Tim Harford reviewed a new book, The Origins of Happiness, which argues that happiness should guide government policy. Richard Layard has long argued that depression is an avoidable disease which should be one of the top health priorities of government. Unfortunately, Americans have spent $11.3 billion on anti-depressants per year in the 2010s, but it hasn’t worked. Rates of depression have not decreased relative to where they were before we started medicating everyone. That is partly because anti-depressants don’t work long term for the vast majority of people. Traditional societies don’t have such high levels of depression like in the US. For example, the Amish have less trouble with depression than mainstream America and Costa Rica is happier than the US.
Johann Hari wrote a new book, Lost Connections, which explains that there are actually three causes of depression and America has almost exclusively focused on treating the biological cause with drugs which hasn’t worked out well. He wrote a fascinating article to make his case:
Derek Summerfield happened to be in Cambodia conducting some research on the psychological effects of unexploded land mines — at a time when chemical antidepressants were first being marketed in the country.
The local doctors didn’t know much about these drugs, so they asked Summerfield to explain them. When he finished, they explained that they didn’t need these new chemicals — because they already had antidepressants. Puzzled, Summerfield asked them to explain, expecting that they were going to tell him about some local herbal remedy. Instead, they told him about something quite different.
The doctors told Summerfield a story about a farmer they had treated. He worked in the water-logged rice fields, and one day he stepped on a land mine and his leg was blasted off. He was fitted with an artificial limb, and in time he went back to work. But it’s very painful to work when your artificial limb is underwater, and returning to the scene of his trauma must have made him highly anxious. The farmer became deeply depressed.
So the doctors and his neighbors sat with this man and talked through his life and his troubles. They realized that even with his new artificial limb, his old job — working in the paddies — was just too difficult, that he was constantly stressed and in physical pain, and that these things combined to make him want to just stop living. His interlocutors had an idea.
They suggested that he work as a dairy farmer, a job that would place less painful stress on his false leg and produce fewer disturbing memories. They believed he was perfectly capable of making the switch. So they bought him a cow. In the months and years that followed, his life changed. His depression, once profound, lifted. The Cambodian doctors told Summerfield: “You see, doctor, the cow was an analgesic, and antidepressant.”
…[There are three causes of depression]: biological (like your genes), psychological (how you think about yourself), and social (the wider ways in which we live together). Very few people dispute this. But when it comes to communicating with the public, and offering help, psychological solutions have been increasingly neglected, and environmental solutions have been almost totally ignored….
…Irving Kirsch, a professor of psychology who now teaches at Harvard Medical School, was initially a supporter of chemical antidepressants – but then he began to analyze this data, especially the data the drug companies had tried to keep hidden from the public. His research concluded that chemical antidepressants give you a boost, above the placebo effect, of 1.8 points on average on the Hamilton scale. This is less than a third of the boost that you get, by some estimates, from improving your sleep patterns… Although antidepressant prescriptions have increased 500 percent since the 1980s, there has been no discernible decrease in society-wide depression rates.
… But the scientists who study the social and psychological causes of these problems tend to see them differently. Far from being a malfunction, they see depression as partly or even largely a function, a necessary signal that our needs are not being met.
Everyone knows that human beings have innate physical needs — for food, water, shelter, clean air. There is equally clear evidence that human beings have innate psychological needs: to belong, to have meaning and purpose in our lives, to feel we are valued, to feel we have a secure future. Our culture is getting less good at meeting those underlying needs for a large number of people — and this is one of the key drivers of the current epidemic of despair.
… Using [standard medical] guidelines, every person who has lost a loved one — every grieving person — should be classed as mentally ill. The symptoms of depression and the symptoms of grief were identical.
Embarrassed, the psychiatric authorities came up with an awkward solution. They created something called “the grief exception.” They told doctors to keep using the checklist unless somebody the patient loved had recently died, in which case it didn’t count. But this led to a debate that they didn’t know how to respond to. Doctors were supposed to tell their patients that depression was a brain disease to be identified on a checklist — but now there was, uniquely, one life situation where that explanation didn’t hold.
Why, some doctors began to ask, should grief be the only situation in which deep despair is not a sign of a mental disorder that should be treated with drugs? What if you have lost your job? Your house? Your community? Once you entertain the idea that depression might be a reasonable response to some life circumstances …our theories about depression require “an entire system overhaul.”
Rather than do this, the psychiatric authorities simply got rid of the grief exception. Now grieving people can be diagnosed as mentally ill at once. Cacciatore’s research has found that about a third …of parents who lose a child are drugged with antidepressants or sedatives in the first 48 hours after the death.
…To those doctors in Cambodia, the concept of an “antidepressant” didn’t entail changing your brain chemistry, an idea alien to their culture. It was about the community empowering the depressed person to change his life.