interested in investigating placebo effects wherever I could find them, and it seemed to me that depression was a perfect place to look. Why did I expect to find a large placebo effect in the treatment of depression? If you ask depressed people to tell you what the most depressing thing in their lives is, many answer that it is their depression. Clinical depression is a debilitating condition. People with severe depression feel unbearably sad and anxious, at times to the point of considering suicide as a way to relieve the burden. They may be racked with feelings of worthlessness and guilt. Many suffer from insomnia, whereas others sleep too much and find it difficult to get out of bed in the morning. Some have difficulty concentrating and have lost interest in all of the activities that previously brought pleasure and meaning into their lives. Worst of all, they feel hopeless about ever recovering from this terrible state, and this sense of hopelessness may lead them to feel that life is not worth living. In short, depression is depressing. John Teasdale, a leading researcher on depression at Oxford and Cambridge universities, labelled this phenomenon ‘depression about depression’ and claimed that effective treatments for depression work at least in part by altering the sense of hopelessness that comes from being depressed about one’s own depression?!

Whereas hopelessness is a central feature of depression, hope lies at the core of the placebo effect. Placebos instil hope in patients by promising them relief from their distress. Genuine medical treatments also instil hope, and this is the placebo component of their effectiveness.

When the promise of relief instils hope, it counters a fundamental attribute of depression. Indeed, it is difficult to imagine any treatment successfully treating depression without reducing the sense of hopelessness that depressed people feel. Conversely, any treatment that reduces hopelessness must also assuage depression. So a convincing placebo ought to relieve depression.

It was with that in mind that one of my postgraduate students, Guy Sapirstein, and I set out to investigate the placebo effect in depression, an investigation that I describe in the first chapter of this book, and that produced the first of a series of surprises that transformed my views about antidepressants and their role in the treatment of depression. In this book I invite you to share this journey in which I moved from acceptance to dissent, and finally to a thorough rejection of the conventional view of antidepressants.

The drug companies claimed and still maintain that the effectiveness of antidepressants has been proven in published clinical trials showing that the drugs are substantially better than placebos (dummy pills with no active ingredients at all). But the data that Sapirstein and I examined told a very different story. Although many depressed patients improve when given medication, so do many who are given a placebo, and the difference between the drug response and the placebo response is not all that great.

What the published studies really indicate is that most of the improvement shown by depressed people when they take antidepressants is due to the placebo effect.

Our finding that most of the effects of antidepressants could be explained as a placebo effect was only the first of a number of surprises that changed my views about antidepressants. Following up on this research, I learned that the published clinical trials we had analysed were not the only studies assessing the effectiveness of antidepressants. I discovered that approximately 40 per cent of the clinical trials conducted had been withheld from publication by the drug companies that had sponsored them. By and large, these were studies that had failed to show a significant benefit from taking the actual drug. When we analysed all of the data, those that had been published and those that had been suppressed my colleagues and I were led to the inescapable conclusion that antidepressants are little more than active placebos, drugs with very little specific therapeutic benefit, but with serious side effects. I describe these analyses and the reaction to them in Chapters 3 and 4.

How can this be? Before a new drug is put on the market, it is subjected to rigorous testing. The drug companies sponsor expensive clinical trials, in which some patients are given medication and others are given placebos. The drug is considered effective only if patients given the real drug improve significantly more than patients given the placebos. Reports of these trials are then sent out to medical journals, where they are subjected to rigorous peer review before they are published. They are also sent to regulatory agencies, like the Food and Drug Administration (FDA) in the US, the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK and the European Medicine Agency (EMEA) in the EU. These regulatory agencies carefully review the data on safety and effectiveness, before deciding whether to approve the drugs for marketing. So there must be substantial evidence backing the effectiveness of any medication that has reached the market.

And yet I remain convinced that antidepressant drugs are not effective treatments and that the idea of depression as a chemical imbalance in the brain is a myth. When I began to write this book, my claim was more modest. I believed that the clinical effectiveness of antidepressants had not been proven for most of the millions of patients to whom they are prescribed, but I also acknowledged that they might be beneficial to at least a subset of depressed patients. During the process of putting all of the data together, those that I had analysed over the years and newer data that have just recently seen the light of day, I realized that the situation was even worse than I thought.

The belief that antidepressants can cure depression chemically is simply wrong.

In this book I will share with you the process by which I came to this conclusion and the scientific evidence on which it is based. This includes evidence that was known to the pharmaceutical companies and to regulatory agencies, but that was intentionally withheld from prescribing physicians, their patients and even from the National Institute for Health and Clinical Excellence (NICE) when it was drawing up treatment guidelines for the National Health Service (NHS).

My colleagues and I obtained some of these hidden data by using the Freedom of Information Act in the US. We analysed the data and submitted the results for peer review to medical and psychological journals, where they were then published. Our analyses have become the focus of a national and international debate, in which many doctors have changed their prescribing habits and others have reacted with anger and incredulity.

My intention in this book is to present the data in a plain and straightforward way, so that you will be able to decide for yourself whether my conclusions about antidepressants are justified.

The conventional view of depression is that it is caused by a chemical imbalance in the brain. The basis for this idea was the belief that antidepressant drugs were effective treatments. Our analysis showing that most if not all of the effects of these medications are really placebo effects challenges this widespread view of depression. In Chapter 4 I examine the chemical-imbalance theory. You may be surprised to learn that it is actually a rather controversial theory and that there is not much scientific evidence to support it. While writing this chapter I came to an even stronger conclusion. It is not just that there is not much supportive evidence; rather, there is a ton of data indicating that the chemical-imbalance theory is simply wrong.

The chemical effect of antidepressant drugs may be small or even non-existent, but these medications do produce a powerful placebo effect. In Chapters 5 and 6 I examine the placebo effect itself. I look at the myriad of effects that placebos have been shown to have and explore the theories of how these effects are produced. I explain how placebos are able to produce substantial relief from depression, almost as much as that produced by medication, and the implications that this has for the treatment of depression.

Finally, in Chapter 7, I describe some of the alternatives to medication for the treatment of depression and assess the evidence for their effectiveness. One of my aims is to provide essential scientifically grounded information for making informed choices between the various treatment options that are available.

Much of what I write in this book will seem controversial, but it is all thoroughly grounded on scientific evidence, evidence that I describe in detail in this book. Furthermore, as controversial as my conclusions seem, there has been a growing acceptance of them. NICE has acknowledged the failure of antidepressant treatment to provide clinically meaningful benefits to most depressed patients; the UK government has instituted plans for providing alternative treatments; and neuroscientists have noted the inability of the chemical-imbalance theory to explain depression. We seem to be on the cusp of a revolution in the way we understand and treat depression.

Learning the facts behind the myths about antidepressants has been, for me, a journey of discovery. It was a journey filled with shocks and surprises, surprises about how drugs are tested and how they are approved, what doctors are told and what is kept hidden from them, what regulatory agencies know and what they don’t want you to know, and the myth of depression as a brain disease. I would like to share that journey with you. Perhaps you will find it as surprising and shocking as I did. It is my hope that making this information public will foster changes in the way new drugs are tested and approved in the future, in the public availability of the data and in the treatment of depression.

1

Listening to Prozac, but Hearing Placebo

In 1995 Guy Sapirstein and I set out to assess the placebo effect in the treatment of depression. Instead of doing a brand-new study, we decided to pool the results of previous studies in which placebos had been used to treat depression and analyse them together. What we did is called a meta-analysis, and it is a common technique for making sense of the data when a large number of studies have been done to answer a particular question. It was once considered somewhat controversial, but meta-analyses are now common features in all of the leading medical journals. Indeed, it is hard to see how one could interpret the results of large numbers of studies without the aid of a meta-anaiysis.

In doing our meta-analysis, it was not enough to find studies in which depressed patients had been given placebos. We also needed to find studies in which depression had been tracked in patients who were not given any treatment at all. This was to make sure that any effect we found was really due to the administration of the placebo. To better understand the reason for this, imagine that you are investigating a new remedy for colds. If the patients are given the new medicine, they get better, if they are given placebos, they also get better. Seeing these data, you might be tempted to think that the improvement was a placebo effect. But people recover from colds even if you give them nothing at all. So when the patients in our imaginary study took a dummy pill and their colds got better, the improvement may have had nothing to do with the placebo effect. It might simply have been due to the passage of time and the fact that colds are short-lasting illnesses.

Spontaneous improvement is not limited to colds. It can also happen when people are depressed. Because people sometimes recover from bouts of depression with no treatment at all, seeing that a person has become less depressed after taking a placebo does not mean that the person has experienced a placebo effect. The improvement could have been due to any of a number of other factors. For example, people can get better because of positive changes in life circumstances, such as finding a job after a period of unemployment or meeting a new romantic partner. Improvement can also be facilitated by the loving support of friends and family. Sometimes a good friend can function as a surrogate therapist. In fact, a very influential book on psychotherapy bore the title Psychotherapy: The Purchase of Friendship. The author did not claim that psychotherapy was merely friendship, but the title does make the point that it can be very therapeutic to have a friend who is empathic and knows how to listen.

The point is that without comparing the effect of placebos against rates of spontaneous recovery, it is impossible to assess the placebo effect. Just as we have to control for the placebo effect to evaluate the effect of a drug, so too we have to control for the passage of time when assessing the placebo effect. The drug effect is the difference between what happens when people are given the active drug and what happens when they are given the placebo. Analogously, the placebo effect is the difference between what happens when people are given placebos and what happens when they are not treated at all.

It is rare for a study to focus on the placebo effect or on the effect of the simple passage of time, for that matter. So where were we to find our placebo data and no-treatment data? We found our placebo data in clinical studies of antidepressants, and our no-treatment data in clinical studies of psychotherapy. It is common to have no-treatment or wait-list control groups in studies of the effects of psychotherapy. These groups consist of patients who are not given any treatment at all during the course of the study, although they may be placed on a wait list and given treatment after the research is concluded.

For the purpose of our research, Sapirstein and I were not particularly interested in the effects of the antidepressants or psychotherapy. What we were interested in was the placebo effect. But since we had the treatment data to hand, we looked at them as well. And, as it turned out, it was the comparison of drug and placebo that proved to be the most interesting part of our study.

All told, we analysed 38 clinical trials involving more than 3,000 depressed patients. We looked at the average improvement during the course of the study in each of the four types of groups: drug, placebo, psychotherapy and no-treatment. I am going to use a graph here (Figure 1.1) to show what the data tell us. Although the text will have a couple more such charts, I am going to keep them to a minimum. But this is one that I think we need, to make the point clearly. What the graph shows is that there was substantial improvement in both the drug and psychotherapy groups. People got better when given either form of treatment, and the difference between the two was not significant. People also got better when given placebos, and here too the improvement was remarkably large, although not as great as the improvement following drugs or psychotherapy. In contrast, the patients who had not been given any treatment at all showed relatively little improvement.

The first thing to notice in this graph is the difference in improvement between patients given placebos and patients not given any treatment at all. This difference shows that most of the improvement in the placebo groups was produced by the fact that they had been given placebos. The reduction in depression that people experienced was not just caused by the passage of time, the natural course of depression or any of the other factors that might produce an improvement in untreated patients. It was a placebo effect. and it was powerful.

Figure 1.1. Average improvement on drug, psychotherapy, placebo and no treatment. ‘lmprovement’ refers to the reduction of symptoms on scales used to measure depression. The numbers are called ‘effect sizes’. They are commonly used when the results of different studies are pooled together. Typically, effect sizes of 0.5 are considered moderate, whereas effect sizes of 0.8 are considered large. So the graph shows that antidepressants, psychotherapy and placebos produce large changes in the symptoms of depression, but there was only a relatively small average improvement in people who were not given any treatment at all.
.

One thing to learn from these data is that doing nothing is not the best way to respond to depression. People should not just wait to recover spontaneously from clinical depression, nor should they be expected just to snap out of it. There may be some improvement that is associated with the simple passage of time, but compared to doing nothing at all, treatment even if it is just placebo treatment provides substantial benefit.

Sapirstein and I were not surprised to find that there was a powerful placebo effect in the treatment of depression. Actually, we were quite pleased. That was our hypothesis and our reason for doing the study. What did surprise us, however, was how small the difference was between the response to the drug and the response to the placebo. That difference is the drug effect. Although the drug effect in the published clinical trials that we had analysed was statistically significant, it was much smaller than we had anticipated. Much of the therapeutic response to the drug was due to the placebo effect.

The relatively small size of the drug effect was the first of a series of surprises that the antidepressant data had in store for us.

One way to understand the size of the drug effect is to think about it as only a part of the improvement that patients experience when taking medication. Part of the improvement might be spontaneous that is, it might have occurred without any treatment at all and part may be a placebo effect. What is left over after you subtract spontaneous improvement and the placebo effect is the drug effect. You can see in Figure 1.1 that improvement in patients who had been given a placebo was about 75 per cent of the response to the real medication. That means that only 25 per cent of the benefit of antidepressant treatment was really due to the chemical effect of the drug. It also means that 50 per cent of the improvement was a placebo effect. In other words, the placebo effect was twice as large as the drug effect.

The drug effect seemed rather small to us, considering that these medications had been heralded as a revolution in the treatment of depression, blockbuster drugs that have been prescribed to hundreds of millions of patients, with annual sales totalling billions of pounds: Sapirstein and I must have done something wrong in either collecting or analysing the data. But what? We spent months trying to figure it out.

ARE ALL DRUGS CREATED EQUAL? DOUBLEBLIND OR DOUBLE-TALK

One thing that occurred to us, when considering how surprisingly small the drug effect was in the clinical trials we had analysed, was that a number of different medications had been assessed in those studies. Perhaps some of them were effective, whereas others were not. If this were the case, we had underestimated the benefits of effective drugs by lumping them together with ineffective medications. So before we sent our paper out for review, we went back to the data and examined the type of drugs that had been administered in each of the clinical trials in our meta-analysis.

We found that some of these trials had assessed tricyclic antidepressants, an older type of medication that was the most commonly used antidepressant in the 1960s and 1970s. In other trials, the focus was on selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine), the first of the ‘new-generation’ drugs that replaced tricyclics as the top-selling type of antidepressant. And there were other types of antidepressants investigated in these trials as well. When we reanalysed the data, examining the drug effect and the placebo effect for each type of medication separately, we found that the diversity of drugs had not affected the outcome of our analysis. In fact, the data were remarkably consistent much more so than is usually the case when one analyses different groups of data. Not only did all of these medications produce the same degree of improvement in depression, but also, in each case, only 25 per cent of the improvement was due to the effect of the drug. The rest could be explained by the passage of time and the placebo effect.

The lack of difference we found between one class of antidepressants and another is now a rather frequent finding in antidepressant research. The newer antidepressants (SSRIs, for example) are no more effective than the older medications. Their advantage is that their side effects are less troubling, so that patients are more likely to stay on them rather than discontinue treatment. Still, the consistency of the size of the drug effect was surprising. It was not just that the percentages were close; they were virtually identical. They ranged from 24 to 26 per cent. At the time I thought, ‘What a nice coincidence! It will look great in a PowerPoint slide when I am invited to speak on this topic.’ But since then I have been struck by similar instances in which the consistency of the data is remarkable, and it is part of what has transformed me from a doubter to a disbeliever. I will note similar consistencies as we encounter them in this book.

The consistency of the effects of different types of antidepressants meant that we had not underestimated the antidepressant drug effect by lumping together the effects of more effective and less effective drugs. But our re-examination of the data in our meta-analysis held another surprise for us. Some of the medications we had analysed were not antidepressants at all, even though they had been evaluated for their effects on depression. One was a barbiturate, a depressant that had been used as a sleeping aid, before being replaced by less dangerous medications. Another was a benzodiazepine a sedative that has largely replaced the more dangerous barbiturates. Yet another was a synthetic thyroid hormone that had been given to depressed patients who did not have a thyroid disorder. Although none of these drugs are considered antidepressants, their effects on depression were every bit as great as those of antidepressants and significantly better than placebos. Joanna Moncrieff, a psychiatrist at University College London, has since listed other drugs that have been shown to be as effective as medications for depression. These include antipsychotic drugs, stimulants and herbal remedies. Opiates are also better than placebos, but I have not seen them compared to antidepressants.

If sedatives, barbiturates, antipsychotic drugs, stimulants, opiates and thyroid medications all outperform inert placebos in the treatment of depression, does this mean that any active drug can function as an antidepressant? Apparently not. In September 1998 the pharmaceutical company Merck announced the discovery of a novel antidepressant with a completely different mode of action than other medications for depression. This new drug, which they later marketed under the trade name Emend for the prevention of nausea and vomiting due to chemotherapy, seemed to show considerable promise as an antidepressant in early clinical trials. Four months later the company announced its decision to pull the plug on the drug as a treatment for depression. The reason? It could not find a significant benefit for the active drug over placebos in subsequent clinical trials.

This was unfortunate for a number of reasons. One is that the announcement caused a 5 per cent drop in the value of the company’s stock. Another is that the drug had an important advantage over current antidepressants, it produced substantially fewer side effects. The relative lack of side effects had been one reason for the enthusiasm about Merck’s new antidepressant. However, it may also have been the reason for its subsequent failure in controlled clinical trials. It seems that easily noticeable side effects are needed to show antidepressant benefit for an active drug compared to a placebo.

. . .

from

THE EMPEROR’S NEW DRUGS

by Irving Kirsch

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