by Jacob Williams • last updated 2025-02-08 • Markdown • PDF
A pretty crazy story about him nearly dying in Vietnam after failing to peel an apple.
Hari was on increasing doses of antidepressants most of his adult life, but now thinks it wasn’t solving his depression, and that depression is caused by external factors rather than bad brain chemistry.
He also says:
Really surprising claim: he says there are trace amounts of antidepressants in the water supply. Is this true? Is it enough to have any effect?
Referencing work by Irving Kirsch, Hari says antidepressants have a minimal effect, and that this is generally accepted by researchers. One reason for an exaggerated impression of their effect is publication bias—but unpublished studies can be accessed via FOIA requests. Another issue is failure to pay attention to the difference between placebo groups and no-treatment groups, which is necessary to measure how much better than placebo a drug is (I didn’t find the discussion of this totally clear).
He also mentions a case of deliberate deception by GlaxoSmithKline in marketing Seroxat/Paxil.
Hari says there was never good reason to believe depression was caused by chemical imbalance.
Very few scientists now defend the idea that depression is simply caused by low levels of serotonin, but the debate about whether chemical antidepressants work—for some other reason we don’t fully understand—is still ongoing. There is no scientific consensus. Many distinguished scientists agree with Irving Kirsch; many agree with Peter Kramer.(Hari 44)
He mentions the Star-D trial and subsequent studies, which find 65-80% “of people on anti-depressants … continue to be depressed”(Hari 45)
Peter Kramer is mentioned as a main proponent of antidepressant effectiveness, but Hari represents him as antagonistic and evasive. Hari says Kramer argues that the drug trials are bunk anyway (so the low effectiveness they show is irrelevant), because poor people are highly incentivized to participate and lie, but Hari doesn’t make clear why Kramer thinks we should assume the drugs are effective.
Conveying Joanne Cacciatore’s ideas, Hari thinks the (now-removed) grief exception in the DSM suggest the arbitrariness of assuming depression is caused by a chemical imbalance.
They had been forced to admit, in their own official manual, that it’s reasonable—and perhaps even necessary—to show the symptoms of depression, in one set of circumstances.
But once you’ve conceded that, it invites an obvious follow-up question. Why is a death the only event that can happen in life where depression is a reasonable response? Why not if your husband has left you after thirty years of marriage? Why not if you are trapped for the next thirty years in a meaningless job you hate? Why not if you have ended up homeless and you are living under a bridge? If it’s reasonable in one set of circumstances, could there also be other circumstances where it is also reasonable?(Hari 51–52)
Hari talks about some 1978 research by George Brown and Tirril Harris that interviewed women who had been classified as depressed, and women who hadn’t, and concluded that difficulties and stabilizers had a great deal of predictive power, and that the distinction between ‘endogenous’ and ‘reactive’ depression wasn’t visible in the data.
Hari says the bio-psycho-social model has become dominant among psychiatrists, but not sufficiently known to the general public.
Hari mentions a 2011-2012 Gallup poll that “studied millions of workers across 142 countries”(Hari 76) and found only 13% described themselves as “engaged”, with 24% “actively disengaged”.
Referencing Fleming’s Mythology of Work and Bregman’s Utopia for Realists, Hari says work “is spreading over more and more of our lives”(Hari 77). I can’t tell if he’s claiming actual worked hours are increasing or just that there’s a greater expectation to be always available.
Hari describes Michael Marmot’s research on the British Civil Service showing that people at higher levels had less risk of heart attack and depression; and that:
If you worked in the civil service and you had a higher degree of control over your work, you were a lot less likely to become depressed or develop severe emotional distress than people working at the same pay level, with the same status, in the same office, as people with a lower degree of control over their work.(Hari 82)
Various research on the downsides of loneliness and that it causes depression.
This was surprising:
Anywhere in the world where people describe being lonely, they will also—throughout their sleep—experience more of something called “micro-awakenings.”(Hari 95)
Hari pushes back against the idea that overuse of Internet/smartphones are “mainly caused by something inside the technology itself”(Hari 106); rather:
The Internet was born into a world where many people had already lost their sense of connection to each other. The collapse had already been taking place for decades by then. The web arrived offering them a kind of parody of what they were losing…(Hari 107)
Hari discusses Tim Kasser’s research showing that materialistic values make people more depressed. (There’s a footnote on whether this is correlation or causation, admitting you can only do so much to prove it but saying there are some lines of evidence for causation. Interestingly it says there’s evidence that depression causes materialism, too.)
Kasser also found that achieving extrinsic goals doesn’t make you happier, but achieving intrinsic goals does.
Kasser and Richard Ryan “found that the more materialistic you become, the shorter your relationships will be, and the worse their quality will be.”(Hari 118) Kasser also found that “highly materialistic people… experience significantly fewer flow states.”(Hari 118)
Hari thinks advertising is making us more materialistic. He mentions a 1978 experiment where kids shown a commercial about a toy “mostly chose to play with the mean boy with the toy. If they hadn’t seen the commercial, they mostly chose to play with the nice boy who had no toys.”(Hari 121) I’m curious if this replicated.
Vincent Felitti saw a link between obesity and childhood trauma, and helped run the Adverse Childhood Experiences study to validate it. That study found “for every category of traumatic experience you went through as a kid, you were radically more likely to become depressed as an adult.”(Hari 135)
The psychologist Paul Gilbert started to make the case that depression is, for humans, in part a “submission response”—the evolutionary equivalent of Job, the baboon at the bottom of the hierarchy, saying—No, no more.(Hari 145)
The more unequal your society, the more prevalent all forms of mental illness are.(Hari 147)
It’s been known for a long time that all sorts of mental health problems—including ones as severe as psychosis and schizophrenia—are considerably worse in cities than in the countryside…(Hari 154)
Hari summarizes Alcock et al 2014 as finding “people who moved to green areas saw a big reduction in depression,6 and the people who moved away from green areas saw a big increase in depression.”(Hari 154)
He cites The Natural Principle for the finding that people like pictures of savannas more than other landscapes. I find this surprising since that’s not the landscape I feel most drawn to.
It’s hard for a hungry animal moving10 through its natural habitat and with a decent status in its group to be depressed, she says—there are almost no records of such a thing. The scientific evidence is clear that exercise significantly reduces depression and anxiety.(Hari 156)
Isabel Behncke also speculates that being in nature combats “the feel[ing] that ‘now everything is about you.’”(Hari 158)
Hari mentions a Howard Frumkin paper talking about how just being able to see nature from their cells made prisoners “24 percent less likely to get physically or mentally sick.”(Hari 159) This seems like an implausibly large effect…
Hari mentions Michael Chandler’s research on First Nations tribes, finding those with more control had lower suicide rates.
Chandler also did a study which found depressed children had trouble discussing questions about whether fictional characters, or they themselves, would be the same person over time. (This seems pretty weird.)
Hari connects this to the notion of a “precariat”, gig work, etc.
There was a window when people on middle-class and working-class incomes had some sense of security and could plan for the future. That window has been closing, as a direct result of political decisions to free businesses from regulation and to make it very hard for workers to organize to protect their rights, and what we are losing is a predictable sense of the future.(Hari 172)
When you have a stable picture of yourself in the future, [Hari’s friend Angela] explained, what it gives you is “perspective—doesn’t it? You are able to say—‘Okay, I’m having a shitty day. But I’m not having a shitty life.’”(Hari 173–74)
Is this an actual fact? “if you raise a baby in total darkness, the baby will shed the synapses that relate to eyesight—the brain has figured out he won’t need them and that it’s better to deploy that brainpower somewhere else.”(Hari 177) (The citation is In The Realm of Hungry Ghosts.)
Is this meant literally? “Because you are feeling intense pain for a long period, your brain will assume this is the state in which you are going to have to survive from now on—so it might start to shed the synapses that relate to the things that give you joy and pleasure, and strengthen the synapses that relate to fear and despair.”(Hari 179)
From conversations with Marc Lewis, Hari says depression does cause brain changes, and these “can then acquire a momentum of their own that deepens the effects from the outside world.”(Hari 179) Recovery from depression also changes your brain.
Twin studies indicate “for depression, 37 percent of it is inherited, while for severe anxiety, it is between 30 and 40 percent.”(Hari 181) Hari talks about the 5-HTT gene making you susceptible to depression but only when triggered by events in your life.
Is there any depression of the “purely internal kind” (“endogenous”)(Hari 182)? Hari gives a range of estimates on the frequency of this but says they’re all small.
Hari thinks the desire to see depression as purely a disease caused by biological factors is partly rooted in a desire to reduce stigma, but that research shows this has the opposite effect (Mehta and Farina 1997).
Hari quotes Laurence Kirmayer:
“Psychiatry has undergone a real constriction from this bio-psycho-social approach. While some people still pay lip service to it, mainstream psychiatry has become very biological.” He furrowed his brow. “It’s very problematic.”(Hari 189)
Nice quote from “the Eastern philosopher Jiddu Krishnamurti”:
“It is no measure of health to be well-adjusted to a sick society.(Hari 190)
Hari tells a story about man in Cambodia who was depressed after he lost his leg, who was no longer depressed after his community bought him a cow (milking a cow was work he could do better than what he was doing before).
Hari tells the story of Nuriye Cengiz and the protest movement against high rents in the Kotti neighborhood of Berlin. It’s a very inspiring story of different groups of people coming together, with a bizarre twist involving a man named Tuncai who turned out to have escaped from a psychiatric institution—and who the protesters got freed again to live and work with them.
I’m not sure the extreme dichotomy implied in the opening paragraph of this chapter is justified:
In most parts of the Western world, Nuriye would have been told there was something wrong with her brain chemistry. So would everyone else in Kotti. They would have taken their pills and stayed alone in their little apartments until they were thrown out and scattered.(Hari 218)
Hari talks about research by Ford, Tamir, and Mauss with this super interesting conclusion:
If you deliberately try to become happy, you will not become happier—if you live in the United States. But if you live in Russia, Japan, or Taiwan, you will become happier.(Hari 219)
If you decide to pursue happiness in the United States or Britain, you pursue it for yourself… But if you consciously pursue happiness in Russia or Japan or China… You try to make things better for your group—for the people around you.(Hari 220)
Hari says multiple studies found Amish people to “have significantly lower levels of depression than other Americans.”(Hari 228). He notes that 80% of people choose to return to the community after Rumspringa. On the community he visited:
It had a profound sense of community and home; yet that home had often vicious house rules. It’s a sign of how potent community and meaning are that when they were added to the scale, they could even, for some people, seem to outweigh the real and terrible pain these problems cause.(Hari 229)
“Social prescribing” refers to a technique used at the Bromley-by-Bow Center where people are put into groups to do volunteer work. Hari talks about a woman named Lisa who found this transformative in dealing with her depression.
Hari also mentions—with some disclaimers the study limitations—that initial studies in “therapeutic horticulture” show very promising results.
Using the example of a cooperative bike shop, Hari presents worker cooperatives as a path toward less depressing work environments.
…here’s the thing that most fascinated me—and showed me a way beyond the obstacle I thought was insurmountable. The actual day-to-day work, for most of the people here, hasn’t changed radically. The guys who fixed bikes before fix bikes now. The guys who did publicity before do publicity now. But changing the structure radically changed how they felt about the work itself.(Hari 251)
He references Baard et al 2004 as evidence that businesses with less “top-down control,”(Hari 254) can also be more successful in the market. And he says “there are tens of thousands of democratic workplaces like Baltimore Bicycle Works, all over the world.”(Hari 254)
Hari mentions how São Paolo “banned all outdoor advertising”(Hari 257) and “[s]everal countries, including Sweden and Greece, have banned advertising directed at children.”(Hari 257)
He discusses a study by Kasser and Dungan where having people do open-ended discussions about money and values led to them becoming less materialistic.
Hari talks about loving-kindness meditation as a way to overcome envy and feel “sympathetic joy” for others. He also mentions more general evidence for meditation helping with depression. Citations include Farias and Wkholm’s book Buddha Pill and Sedlmeier et al 2012 (a meta-analysis).
He talks about Roland Griifith’s research on psilocybin. He casts this as accomplishing something similar to meditation. He gives two caveats:
Hari talks about research by Vincent Felitti finding that just having doctors discuss childhood trauma with patients seemed to make them healthier.
Hari advocates for UBI. He gives an interesting story about a 3-year Canadian experiment in the 1970s that wasn’t analyzed until like 30 years later. He mentions Rutger Bregman as “the leading European champion of the idea of a universal basic income.”(Hari 304)
If UBI sounds like a pipe dream, Hari reminds us huge changes have happened before, e.g. the acceptance of gay marriage (within a relatively short time span!).
It happened for one reason only. Because enough brave people banded together and demanded it.(Hari 308–09)
Hari admits there may be some role for “chemical antidepressants”: “some credible scientists argue they give some temporary relief to a minority of users, and that shouldn’t be dismissed. The false story is the claim that depression is caused by a chemical imbalance in the brain and that the primary solution for most people is a chemical antidepressant.”(Hari 312)
Hari says he has made a lot of personal progress, but knows not everyone has the privilege to make the same changes; these problems are ultimately societal and need societal solutions.
He compares the pain of depression to that of touching “burning stove”(Hari 315); “It’s a signal, saying—you shouldn’t have to live this way, and if you aren’t helped to find a better path, you will be missing out on so much that is best about being human.”(Hari 315). What I don’t like about this analogy is that the one pain is a signal that you’re in danger of physical injury, while the pain of depression often seems to make a life that would otherwise be good—even if, as he points out, not as good as it could be—unbearable.
And now I realized—just like it is an insult to Joanne to say that her ongoing grief for her daughter is a form of mental dysfunction, it was an insult to my teenage self to say that his pain was just the result of bad brain chemistry. It was an insult to what he had been through, and to what he needed.
All over the world today, people’s pain is being insulted. We need to start throwing that insult back in their faces—and demanding they engage with the real problems that need to be solved.(Hari 315–16)