From 1978-1994, American psychiatrists updated the Diagnostic and Statistical Manual (DSM) and included, in detail, all the symptoms of different mental illnesses so they could be identified and treated in the same way across the United States.
For example, they laid out nine symptoms that a patient had to show to be diagnosed with "depression." They did the same for countless other "mental illnesses." The manual was sent out to doctors across the US and they began to use it to diagnose people. However, doctors quickly complained that, if they followed this guide, they had to diagnose every grieving person who came to them as "depressed" or "anxious" and start giving them medications.
For example, if you lose someone, it turns out that all these "depression" symptoms will come to you automatically. So, the doctors wanted to know, are we supposed to start drugging all the bereaved people in America? The DSM authors said, oops, "depression" didn't apply to grief and granted a "grief exception."
Hmm. Doctors were confused. They were instructed by Big Pharma to tell patients that depression is just the result of a spontaneous chemical imbalance in your brain, a natural lack of some chemical, like Serotonin. It’s not caused by your life – it’s caused by your broken brain. How did this explain the grief exception? If you agree that the symptoms of depression are a logical and understandable response to one set of life circumstances – losing a loved one – might they not be an understandable response to other situations? What about if you lose your job? What if you are stuck in a job that you hate for the next 40 years? What if you are downsized and can't find meaningful work again? What about if you are alone and friendless? What if your wife or husband has an affair or leaves you? What if your children are drug addicts and living in your basement?
Drug companies would fund huge numbers of studies and then only release the ones that showed success for psychiatric medications. The rest were buried. We all know that when you take selfies, you take 30 pictures, throw away the 29 where you look bleary-eyed or double-chinned, and pick out the best one to be your Tinder profile picture. It turned out that the drug companies – who fund almost all the research into these drugs – were taking this approach to studying chemical antidepressants. They would fund huge numbers of studies, throw away all the ones that suggested the drugs had very limited effects, and then only release the ones that showed success.
The grief exception blasted a hole in the claim that the causes of depression are sealed away in your skull and caused by a chemical balance. They needed to hide the fact that depression is a natural response to life's ups and downs. So, Big Pharma and Big Psychiatry conned us in a sneaky way. With each new edition of the DSM manual they reduced the period of grief that you were allowed before being labelled "mentally ill" – down to a few months and then, finally, to nothing at all. Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness and depression at 10.01am and start drugging you straight away. Grieving people were IMMEDIATELY told they were "mentally ill" if showing any distress.
This debate reveals a key problem with how we talk about depression, anxiety and other forms of suffering: we don’t consider LIFE context at all. We act like human distress can be assessed solely on a checklist that can be separated out from our lives, and labeled as brain diseases. If we started to take people’s actual lives into account when we treat depression and anxiety it would require an entire system overhaul. When you have a person with extreme human distress, we need to stop treating the symptoms. The symptoms are a messenger of a deeper problem. Let’s get to the deeper problem.
Most people who take anti-depressants feel better for the first few months. Then the pain seeps back through. The dosage is increased or the medication changed. Still the pain breaks back through. If medication is a cure for depression, why are people still depressed when they are doing everything the psychiatrist tells them to do? Around 25% of US adults are taking at least one drug for a psychiatric problem. In Britain, antidepressant prescriptions have doubled in a decade. What has been causing depression and its twin, anxiety, to spiral in this way? How could it really be that in our separate heads, ALL of us had brain chemistries that were spontaneously malfunctioning at the same time? It turns out that between 65 and 80% of people on antidepressants are depressed again within a year.
What is the best scientific evidence about what really causes depression and anxiety? There are seven specific factors in the way we are living today are causing depression and anxiety to rise – alongside two real biological factors (such as your genes) that can combine with these forces to make it worse. How do we know depression is even caused by low serotonin at all? It turns out the evidence for that is strikingly shaky. Attributing depression to spontaneously low serotonin is deeply misleading and unscientific. There was never any basis for it, ever. It was just marketing copy. In 1993, Big Pharma released second-generation anti-depressants called Selective Serotonin Reuptake Inhibitors (SSRIs) to treat low serotonin. THEY MADE TRILLIONS OF DOLLARS OFF THIS MARKETING SCAM.
So what really causes depression? We all know that every human being has basic physical needs: for food, for water, for shelter, for clean air. It turns out that, in the same way, all humans have certain basic psychological needs. We need to feel we belong. We need to feel valued. We need to feel we’re good at something. We need to feel we have a secure future. And there is growing evidence that our culture isn’t meeting those psychological needs for many – perhaps most – people. We have become disconnected from things we really need, and this deep disconnection is driving this epidemic of depression and anxiety all around us.
There is strong evidence that human beings need to feel their lives are meaningful – that they are doing something with purpose that makes a difference. It’s a natural psychological need. But Gallup Polling says that 87% of people say they are NOT engaged in their work, are sleepwalking through their workday or actively HATE their jobs. Most of the depressed and anxious people are in the 87% who don’t like their work. It turns out if you have no control over your work or your home life, you are far more likely to become depressed. Humans have an innate need to feel that what we are doing, day-to-day, is meaningful. Also, the sharing of personal feelings (self-disclosure) plays a major role in the relief of stress and depression. Depression is a disease of loneliness and unmet needs.
Depression results from feeling controlled and unappreciated in your home and work environments. Finding an antidepressant doesn't mean finding a pill to change your brain chemistry. It means finding a way to solve the problem that is causing your depression in the first place. We need to move from focusing on chemical imbalances to focusing on life imbalances. This pain you are feeling is not a pathology. It’s not crazy. It is a signal that your natural psychological needs are not being met.
Exercise works almost as well as antidepressants for many people. And you don't have to run a marathon. Just take a walk with a friend. Join an exercise group or work out with a friend. You'll stay in touch and have support to keep yourself on track. As time goes on, move more until you exercise on most days of the week. You'll feel better physically, sleep better at night, and boost your mood. No specific foods treat depression, but a healthy diet helps depression.
If you are depressed and anxious, you are not a machine with malfunctioning parts. You are a human being with unmet needs. The only real way out of our epidemic of despair is for all of us, together, to begin to meet those human needs – for deep connection, to the things that really matter in life.
• This is an edited extract from Lost Connections: Uncovering the Real Causes of Depression
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