Johann Hari on Lost Connections
Sep 6 2021

Lost-Connections-200x300.jpg Author and journalist Johann Hari talks about his book, Lost Connections: Why You Are Depressed and How to Find Hope, with EconTalk host Russ Roberts. Hari, who has suffered with depression as a teenager and an adult, offers a sweeping critique of the medical establishment's understanding of depression and the frequent reliance on pharmaceutical treatments. Hari argues that it is our lost connections with each other, with our work, and with ourselves that explains the rise in depression in recent times.

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Explore audio transcript, further reading that will help you delve deeper into this week’s episode, and vigorous conversations in the form of our comments section below.

READER COMMENTS

aleksi raudasoja
Sep 7 2021 at 3:52am

Great episode!

Would like to see more talk on how western societies and governments increase the problem of lost connections.

When more and more responsibility of caring peoples suffering are put on governments, we will be lacking the good effects from people taking care of each other. When the government helps you, it is very much one-sided. You cant help the government back in away that you could get the same sense of meaningfulness. Also, When other people help you, it feels like the I’m important to those people helping me, they help me because they respect me and think I’m important to them. Very difficult to get the same sense from governmental intervention I think.

I think trust and responsibility are the key. How to put more trust and responsibility to people to take care of each other?

Floccina
Sep 7 2021 at 3:56pm

Do you mean, if Social Security did not exist more families would include children and grand parents? Which might be more efficient because the grandparents can help with the children and more social more people to talk to.

Darryl Byram
Sep 10 2021 at 1:26pm

To piggyback on that, how do our economic systems (e.g. capitalism) contribute to this?

For example, when they talked about the Jewish tradition of Shiva.  I suspect that a lot of why people feel the pressure to return to work quickly is because they feel guilty about getting behind on their work, and they know that if they take “too long” away from work to grieve, their employer will not be pleased.  That employer might have a stack of highly qualified resumes that they can visit to replace that grieving person.

I’m not one of those folks who constantly bemoan capitalism as if it’s morally evil (I think that’s intellectually lazy), but our current system is incentivizing hyper-productivity and rewarding this “toughness”.  Another example, before 2020 it was a badge of honor for employees to come into the office when they were sick.  Most coworkers would rather that person stay home but they were trying to look good and tough in front of their bosses, and when we were sick we felt that guilt precisely because so many of our coworkers were able to make it into work.

I think the Schumpeter analysis that capitalism is a tide that indiscriminately washes away customs, norms, and values is accurate.  This example appears to be one of those values.

Fred Giertz
Sep 7 2021 at 8:10am

The lack of connections and loneliness are certainly a major problem in today’s world.  Unfortunately, it is only one of many.  I think the focus on the lonely-man mass shootings is somewhat misplaced.  First, the lonely-man may be lonely for a reason.  His own often pathological behavior may be the cause of his isolation rather than isolation causing the behavior.  It is a complicated interrelationship.

The major problem of violence and murder today is not the lonely man, but the highly connected gang member.  In Chicago last year, there were nearly 800 murders.  A tiny percentage of these fit the lonely man scenario.  Further, few of these are people striking out at there “oppressors.”

Gang members  often have apparent high self esteem  with close connections and in-group cohesion with their fellow members.  The victims of this violence are usually rival gang members or unfortunate bystanders.

Historically, many mass killings (race riots, pogroms, labor-industrial violence,  etc.) were perpetrated by members of groups who, while possibly alienated, were still closely connected within their group.

 

Rob
Sep 7 2021 at 11:50am

Johann says that it’s clear that rates of loneliness have been increasing in recent decades. This article from Our World In Data argues that this is probably not the case.

Martin
Sep 7 2021 at 3:28pm

As a psychiatrist I have mixed feelings about this episode.

On the one hand, surely it is important to focus on depression (and any psychiatric illness) in the context of the whole person, including social connections, sense of meaning and purpose in life, etc etc, alongside biological/medical considerations.  Anything that draws attention to this is probably doing at least some good.

However Hari often puts up straw-men to knock down a little too easily, such as the idea that the “chemical imbalance” theory of depression is something that is taken seriously and literally by the psychiatric establishment, or the insinuations of conspiracies to over-prescribe antidepressants, or the silly anecdote about Cambodia which seems intended to leave the impression that “if only we in the West spent 5 minutes talking to someone we could deal with their depression better”.

I don’t know many (or any?) psychiatrists who actually think about mental illness or its treatment in the simplistic ways Hari seems to think.  I understand that some of these issues are dealt with in a more nuanced way in his book, but how one talks about these things on podcasts matters too.

I’ll add something that other psychiatrists discussing his book have noticed as well: his take on antidepressants is too pessimistic and doesn’t reflect reality.  It is popular to talk about how ineffective antidepressants are, and it is true they are far from perfect and there has been substantial mischief from big pharma on this issue.  But I think the deeper point is that, like most medicines, they work better for some people than for others, and for many people they work better if you are more depressed.  In other words, antidepressants tend to be less effective for “mild depression” and all the varieties of what we might call ordinary unhappiness, and relatively more effective for true major depression.

But as always I’m happy that Russ has interesting guests on with thought provoking material.

 

Todd D Mora
Sep 9 2021 at 10:12am

I don’t think Johann or Russ were saying there was a conspiracy to over prescribe anti-depressants, I took it as there were incentives for doctors and pharmacuetical companies to ignore other options for dealing with people who presented the symptons of depression.  I think opiod crisis is a prime example of incentives go awry and patients literally dying because of it.

Additionally, the DSM creates a diagnostic box and now things must fit into the box. I think the Cambodian story was for illustrative purposes to show that there may be effective diagnostic and treatment techniques that don’t have to fit into the box.

Floccina
Sep 7 2021 at 3:51pm

Seems to me that this discussion is about the margin of depression. There are people on the margin. Some people struggling with depression might not be if social behavior was different.

I’ve run into this in discussing homelessness, someone will say that more housing will not help because the homeless are either hopelessly addicted to drugs or severely mentally ill. I say sure but there are people are the margin who could live in homes if homes were 1/2 the price. Not to mention the fact that it would make it cheaper to help them.

Also if depression is rising, (I think it might not be) could it be due to less physical activity?

miller
Sep 8 2021 at 11:02pm

While there is much to be said about the chemical nature of depression, by far the major contributor to what I perceive as pervasive alienation in my city is restaurants. Yet they keep on getting built, one after the other. People keep to themselves when they eat and tons of people line up in their cars separated from each other to eat at drive-throughs.

I’ve tried to raise this issue, but it seems like my city is doubling down. Not only have they decided to redo vast swathes of parking spaces, but outdoor areas remain gated and radiate the feeling that the people there are not there for you.

I’m also not allowed to be myself at the library or gym, so I’m personally in a constant dissociative state. This has nothing to do with chemicals in my brain, but rather our built environment.

Instead of pumping people with anti-depressants, why not just, I don’t know, remove gates from restaurants, for example? Such a simple fix. Would cost next to nothing and would probably also increase sales by attracting more people.

Arvin Simon
Sep 8 2021 at 11:04pm

Another thought-provoking episode. There is much to say about how violence is a manifestation of social alienation and breakdown of our tribal units and quasi-tribal institutions.

I will recommend this episode from the Psychiatry and Psychotherapy podcast to accompany this piece. Both episodes, coincidentally, were released at nearly the same time. The linked episode presents a much more psychological perspective but finds fertile, common ground.

Ralph Casale
Sep 16 2021 at 9:44am

I enjoyed this episode.  To weigh in on the Vegas shooting / 2nd amendment segment, I’ve long thought that a return to established local ‘well regulated militias’ could be part of improving the current situation.  Weapon ownership, beyond those of designated by the ATF as primarily items of ‘simple hunting and personal protection’ would require being a member in good standing with a local licensed and registered militia (possibly NLT 20 and NMT 200 members).  The militia would have to be willing to vouch for you, and put their rights on the line for yours.  Such militias would readily form around sportsman clubs, gun shops, and local organizations (VWF, churches, etc.).  One could even credit the framers of the bill of rights for recognizing this ‘social aspect’ as a necessary component for gun ownership.

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AUDIO TRANSCRIPT
TimePodcast Episode Highlights
0:37

Intro. [Recording date: August 11, 2021.]

Russ Roberts: Today is August 11th, 2021, and my guest is journalist and author, Johann Hari. His latest book, and the subject of today's conversation, is Lost Connections: Why You're Depressed and How to Find Hope.

I want to warn listeners listening with children, today's episode is likely to deal with a number of adult themes.

Johann, welcome to EconTalk.

Johann Hari: Oh, I'm so excited to be with you. I have this slightly weird feeling, because I've listened to your voice so much, I feel like I've slipped into my own iPhone. But, other than that weirdness--

Russ Roberts: That's kind of frightening. Yah. Well, it's great to talk to you.

1:11

Russ Roberts: The book is fabulously interesting. It touches on a number of themes we've talked about here on the program. Parts of it, I am not as enamored with. But, all of it is thought-provoking and the overall themes of the book are extremely important. Extremely interesting.

I would remind listeners: This is not a medical program. We're not giving medical advice. Take everything you hear here with a grain of at least one--maybe more than one--grain of salt. But it's a very, very interesting set of topics that you've chosen to write about.

So, I want to start with your own personal story. You write about your own bouts and challenges of depression, and your use of antidepressants. So, please give listeners and viewers a little summary of your own--how you came to be interested in these themes.

Johann Hari: Yeah, I'm really interested to hear the bits you agree with and the bits you disagree with. I welcome debate on these questions.

For me personally, I think I wrote the book because there were these two mysteries that were really important to me. And, every book I've ever written is because there's something I actually wanted to know for myself. There's a slightly selfish component to all of them.

So, the first mystery is: I'm now 42-years-old, and all throughout my lifetime, depression and anxiety have increased in the United States, in Britain, and across the Western World.

Now, we've all seen very acutely in the last 18 months, huge increase in depression and anxiety. But, actually, they were rising well before that. We've now seen an acute spike, I think, for very related reasons. So, I wanted to understand: Why is that happening? Right? Why is it that with each year that passes, more of us are finding it hard to get through the day? Especially when in many ways, we're more materially prosperous than we've ever been. So that, I wanted to understand that.

And, I wanted to understand it--you know, as you allude to--for a more personal reason, which is that when I was a teenager, I remember going to my doctor and explaining that I had this feeling like pain was leaking out of me and I couldn't control it. I didn't understand it. I was quite ashamed of it. And, my doctor, who was a very well-meaning person, told me a story that I now realize contained some truth but was hugely and radically oversimplified.

My doctor told me, 'Well, we know why some people get like this. Some people just naturally have a chemical imbalance in their brains. You're clearly one of them. All we need to do is give you some drugs. You're going to be fine.'

So, I was given a chemical antidepressant called Paxil in the United States, Seroxat in Britain. And, it gave me significant relief initially.

And, then fairly soon afterwards, these feelings of pain started to come back--not as acutely as they had been, but they started to come back. So, I went back; my doctor gave me a higher dose. Again, I felt better. Again, the feelings came back. And, I was really in this cycle of taking higher and higher doses, until at the end of 13 years, I was taking the maximum possible dose you were allowed to take for a really long time.

And, I started asking myself, 'Well, what's going on here?' Because according to the story our culture tells, I'm doing everything you're meant to do, yet I still feel really bad.

So, to really investigate this--I was trained in the Social Sciences at Cambridge University. I wanted to use my training in the Social Sciences, and also my experiences as a journalist, to really investigate this.

So, I ended up going on a, as you know, really big journey all over the world. I traveled over 30,000 miles. I wanted to meet the leading experts in the world about what causes depression and anxiety, and what solves them. And, people who are pioneering very different solutions all over the world.

So, I ended up meeting just a crazy mixture of people, and going to a mad mixture of places from an Amish village in Indiana--because the Amish have very low levels of depression and anxiety--to a city in Brazil that banned advertising to see if that would make people feel better, to a lab in Baltimore, where they were giving people psychedelics to see if that helped. And, I learned a huge amount.

The core of what I learned, I think, is that there's scientific evidence for nine different causes of depression and anxiety. Two of them are indeed in our biology. So, my doctor wasn't totally wrong and was certainly well-meaning.

But, actually, most of the causes of depression and anxiety for which there is evidence, are not factors in our biology. They're factors in the way we live. And, once you understand them, what I learned from all these places I went to, was that that opens up a very different set of solutions that should be offered to people--alongside, of course, the option of chemical antidepressants for people who want them.

5:47

Russ Roberts: And, just to make clear, a challenge in this kind of work, inevitably, is that depression is not visible. It does not have a chemical marker. There might be serotonin shortage--insufficiency, whatever you want to call it. But, as you point out, and you'll probably talk about later, that's not what depression actually literally is. It could be correlated. It could be a totally misleading marker; but it requires a diagnosis.

So, the fact, for example, that the Amish have low rates of depression: They have low rates of measured depression. I happen to agree with you. You were among them for a while. I suspect they also have low actual rates. But, it could be a community where it's hard to admit to having mental health issues. We know that over the last, I don't know, 2000 years of human history, there was a thing called 'melancholia' that people were ashamed of. And, certainly, depression was something people were ashamed of.

So, the fact that depression has risen in the United States could be simply an increase in the diagnosis, but not the phenomenon. I happen to agree with you that it is an increase, I suspect, in the actual phenomenon. But, I think it's important to just say that, because as eager as some people are to mark this as a disease--and it may be in some dimension--it is not like a cancer that can be a bio-assayed in a laboratory and then definitively defined.

Johann Hari: I think that's really important. And, I thought about this a lot in relation to my grandmothers. My dad's from Switzerland, and my Swiss grandmother lived all her life in a tiny village in the Swiss mountains. And, I loved my grandmother. She was a remarkable woman, and she lived to be 90. And if I think about my grandmother--or, my other grandmother, my Scottish grandmother, who was in a very poor working class part of Scotland. If I think about my grandmothers' lives--and obviously, I knew them very well--my Scottish grandmother effectively raised me--they were, by our understanding, depressed quite a lot of their lives. They were really denied opportunities. My Scottish grandmother had an extremely difficult life in all sorts of ways. They would never have used that word about themselves. Indeed, they would have strongly rejected that word about themselves. I mean, it wouldn't have made any sense to them to talk about it. Maybe towards the end of their lives, they would have known a kind of concept of depression.

So, you're definitely right. There's both been a rise of a kind of narrative about depression that just didn't exist in the past, or existed, as you say, in very different forms--concepts like melancholia, which are quite distinct.

Also, there's definitely been an increase in people describing themselves as depressed. Some often for very good reasons. There's been a reduction in stigma around these problems.

So, you're absolutely right: Part of the phenomenon of rising rates of depression and anxiety diagnoses is just more people describing themselves that way, who would have felt that way in the past, but not used those words or that language.

That phenomenon is certainly happening. I think alongside that phenomenon, there is a real increase. I think it's reasonable to reach that conclusion, although there are other reasonable people who disagree, for a few reasons. One is there are some biomarkers for depression. Actually, serotonin is not a good one. I can go into why, if you want.

So, for example, one thing that we know--Professor John Cacioppo, who is at University of Chicago, did a lot of good work on this. One thing we know is people who are depressed, tend to experience in their sleep, a lot of what I call micro-awakenings, which are where you wake up slightly when you're asleep. You often won't even know you've done it. So, people who are depressed tend to have higher levels of micro-awakenings. And so, that's one proxy measure. It's not perfect, obviously.

And, we do know, because he did a very good study with a group like the Amish--it wasn't the Amish; it was another group who lived very much like them called the Hutterites, who are actually even more extreme than the Amish. And, the Hutterites have extremely low levels of micro-awakenings. So, it's not just that they're less likely to describe themselves as depressed. They're less likely to show that fairly good, rough proxy for depression, which I think is why we can infer it's not just a cultural thing, where they're not saying it. They're actually feeling it less than the rest of us.

I think another reason why it's reasonable to infer depression and anxiety have gone up, is that there are certain factors that we know cause depression and anxiety. And, we know that a lot of them have risen.

So, let's give a really obvious one: loneliness. Again, Professor Cacioppo, wonderful man, sadly died recently, spent 30 years studying this. And, demonstrated very clearly--there was a long time when people thought, 'Well, yes, depression and loneliness go together.' But, is it you become depressed and then you become lonely? And, of course, that is true in many cases. But, he proved that loneliness causes depression and anxiety.

And, we know that loneliness has massively gone up, and that's just one of several factors.

So, I do think it's reasonable to conclude there is a real phenomenon going on here, of depression and anxiety themselves increasing.

11:12

Russ Roberts: A couple of things. I think we should make some distinction for listeners who are not immersed in this area. You allude to, at the very beginning of the book, about what it's like to be depressed. I think people who are not depressed assume that people who are depressed are unhappy. We're talking about something different from unhappiness, certainly different from, 'Oh, I had a bad day today.' We use the word 'depressed' sometimes casually that way. But, the way we're trying to use it, I think, in our conversation is: deep despair, deep pain, difficulty in going on with life, a feeling of meaninglessness, of extreme darkness, disinterest in all kinds of things, getting up in the morning, living, and so on.

So, this is--well, I'll let you talk about that. And, then I want to put a footnote on. So, you go first. When you talk about depression being on the rise, or loneliness being correlated with it, of course, people who are lonely--if my wife goes out of town for two weeks, I might be lonely for two weeks and miss her, and feel sadder than I usually do. And, if I am sad, she isn't there to cheer me up. That's not what we're talking about, if I understand you correctly.

Johann Hari: So, I've slightly shifted my perspective on this, in that I used to say--in fact I wrote--that these are wholly different states. Unhappiness and depression are wholly different states. And, in one sense they are.

But, actually, they're a continuum. Now, of course, lots of things are a continuum that can lead--falling over in the street is very different to falling off a cliff. They're both forms of falling.

So, there is a continuum. Of course, as you move along the continuum, your experience becomes progressively more extreme, to the degree where it seems, and in some ways is offensive to say, 'Oh, I feel depressed today' because you lost your keys. Very different to saying, 'I'm so depressed. I can't get out of bed.'

I do think there is a continuum. I think there's fairly good evidence. The factors that are making some people unhappy are making others depressed.

And the best definition I heard of this--[?] I asked huge numbers of people about this--the best definition I heard of this was from Dr. Tirril Harris, who is a brilliant academic psychologist here in London, who did really pioneering and breakthrough work in the 1970s into the causes of depression. Some of the most important works that have been done on this, I think. And, her definition of depression to me, was very good, I thought. She said, 'Look, everyone experiences hopelessness sometimes. It's a natural part of being alive. But, depression is when that hopelessness spreads over your whole psyche like an oil slick,' which I thought was a really good way of explaining it.

Russ Roberts: You know, I really found the micro-awakening remark as a marker of this fascinating. One of the themes--and I don't want to go into it in depth--but you talk about the fact that for a long time, anxiety and depression were thought of as two different things. Now, a lot of people are starting to think they're very similar, and certainly are often intertwined.

But, I'm thinking about the fact that my dreams have been particularly vivid over the last year-and-a-half during COVID. And, it's a talked-about phenomenon. I've read about it. It's not just me. And, I think, part of that--and I also don't sleep very well, and I don't sleep very long. And, I think part of that is the fact that there's more anxiety in my life, worrying about COVID. I just moved--to Israel. There's a lot of stress involved in a move across national borders. Any move; and international is more stressful. And, I think I suspect I'm waking up more at night, without being fully aware, but sensing a dream, because I'm half-awake. And, I think that's a common phenomenon, especially in these times of increased anxiety about just life in general.

You know--this is--it's a tragic time for many. Many of us, it has not been tragic. It's just been a little bit stressful. I was going to say, it's nothing like war. I'm sure there were parts about being in the Blitz in London, for example, that were exhilarating. If you died, it wasn't exhilarating. If you lost a loved one, it wasn't exhilarating. But, if you survived, there was a certain heroic connection that you felt with others, the kind of thing we're going to be talking about today.

Whereas COVID, not so much heroic parts to it: it's just there's some tragedy and your life is uprooted and disrupted. And, you don't know when it's going to end, and you don't know if you're at risk, and when if you ate too close to someone with a mask off--and, all that stuff, I think weighs on us in subconscious ways. Sorry for that long, rambling observation.

Johann Hari: No, no, that's so true. Yeah, COVID is not as ennobling an enemy as the Nazis.

Russ Roberts: Yeah. Exactly.

Johann Hari: You don't get the pleasure of feeling you're resisting the most evil people in the world, although we have regressed into a kind of tribalism about our fellow citizens, which I think is unhelpful in that way.

I think you're right. I think there's several really important things you said there.

In terms of the sleep, a great guest for you would be Dr. Charles Czeisler, who's at Harvard Medical School. He's done really fascinating work about this. He's probably one of the two or three leading sleep experts in the world. I think you're totally right about that.

In terms of anxiety and depression, this is another thing I changed my mind about. So, I thought they were--and, indeed, much more importantly than me thinking it, academic psychology thought this for a really long time. And, interestingly now, NIMH, the National Institute of Mental Health, is not funding so much separate research into those.

Professor Robert Kohlenberg is really interesting on this. Generally, because the same things that cause depression, cause anxiety, and the same things that reduce depression, reduce anxiety, I started to think of it as a bit like: they're like similar tunes, played by very different bands. Like, depression is some bleak, emo band. And, anxiety is more like, what are those terrible, like, heavy metal, slipknot bands. But, they're playing essentially the same tune, but in different ways.

17:02

Russ Roberts: Yeah. The other thing I want to get at, the other footnote I want to add, which I thought was extraordinary--and we've touched on this in the program; I find it so interesting. You talk about that in the DSM [Diagnostic and Statistical Manual of Mental Disorders], the diagnostic manual for psychiatry, there are certain attempts to describe depression. And, then there was this, for a long time, an exclusion of sorts, which was for grief.

So, if you lost a child, you lost a loved one, a spouse, particularly in tragic situations, it was, quote, "normal" to struggle to return to normal life in the face of that.

Talk about the history of that, because I thought that was kind of extraordinary. In a way, it was an opening of the door to the idea that maybe this isn't just a brain disease, but is also part of what happens in your day-to-day life.

Johann Hari: I'm so glad you asked about this, because people generally don't ask about that part of the book. And, for me, it was one of the moments when it fell into place for me, this different way of thinking.

So, I learned about it initially from a remarkable woman named Dr. Joanne Cacciatore, who is now arguably the leading expert on traumatic grief in the United States.

And, Joanne was already a Professor of Social Work when this happened, I think. But, her daughter died. Her daughter, Cheyenne, died shortly after being born. And, Joanne was very struck that almost immediately after her child died--I think that day, if I remember rightly--the doctors were urging her to take drugs, to take antidepressants and sedatives. And, Joanne just instinctively thought--I don't she would have put it so articulately then, although she may have done--'No, no, the pain I'm feeling isn't a malfunction. It's not a disorder. My child just died.'

Actually, grief is a form of love. Right? If your neighbor across the street dies and you don't know your neighbor, I mean, you feel sad in a kind of passing way, but you don't love them. Grief is a form of love. You're grieving the person you've lost.

So, Joanne began to research this, obviously later. And, she discovered--I forget the figures; I think they're in the book--but an extraordinarily high percentage of parents whose children die are given antidepressants, and indeed, even anti-psychotics. And, a huge number are given sedatives immediately after their children's death. And, often, for quite long periods of time.

And, very often, their grief is deeply pathologized by the mental health system.

So, she gives an example of a mother--I'm pretty sure it's a woman she worked with--who had a child who died in dreadful circumstances. And, she told her psychiatrist that as she went to sleep, she felt she heard her child talking to her. Not in a disturbing way: in a way that soothed her. And, the doctor diagnosed her as psychotic and gave her anti-psychotics.

So, Joanne began to research this, and discovered there was a history that has been written about by an investigator, by other people within the realm of psychology, that I think is very important. So, in the late 1960s, up until the 1960s, there had not been a standardized diagnosis of depression that was used across the United States. Right? So, different doctors had different senses of what depression was.

So, the people who write the DSM, the Diagnostic< and Statistical Manual/em>, which is the kind of bible for psychiatric disorders in the United States--there's another equivalent in Europe--decided to do a standardized diagnosis. Partly because insurance companies were asking for it, partly because it seems a sensible thing to do.

So, they drew up checklist of various things. And, people listening could guess what that checklist was. It was things like crying a disproportionate amount, feeling you can't go on. That kind of thing. And, they sent this out to psychiatrists across the United States, and they said, 'Okay, if people match'--I think it was--'six of these 10 criteria for more than two weeks, diagnose them as depressed, and give them what help you believe is appropriate.'

So, psychiatrists start doing this. But, not long afterwards, they come back and they say, 'Look, we've got a bit of a problem here. If we use these criteria in the way you've instructed us, we're going to have to diagnose every grieving person as depressed, because these are also the symptoms of grief.' And, of course, the psychiatrists who wrote the DSM, that's not their intention. They go, 'That's not what we meant.'

So, they invented what became known as the--it has different terms, but--the grief loophole, where they said to them, 'Okay, use these criteria to diagnose people. But, there's an exception. If someone they love has died in the last six months, someone close to them, a relative, they're not mentally ill. It's just a natural response. Don't diagnose them.' So, psychiatrists started doing that.

But, of course, this begs the question: Why is losing someone you love the only criteria, which means it's legitimate to feel terribly, terribly sad? What about if you've lost your job? What about if you're stuck in a job you hate for the next 20 years? What if you've become homeless? There's all sorts of criteria, right?

Russ Roberts: Abusive spouse. Dead-end marriage. Can't get married; desperately want to. Can't have a child, desperately--there's a thousand aspects of life--

Johann Hari: Exactly--

Russ Roberts: that are challenging, that lead to grief, despair, sadness: a whole range of stuff.

Johann Hari: Exactly. And so, what happened was they gradually cut--also under pressure from the insurance companies--they gradually cut back the grief exception, the grief loophole. So, initially, it was six months that you were allowed to be sad. Then it was two months, then it was a month. And, then it was just got rid of altogether.

And, Joanne said to me, Dr. Cacciatore said to me, essentially, she said that point you just made. You just listed--everyone listening will agree--those are all reasons to be sad. Profoundly sad. And, for some people, will be deeply saddening--

Russ Roberts: Devastating, not just challenging.

Johann Hari: Devastating. Exactly. She said, 'The problem with that is once you concede that point, you have to concede that context matters. That actually, it's not just your biology that causes these problems, although biology certainly contributes in many cases. But, the society and your individual's life circumstances matter hugely.' And, as Joanne put it to me: We have a system that is not built to allow all that context in.

A different person, a child psychiatrist in Melbourne, said to me: The problem is we have a model of treating mental distress that is taken from the way we treat tropical diseases. Right? So, think about malaria. So, we know the pathogen that causes malaria. I don't know if pathogen is the right word. I apologize if it's not. But, we know what caused the biological agent that causes malaria. We know how it's transmitted. We know how to prevent the biological agent getting through. And, we know how to treat the individual once it has got through.

And, of course, the treatment of tropical diseases is one of the great miracles of human life. I'm just reading a book at the moment about London in 1666. I mean, a third of the population of London died of plagues in the 17th century. Think about how different that is from our--although COVID has been terrible, how different that is. The treatment of tropical diseases is a miracle. We eradicated smallpox from the human condition.

But, the problem is, human distress is not like a tropical disease. Right? It's not: You identify some limited biological agent, you target the biological agent. So, we've taken this hugely successful model of medicine, and transposed it onto something where it simply doesn't map very well. It's not like that.

And, I think--just to say one other things about grief: it really helped me talking to Joanne and other people about the grief exception, because I realized, I actually don't think it's a coincidence that grief and depression have the same symptoms, or manifest in the same way--and some people would object the word 'symptoms,' there.

I think, in a sense, what depression is, is grief for your own life not being how it should, for your own needs not being met. Everyone listening knows they have natural physical needs. Obviously, you need food, you need water, you need shelter, you need clean air. If I took those things away from you, you'd be in terrible trouble.

But, there's also strong evidence, going back to the 1950s and Abraham Maslow, that all human beings have natural psychological needs. You need to feel you belong. You need to feel your life has meaning and purpose. You need to feel that people see you and value you. You need to feel you've got a future that makes sense. And, our psychological needs--not in every respect, there are many ways in which the way we live now is much better than in the past--but there are some factors in how we live that mean that we've been getting our psychological needs met less and less. And that is, I believe, a big factor in--I think that's part of what we're grieving for.

Think about something as basic as 41% of Americans agree with the statement, 'No one knows me well.' If no one knows you well, you're right to grieve the fact that you're living in a society and culture, or just living a life where you don't have any close connections.

You know. Now, of course, if someone dies, we can't bring back the dead. There's no solution to that grief--sadly, although we can honor the person who died, or we can continue some of the things they stood for. But, with these forms of grief, there are lots of things we can do. And, that, to me, is the most optimistic aspect of what I learned.

26:35

Russ Roberts: Well, we'll get to that. The point I want to emphasize, though--and we haven't really touched on this; it's extremely important, and, it's our segue from what we've been talking about to this more optimistic story--is that: I would never judge anyone who wanted to take a drug to deal with the grief of any kind, sadness of any kind. I don't think it's--it's not my thing. You're free to deal with the challenges of life as you see fit. Of course, often I'm paying for it in the form of subsidies, through healthcare and government. But, let's put that to the side, just for a moment.

My point is that our culture, for some reason, has encouraged people to believe that grief is abnormal.

And, I find that deeply shocking and unhelpful. I think grief is cathartic. I think it's part of being human. I may have told this story before on the program. I apologize if I'm repeating myself. But, I had a friend who lost a spouse, who had been married maybe 70 years. A long, long time.

And, she confessed to me. She said, 'I talk to him every day.' And, I said, 'Of course you do.' And, she said, 'My friends say I shouldn't.' And, I said, 'I don't agree with your friends.' Her friends were like, 'You have to get back to normal--to real life. You have to cope with the fact that your husband is gone. That's not going to change. You shouldn't try to talk to him.'

And, my view was exactly the opposite. He's part of you. Always will be. Talk to him all you want. I don't know if he's listening. That's a different question. She didn't claim that he was listening. That might be considered a little bit abnormal--or maybe not. I'm not going to judge that either. But, certainly it's healthy, to me, to continue to connect to someone you loved and were with for decades. And, the idea that, 'Okay, time to get back to normal,' I view as a strange--it's not normal. Why would you pretend it's normal? You've lost someone you care about.

And, the story you tell in the book, of the women you mentioned just now, who'd lost a child--at birth, roughly--it's a devastating experience. It would be abnormal to go, 'Oh, well. Back to life. I'll be fine tomorrow. And, if I can't be, I need a drug to help me do it, so give me one.' I think that culture--I think there are things happening in our culture that are part of that.

But, part of it, which is what you mentioned a number of times, is that the pharmaceutical companies have an incentive, of course, for that to be the culture. Their products are subsidized by taxpayers and by other subtler forms of subsidy. And, I don't think that's healthy. I think it's unhealthy, even though some would say it is healthy. That's a personal opinion.

Johann Hari: I think that's really important. Just as you were saying that, I was thinking about the--I think you're totally right. There is no previous human society that responded to grief like this. We have no record of any society.

I'm not Jewish, but I grew up in a Jewish neighborhood. And, a lot of my family intermarried with Jewish people. And, one thing I always envied as a child and loved about the Jewish community is the rituals around death. I remember when I was young, one of my neighbors died, and going and sitting there while they were sitting shiva--

Russ Roberts: a seven-day period where you isolate yourself from your regular life, and are comforted by friends and relatives who come to visit. You're not allowed--you're not allowed--to go back to your normal life for seven days.

Johann Hari: Exactly; and the deep wisdom of that. And, then, of course, the ongoing mourning rituals that go on for a long time after the person who dies, which are exactly the antithesis, indeed, of the DSM mentality, which is, 'Okay, you've had your two weeks, you've been allowed to be sad. Come on now.' You can see--

Russ Roberts: Party time--

Johann Hari: how deeply inhuman that way of thinking is.

But, Joanne Cacciatore said, 'In our society, we just do not understand human distress.'

And, the way I came to think of it is: in a way, I think part of the core of what I learned in writing Lost Connections is that we have inadequate maps of our pain. Right? Over many thousands of years, the Jewish community has developed a map for the pain of grief that is beautiful and profound. And, to me, seems to match human needs very wisely. And, what we're doing, what we've done--and, of course, there were many aspects of religious maps of how to think about the world that I disagree with. I'm gay. You can imagine, I have plenty I don't agree with.

But, what we've done is we've been writing these new maps. We've been telling people they are simply scientific facts. They are not. That these are highly contingent social constructs. Although, of course, there is plenty of scientific evidence for various aspects of this debate. And, I just don't think they're very good maps. I don't think they work very well.

31:20

Russ Roberts: Yeah. Well, we'll come back to that, I think. But, I want to make one more point, before we go into some of the environmental--or, 'context' is a better word, I think--reasons for depression.

One of my favorite parts of the book, as listeners will not be surprised to hear, is where you point out, as we have talked about many times on this program, that the evidence for the effectiveness of SSRIs--Selective Serotonin Re-uptake Inhibitors--this class of drugs that supposedly works to fix a brain inadequacy, that evidence is much more complicated than it appears.

And, we've talked about it on the program. And, when we do, people say, 'I've taken them for years, they've helped me a great deal.' Of course, I am sure that is the case. I'm also sure that for some people, they do very little. For some people, there is this suspicion that it actually increases the risk of suicide.

So, it's a complicated picture. But, what's interesting to me--and I'm not going to, there's no final judgment here--but what is interesting that is, I think a legitimate judgment, is that the statistical evidence for their effectiveness was distorted, as we've talked about on the program, by the financial incentives of the pharmaceutical companies.

And, when you look at a richer range of evidence, the studies they didn't use--for example, when they submitted drugs for FDA [Food and Drug Administration] approval--a different picture emerges.

And I thought--I think that's just an extremely important issue. We've talked about this with Gary Greenberg, when we talked about the placebo effect. We talked about it with Jacob Stegenga about medical nihilism: that a lot of the seemingly gold-standard aspect of clinical trials is not quite as scientific--I'll just be more blunt: It's not as scientific as people believe. And, I think that point is just extremely important.

If they're helpful to you as a listener, continue to use them. But, for you, Johann, they were not so helpful. And, you dealt with the side effects for a long time. And, to me, it's a tragedy. To me, it's an over-prescription of these drugs, without the impact that is claimed for them.

Johann Hari: My biggest problem--it's not actually with the drugs themselves. It's with the story that accompanies the drugs. Because, it is very well-intentioned to say to people, 'The reason you feel this way is just because there's something biologically wrong in your brain.' Right? Everyone who says that--I mean, of course there are some people who say it because they have a financial motivation, as you stress. Setting those people aside, most people who say that are wholly well-meaning.

The problem is: it's not a good map of people's pain. So, and if you look at the psychiatry textbooks, they all say--so, in theory, everyone is meant to agree with this: There are three kinds of causes of depression. Three contributions, three kinds of contributions.

There are biological contributions. Like, for example, your genes can make you somewhat more sensitive to these problems, though they don't write your destiny.

There are psychological problems. Like, grief would be one. Childhood trauma, all sorts of things.

And, there are social problems. Like, loneliness, financial insecurity, and so on.

So, it's called the biopsychosocial model.

But, as Professor Lawrence Kirmayer at McGill University said to me, 'In theory, we have a biopsychosocial model. In practice, we have a bio-bio-bio model.' And, the problem with it is, if the only story you tell people is there's a problem in your brain, what you're saying to people in effect--and this relates back to what we were saying about grief, but goes much wider--what you're saying to people is this distress you feel is like a glitch in a computer program. Right? It's an internal malfunction.

And, what I learned is, it's much healthier and much more truthful for us to understand it--although there's certainly for some people biological contributions--it's much healthier to think of it not as a malfunction, but as a signal. As a signal that something's not right.

And, there was a breakthrough I had in this, and I want to stress--like you've stressed, you know--there is a legitimate debate about chemical antidepressants. They helped me for a short time, then they didn't help me.

And, actually, in a funny way, when you look at the scientific evidence about chemical antidepressants, it's rather banal. And, although the truth--although the debate is very charged, I actually think that banal truth is something that pretty much everyone you walk past on the street--not everyone, the vast majority of people--instinctively know, which is, I would say: Just look at three things.

So, depression is generally measured, is often measured by something called the Hamilton Scale, which measures how depressed people are. I've always felt really sorry for whoever Hamilton was, by the way, that he's remembered primarily by how miserable we are.

So, the Hamilton Scale goes from 1, where you would be dancing around in joy, to 51, where you would be acutely suicidal--or it might be the other way around. But, anyway.

And, to give you a sense of movement on the Hamilton Scale: If you improve your sleep patterns, like you maybe need to, you will generally improve your mood six points on the Hamilton Scale. And, if your sleep deteriorates, like when you have a baby, often, you'll go six points the other way.

On average, over time, chemical antidepressants move you 1.8 points on the Hamilton Scale. So, it's important to say a few things about that. That's an average. So, some people get more. I initially got more. Over time, I got less. Some people say that that's a little bit too low, and it should be more like 2.4 points. But, it's important to stress that's a real effect. That might be the thing that gets you off the ledge. It's something for some people.

But, equally, you can see that that's not solving the problem for a lot of people.

As you know, from the other, I think most important piece of research on chemical antidepressants, which is called the STAR*D trial. So, there is shockingly little long-term evidence into chemical antidepressants. The best research we have is called the STAR*D trial. It's very simple. People go to their doctor, they say, 'I'm depressed.' They're given chemical antidepressants. And, this study just follows them to see what happens.

And, what it found is over time, most people given chemical antidepressants do become depressed again. It's important to say that's not everyone, but it's most people. That doesn't, to me, tell me there's no value in these drugs. But, it tells you we need to have a much wider menu of options, a much deeper response.

Also, the other crucial fact is that a lot of these drugs can cause quite extreme side effects. In 70% of men, it will diminish their sexual functioning, for example. That's not a trivial number of people. And, that's just one of many side effects. For me, it caused an enormous amount of weight gain that really just fell off when I stopped using them. And, of course, weight gain in itself is quite depressing.

So, there's a big, broad debate about that. But, for me, the most important thing I learned about chemical antidepressants--I remember the moment I learned this: So much of what I had been taught by these experts fell into place. I went to interview a South African psychiatrist called Derek Summerfield. And, Dr. Summerfield happened to be in Cambodia in 2001, when they first introduced chemical antidepressants for people in Cambodia. So, he was there studying something else. He was just there by coincidence.

And, the local doctors, the Cambodians, were like, 'Well, what are chemical antidepressants?' They'd never heard of them. 'What are antidepressants?' they said. And so, he explained. And, they said to him, 'Oh, we don't need them. We've already got antidepressants.' And, he was like, 'Well, what do you mean?' He thought they were going to talk about some kind of herbal remedy.

Russ Roberts: Leaves. Some tree leaf they chew on. Yeah.

Johann Hari: Exactly. Instead, they told him a story. There was a farmer in their community who worked in the rice fields. And, one day, he stood on a landmine and he got his leg blown off. So, they gave him an artificial limb. They're good at that in Cambodia. And, after a while, he went back to work in the rice fields.

But, apparently, it's extraordinarily painful to work underwater when you've got an artificial limb. And, I'm guessing it was fairly traumatic to go and work in the field where the guy got blown up. He started to cry a lot. After a while, he just was crying so much he couldn't get out of bed. He had what we would call classic depression. This is when the Cambodian doctor said to Dr. Summerfield, 'Well, that's when we gave him an antidepressant.' And, he said, 'What was it?'

They explained that they went and sat with him. They listened to him. They realized that his pain made sense. Only had to spent five minutes with the guy to see why he was so upset. One of the doctors figured, 'If we bought this guy a cow, he could become a dairy farmer. He wouldn't be in this position that was screwing him up so much.' So, they bought him a cow.

Within a couple of weeks, his crying stopped. Within a month, his depression was gone. It never came back. They said to Dr. Summerfield, 'So, you see doctor, that cow, that was an antidepressant. That's what you mean, right?' Now, if you've been raised to think about depression the way we have, that sounds like a joke. 'I went to my doctor, because I was depressed. She gave me a cow.' Sounds ludicrous. But, what those Cambodian doctors knew intuitively from this individual and unscientific anecdote, is what the leading medical body in the world, the World Health Organization [WHO], has been trying to say for years: If you're depressed, if you're anxious, your pain makes sense. And, the most effective strategy is to deal with the underlying causes of that pain.

Now, for some people, it would be worth taking drugs to take the edge off. I wrote an entire book about addiction. That's all about love and compassion for people who are using drugs to anaesthetize their pain. I wouldn't dream of judging anyone. I would do it myself in the situation that a lot of people are in. I did do it myself for a long time.

People who want to avoid having this complex conversation say that people like you and me are pill-shaming, or trying to shame people. Nothing could be further from the truth. It's precisely because we love those people and honor their pain, that we want to have a truthful conversation. It isn't about taking anything away from people. I want to expand the menu options.

Anything that reduces depression should be counted as an antidepressant. For some people, that will include drugs. But, precisely because of the limitations of those drugs and the side effects, we need to have a much broader menu of options, that's much more truthful about what's actually causing this problem.

41:33

Russ Roberts: So, what we've just talked about is roughly the first third of your book. It was very powerful, because of the personal narrative, as well as the narratives of the people that you interviewed and talked about, some of which you've mentioned today.

The next part of the book is much more radical, ambitious, provocative, which is: the source of a lot of depression, and the rise over time of depression in the world, especially in the West, is an increase in--we could call it loneliness, but it's a loss of connection. The book is called Lost Connections.

And, I want to say upfront, I'm deeply sympathetic to that. I think it's true. But, I disagree with a lot of what you said about that. And, we'll get into some of that, I hope. But, talk about some of the examples that you use and the causes. You list nine. But, talk about some of the more important ones that you write about that we've lost, the connections we've lost as human beings.

Johann Hari: Yeah. So, we touched a little bit on loneliness, but I think it's worth exploring that a bit more, because there's lots that I talk about. So, Professor Cacioppo, who I mentioned before, I remember one of the times I spoke to him. So, there's been a huge increase in loneliness in our culture. And, again, this is something we can be fairly sure of. There's very good sociological evidence, people like Professor Robert Putnam. There's this study that--

Russ Roberts: There's certainly--there's undeniably an increase in aloneness. People spend more time by themselves than they used to. And, that can be--and I think you've pointed this out--that can be loneliness. Not always. And, for many people, it's not. But, for many people, it is. So, certainly, aloneness has increased. And, I think loneliness has, too.

Johann Hari: So, remind me just to come back to that in a sec. I'll just give you the evidence for aloneness and then come back to that, because you've raised a really important distinction that was very clarifying for me when I was doing the research.

So, for example, there's a study that asks Americans, 'How many close friends do you have who you could turn to in a crisis?' And, when they started doing it a while back, the most common answer was, 'Five.' And, today, the most common answer--not the average--but the most common answer is, 'None.'

So, there's been this--what is life like if you have nobody to turn to when things go wrong? You know.

I remember talking to Professor Cacioppo, and him saying to me, 'Why do we exist? You, me, everyone you've ever met. Why are we here?' One key reason is that our actions--

Russ Roberts: Tough question.

Johann Hari: Exactly.

Russ Roberts: Not an easy question.

Johann Hari: He didn't entirely resolve this debate. But, it reminds me of one time I was on BBC Radio [British Broadcasting Corporation Radio], and we were debating: Does God exist? And, they said, 'Okay, you've got three minutes.' It's like: We're not going to resolve this one.

Russ Roberts: And, 'A tweet. We'll give you a tweet on top of the three minutes. Two tweets.'

Johann Hari: Exactly.

He said, one key reason we exist is that our ancestors on the savannas of Africa were really good at one thing. A lot of the time, they weren't bigger than the animals they took down. They weren't faster than the animals they took down. But, they were much better at banding together into groups and cooperating. Just like bees evolved to live in a hive, humans evolved to live in a tribe. And, we are the first humans ever to disband our tribes and tell these very extreme, individualistic narratives about who we should be.

And, the point you made about the difference between aloneness and loneliness, I think is super-interesting. So, when Professor Cacioppo--more than 30 years ago now--started studying loneliness, initially he thought, 'Oh, well, the way you study loneliness is you study how many social connections people have.' Right? That seems like a good proxy for loneliness. So, no one, if you asked them, 'Do you feel lonely?' no English-speaker has any difficulty knowing what you're describing and saying yes or no.

But, interestingly, it proved to be much harder to define at first, because it turned out, the number of people you speak to every day bears very little relationship to how lonely you feel. They're not good proxies at all. And, he was trying to think, 'Well, why is that? What's going on there?' And, he studied it more--years of study to make this breakthrough.

And, what he found was: it's not how many people you speak to every day that determines whether you're lonely. It's how many reciprocal relationships you have with people that you turn to.

So, he gave the example, [inaudible 00:46:02] when he said, 'Look, if you've never been to New York before and you go to Times Square for the first time'--not in COVID times, but in the before-times--'you're not alone. You're surrounded by other people. But, you don't care about them. They don't care about you. If you fall over, maybe someone will help you; maybe they won't. But, you know, there's no reciprocity.' So, you actually feel quite lonely.

Well, think about when you're in hospital. You can push the button and a nurse will come. You're not alone. But, you often feel lonely, because there's no reciprocity. If you said to the nurse, 'How are you doing? Can I help you? Would you like me to hand out the pills to the person on the next bed?' The nurse is going to say, 'No, no, no. That's not--.' They will reject reciprocity.

What heals loneliness is relationships where you are giving to someone and they are giving to you.

And, it's not on a one-to-one ratio. It's just: you know, I've got your back, you've got mine.

It's also why, often, people feel very lonely when a relationship breaks down, even while the person is still there. I know I've had this experience, where, you know, the relationship is breaking down. The other person is still there. You're not physically alone. And yet, you feel terribly lonely, because you realize that reciprocity is gone.

So, you're absolutely right.

The reason this is so important--apart from just it's important to understand what causes our problems--to me, the reason this is so important is that once you understand this, opens up a very different set of solutions to this problem. So, one of the heroes of my book is a doctor named Sam Everington. So, he's a general practitioner, a family doctor in East London, where I lived for a long time, a poor part of East London.

And, Sam was really uncomfortable because he had loads of patients coming to him with terrible depression. And, like you and me, he's not completely opposed to chemical antidepressants. But he could see two things. Firstly, that chemical antidepressants took the edge off for some of them, but often didn't solve the problem.

But, more importantly, secondly, they were depressed and anxious for really understandable reasons, like: they were terribly lonely. So, one day, Sam decided to pioneer a different approach that's subsequently spreading all over Europe. A woman came to see him named Lisa Cunningham, who I got to know later. And, Lisa had been shut away in her home with crippling depression and anxiety for seven years. Sam said to Lisa, 'Don't worry. I'll carry on giving you these drugs, but I'm also going to prescribe something else. I'm going to prescribe for you to come here to the doctor's offices twice a week and meet with a group of other depressed and anxious people--not to talk about how lousy you feel. You can do that if you want, but that's not the point of it. I want you to find something meaningful to do together. Right? As a group.'

So, the first time the group met, Lisa literally vomited with anxiety. It was just so overwhelming. But, the group started talking. They were like, 'What could we do?' These are inner-city, East London people like me: they didn't know anything about gardening. But, there was an area behind the doctor's offices that was just, like, scrubland. And, someone said, 'Well, we could turn that into a garden.' So, they started to take gardening books out of the library. They started to learn all about gardening. They started to get their fingers in the soil. They started to learn the rhythms of the seasons.

There's a lot of evidence that exposure to the natural world is a really powerful antidepressant. But, they started to do something even more important. They started to form a tribe. They started to form a group. They started to care about each other. If one of them didn't show up, the others would go looking for them, saying, 'Hey, what's wrong?' If they had a problem, they'd try to figure out solutions to it. The way Lisa put it to me, 'As the garden began to bloom, we began to bloom.'

Now, this approach is called social prescribing. There's lots of small studies going on a bit at the moment. One study in Norway found it was more than twice as effective as chemical antidepressants in reducing depression. There's similar study with anxiety--I think for obvious reason. Right? It's dealing with one of the reasons why they felt so bad.

And, you mentioned the role of the pharmaceutical companies. There is a $10-billion dollar industry to tell Lisa the reason she felt that way is because there's something wrong with her brain. There is a $0-dollar industry to tell her, 'You might want to take up gardening with a group of people who care about you, and form relationships.' Right?

Now, in my view, every doctor's office in the world should have a social prescribing wing. Almost everything is easier in life when you are facing it with a group. Actually, chronic pain: they've been doing social prescribing for that. It seems to be having great results. Grief: much easier in a group. It's actually weirdly reconstituting the idea of the shiva in a funny way in that grief group and the kind of communal support you would've got from Jewish mourning rituals or just Jewish rituals more generally.

So, to me, that's a really important example of how, when you understand the causes, it opens up a huge thing you can add to the menu. It's actually much less expensive; and the early initial evidence--we should stress it's initial evidence since it's from relatively small studies--suggests it's significantly more effective.

50:57

Russ Roberts: So, listeners won't be surprised--but, as a sometimes-listener, Johann, you probably won't be surprised either--but the social science evidence that you use to support the claims of Lost Connections--I'm not the biggest fan of that work. It's experimental work in social psychology. A lot of that work has failed to be replicated. There's a publication-bias issue that a lot of the work that wouldn't confirm it doesn't get published. So, I'll just say I'm skeptical of some of that--for example, that inequality is a cause of depression, meaning income inequality.

But, where I agree with your claims--not because it resonates with the way I think about the world, which is, I think, often how we choose really how to decide what we think is true or not--is that, again, whether one can debate the impact of lost connections on one's mental health. I don't think you can debate that we have fewer connections.

You mentioned one just now. You mentioned that we have fewer friends we can turn to. Certainly, we have a lessened sense of community in the West. Certainly, we live more in urban settings where people are leading more individualized lives. Religion is on the decline. Something you didn't talk about it in the book but I think is not unimportant: Family is on decline, which you didn't talk about in the book. I think those two things were my biggest complaints about the book because I think those are not unimportant in our lost connections.

Now, we may struggle to improve those. That's, I think, the challenge. If you say, 'Well, okay, fine. Maybe you're right. What do we do about it?' Now, you point out in your book: You say, 'I'm an atheist.' So, now what? If I said, 'Well, God's really helpful. You should try it,' but 'I don't believe in it.' Or, 'You'd be really great if you had a nuclear family and you could visit your grandparents and your grandchildren,' and blah, blah, blah. Well, most of us have chosen lives where that's not an option. And, the idea that we would--and this comes up a lot in this program--the idea that there would be policy levers that we could turn to for those things, I think is a mistake. But, if we ignore those as a cause, I think we are missing some of the picture, at least. Let's put religion to the side. I'm a religious person--

Johann Hari: Well, no, it's interesting you say that, because I changed my mind on this a little bit.

So, it's funny, I remember one of the other things I envied as a kid about the Jewish community I grew up in is that it seemed to me the Jewish people, you can get all the benefits of religion without having to believe in God--

Russ Roberts: Sure--

Johann Hari: I remember going around when I was a kid and asking all the Jewish people in my neighborhood--I could see they were very communally involved--and I would say to them, 'So, you must really believe in God.' And one of those going[?], like, 'No, I don't believe in God at all'--

Russ Roberts: Not necessarily--

Johann Hari: Exactly. So, it seems to me Jewish people get an incredible sense of--not all, clearly, but a lot of Jewish people--you get the community and the collective story, which is an incredible story, without the necessity--although, of course, a lot Jewish people do believe in God--of a kind of supernatural belief.

But, I started to change my mind on this. So, for a long time--so, as a child, my parents were religious; and I just looked within myself and just didn't find any--it just didn't resonate with me. I didn't believe it. And then, I had a quite a long period where I was a kind of Dawkinsian atheist.

Russ Roberts: That's Richard Dawkins, for those of you listening in. Dawkinsians, a little hard to hear. But, I think you meant Richard Dawkins.

Johann Hari: Yeah. Yeah. Who, by the way, I think is the best science writer in the world and remains someone I hugely admire. By which I mean a proselytizing atheist: I was trying to persuade people of the merits of atheism.

And I found, in the course of doing this research, I lost all of my proselytizing atheism. And I feel much more humble about it. Partly because: Let's imagine a scenario where tomorrow, everyone in the United States or Britain became an atheist, and all the churches, mosques, and synagogues fell into disrepair. If I'm honest, that would be a worse society the next day. A significantly worse society.

And the realization of that, to me--it was a gradual realization. I didn't have some Damascene moment, although you are actually physically quite close to the actual road to Damascus, so it feels appropriate to bring it up--

Russ Roberts: I can see the Temple Mount with the Dome of the Rock and the walls of the old city of Jerusalem from about three feet from here, out that window.

Johann Hari: I've never forgotten: I once got lost in Jerusalem, and I was trying to find my hotel and I stopped someone. I said, 'How do I find this place?' She said to me, 'Go to the end of this road. Go right. You'll see the Garden of Gethsemane. Go through there. Turn right.' I was like, 'Wait. The Garden of Gethsemane.' 'Yeah, yeah. Just go through that.' I was like, 'What?' Even for an atheist like me, it was quite impressive.

But, so, I think in terms of the--look, these religious practices evolved over a long period of time because they embody huge amounts of human wisdom. Does that mean I think that every aspect of them is true? Of course not. But, I'm a lot more humble about the wisdom embodied in those ideas while continuing to disagree with many aspects of it, of course, than I was before.

56:22

Russ Roberts: So, I'm not a proselytizer. I'm not going to tell you that, 'Oh, religion's the best solution.' And, I actually am going to disagree with that a little bit about the mosques, temples, and churches. If they all disappeared--which is sort of what they're doing now: that's not really a hypothetical experiment. The world is becoming less religious. And as you point out many times in the book--and you referenced Sebastian Junger, and we've had him on the program talking about tribes--we're tribal people. We're tribal animals. We like belonging. Obviously, not everyone. Some people like to be in Times Square by themselves. They don't feel alone. But, most of us do that every day, we're going to struggle a little bit. And, if we don't feel we're part of something larger than ourselves, we're going to struggle emotionally. And I think that's a deep insight of your book.

And, I've suggested on the program, as have some of my guests, that a lot of what we're seeing in the world right now is a search for alternatives. I don't want to offend anyone, but the fact is, is that a football game, a political party, a rally--these are ways that we connect with other people for a cause that we think makes the world a better place. For a long time, religion did that. For many people now--for better or for worse; it's just a fact--it doesn't do that for them.

So, not judging, again, religious people or atheist. This is a trend in human history over the last--really, it's the last 200 years. But, the last 25, it's particularly accelerated, particularly among younger people. And so, my view would be if we do lose all the churches, mosques, and synagogues, and whatever other houses of worship people will turn to, we will find the others. The challenge is: You have to find good ones.

And, of course, religion's a mixed bag. There are things that were done in the name of religion that were horrifying. Still are horrifying. I'm not going to defend that. We're not going to get into that. But, the challenge is--you know, to take sports as an example: Sports is kind of empty. There's no real value there. There's some artistic expression on the field. But, the main value I think for the participants is a feeling of collective belonging. And, that's nice. But, the underlying principle isn't so uplifting.

Art can do it. Building a house for somebody who has lost their house. There's a thousand ways we can work together to make the world a better place and to get, as you point out, outside of ourselves. Religion was really good at that. We're going to have to develop--if religion doesn't--if there's no reversal of this trend, I think we as human beings will look for other ways to satisfy it. And, let's be honest: some of the ways, like religion, are a mixed bag. Some of them are not just, well, kind of empty, but actually kind of destructive. They rely on otherness, looking down on other people--which is the dark side of religion. It's the dark side of tribalism, right? The insight of Sebastian Junger that you talk about, which is, I think, deeply important.

We're tribal. That's just the way we are. Don't say, 'Well, tribalism's horrible.' It doesn't matter whether it's horrible or not. We look for it. We seek it out. We have a natural aversion to the Other. We have a natural connection to the people we've defined as our tribe. So, I just think--I think this conversation, and I want you to respond to it, I think this is the conversation 2021 that we have to come to grips with.

Johann Hari: I think you're right. I think it's so important--now, partly because of COVID. My friend, Andrew Sullivan, said to me--he was talking about depression--he said, 'It's like we ran a collective experiment to see if your book was right.' And, look, depression, anxiety, and indeed addiction massively went up.

But, I think you're right as well, because it's also relevant because of politics. And, and, I think in a way--and the fact that this--how to put it? So, one of the religions we are adopting in the absence of those previous religions--and the previous religion was flawed and the new religion is flawed--is politics. Right?--

Russ Roberts: Yeah--

Johann Hari: Whether it's Trumpism, wokeism--

Russ Roberts: Ideology.

Johann Hari: Yeah.

Russ Roberts: Trumpism, anti-Trumpism--they're both really serving this role in many people's lives, for better or for worse.

Johann Hari: Exactly. To me, so much of the political discourse is directed at the surface phenomena rather than at the underlying issues.

And there are lots of totally legitimate political disagreements. Right? You can disagree about levels of taxation, and what the right health care policies are, and what the right gun control or not policies are. These are totally legitimate policy debates. I'm not talking about them.

But, I think so much of the rise of this very extreme polarization and rage, which is really catastrophic, is the search for extreme forms of meaning in the absence of just ordinary meaning.

Healthy societies, you get a sense of meaning from knowing people, from them knowing you. This person got married, that person died, this person was kind to me, that person noticed that I had a haircut. All of these, the great mulch of life.

What happens when you have profound loneliness and separateness is the mulch of life breaks down, and people develop these extreme--the sociological term for it is parasocial relationships. It's where you believe you're having a relationship with someone you don't know. So, it might be President Trump, it might be President Obama. It could be anyone--someone admirable, someone not admirable. It doesn't matter. You [?] these extreme parasocial relationships, these extreme forms of commitment.

Also, just your thinking can just spin off. There's a moderating effect of ordinary social discourse, where I might say something extreme and people go, 'Oh, Johann, that sounds crazy.' And, I think, 'Oh, maybe that is a bit crazy.' And you get lots of the--often, the signals are more subtle than that. Right? Social discourse just naturally moderates your thinking. And if you are entirely alone, your thinking can spin off in these totally wild directions.

I think about the guy who went to shoot up the pizzeria that was the center of the so-called QAnon conspiracy. I think it was a pizzeria where they believed there was children being held in dungeons underneath there, or--I forget the details. You see this guy being interviewed: he seemed like actually quite a nice person. You know, he was like, 'I thought there were children being held there.' You know, 'I was trying to help them.' And, he seemed like a perfectly reasonable person. You could just--I didn't do any research on this guy but from the little I saw, he seemed to me actually just a profoundly lonely person in search of meaning. Now, he may have had other views. I don't know about it. I don't want to comment too much on him.

But, just as a wider phenomenon, I do think that this phenomenon of disconnection from other people, disconnection from meaningful values, disconnection from a sense of the future is producing--I don't want to be simplistic because there's many, many things going on--but I think it's one key factor in a lot of these very concerning phenomenon that we're seeing at the moment.

1:03:22

Russ Roberts: So, I wrote an essay a couple of years ago called "The Lonely Man with a Gun." And, a lot of these tragedies of mass murder of strangers are a lonely man with a gun. I was asked to write about it, by the way. I was asked to adapt it for a website I won't name, but they didn't want me to say, 'A lonely man,' because that was sexist. And I wanted to say, 'But, it's usually'--

Johann Hari: Despite the fact that they are all men?

Russ Roberts: They're all lonely men. I'm sorry. And maybe we could learn something from that, and I think we should.

But, it's amazing to me--and I understand it, and I try to be, as you are suggesting, sympathetic to people who don't agree with me--I try very hard. But, the response to these tragedies, whether it's the pizzeria, or synagogue in Pittsburgh, or the nightclub in Florida--is it Florida?

Johann Hari: Yeah--

Russ Roberts: Just is horrible. Las Vegas, the crowd in Las Vegas at the concert.

The natural response of many people to that is, 'Obviously, we have to control guns.' And, then the response on the other side is always, 'No, but guns are okay--either because I like to hunt, or I think for the Second Amendment, it's important, or because I think it reduces the risk of tyranny.' There are a lot of--like you said, that's an interesting policy debate. I've been in that debate many times.

But, no one says--well, to me is the more important question, which is, 'Why would somebody want to kill a bunch of strangers? What kind of society has so much dysfunctionality that not only does this happen--' I mean, once would be a lot.

You could say, 'Once, okay, it's just a weird outlier.' It happens occasionally. I wouldn't say it happens often. Doesn't matter. Occasionally is way too often. It is a signal that something has gone dark about how we connect to other people.

So, in this part--Johann, this is the part of your book I totally agree. I don't like the inequality thing. I think that research is just wrong. But, I do think that the lost connections part--and I think it's very complicated, you blame, at times, capitalism, the profit motive, or the workplace motives. I think it's more complicated than that. I think it's the breakdown of the family, and I think it's the breakdown of other things that in a healthy society, connect us to each other.

And, we should be worried about this. This is not just like, 'Oh,'--it's a different version of your point, which is like, 'Oh, here's a person whose life has spiraled of control. Let's give him a drug.'

Here's a person who has shot a bunch of strangers because they think it's a meaningful act. And our first response is to take away guns. It might be a good idea, by the way. I don't agree with it, but it's a legitimate policy response.

But, you have to consider the underlying cause. Why would you not confront that? That makes no sense whatsoever.

So, the part of your book I salute and applaud and think is incredibly important, even though I don't always agree with what you think are the solutions, is that: not every case of depression is going to be caused by people connecting to other people or creating the social connections we once had. But, it would help. It would help. And I think--I want to let you close and talk about that. Again, I may not agree with all the solutions you propose.

And I also want you to talk about the personal response a person can have because I think that's extremely important. I don't think you're suggesting in the book that if you're despairing, 'Oh, don't worry about it. Just connect yourself to other people.' You're not saying that. Or, 'It's easy to fix. Don't take the drugs. Go make some friends.'

Now, that's not irrelevant, but I don't think that's your personal or policy response. So, talk about how you think we ought to respond to this. It's a crisis, actually, that we pretend is, like, no big deal. It's really strange. One in 10--I checked this recently--the estimate is something like one in 10 Americans are taking antidepressants. One in 10?

Johann Hari: One in three middle-aged women at any given time.

Russ Roberts: What the heck?

Johann Hari: That's one in 10 at any given time. So, bear in mind, across a year, that's significantly more than one in 10.

Russ Roberts: I don't get that. I don't get it.

Johann Hari: It's remarkable.

Russ Roberts: Go ahead.

Johann Hari: That's one in 10 just with chemical antidepressants. Bear in mind, all the other forms of pain relief that people are taking.

Russ Roberts: Alcohol, yeah.

Johann Hari: Alcohol, which has massively increased--

Russ Roberts: Recreational drugs--

Johann Hari: Yeah, exactly. Or, prescription drugs, as well.

And, there's a few things in what you just said that I'd like to pick up on, if that's okay because I think it's really fertile and interesting and it connects to something I've been researching for the last few years. Just to say about capitalism, by the way, I don't want your listeners to get the wrong impression. So, I'm strongly in favor of a very significant market component to the economy. I mean, we would disagree about how much of it should be the market component.

Russ Roberts: Yeah, no big deal. We're still friends. Go ahead. And we're having a civil conversation. It's wonderful.

Johann Hari: I also think--I want to say about capitalism because some people did say about the book, 'Oh, he's saying capitalism is the cause of this problem,' which is absolutely not what I think. I think there are extreme iterations of capitalism that can make these problems worse. But, of course, there are many configurations of human societies that don't meet people's psychological needs. So, the Soviet Union, for example--

Russ Roberts: Well said. Well said.

Johann Hari: I bring up the Soviet Union, the absolute abyss, human nightmare of communism, for example--

Russ Roberts: Cuba, Venezuela--

Johann Hari: That was not, obviously not a capitalist society and was, radically did not meet people's needs and had staggeringly high levels of suicide and despair.

So, there are some people who say things like, 'Capitalism causes depression'; I want to go, 'Mmmhmm. My parents did go to East Berlin when it was a Communist tyranny. You might want to--' I mean, they were living in West Berlin so they weren't going there out of ideological sympathy. 'You might want to think about that.' So, yeah, it would be grossly simplistic and indeed foolish to say capitalism is the cause of this.

And indeed, some of the fruits of having a market economy--like the huge fall in hunger--have massively reduced depression. One thing that makes you miserable is not having enough food. So, you mentioned Venezuela or Cuba: people neglect those insights, the need for a market component to the economy at great cost.

In terms of--it's interesting you mentioned that about a shooting because I've been doing some research. I'm writing a book about Las Vegas. I've not meant to talk about it too much. But, I've been looking a lot into, who was the person who carried out the, well, the worst massacre in modern American history. He--

Russ Roberts: Okay, so right now, hang on one sec. I'm going to interrupt you. I apologize. But, I'm going to edit out that name. So, listeners: It's just going to be blank. You mentioned someone's name. So, my view on this is: if you decide you want to increase your sense of belonging and mattering by getting your name in the paper, I understand papers have issues about what they think their responsibility is, but we don't here. So, we're not going to commemorate that person's name. So, somebody in Las Vegas killed a lot of people. Sorry, go ahead.

Johann Hari: THat's interesting. In general, it's so difficult as a journalist because I agree with that. I mean, I remember when Jacinda Ardern, the Prime Minister of New Zealand, did that fantastic speech after the monstrous massacre in Christchurch and said exactly that: 'We will not say this person's name.' It makes it slightly difficult as a journalist, though.

Russ Roberts: I understand, hard to write a book.

Johann Hari: Yeah. Yeah. So, I'm not writing a book specifically about him. He's a rather tangential aspect of it. But it meant that I was researching some aspects of him and his life. Let's call them the killer, the killer in Vegas. It'd be fascinating to research him because--I think--I mean, obviously, you never want to generalize from individual cases. And, obviously, I never met this man. So, I'm just using this slightly as a bridge to talk about another aspect of this.

So, it's clearly the case that this killer was profoundly socially alienated. He appeared to have no friends. I also think there was another aspect to his story. So, people who don't remember: He rented a room at the Mandalay Bay, and he smashed a window, and he shot down a country music festival, and he shot 520 people, and 59 of them died. The death toll just went up because someone died a few weeks ago, if I remember rightly. As monstrous an attack as you can imagine. Of course, there's a legitimate of the gun control debate. And I think, even--I believe the great majority NRA [National Rifle Association] members believe that we should ban bump stocks, which he was using, which are weapons of war.

Anyway, park the gun debate because everyone knows that debate. I feel like it's rather sterile. And, there is nothing that I could add to that debate. The killer was both profoundly lonely, but also was a manifestation of another aspect of the causes of depression and anxiety--I mean, beyond dystopian and grotesque manifestation. I suspect we might disagree on slightly; I'd be interested to hear your thoughts on it, which I think is a corruption of values that has taken place.

So, the way I try to explain in the book is: Everyone knows that junk food has taken over our diets and made us physically sick. And, I say that with no superiority--there was literally a McDonald's bag the other side of the laptop of which I'm speaking to you. And, we know that what happens is that junk food appeals to the part of us that needs nutrition, but actually doesn't really meet that need and in fact screws you up. But, I think there's some evidence--and I believe this is actually highly compatible with a capitalist worldview--that a kind of junk values have taken over our minds and made us mentally sick. And, for thousands of years philosophers have said: If you think life is about money and status and showing off, you're going to feel terrible. Right? It's not exactly how Confucius and Schopenhauer put it, but that is basically what they said. But, nobody--

1:13:13

Russ Roberts: Or Adam Smith. A lot of smart people--it's in the Bible--a lot of smart people have said: 'Whoever gets the most toys wins' is a bad model for life.

Johann Hari: Exactly, and Adam Smith, I think, is one of the greatest writers about this, actually--The Theory of Moral Sentiments is really a masterpiece on this question.

But, weirdly nobody had scientifically investigated what Adam Smith, and Confucius, and all these other people said until an extraordinary man I got to know named Professor Tim Kasser, who studied this question; and he discovered loads of really important things.

But, for the purposes of this conversation, I think he discovered two quite important things. Interestingly, it was not through experimental psychology, which, like you, I'm rather skeptical of. It wasn't primarily through that. It was primarily through sociology, really: just studying long-term trends and [?] this type of question.

But, he basically discovered two key things. Firstly, the more you think life is about money and status and showing off, the more likely you are to become depressed and anxious. It's a significant effect.

And, secondly, as a society, as a culture, we have become much more driven by these junk values throughout my lifetime. And, I think in a way I was always struggling between how radical what he discovered is and how banal is it. Right? It's incredibly banal. No one listening thinks, 'If I said to you, are any of you going to lie on your death bed and think about all the shoes you bought, and all the likes you've got on Instagram?' Right? No, you're going to think about moments of love and meaning and connection in your life.

But, as Professor Kasser put it to me, we're geared to not think that way. And, the killer in Vegas, whose name we won't say, is a very extreme manifestation. This is a man who was obsessed--he was originally based in Reno--obsessed with--it's interesting, he was a video poker player, which is the most isolated and lonely form of gambling. I was[?], because I've been spending a huge amount of time in Vegas, no one looks more miserable than the video poker players. I've spent a lot of time observing them. It's the loneliest form of gambling. You're playing against a machine, right? You're blankly playing against machine. He would sit there for 10 hours a day blankly playing against the machine.

But, he was in it partly for the winnings, but actually mainly for the perks. So, the people who knew him say, 'Oh, he was in it for the comped rooms, the people who make a fuss of you, the kind of simulation of social life.'

Russ Roberts: Yeah, of mattering, belonging, feeling important, dignity.

Johann Hari: Exactly. But, he did also really care about the money, actually.

So, it was this combination of these two things: it's the loneliness and the corruption of values.

And, then what happened is--of course, the way the whole system works, is: they'll comp you while you're spending, but when you stop, obviously the comps stop. Right?

So, he leaves Reno and comes to Vegas. And the best theory about why he carried out this massacre--and I'm indebted for this to a documentary maker called Ram Denison who interviewed the killer's brother in great detail; I'm hopefully going to interview the killer's brother as well, but he interviewed him in detail--was basically he was enraged that these benefits had been withdrawn from him.

He believed the folly of Vegas, and he wanted to massively harm MGM [Metro-Goldwyn-Mayer], who owned the Mandalay Bay. So he carried out massacre, partly because he was going to kill himself--it was obviously a form of suicide--but also he wanted to carry this massacre because it would cause tremendous financial harm to MGM, who he blamed for withdrawing these perks from him. And, in that monstrous limited sense, it did do a lot of harm to MGM.

So, he had a sense of how to achieve his goals and achieved his goals. I mean, he achieved them at the expense of brutally murdering people and horrifically traumatizing many more.

But I think it's a kind of illustration of these--he's an illustration--yeah, another illustration, I'm going to read [inaudible 01:17:03], I'm really interested in this question--a profoundly--you know, it goes a bit too far to say this, but Krishnamurti, the Bengali philosopher, said, 'It's no sign of good health to be well-adjusted to a sick society.' And you think about a society that establishes the idea that, you know: 'You should be alone; you should spend most of your time interacting through screens; you should think about yourself primarily as an isolated individual, not as part of a group; insofar as you have a narrative for yourself it should be about earning money and spending it and displaying it on screens to make people jealous,'--those aspects of the society are sick. There's many hugely positive aspects of our societies as well. I'm very glad to be alive today, so don't misunderstand me: it's an aspect of sickness, and every society has had an aspect of sickness. We don't want to be forcibly nostalgic about the past or overly pessimistic about our present, because then that would not be right.

But, I do think--I do think we need to think more deeply about these problems. And, the single most important breakthrough we need to make is to understand that our pain makes sense. That we're feeling this way for reasons.

And, you're right: there's a trivial way in which this can be read. And as you know, I don't--I very carefully do not offer this trivial reading in the book, but some people who hadn't read the book sort of accused me of saying--you could imagine a glib iteration of saying this, 'Okay, so your pain makes sense, so hey, if you're feeling down, why don't you just go to the shop and befriend the first person you see? Or why don't you just think differently about your [crosstalk 01:18:42]?'--

Russ Roberts: Build a garden with a bunch of friends--

Johann Hari: Exactly. You can see that there's a--and Lisa, think about Lisa, who was the person who I talked about who was prescribed to that gardening program--she could not have done that on her own. It took 'medical'--and I'm putting medical in inverted commas--medical intervention for her to do it.

And, think about the parable of the cow, right? What those Cambodian doctors did not say to the man who was crying all day is, 'Oh, okay, you're sad because, you know, you got blown up in this field and your leg hurts. Okay, we've told you your problem, you solve it. Bye.' The community, having understood the problem with more complexity than we would, the community together--it wasn't the doctors who bought the cow, it was the village, people checked in in the village--bought the cow for this guy.

So, it's about, once you understand the problem in a deeper way, that opens up a broader range of solutions.

Now I suspect, as we know, you and I would differ about the role of the state in that. But, even just opening it up without proposing state-based interventions opens up community-based interventions. If you don't understand why you feel bad, or worse, if you have an inaccurate story about why you feel bad, you will be trapped. You will likely be trapped. Not in every case--some people will just make a natural recovery. But you'll be more likely to be trapped.

The more we understand these problems, truthfully in relation to the best science and the best wisdom, I mean, there's nothing in those connections that isn't in the Torah, right? Pretty much?

1:20:14

Russ Roberts: Yeah, these are old values, right?

Johann Hari: Yeah.

Russ Roberts: They're very old.

And I think the challenge is how we get there from here, to a different set of values than the ones maybe that we have.

I think it's way too easy to blame it on capitalism or advertising. We're human beings. We're flawed. And, we struggle to overcome our flaws.

And, we used to have a set of overarching values that came from religion, or family, or our nation. Most of those are gone. And there are good things about that. We both recognize that. But, they're not being replaced.

I don't think--the place I disagree with is I don't think there are too many people who are the prophets, P-R-O-P-H-E-T, of profit. I don't think--even economists understand that it's not about how much money you have. I think there's a tendency to overvalue it because of the way we conceptualize human wellbeing--that's a long, another conversation. We'll put that to the side.

Johann Hari: But don't you think--I think there's some truth in that. But I think more about--I think a bit in a more primal, almost mythical way. I was just watching with my godsons The Searchers, the John Wayne movie. You think about the vision of John Wayne, right? I'm obsessed with John Wayne movies. I think he's amazing. Which is not popular on my side of politics, but I have to be honest about it--

Russ Roberts: Whatever--

Johann Hari: You think about the primal image of John Wayne as this lone cowboy, you know, in the wilderness, which is a very primal idea in our culture.

Russ Roberts: Agreed.

Johann Hari: Even the cowboys were not--I mean, any cowboy would have died if they'd done what John Wayne did. It was completely impossible to do that. That is a myth in the truest sense, right? The actual cowboys were not individualists. If they had been they would have all died.

Russ Roberts: Yeah.

Johann Hari: So, you think about these very primal ideas we have in our culture, which is that--which go deeper than the idea of the profit, much deeper than the idea of the individual profit motive--it's this idea that--it's almost a grammar of our thought.

There was an interesting person I interviewed for the book that, again, helped me to think about this. She's a woman called Dr. Brett Ford--who I interviewed in Berkeley; she's now in Toronto--who, as part of a big team did this really interesting research.

They wanted to figure out: If an individual decides they want to be happier--let's say that you were going to say 'I'm going to spend two hours a day trying to be happier'--would it work? And, they did this research in four countries: in the United States, Russia, Taiwan, and Japan.

And, what they found at first seemed really odd. In the United States, if you want it to be happier, if you consciously tried to make yourself happier, in the main it did not work. In the other countries if you consciously tried to make yourself happier, in the main it did work. And, they were like, 'Well, why would that be? What's going on?'

When they looked at it what they discovered is, in the United States, if you tried to make yourself happier--surely this would be true of Britain as well--in the main you do something for yourself as an individual, you work harder to get a promotion, you buy something and display it on social media, you do something individualistic, we have an individualistic conception of happiness. Turns out that just doesn't translate to actual happiness very much.

In the other countries--of course there are exceptions on both sides--in the other countries, in the main, if you try to make yourself consciously happier, you did something for someone else: your friends, your family, your community. So, they have an instinctively collectivist idea of happiness. And you asked about--which does work, works better.

And, you asked about personal things that people can do, and of course I argue in the book for some bigger social changes. But, for me personally the biggest change, and it's in some ways embarrassingly small, and in other ways has had a real effect on me, is when I feel down now, I don't ever feel depressed like I did before. But when I feel down now, before a lot of the time I would try to deal with feeling down by an individual, external achievement, some impressive showy thing. And, of course I still do that a lot, I'm talking to you, right?

Russ Roberts: Don't we all, don't we all.

Johann Hari: But, what I also try to do, more, is I've realized that even when I don't feel good, you can usually make someone else feel good.

And, in a profoundly lonely society, often you can do that just--look, I'm not Oprah: I can't turn up and give people a car, right? But what I can do is turn up, leave my phone on, and listen to them; and just sit there and be present, and tell jokes and laugh or listen, or help them think of solutions, or just sit with them in their pain, if they're in pain.

So, I try to deal more with my pain and distress by being present with other people and trying to do something for someone else rather than for myself.

Now, I don't want to act like I'm some self-aggrandizing person. I wouldn't even claim I do that 50% of the time when I feel bad. But, it's become a bigger part of my personality than it was before. And for me, in line with the research by Dr. Ford and other people, that really has helped me. You know.

1:25:16

Russ Roberts: Again, I think that's a well-known truth. I don't think you need research to do that. I'm not sure it's--I don't believe--I strongly disagree--that America versus, say, Russia, or Japan, has different effects of that because America is a more individualistic society.

Individualism does not preclude--should not preclude--being engaged with others. Right? And, I think that's a misunderstanding of the American ethos, or the Classical Liberal ethos that I espouse philosophically of limited government.

It doesn't mean we're on our own. It means that we voluntarily choose to interact with others and create a civil society.

And we do that in many, many ways. We do that through family, and we do that through community, religious and otherwise, neighborhoods. All those things in America have struggled to be sustained.

Now, you could argue that's because of our individualist ethos. I don't think so. I think it's a more complicated--I don't know the answer to it.

Johann Hari: I really [crosstalk 01:26:20].

Russ Roberts: My point is there's a correlation. There's a third factor that I think is driving some of these cross-national comparisons, which is: Family, Community, fill in the blank.

I think a lot of societies in the East, certainly in parts of the West, are much more family-oriented, much more community-oriented.

But I don't think it's a philosophical or an ideological issue. It's a much more--it's an urban, rural, there's so much going on there. So, I just think it's a mistake to judge as a--to pick a phrase you don't use, I don't think, maybe once--some kind of neoliberal phenomenon of political ideology. I don't think that has anything to do with it. Personally. But, of course I would say that, because it would be damning for me, for my worldview, if it were.

So, I understand, I recognize that I may have some issues here. But, I do think on should be open to these other social trends that are happening at the same time cross-country that I think make it hard.

But, let's close on this optimistic note, and I'll let you have the last word--you can comment on that, too, if you want. Connecting to others is a really good thing. It has nothing to do with capitalism, nothing to do with ideology. And you could do it in family, you could do it with friends, you could do it in a club. There's a thousand ways to do it. But they clearly are a source of meaning for all human beings--almost all. There are exceptions, but almost all human beings find those interactions meaningful. And, I think we've lost a lot of those interactions for a whole bunch of complicated reasons, and I think it would behoove us--to use a word that's out of fashion that I like to use about once a year--it would behoove us to think about how to rebuild some of that connection.

And, we would disagree over the role the government might have, I think, in creating those connections. I think government unintentionally--government doesn't have intentions--but individuals who have used government have unintentionally pushed us in directions that I think have been harmful to some of those ways that we connect with others. But, I think that's the bottom line. What you said is not banal or trivial. The way we find happiness in life is by doing good, either to ourselves or with others, or to others: Listening, giving, smiling. There's a thousand ways you can bring a little bit of brightness to the day. It's the biggest cliche of all time. But, it's true. And that's why it's a cliché: it's true.

Johann Hari: It's funny because it's both a cliché--I remember, I think you just put that beautifully. And there was this, I remember the night before my book came out I said to one of my closest friends, 'You know, I'm really proud of the research I've done. I think there's really important stories in this book, and a lot of things to be learned. But, I think the reaction of most people who read this book will be: This is really banal and obvious. Did we really need a book to tell us all this?' And, then the book came out, and I kept being introduced in interviews, people would say, 'Well, now we're going to speak to Johann Hari, who has written an incredibly controversial new book.' Right?

And, I remember that when it started happening I was just like, 'Why? This is really weird.'

And, I remember one interviewer, I think it was during PR[?Public Radio?], I was talking about, again, what I think is the most, and obviously we're only covered a small amount of what was in the book. But about what I think is the most obvious point in the book, which is: Loneliness makes you feel terrible. Right? And, I remember I was talking about how loneliness causes depression, and the interviewer said to me, 'Well, this is a very controversial argument.' And, I remember thinking, 'This is insane.' Right?

And I think I said--actually I can't remember if I said it at the time--but I said, 'If we could go back 60 years and say to your grandmother or my grandmother "Do you think being lonely will make you feel worse?" Right?' My grandmother would've clipped me 'round the ear and said, 'Why are you wasting my time with such ridiculous questions?' Right?

So, what we've been talking about--I think we have very similar instincts on this aspect of it--is in a very peculiar spot, where it is both banal and radical, in that: there's nobody, very few people if we stopped them in the street and, you know, kidnapped them and forced them to listen to this podcast, would disagree, I think, with large parts of what we're saying.

And yet, we have been trained to think about problems like depression, anxiety, and addiction in a radically different way. Right?

I mean, I've had conversations with some people where you'd say to them, 'Okay, do you think?'--when my book was controversial, when it came out, I remember speaking to some of the critics, and I said to them, 'Do you think loneliness increases depression and anxiety?' 'Yes, I do.' 'Do you think if you've been abused as a child it makes you more likely to be depressed and anxious?' 'Yes, I do.' 'Do you think financial insecurity makes you more likely to be depressed and anxious?' 'Yes, I do.' 'What causes depression and anxiety?' 'A chemical imbalance in your brain.'

Right--so, we're in this weird--it's true cognitive dissonance, where people hold two sets of insights in their mind at the same time and don't see the contradiction.

But the problem with it is: We know these things, and yet we have systems to respond to this problem--depression, anxiety, which is a real, terrible, agonizing problem--that ignore pretty much all of those insights and have a wholly different narrative.

Now it's not that that narrative doesn't contain some truth. Like I said, I believe in a bio-psychosocial model. There are real biological contributions to these problems. Some forms of drugs can take the edge off for some people.

But, we've allowed that insight, which is a small part of a much bigger picture, to eclipse essentially the whole picture--to dominate the whole, a). of the medical profession's response to these problems, but b). a huge amount of the cultural conversation about these problems.

And, we've created this extraordinarily defensive discourse where anyone who argues, like you and I do, for a broader conversation is treated as if they're saying to everyone, 'I'm going to go into your bathroom cabinet, take your Prozac and burn it.' Right? Which is not at all what we're arguing for. Or worse still, 'We're going to come into a bathroom, tell you you're a bad person for taking Prozac,' which is the antithesis of what we believe. Right?

So, it's really interesting to see what seems--I'm always interested in arguments that are both obvious and very controversial, because then, that suggests to me that it's gone to something quite deep in the culture. There's some rub, some tectonic rubbing in the culture if those things are true, because very few people dispute what we're saying, right?

I mean, you'll get some people who say--and they may be right, I don't think they are based on my reading of the science--but you'll get some people who say to me, you know, some really admirable people--Dr. Andrea Cipriani who's an Oxford University, Professor, Cipriani, I should say--is a great person who says, 'Look, you're right about all the social causes,' I mean, I'm paraphrasing, 'But, you're right about all the social causes, but you underestimate the value of chemical antidepressants.' Right? 'They're more useful than you think.'

Russ Roberts: Maybe.

Johann Hari: Maybe. Right. But I don't think he is, although I do think they have some value, but he may be right. Those are legitimate debates.

But it's interesting to me that what we're saying is reacted to as controversial, which is precisely why we need to have these conversations and why we need to have them in these non-polarized ways.

And, I think you're totally right what you said before: this isn't just a fault line about depression and anxiety. I mean, those are huge enough: like you say, one in 10 Americans are taking chemical antidepressants.

But this isn't just a fault line for that debate: this is a fault line for so much more. A profoundly lonely society that connects to the wrong things and has values that are going awry in many ways. It's going to be a society that has dysfunctional politics that has just a huge amount of pain in it that could be prevented. We can't prevent all human pain, many parts of the human condition are tragic, but there's preventable pain here that we could be dealing with.

Russ Roberts: My guest today has been Johann Hari. His book is Lost Connections. Johann, thanks for being part of EconTalk.

Johann Hari: Thank you so much, I meant to say--my publishers taze[?] me if I don't--anyone who wants any more information about the book, or more importantly you can actually listen to audio of a lot of the people we've been talking about--the experts--or you can find out where to get the audio book at www.thelossconnections.com. And, I really enjoyed this conversation. I really enjoyed the spirit of entering into this conversation, and we need much more conversation like this, and I'm really worried that the culture is moving in the opposite direction, of everyone screaming at everyone else, and it's horrifying.


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