217: this book explains why we’re actually depressed [mental health book club series]

Episode Transcript
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(00:00):
Welcome to She Persisted, the Gen.
Z mental health podcast. I'm your host, Sadie Sutton.
Let's get into it. When we think about as a society
why we see more depression and why this is becoming such a
common emotional experience. Johan presented a great quote,
which is that we're being propagandized to live in a way
that doesn't meet our basic psychological needs.
So we're left with a permanent, puzzling sense of

(00:20):
dissatisfaction. What do we reward a society?
It's those external markers. It's those external goals that
we all are in pursuit of. Hello, Hello you guys, and
welcome back to Super Assisted. I am really excited you're here
today. We are doing a solo and this is
the first of our book club series.
We are going to be going throughsome of my favorite books in the

(00:42):
mental health sphere that maybe you don't have time to read.
You're not a big reader and I'm going to share with you some of
my favorite learnings, quotes, findings from these books and
hopefully you'll be able to implement them in your own life.
I'm a huge reader. I have many a favorite book in
the mental health niche and category, so I'm really excited

(01:02):
to take you guys through these and we're starting with one of
my favorites. You guys have heard me talk
about so many times, which is Lost Connections by Yohan Hari.
This book is really a master class in the environmental
social factors that cause us to be depressed and really a new
way that we can think about and consider depression.
And how you can really feel hopeful as a result of that and

(01:25):
feel like you have a really concrete understanding of things
you can work to change and adjust and how you can set
yourself up for success from a preventative perspective.
So to give you guys a little background, Johann Ari is the
author of three New York Times best selling books.
His books have been translated into 40 languages and then
praised by a broad range of people from Oprah to Noam
Chomsky, from Elton John to Naomi Klein.

(01:46):
His first book is Chasing the Scream.
The second is Lost Connections, which we're talking about today.
His third book, Stolen Focus, and then he just released Magic
Pill this past year and we had him on the podcast to talk about
that. So anyways, huge fan his work,
but today we're focusing on LostConnections because this is one
of my favorite books that I've read about depression.
I think he just presents his arguments and such an

(02:07):
interesting way. The anecdotes that are included,
the research that was done is just really incredible.
And it's a lot of things that aren't like accepted as common
knowledge, which is really fascinating.
So let's dive into lost connections, why you're
depressed, and how to find hope by Yohanari.
So he starts this book with a sentiment which I really related
to in my experiences with depression.

(02:29):
And it's one of the first thingsI highlighted and annotated,
which is that my life was good. Sure, I had some problems, but I
had no reason to be unhappy, certainly not this unhappy.
And I think this is a sentiment that a lot of us can relate to
where there wasn't some huge shift that took place or a loss
or trauma that resulted in US feeling depressed.
So even though you know these feelings are real and they're

(02:51):
really debilitating and overwhelming, there's not a
'cause you can point to which you almost then end up in a
cycle of invalidation about why am I depressed?
I don't deserve to be depressed.I don't have a reason to feel
this way or there's definitely no reason for me to feel this
way to such an extreme. And not having a cause or a

(03:12):
reason you can point to almost increases and exacerbates that
distress. And so I think this book does a
great job of explaining what those causes are that we aren't
as familiar with, like a trauma or a loss or a huge shift that
took place in our life. And so we can kind of reach that
understanding of, OK, here's whyI feel this way.
Here's how I can address that. And I think the reasons that

(03:35):
Johan presents are really sound and backed in evidence and are
things that a lot of you guys will relate to.
So we're going to start with a little bit of a background on
depression as a whole, which is like the misconceptions that we
as a society have promoted and embrace and debunk those a bit.
And then we're going to dive into the actual causes that

(03:57):
Yohan presents, and then in tandem with that, the solutions
to counteract those. So in response to Johann's
experience of being depressed, struggling with mental health,
the solution presented to him byclinicians was medications,
antidepressants. I think this is a really common
first string of interventions that a lot of us have
experienced. The stat is that one in five US

(04:20):
adults have taken medication fora psychiatric problem.
That's 20% of us. That's a really large portion of
the population. So these are really widespread
intervention and the messaging here that this sends that we
kind of embrace and internalize is that if you have a broken
brain that can't generate the right happiness producing
chemicals, what is the point of asking questions about why we're

(04:41):
depressed, right? It's just the brain.
It's a, it's a broken problem related to our internal systems.
And so Johan explains that like it's, it's kind of cruel to ask
these questions. You wouldn't ask a dementia
patient where they left their keys because they don't know if
your brain is the problem. If it's like a broken internal
system, why would we even ask what are the environmental

(05:02):
causes of this depression? And so this is a larger theme
that he dives into, especially in the first part of the book,
which is like the chemical imbalance theory, right?
Like, your brain is lacking serotonin and dopamine.
Something's not working right inthe brain.
And the alternative, which is depression, is a signal that
something in your life isn't going right, right.

(05:24):
It's a totally valid, normal evolutionary response to
something being wrong in your life.
And So what can we do to addressand figure out and figure out
and navigate the cause of that depression in our life?
And there's been a lot of interesting research on this.
We had Doctor Hans Schroeder on the podcast.
He's the University of Michigan professor.
You guys should absolutely listen to that episode because

(05:46):
we talk a lot about this idea where the messaging around
depression specifically has a really strong relationship with
how people go through treatment,right?
So when we tell people that it'sa chemical imbalance, they feel
less hopeful about going to therapy and they get worse
results because they are like, this is a problem with my brain.
It's not a problem with me, it'snot a problem with my life.

(06:07):
So why would I go to therapy to fix something that is going to
be addressed by medication or that I can't solve by making
changes in my day-to-day life? Similarly, what we tell people
that depression is lifestyle factor, is it something that
you're doing, it's a problem with your day-to-day can be
really invalidating. And people can get defensive and
feel overwhelmed and they're like, I don't want to feel this

(06:27):
way. What do you mean?
I've done this to myself. And so there is a lot of nuance
around how do we talk about depression?
How do we explain depression to patients?
And this is a lot of parallels to like the DVT framework of
acceptance and change. It was so pivotal and getting
people that were really struggling with our mental
health to make meaningful shiftsand alleviate extreme suffering.

(06:47):
And so the idea that if a therapist goes to their patients
and says you just have to acceptthe situation is the cards
you've been dealt. The patient feels really upset.
And it's like, so you're not going to help me.
You're saying this is my fault. What do you mean?
And then when you tell people just change the situation,
they're like, do you not understand how painful this is?
How much I've tried to shift this, It's not working.

(07:08):
Like this isn't helpful either. But when you say like, we have
to deeply accept that this is really painful and uncomfortable
and not ideal and also look to see what we can change, They're
a lot more receptive in their responses and willing to change,
take steps towards recovery. So we're going to come back to
this idea of like, after all themisconceptions, where are we

(07:28):
left? How can we adjust this
messaging? But we're going to start talking
about antidepressants. But there's a huge disconnect
between like public understanding and what's
actually in the literature. And I'm sure this will shift in
coming years. But for now, I'm going to give
you like a brief overview, whichJohan also does in his book
because it's something that I don't think we widely
understand. Even if you're honored to

(07:49):
antidepressant or you have a family member or friend or
whatever it is. So there's a quote here that is
really powerful that Johann presents, which is that when you
are prescribing someone antidepressant, you're giving
her a drug which will usually have a chemical effect on her
body in some way, and you were giving her a story about how the
treatment will affect her. The story you tell is often just

(08:09):
as important as the drug itself.This is what we're talking
about, right? Like, what does it say to
patients? What are we telling patients
when we present them with a medical intervention for
depression and tells them that there's a chemical imbalance,
that this is out of their hand, that it's not an environmental
thing? And a big piece that's at play
here and a big mechanism of change in mental health is the

(08:31):
placebo effect. This is the idea that it's not
necessarily a result of the chemical intervention within the
drug itself, but how we're thinking about the drug, right?
Like, so if we expect to not feel depressed from an
antidepressant, for a lot of people, that belief in itself
allows change to take place. And it's not just a change in
how we feel, but physical effects happen in our bodies as

(08:53):
well. And the placebo effect is
fascinating. We have to do an episode at some
point about this because it truly knows no bounds.
And like how powerful the mind of the body are at when we
believe things they do become true and not just like in a woo
woo manifesty way, but like froman intervention standpoint.
But basically the TLDR here is that if you expect it to work
for many of us, it will. And So what that looks like in

(09:14):
the research that's been done isthat when you give patients
antidepressants, one in four is the natural recovery, right?
So like, if you didn't give people an intervention, if you
didn't prescribe them a medication, how would they feel
a year from now? How would they feel six weeks
from now? What's the natural course that
depression takes? So 25% is just naturally they
start to feel better. Two out of four people is the

(09:36):
story that you're told, or one in two people, I guess we should
say, is a story that you're toldthat placebo effect, right?
You expect it to work. So for many of us it will.
And I love the placebo effect from a mental health
perspective. And I think there's something
that gets lost in the conversation because when you
tell people that, yes, you're struggling and yes, this is
totally something that's not normal to experience and you're

(09:58):
in pain and you're distressed. And I see that so much.
Here's a prescription. Here's some medication to help
you treat this thing which is really overwhelming and
distressing and you shouldn't feel this way, and this will
help. The piece that gets lost here is
like, OK, we just believe it andthen things automatically shift.
There's also this element of what environmental changes do we
make when we feel like things are getting better or we expect

(10:20):
them to shift? Do you spend more time with
friends and family? Are you more consistent with
your sleep schedule? Are you eating more balanced?
Are you getting more movement inthroughout your day?
Are you more engaged with work or school or things that you're
passionate about? Like what environmental changes
do we make as a result of believing that this thing will
help us feel better and that we are feeling better, right?

(10:41):
So it's not just like the beliefthat things will change, but we
also take action based on the belief that we're getting better
and we will feel better. And that also in turn helps our
mental health. So the 25% of the effects is
just natural recovery, 50% is that placebo effect, the story
that we're told. So only 25% is that chemical
change that is addressing the serotonin production or the lack

(11:04):
of dopamine, whatever it is, right?
So 75% is not actually due to the intervention itself.
And the other piece that is helpful to consider here is that
almost all the studies that havebeen done on antidepressants are
done by the companies that produce these medications,
right? Like they have to prove that
they're effective to be able to put them on the market.
And so there hasn't been a lot of independent research on how

(11:28):
well antidepressants work and what the advocacy is
independently. And the interesting part of this
is that a lot of these studies are never published because they
don't show results. And I'm not trying to be like,
Oh my God, we're being lied to. Like the results are.
It's just helpful to know, right?
Like we don't even have access to all the information.
So about 40%, four out of 10 studies that are done by these

(11:49):
companies never actually get released or given to the public.
So on top of this idea that the studies that are released, we
know that 25% is natural recovery, 50% is the story
you're told, and 25% is actuallythe chemical reaction or the
chemical result that takes place.
In addition to that, 40% of the studies have never been

(12:09):
released, which we would assume that maybe they don't show the
effect that we would want to seeto support the efficacy of a
drug. The other thing is that to take
a drug to market, you have to show that it in a statistically
significant way performs better than the placebo.
So if people are given a placeboand mentally think that they're
taking the drug or they have their natural recovery, you have
to outperform the placebo to be able to take a drug to market.

(12:32):
So that's also helpful context to consider.
And like how are these drugs studied as being effective?
They just have to be better thandoing nothing.
So based on this background of like the placebo effect and what
the actual medications do from an intervention perspective,
when we look at all of the research on antidepressants as a
whole and all the research that's been done about the

(12:53):
chemical imbalance associated with depression, there's no
scientific basis to that. It's just marketing copy that
emerged at the beginning of the production and marketing of
antidepressants as an intervention.
There's no scientific basis to the chemical imbalance.
There's no such thing as your brain not having enough
serotonin or the threshold of serotonin you require to be

(13:16):
produced isn't being met and that's why you're depressed.
There's no scientific or research basis to this idea that
a chemical imbalance is what causes depression.
And we've done a lot of researchon this.
We've done a lot of studies independent of these drug
companies, done by drug companies.
And there just is not research that supports this idea, which
I'm sure you're listening to this and you're like, this

(13:36):
sounds really suicide. What are you?
No, like if you read the research, if you read the
articles, if you read the meta analysis, there's not research
that supports the chemical imbalance theory.
That's not why we're depressed. It truly was marketing copy.
That was a great way to explain to people why this intervention
would help you being depressed, which is that there's a problem

(13:57):
in your brain. It's not balanced, you don't
have enough chemicals. And this pill will help you get
back to that level of equilibrium, will reach that
balance again. And here's the intervention that
will help your depression. And the thing about this
chemical imbalance theory is that it does serve a purpose,
right? It's really validating.
It tells us that we're not lazy,we're not wrong, we're not
insufficient. It's a biological issue, right?

(14:19):
It's not your fault that you're depressed.
Your brain's doing something wrong.
And when you're so overwhelmed and distressed and exhausted
from suffering with mental health issue, hearing that it's
not your fault, it's your brain is incredibly validating, right?
So it does serve a purpose. It also might help reduce
stigma, right? Like it's not the person, it's
not the behaviors or the choicesthey're making or them and who

(14:39):
they are. It's their brain.
But this isn't necessarily true when we look at the research.
So Johann presents some really interesting research about how
people interact, like how hostile they are towards people
with mental illnesses. If they're told it's like a
biological issue, it's their brain versus if it's like a
social issue, something happenedto them, they were traumatized,

(15:01):
right? So like, is it something they
went through or is it a biological issue?
Is it a chemical imbalance? And what they found is that when
people are told that the reason someone is struggling from a
mental illness is because of a disease, you're more hostile.
People are more hostile to people where it's like it's a
chemical imbalance. It's a problem with the right.
So it doesn't necessarily increase stigma, even though we

(15:22):
might think that it would if we understand that it's not your
fault, it's just something internal.
But it doesn't change in a meaningful way how we treat
people. And so we end up with this
question, right? So is it is it a moral failing
that we just as people are making ourselves depressed?
Or is it a brain disease, right?Like is it not our fault?
It's something's going wrong internally.
And there's this new kind of perspective that we can come at

(15:45):
it with. And there's been a lot of
research that's been done on this.
And we talked about pawn Schroeder work.
We talked about your own Harvey's work that he presents
in this book. It's a signal.
It's a sign that something in our life is not going the way it
should be. And we are responding in a
completely evolutionarily, emotionally, socially
proportionate way by feeling depressed.
And some people will say our needs aren't being met.

(16:07):
The way you hand frames this is that that we are experiencing
disconnection on different levels.
And we'll get through all those different areas of disconnection
and what they mean and the examples he presents.
But this is an interesting idea when we think about depression
has a signal because it suggeststhat as humans, we universally
are vulnerable to this, right? Like if we don't get these needs

(16:27):
met, we will feel depressed. And we'll all feel that way if
we are not living our lives in away that gets these basic needs
met. And then the last piece that
we're going to talk about, aboutthis chemical imbalance copy and
idea is that it can be really disempowering, right?
So when we are told that your distress has no meaning, right?
So you're feeling depressed because of something in your
brain. It's not your relationships,

(16:48):
it's not your job, it's not the school you're at, it's not any
of those things. It's just your brain that can be
really disempowering. And again, like Johann says, it
sends the message that your distress has no meaning, even
though it can be somewhat validating, being like, it's not
your fault, I know you're tryingand this is happening Despite
that. It also can be really
disempowering and invalidating to say it's actually not your

(17:10):
life. You should feel fine based on
the life you're living. It's just a disease.
It's just a chemical imbalance, just your brain.
And so when we say no, your distress does have meaning, it
makes sense you feel this way. You're not getting these needs
met. That can be really empowering in
turn, when we truly listen to and value and take meaning from

(17:30):
that signal that we're getting with regard to feeling
depressed. So again, you're probably like,
OK, like I'm buying into this whole signal thing.
I get it. It's a better way to frame
depression. It makes more sense.
But you're like, but all I've heard my entire life is
depression is a chemical imbalance.
I'm not buying this thing that there's no evidence to support
that. Sadie, give me more because

(17:51):
there's no way that's true. That's all I've ever heard.
So there has been extensive studies, like I've said, and
there's no direct relationship between serotonin levels and
depression. It just doesn't exist no matter
how many times we study it, no matter how many populations we
look at the relationship betweendepression and serotonin, which
most antidepressants that you take are selective serotonin

(18:12):
reoptic inhibitors. So what they do is they inhibit
the reoptake of serotonin. So if you think about like a
hose and serotonin is coming through the hose, and if you're
spraying a hose on grass, the grass will absorb the water,
right? So then you can keep spraying
water. The water will keep being
absorbed by the grass. What selective serotonin

(18:33):
reuptake inhibitors do is that they kind of turn the grass into
concrete. So instead of absorbing the
serotonin, they're not allowed to be reuptaked.
So as you spray your hose onto the water, it starts to pool it
sit there. There's more serotonin in that
neurosynaptic gap, right in the neurosynaptic left.

(18:53):
I think it might actually be called, I took like 1 cognitive
neuroscience class in college. So basically what selective
serotonin reuptake inhibitors dois that they make serotonin
harder to be absorbed. So there's more floating around
in your brain, the concentrationincreases, it doesn't absorb it
as much as it used to. And so instead of being
reuptake, it inhibits the reuptake and more serotonin is

(19:16):
present. So they've done research on this
and again, there's no statistical relationship.
There's no connection between your level of serotonin and
depression just doesn't exist. And you might be like, well,
maybe it's dopamine, maybe it's neuro epinephrine, like maybe
it's cortisol, maybe it's these other things.
Nope. When they study the level of

(19:37):
dopamine in the brain and depression, no relationship.
When they study the relationship, neuro epinephrine
and depression, no relationship.The caveat that I will give
here, we talked about placebo effect, we talked about natural
recovery. The studies that have been done
on antidepressants, they do showthat the magnitude of benefit
when compared to placebo is better and severely depressed

(19:57):
individuals. So when you take someone who is
like subclinical or moderate depression, they don't benefit
as much from the antidepressantsas severely depressed.
Individuals, but the bulk of therelationship, the bulk of the
effect size is not from the intervention of antidepressant,
but there's more effect in this population.
So I do want to give that caveat, Right.

(20:18):
It's not like antidepressants 100% don't work.
They don't work for anyone. It's a huge hoax.
There is a small effect size. It does work better in severely
depressed populations. There are other mechanisms
through which antidepressants can cause change and promote
hope and agency. But I do want to add that caveat
that we know antidepressants don't really work for

(20:38):
subclinical depression, moderatedepression, it really isn't
effective as an intervention. For severely depressed, the
effect is more significant. And then another important piece
of data that Johann presents is that 65 to 80% of people that go
on antidepressants continue to be depressed.
And this isn't like totally, completely insane within the
mental health world of interventions, right?
Like when we look at all the effect sizes of talk therapy or

(21:03):
psychotherapy, going to see a therapist and talking through
your problems, it's about a 50% chance of that works, right?
So like one and two people that will work for most people see a
huge number of therapists beforethey find ones that work.
So the idea that people that arereceiving this intervention as a
first line intervention, or maybe it's the second thing
they've tried, the idea that 65 to 80% of them continue to be

(21:24):
depressed. I wouldn't say that that's
crazy. But when you are hearing that,
it might be like, wow, that's a little bit fascinating.
And then the other thing that I'll mention here, while we're
talking about effect sizes and things that we see in the
research is that the side effects are really, really real.
And Johan mentions this in the book as something that people
also should consider, which is that while the chemical effects
of antidepressants are murky in some context and not totally

(21:48):
solidified and not totally established as a correlational
relationship, we do know that the side effects that people
experience from antidepressants are really real and can add
additional distress. And so it's also something to
consider when using this as an intervention.
So why don't we just throw this out the window, right?
Like, why don't we just completely abandoned this and
ignore this? Why is this something that we're
using as an intervention and in such a widespread context,

(22:11):
right? Like, why are one in five adults
taking psychiological medications for mental illnesses
if the effect sizes are really misunderstood or misconstrued or
unknown? And Johann has a really
beautiful quote that encapsulates this.
And I think again, adds new onesto this, this story, which is
that giving a person a story about why they're in pain is one
of the most powerful things thatyou can ever do.

(22:33):
And hearing this quote, I'm like, yes, absolutely, 100%.
And this is one of the reasons why we're doing this episode.
But it's also one of the reasonswhy I do the podcast, which is
that I'm really incredibly passionate about explaining
these things and helping you guys understand why these things
happen in our mental health and why we feel the way that we do.
And that there are explanations and there are ways to understand

(22:54):
this. And then in turn shift these
behaviors and adjust our lived experiences and build our life
worth living. And so my goal with the podcast,
but also in this episode in particular, is can we explain
why these things happen when we're depressed?
Can we increase our understanding collectively?
And can we create that story, right?
Can we give ourselves a story for why we're in pain And give

(23:15):
ourselves that power back to make changes that are lasting
and meaningful and really profound?
And there's some interesting kind of other things that Johann
presents within the first part of the book, which I want to go
through before we dive into the causes of depression.
One is the grief exception. So when the DSM was created,
there was this exception writtenin for depression, which is that

(23:37):
if you lost a loved 1A year ago,you cannot be classified as
depressed because there's a reason, right?
So you're allowed to exhibit thesymptoms of depression, which
colloquially most of us are aware of, but in case you're
not, it's changes in sleep, appetite, energy, loss of
interest and things you used to enjoy disrupted sleep, being
more tearful, emotional. Like.

(23:58):
I'm not giving you a full comprehensive list there, but
that some of the DSM criteria for being depressed and it has
to be for at least two weeks. But when the DSM was first
created, they were like people who are grieving experience
those symptoms of depression. Their sleep changes, their
appetite changes, they're less interested in things they used
to enjoy. They're sad, they're tearful.
So they wrote the DSM and said if you lost a loved 1A year

(24:21):
before, you're not depressed. There's an exception.
And then when they do the next version of the DSM, it was one
month. If you lost a loved one within a
month, even though you experience the symptoms of
depression, you're not depressed.
It's grief. Then it was two weeks.
If you lost a loved one within the last two weeks, you were
allowed to experience depression.
But it's grief. It's not depression.
You're not diagnosed. The most recent version of the

(24:42):
DSM removed this grief exception.
So even if you lost a loved one,those symptoms, those
experiences still can be classified and diagnosed as
depression. And this is really fascinating
because what this tells us in the messaging that this gives,
how we can kind of conclude and interpret this, is that it's
reasonable to be depressed aftera loss in that context, right?

(25:03):
So like this is kind of segwaying into the losses that
we've experienced, disconnections, the causes of
depression. But the idea here is that we
know and we understand in some contexts it makes sense and it's
a normal response and it's quoteUN quote OK to feel depressed.
One of those examples being grief.
And so if it's OK to feel depressed after a loss, what

(25:26):
other losses are we potentially experiencing that would cause a
normal proportionate, evolutionarily sound response of
depression in our lives? And so Johan presents this
question based on this grief exception and this being added
to the DSM in the way that we understand mental illnesses,
which is that grief and depression have identical

(25:48):
symptoms. So what if depression is a form
of grief? What if it's a response to a
loss and not all these other stories and things that we've
been told it? But what if that is truly what's
happening, is that we've lost something and we are in
response, grieving that loss in our life.
If that's the understanding we take, that means that our
depression is a response to our circumstances.

(26:09):
It means that human distress cannot be assessed separate from
our lives. We can't just say it's a
chemical imbalance. It's the way your brain is
processing things. It's your life.
It's the way that you're living your life.
It's things in your life. And that's why you feel this
way. And there's this other piece,
which we're again, going back tothis chemical imbalancing,
because it is such common messaging surrounding
depression. We're told this all the time.
It's a really common response tocoming into a doctor's office or

(26:33):
a therapist office or a psychiatrist's office and being
depressed. And what are the potential
consequences of that messaging is that when we're told our pain
is a result of our malfunctioning brain, we're
disconnected from ourselves and therefore disconnected from
others. And that's kind of what Johan
presents is like why we should embrace this new way of thinking
about and treating depression. So instead, what we do is we

(26:54):
listen to our pain, we pay attention to it.
What is it trying to tell us? And like we said at the
beginning of this episode, or depression acts as a signal.
And so we end Part 1 of Lost Connections with an amazing
quote from Johan where he says depression is in fact, to a
significant degree a problem notwith your brain, but with your
life. So if we're depressed because of

(27:15):
our life, what are these causes?What are these needs not being
met? What are we grieving?
What are the losses that have occurred?
And that gets us into Part 2, which is that there are 9
disconnections that we experience that lead to feelings
of depression and grief. The first one we're going to
dive into is meaningful work. And so the question that we ask
ourselves when trying to evaluate if this is a loss that

(27:36):
has occurred in our life, if we're disconnected from this, is
do we feel like we made a difference in anyone's life
today? And maybe it's as a student,
maybe it's through your relationships, maybe it's
through your actual job, if you're at that point in your
career, maybe it's through volunteer work.
Maybe it's through sharing your story, whatever it is.
But when we don't feel like we've made a difference in
anyone's life, we feel depressed.

(27:59):
That's a 'cause that takes place.
And this also lines up with something we talked about on the
podcast before, which is positive psychology research,
where we research not people that are struggling, not people
that are like below the average people that are above the
average people that are thrivingand doing great.
So what are the happiest people do that allows them to be
effective and successful with their well-being?

(28:19):
And there's a framework for thisthat Doctor Salasman created
called Perma. And so Perma stands for positive
emotions, engagement, relationships, meaning and
achievements. And when we have these things in
our life, we have good well-being and we find that we
do mentally and physically and generally well.
But getting back to what is meaningful work, how do we
understand this concept? It's important that we're

(28:39):
challenged in a healthy way and that we feel valued.
So when we look at research on people in the workforce, 13% of
people are engaged in their jobs, 63% are not engaged, and
24% are actively disengaged. So when it comes to us as a
society doing meaningful work and feeling like we have a
purpose and are really tapped into our day-to-day, that's not

(29:01):
great stats. Another one is that twice as
many people hate their jobs as love them.
Again, really challenging to feel like we are engaged in
meaningful work when that is kind of as a society, how we
feel about these roles. And another thing related to
what we talked about on the podcast before is the sense of
agency, right? So do we feel like our actions
have a meaningful impact on our lives and on outcomes comes and

(29:24):
on things changing and we can feel disconnection from
meaningful work when we feel really out of control.
And that really diminishes theirsense of agency, which is really
important for our mental health.And the other piece of having
meaningful work that's importantthat what our work life is
enriching, our life is fuller and that extends to our life
outside our work, right? Like you have the best day, you

(29:44):
come home, you talk to your partner or your friends or your
family, you have energy, you want to see people, you want to
engage in your hobbies, go work out, do all these other things
versus coming home from work andbeing burnt out.
You don't want to do anything. So you not only are having like
this negative experience in the workplace, but it really
trickles out into these other areas and really impacts your
ability to maybe bounce back or continue to maintain or even

(30:08):
improve your mental health outside of work.
And so the quote that you had presents here in this part is
that disempowerment is at the heart of poor health.
And he gives a really fascinating anecdote about tax
return workers. I want to say it was in the UK,
but I may be wrong and suicide rates.
And so there was a really high rate of suicide in this specific

(30:29):
department and the specific role, which was tax return
workers. And when they looked into it,
the reason why was that these workers never felt like they got
their head above water. Every time they finished a tax
return, there was like 65 more on their inbox on their desk.
Like the work never ended. They never felt like their head
was above water. There was always more to do.
They felt like they had no control over that facts.

(30:51):
There was that lack of control. And no matter how hard they
worked, they were still behind. And there was also never a thank
you or any recognition. So when you're thinking about
the roles that you engage in, the jobs that you have, your
career that you go into making sure that you feel like you are
able to get your head above water.
There's a point where you're like, OK, I did that.
I killed that project. There was like that sense of

(31:13):
completion, not like it never ending cycle that you have a
sense of control and that when you work hard, you're not always
behind. And then you have that thank
you, you have that recognition. People see that you're trying
hard and doing well and making an impact.
And so the the last way that will kind of explain this lack
of meaning phenomenon is that despair is there's a lack of

(31:35):
balance between effort and rewards, and the societal
messaging that accompanies that is that you're irrelevant.
And so meaningful work helps us feel like we matter and we have
a sense of meaning and that people need us and rely on us.
And that's really important as humans to have that in our
lives. OK, loneliness.
Really fascinating thing about loneliness.

(31:56):
We know it's bad, right? Like being lonely isn't good.
When we've done studies where people are isolated, there's
always adverse consequences physically, psychologically.
Like we know loneliness isn't great.
We're in a loneliness epidemic. The surgeon generals talked
about it, all the things. But an interesting thing that
Johan presents here is that loneliness is correlated with
high cortisol and stress. So being acutely lonely, so

(32:17):
being really, really lonely is as much stress as high cortisol
as getting punched in the face by a stranger.
They've done studies that compare cortisol levels of being
really lonely, chronically lonely, acutely lonely, and the
cortisol that results from beingpunched in the face by a
stranger. And the amount of stress
experienced is the same. We also know that lonely people

(32:39):
are three times more likely to get sick with a cold.
There's a lot of fascinating research in the positive
psychology world on like how much more likely pessimists are
to get sick, how their outcomes after surgery are worse.
Like how we think about things and how we feel really matters
from a physical standpoint. But being lonely, again, that
level of stress, it impacts our immune function.
We know that people that are acutely lonely are more likely

(33:01):
to die over a nine year period. So mortality rates are impacted.
And what we can conclude from this is that loneliness is
deadly not only from a psychological standpoint that we
know that people are lonely or more likely to commit suicide,
but we also know that physiologically, our physical
health is really impacted by howconnected we are.
And if we're engaged in our relationships, we also know that

(33:22):
there's a lot of psychological impacts.
Lonely people are anxious, they have lower self esteem, they're
more pessimistic, they're more scared that other people will
dislike them. And there's a studied
correlation, there's a established link that loneliness
leads to depression. So when we're lonely, when we're
isolated, when we're not around people, when we don't feel seen

(33:43):
by our community, we get depressed.
So again, it's this disconnection, it's this loss,
it's this grief of not being in relationship that causes this
experience of depression. And there's a great evolutionary
cause of this and one that completely makes sense.
So when we think back to cavemandays, if we were surrounded by a
tribe, we survived. If we were alone in the middle

(34:04):
of the desert, a lion would takeus out instantly.
So being connected, being in a tribe, being needed, feeling
like you mattered was literally what led to survival.
And so our bodies respond that it realized if we're not
together, we're not going to stay around, we're not going to
stick around, we're not going tosurvive to the next generation.
So it gave us a biological response to being alone, which

(34:26):
is depression and loneliness andthis really negative emotional
experience that then drives us to find other people and be in
relationship and connect. Because if we didn't connect,
the adverse consequences were extreme.
So it makes sense that when we aren't with people, we have this
adverse emotional experience, which is loneliness and in a
long term way, depression. But a lot of people are more

(34:50):
lonely, even though we arguably are more connected than we have
ever been. And we have to do another
episode diving into this. We've talked about it with
people on the podcast before. There's a lot of different
theories of why this is. But I think that when we think
about why we evolved to have this loneliness response, it
meant that we were in a community, a tribe, right?
A number of people. We had these close
relationships, relationships with this key community.

(35:12):
And today our societal social landscape looks like that we
have less one to one relationships.
So our tribe really no longer exists, but we also have an
extremely large or broader network.
So like both sides of the socialequation are kind of blown out
of abortion and not being set upfor success.
And so these emotional responsesthat we've developed over

(35:33):
hundreds of thousands of years really aren't fitting with this
modern day environment. And as a response, we see
loneliness and depression pop upat a much more alarming rate.
So the way that evolution helpedus stay connected, as Johan
explains us, is that when we're with people, when we're
connected, we feel secure. When we're not with people, we
not only feel bad when we're isolated, but we also feel

(35:56):
insecure. Like we have this internal gut
feeling of like, I'm not protected, I'm not safe.
I don't have my community. There is now a threat to me.
So we're not only feeling bad and negative and depressed, but
we also feel insecure in our life as a whole, which is also,
we know, like change and uncertainty psychologically is
not fun in a negative experience.

(36:18):
And so this is another layer that gets added on to this
loneliness puzzle and this pieceof disconnection, this grief,
this loss that we've experiencedof social relationships.
So there was a really interesting study that was done
that Johan talks about, which isover many decades, scientists
ask people, how many confidants do you have, right?
Like how many close people do you have that you can tell your
deepest, darkest secrets to? How many people can you go to

(36:41):
for advice and support? The most frequent response that
people gave was 3 confidants in their life.
By 2004, the most common response that people gave was
none. The most common experience in US
society that this study looked at was that people didn't have
any confidence in their life. They didn't have any people that

(37:03):
were really in their corner there to support them and help
them navigate challenging situations.
So we see this being more and more widespread, more and more
of a common experience. And we also see more and more
people becoming depressed. And so we talked about
insecurity as a feature of loneliness, right?
Like from an evolutionary perspective, effective, we

(37:25):
evolve so that when we're alone,we also feel insecure.
And the catch 22 here that Johantalks about, which adds a whole
other layer to this, is that we start to become afraid of the
very thing we need most. And this is what social anxiety
is. So when we're lonely, ideally we
would feel like, OK, I feel negative, but I have this drive

(37:45):
to go and find people and build relationships and I'm super
motivated to go and solve this problem.
That's not what happens when we are isolated, when we are not in
relationships, when we're lonely.
We become more suspicious of social contact, we're hyper
vigilant and we're constantly scanning for threats.
So not only feeling depressed, we're not only feeling bad,

(38:06):
we're not only lonely and insecure, but we're also really
suspicious of everyone around us.
And So what happens because of this is that we need more love,
more reassurance than you would have initially when you're
lonely. So if we think about like the
average person at being net 0, right?
Like their needs are met, they're fine.
They don't need that much reassurance.

(38:26):
They have healthy relationships.Once we start being lonely, we
creep down into the negative numbers.
And so then we not only just need a relationship, which would
fill that need of being lonely, but we need more love and more
reassurance because we're insecure, we're isolated and we
are hyper vigilant, suspicious and fearful of threats in our

(38:47):
relationships. And the other thing that we have
to mention here, which I'm sure you guys have experienced, is
that feeling lonely isn't necessarily related to being
alone. We can be in relationships, we
can be in classes, we can be in family contacts and feel really
unseen and misunderstood and really lonely despite being
surrounded by others. So what we're grieving here,

(39:08):
what we're missing here is a twoway relationship.
We need a sense of mutual aid. We both need to be doing things
for each other. It has to go both ways and we
have to feel protected. Again, this goes back to our
evolutionary roots, right? Like if you were kind of just
following everyone house around you never contributed to the
tribe, they don't want you there.
Like you're dead weight. And similarly, if you weren't

(39:28):
protecting your tribe, you're dead weight.
We don't want you. And So what we need to get this
need met and to not feel lonely is a two way relationship.
That sense of mutual aid. We're both helping each other
and we feel protected. We feel like we have each
other's backs and if something happens, it's going to be OK.
We've got each other. So our third disconnection is

(39:50):
meaningful values. Diving to what Yohan presents
here. We know from research that
materialistic people have higherlevels of depression, anxiety.
They generally just have a worsttime in life and they feel
sicker, like physically they experience more sickness and
they have more anger. And we've experienced a really
fascinating shift in society, especially in the Western world

(40:10):
and these really individualisticcultures where we celebrate
achievement. And we talked about in the
Disconnection from Meeting section, this perma framework
positive psychology like achievement and feeling like
what you're doing matters and that you're appreciated.
Valued, that's important, but solely focusing on extrinsic
goals and solely pursuing those is really adverse for our mental

(40:31):
health. And what research shows is that
when we achieve our extrinsic goals, so when we grant that
grade, we get into that school, we get that job, we don't
experience any increase in our day-to-day happiness.
You guys might be like, yeah, duh, of course.
But like, let's really think about this.
If you're in high school right now and you have worked hand and
foot for a certain GPA and that certain grade on that test in

(40:52):
your letter of racks, when you get into that school, that dream
school that you've been working for your whole life, you're not
going to experience any more happiness on a day-to-day basis.
Similarly, if you get in, get that job, you get that offer,
you land that role, your day-to-day happiness isn't
increased from meeting that extrinsic goal.
So people that pursue these intrinsic goals, ones that are

(41:15):
guided by our values and they'refulfilled because they're really
important to us, not just externally, what we get from
them, those people are happier and they become less depressed
and anxious. And there's been 22 studies at
the time that this book came outthat were done on people that
were materialistic and focused on extrinsic goals.
And again, it doesn't have to bematerialistic, right?

(41:35):
Like extrinsic could be a grade in the class, how you're
perceived by others, going to a certain school, getting a
certain job, right? Like it doesn't just have to be
like, I buy things, it's just pursuing things for external
purposes. So 22 studies have been done on
this. And there is a studied
relationship between focusing onmaterialistic things, pursuing

(41:57):
extrinsic goals and depression. When we do that, we become
depressed. And why this happens is that
materialism. And again, we're defining that
as anything that we're doing foran external reason that leaves
us really, really vulnerable to the world that's beyond our
control. Not only is the outcome outside

(42:17):
of our own doing, right? It's depending on the test that
your teacher writes or how your friend responds to your text, or
if you get into that school or get that job.
So it's not only completely dependent on external factors
that you can't control no matterhow hard you try, but it's also
kind of like never good enough, right?
Like there's always going to be another test.
There's always going to be another thing to get into.
There's always going to be another friend you're trying to

(42:38):
impress. There's always going to be that
job you want. So you're never able to be like,
I did it, I got that thing, I have that need met because the
bar is always shifting. And we know we talked about this
in the last section, right? Like not having things in our
control is a really distressing experience as humans.
So what Johann says in the section, which I think is so
important to drive home and makesure that we all remember, which

(43:01):
is that when we focus on the external, we don't meet our
internal needs. And those internal needs are
feeling connected, feeling valued, feeling secure, feeling
like we make a difference in theworld, feeling like we have of
autonomy and feeling like we're good at something.
Those are the internal needs that we all as humans need to
have met. And when we focus on the
external, there's a chance that as a by product, those needs

(43:23):
might get met, but it's really not a guarantee.
And it's really not a great way to go about it because again, it
doesn't impact our day-to-day happiness at all.
And we're not getting those internal needs met.
And internal leads to depression, which if you've been
depressed, you're like, Oh my God, I was missing all those
things. Like, that's really what
depression feels like when we describe.
It is like not feeling connected, not feeling valued,
not feeling secure, not feeling like you make a difference, not

(43:45):
feeling like you have control, and not feeling good at
anything. It sucks.
It's really painful. And so when we think about as a
society why we see more depression and why this is
becoming such a common emotionalexperience.
Johan presented a great quote, which is that we're being
propagandized to live in a way that doesn't meet our basic
psychological needs. So we're left with a permanent

(44:06):
puzzling sense of dissatisfaction.
What do we reward a society? It's not really those internal
needs we just mentioned. It's those external markers.
It's those external goals that we all are in pursuit of.
And it's really, really heartbreaking when we think
about this, like even high schoolers, the goals they're
pursuing and the markers that they see is important, which is

(44:28):
like GPA and SAT score. And then trying to get into
college and finding an interest in all these jobs.
Like, it's not those other internal needs that we know are
really important psychologicallyto get met.
The next one is disconnection from child to trauma.
So this anecdote that Joanne presents in this chapter has
stuck with me for years. I read this book a number of

(44:48):
years ago and I still think about this to this day, which is
that there was a study that was done where they took morbidly
obese patients. And they're like, what if we
just, like, don't give them any food at all?
Like what if to solve this obesity issue, we literally
don't feed them anything, but like, obviously people would
die. So they're like, we're going to
hydrate them, we'll give them Ivs, we're going to give them
supplements that they don't suffer vitamin deficiencies.

(45:09):
But like literally what if they just live off their fat stores?
And it worked. The people in the study, they
became healthy, they lost weight, they went back to being
a, a normal healthy weight. But the people that lost the
most weight throughout this study, they either panicked,
they were enraged, or they were suicidal.
And it was because they felt really, really, really
vulnerable in this new state. And this quote that's in this

(45:33):
chapter is just absolutely heartbreaking.
But it's that overweight is overlooked.
And that's the way I needed to be.
And the solution to this obesityproblem wasn't not eating.
It wasn't what they were doing in their life that was causing
this behavior. It was why they ate.
It was why they were binge eating or why they had put on

(45:54):
all this weight so that they were invisible.
And a lot of these people had gone through really traumatic
childhood experiences, a lot of sexual assault, things where
they felt really unsafe and vulnerable and threatened in
their day-to-day lives. And being overweight and being
overlooked that emotionally was a lot safer than being in a body
or in a position where there wasa lot of attention and eyes on

(46:17):
them. And I just, I still keep going
back to this because it's such acrazy study idea, but also what
they learned from permit was so fascinating.
Diving more into childhood trauma ACE scores, you guys
might have heard of these because they are becoming like a
more common phenomenon and something that we're aware of.
But a stands for adverse childhood experiences.
And basically the studies on ACEscores have showed that for

(46:38):
every traumatic event you experienced as a kid, you are
radically more likely to be depressed as an adult.
And there are like so many different things that ACE scores
impact. It could be rates of diabetes,
obesity, how will you sleep? Like lots of physical health
markers, but also lots of mentalhealth markers and the things
that they describe as childhood trauma.
It could be like parents being divorced, physically being

(47:00):
abused, mentally being abused, going through like a natural
disaster. And so for every one of those
traumatic things that you experienced in your childhood,
and you can look up the list of all the ACE criteria, you are
radically more likely to be depressed as an adult.
And another really interesting thing here that Johan talked
about is that emotional abuse isa much more significant driver

(47:23):
of depression than even like a physical assault or abuse.
And beyond that, not just emotional abuse, but being
treated cruelly by parents was by far the biggest driver of
depression. And this is where we go back to
this idea that depression isn't a disease.
It's a normal response to abnormal life experiences.
And so another quote from the section before we get into our

(47:45):
next area of disconnection, which I loved, is that if you
believe depression is solely dueto a broken brain, you don't
have to think about your life orwhat anyone might have done to
you. The belief that it all comes
down to biology protects you in a way for a while.
If you absorb this different story, though, you have to think
about those things, and that hurts.
And that's really true, right? Like if we just say it's our
brain, it's our processing thing, it's not my life.

(48:07):
We don't have to look at these painful experiences.
We don't have to ask ourselves if our jobs are not meaningful,
if we're chronically lonely and unseen.
We can just blame it on this other factor.
And so it's painful, it's challenging.
We don't have that cop out of like, it's my brain, it's not my
fault. And we can really truly get to
the root of the issue and then in turn solve that.

(48:28):
Our next section is disconnection from status and
respect. So we think about how we
describe depression. A lot of language around this is
like feeling down, right? Like I, I feel down, I feel
depressed. And so this like status and
respect thing is really interesting when we think about
how we frame depression as a concept.
And there was an evolutionary purpose of status, which like a
lot of these areas, we had evolutionary purposes.

(48:50):
And now in modern day, our livesdon't fit the way we're wired.
And so then things go awry and we get depressed.
Depression is in part a responseto the sense of humiliation that
the modern world inflicts on us.And so today in our modern
world, status is something that can be taken away at any moment.
We are pervasively insecure, andwe know that being insecure in

(49:13):
your status, not knowing if you're going to have it from one
day to the next is more distressing than knowing that
you're at the bottom of the pyramid.
So like, if we think of the Dance Moms period, the people at
the bottom, they're distressed because they're at the bottom of
the pyramid, but they know that they're there.
The people in the middle who like might be at the bottom at
any point, maybe they'll move up.
It's kind of uncertain. They're more distressed because

(49:34):
their status is insecure and could change at any point.
So again, insecurity change, notknowing what's going to happen
next psychologically, lots of adverse outcomes.
And this is kind of a common theme between these things of
disconnection. And so another piece of data
that also backs this like disconnection from status and
respect thing is that the more unequal society, the more
prevalent mental illness rates. So the United States is like a

(49:55):
fascinating case study and the wealth gap and our status gap
that exists within our society, despite being in like modern
day, where is when we compare that to Norway, where the status
gap is much, much smaller and doesn't exist in such a
pervasive way, they have lower mental illness rates.
So we do see this correlational relationship between how equal

(50:15):
societies are and how much mental illness they have within
their populations. And the other piece of like
things are changing in society at large and we also see
depression rates changing at large.
We look historically, the statusgap that exists today is larger
than it's ever been before. Next form of disconnection is
the natural world. There's been really fascinating

(50:37):
research done on mental illnesses in cities versus rural
areas. And not just like how many
people have mental illnesses in cities, because obviously the
population is denser. But like when we look at a
percentage basis, what percentage of people struggle
more in urban areas versus ruralareas?
And mental health conditions like psychosis and schizophrenia
are much worse in cities than they are in rural areas.

(51:00):
We also see the end research that people that move to green
area see a reduction in depression and vice versa.
If they go from a really green area to a more urban area, they
experience more depression. We also see that when green
spaces are implemented in cities, research supports that
the levels of despair that citizens experience decreases.

(51:21):
And they did this other really great study where they had
people who were depressed take awalk in nature.
They lived in cities, but they're like your prescription
is to do a walk in nature every day.
And they did this with depressedand non depressed people.
And the non depressed people sawa benefit, right?
Like who wouldn't benefit from taking a walk in nature, but the
people that were depressed. So five times the amount of
improvement compared to the non depressed people.

(51:42):
And another kind of like anecdotal piece that Johan
presents from one of the interviews he does in the book
is that when we see natural landscapes, when we're in like a
National Park or we're on a mountain and we're in these like
really wide open areas, we feel that us and our problems are
really small and the world is really big.
And not in an invalidating way, but like that test I have coming

(52:04):
up or that fight I just had withmy friend, when we think about
how big the world is and how many things are going on, we're
so small in a good way. And this too will pass and it's
all going to be OK. And then our last little stat
here, which was fun, which I marked down, is that when we see
the natural world, when we are in environments that
consistently have us engaging with nature, we're 24% less

(52:26):
likely to get sick. So physical and mental benefits,
our last cause of disconnection before we quickly go over our
solutions because I know this episode is long, you guys, it's
a great book. I have so much to say is genes
and brain changes. So we started this episode
talking a lot about like how ourgenetics and our brain like
antidepressants. Really there's not a lot of

(52:48):
research backing that. The chemical imbalance theory
isn't really based in science. It's not totally something that
we can rely on as far as understanding why we're
depressed. But there are a lot of genetic
factors and brain changes that occur that make depression
worse. And so we're going to dive into
those a little bit. So the first thing is that our
brains change based on how we use them.

(53:09):
We have incredible brains that have a single neuroplasticity
where they rewire based on how we use our brains.
There's this really fascinating thing when we're born, we can
hear the linguistic differences between our language and other
languages. We're born with that.
So like these really similar sounds, we can differentiate as
babies, but we only really speakone language for the most part

(53:32):
when we're born. And so within a couple of
months, a couple of years, we lose that ability to distinguish
between those really similar sounds, like use it or lose it.
We don't use it, we lose it. Similarly again, I took a lot of
linguistic classes in high school and it's in college and
it's a great way to explain neuroplasticity.
So these are the examples you'regetting.
When we don't develop language, those language areas become

(53:53):
dormant and we never recover after that critical period.
So if you're not exposed to any linguistic input before, like
say 18 years of age, you're never going to be able to
fluently speak a language. So our brains change a lot.
They are very responsive to our environment.
And we also see this in depressed population.
So our brains change based on how we use them.

(54:15):
And so depressed people, when welook at them in brain scanners,
they have more active areas related to risk and unhappiness.
And so literally, despite the fact that that might not be the
cause, the way that we're using our brains is exacerbating the
issue. And so when our brain assumes a
state of chronic pain and stress, we lose those

(54:35):
relationships and those pathwaysand those synapses that relate
to pleasure, joy, connection, and healthy habits.
So like, we're really strongly wiring these pathways related to
risk, related to unhappiness, related to intense emotional
experiences. And because we're not using
them, we lose them. Those pathways that are related
to pleasure, joy, connection, and healthy habits, those are

(54:57):
less solidified and they're harder to use when we then want
to try and make things better for ourselves, build our life
worth living, trying to invoke those positive experiences.
So even if the original reason that we were depressed, like we
talked about grief. So even if it's been months
since you lost a loved one, the depression itself persists
because the way that we are living our life on a day-to-day

(55:20):
basis, the way that we process information, the way that we
interact with our environment causes that depression and that
depressive experience to persistdespite the environment no
longer being the problem. To kind of relate this all to
what we talked about in the episode as a whole, the origin
isn't necessarily in the brain, but the brain can absolutely
make it worse when it comes to maintaining this depressive mood

(55:42):
and experience. And then the gene piece of this
is also fascinating, which is that depression is 37%
inherited. So it is related to genes, and
it's this thing called 5 HTT. And basically these genes turn
on or off. It's dependent on your
environment. So if you're born with A5 HTT
gene, you might never be depressed, but if you have a
stressful event that you go through or childhood trauma and

(56:06):
experience that's really depressing, that five HTT gene
turns on, it's activated by the environment, and then you have
that genetic susceptibility to being depressed.
So the quote here that Johann gets, which I'm absolutely
obsessed with and I hope you allremember and internalize, is
that your genes can make you more vulnerable, but they don't
write your destiny. So we can be more susceptible to

(56:28):
depression, but it doesn't mean that we're predetermined to be
depressed. Regardless of what happens in
our life. We have a lot of power and
agency. So now that we know these
causes, giving you a little likerecap transition here is that if
all these things are signals that something's not going
right, we as a society have a really distorted sense of our
distress. The way that we are responding

(56:50):
to these signals, the way that we're normalizing these
experiences, the way that we're all embracing these day-to-day
things despite the fact that we're disconnected from these
things that are really importantto our functioning, is really
distorted. And so again, when we go back to
this narrative, which we've really embraced, of biological
malfunction, we feel disempowered.
We feel like our brain isn't good enough.
There's nothing that we can do. We're told that our distress has

(57:12):
no meaning. And the reason why it's so
important for us to push back onthis and kind of embrace this
other way of thinking is this quote the Johann gives, which is
incredible, which is that it's no measure of health to be well
adjusted to a sick society. So if we're seeing that at large
society, we're disconnected frommeaning, we're disconnected from
each other, we're disconnected from values that lead to better

(57:34):
lives. We're disconnected from working
through our childhood trauma. We're disconnected from status
and respect. We're disconnected from the
natural world. We're disconnected from feeling
hope and having a secure future.And our challenges are being
exacerbated by genetics and brain changes that occur as a
result of being depressed. It's not a good sign if we're
well adjusted and normalized to this disconnection that we're

(57:57):
experiencing at large. So how do we respond?
How do we solve this? What are the solutions that we
can implement? And we're going to go through as
quickly because a lot of these things we talked about in the
causes, right? Like if you're disconnected from
relationships, what should you do?
Build more relationships. If you're disconnected from
meaningful work, what should youdo?
Find work that has more meaning.But I did want to give you a
couple little bits and pieces here.

(58:18):
So the seven solutions presentedand lost connections.
The 1st is people. So there was a study that was
done on if people trying to consciously make themselves
happier, did it make them happier?
They're like, OK, we want you togo into the world.
We want you to try and be happy.Like consciously make an effort
to try and make yourself happier.
And we're going to study if it works.

(58:39):
And they found in that Russia, China and Japan, it worked.
When people went out into the world and tried to be happier,
they felt happier. And these are like collectivist
society, right? They're more rooted in
community. They're more rooted than others.
In the US, it was not the case. So when people intentionally
went out and tried to make themselves happier based on like
the values we embrace in the lives we live, they weren't

(58:59):
happier. And so thinking about this, like
individualist versus collectivist societies, that's
definitely something at play. But like, are we being set up
for success in the way our society is set up and run?
And if we just kind of fall intothose patterns and those values
and those ideals, like, are we being set up for success?
Will we feel happier as a result?

(59:20):
Not really. And so the finding from the
study, which Johan kind of presents, is that the more you
think happiness is a social thing, the better off you are.
So that might not necessarily bethe norm within US communities.
It might not necessarily be the norm if we just go on autopilot
into our society. But the more that we emphasize
social and happiness being synonymous, the better off we

(59:43):
are from a well-being perspective.
The other piece here, which I hope you guys kind of
internalize is that if we returnto seeing our distress and joy,
something we share with a network of people around us, we
will feel different. So yes, it's an internal
experience to feel distressed. Yes, it's an internal experience
to feel joy. But if we know that like when we
feel distressed, we talk to others, we get support, we make

(01:00:05):
sure people are in our corner. And similarly, when things go
well, we tell our friends, we celebrate together, we embrace
others accomplishments, we feel differently.
So leaning into others throughout these emotional
experiences as like a collectiveexperience rather than
individual one is huge. So not focusing on ourselves,
focusing on others. And you guys have heard me say
this number of times, but. But when you do studies on like

(01:00:28):
what short term, one thing that people do will cause the longest
and biggest amount of happiness in them and act of kindness for
someone else is what makes that difference.
Like literally takes 2 seconds but you not only feel super
happy in the moment, but the amount of time that that
happiness lasts. Biggest bang for your buck when
it comes to doing something to help your mood.

(01:00:48):
So focusing on others is huge. And then the other quote here,
again, a theme that we found on the podcast, but it's so, so
important. And I love the way that Johann
presented this, which is that even if you are in pain, you can
always make someone else feel a little bit better.
Even if you're depressed, even if you're suffering, even if
you're overwhelmed, there's always some little thing that
you can do to help someone else's day go a little bit

(01:01:11):
better. And that in turn, selfishly will
help your mood. And then a really interesting
piece of data that is related tosociety at large is that the
Amish population has much lower rates of depression than the
average American. Despite being in this same
geographic environment, their rates of depression are
dramatically different from oursin the world outside of those

(01:01:33):
communities. So how are they leaning into
that sense of community, sharingthose experiences, focusing on
others, having a sense of meaning and purpose, all those
things that we mentioned. The next thing that Johan talks
about that I wanted to touch on is social prescribing.
So this is the next solution. And so he talks to a clinician
who explains that patients are depressed because their lives

(01:01:53):
have been stripped of the thingsthat make life worth living.
We talk about this on the podcast all the time.
Is DBT framework as well as of life worth living?
Like your life isn't worth living because it doesn't have
these things that would make it meaningful.
And so the questions we should ask ourselves and not what's the
matter with you, but what matters to you?
What would make our lives worth living?
What can we do to increase thosethings in our life and find a

(01:02:16):
tiny bit of hope based on those things that matter to us?
Next solution, meaningful work and the kind of unlock here is
choosing it like that sense of autonomy is really important.
So you choose the position you see a difference that it makes,
but maybe you're working directly with a population or
maybe it relates to your own experience so you can see the

(01:02:37):
change and shift that's happening and that you directly
benefit from it, right. Like so for me, I think, and I
hope that working in a career inpsychology, knowing that I
struggled and also like learningall these things about mental
health helps my own experience. I, I choose it.
I see the difference it makes when you guys send me the best
messages and listen to the podcast and say that you
appreciate hearing about all thethings and I directly benefit it

(01:02:58):
from it, right? Like reading these books,
learning these things I implemented in my own life and
feel better as a result. And then also within meaningful
work, reconnecting to a sense ofstatus.
So knowing that like, I matter and I have a role in society and
I understand what that is and that won't go away overnight.
And then reconnecting to the future.
And I absolutely love the anecdote that Johann gives in

(01:03:19):
the book, which is that a researcher went and worked with
adolescent patients and psychiatric wards, and he worked
with anorexic patients, and thenhe worked with depressed
patients and they were adolescent teens.
And he would ask them all these questions and for the most part,
mentally they were functioning great, right?
Like, they were smart, they could carry a conversation.
There wasn't anything that was like super wrong.
When he asked anorexic patients about their futures, their own

(01:03:41):
futures, like trying to think about what would happen next and
happened down the line. They were doing, it was fine.
But when he asked suicidally depressed teens to talk about
what would happen in their future or in his own future and
just think about what would happen like weeks and months
from now, they weren't able to do it.
Like they're truly was this complete disconnect from today

(01:04:02):
to what would happen down the line.
And this is a really interestingphenomenon that takes place in
depression. And it's kind of unclear if like
because you're suicidal, do you therefore not identify with and
have any attachment towards the future?
Or do you not have any attachment towards the future
and as a result are suicidal anddepressed?
Like the relationship there is kind of unclear, but
reconnecting to the future and having plans down the line and

(01:04:22):
things you're looking forward tois really important within that
meaningful work context. Then values, we talked about
focusing on intrinsic things, making sure those internal needs
get met, sympathetic joy and overcoming addiction to the
self. So how can we be more other
focused? How can we celebrate others,
support them in their experiences rather than just
being so focused on the internaland being really isolated in

(01:04:43):
those emotional experiences. And then healing and working
through childhood wounds becauseagain, we know that makes us
more predisposed to depression because it's a normal response
to something that happened to us.
So that is our very long, very extensive, but I hope maybe not
enjoyable, but interesting summary of lost connections by
Johann Hari. It's a really fascinating way to

(01:05:05):
look at and unpack and understand why we individually
are depressed. But why is this society we're
seeing more depression than we ever have before?
And how can we think about this differently, especially being
more aware of the misinformationthat's at play on a larger
scale? So if you guys are interested in
the book, even though I just gave you a full summary, it'll
be in the show notes. So if you guys enjoyed this

(01:05:26):
really long, extensive episode, please leave a review,
subscribe, share with a friend or family member, tag me on
social media. And if you guys have other books
that you want me to do for book club, please let me know.
And if you guys like the series or you're like, it's just too
much, please don't give us this misinformation.
Also let me know that. But I think it's kind of a a fun
way to distill findings. So I really enjoyed it.

(01:05:48):
I hope you guys enjoy as well. And with that, I will talk to
you guys later this week for ournext episode.
But I hope you're having a greatweek and that you enjoyed the
episode and I'll talk to you allsoon.
If you enjoyed this episode, if she persisted, make sure to
leave a review, subscribe and share with a friend or family
member. Follow along at at she persist
to podcast on TikTok, Instagram,YouTube and more for bonus

(01:06:08):
content. Thanks for listening and keep
persisting.

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217: this book explains why we’re actually depressed [mental health book club series]

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