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    What Really Causes Depression?

    By Tom Moon, MFT–

    In the late 1980s, when the Prozac family of anti-depressants became available, I saw the new drugs make dramatic changes in the lives of many people. Patients who had been lost for years in the black hole of deep depression suddenly found a new buoyancy and a re-awakened capacity for pleasure. They re-discovered hope and the ability to take risks and explore new opportunities. To many, it seemed as if the cure for depression had finally arrived. And the cause seemed clear, as well. Depression was a chemical imbalance in the brain, which involved chronically low-levels of neurotransmitters. Raise the levels, and the depression would evaporate.

    Unfortunately, with the passage of time, it became clear that depression isn’t that simple. It has no single cause. Thinking of it as a biological disorder helped many overcome stigma and self-blame, and the healthcare industry was happy to fund a cheaper treatment than psychotherapy, but the downside of that idea was that it made it easier to avoid any examination of the deeper life issues that are always present in depression. Over time, the initial excitement faded as the limitations of anti-depressants became clearer: they don’t work for everyone; for others, they only work partially or temporarily, and when they do work, they seem to work best in combination with psychotherapy.

    Journalist Johann Hari, who has himself struggled with depression since his teens, recently wrote an excellent book called Lost Connections: Understanding the Real Causes of Depression and the Unexpected Solutions (Bloomsbury, 2018), which is the result of years of examination of what research from around the world actually shows about the many factors that create depression.

    Hari points out that it has long been recognized that the experience of severe depression is very similar to what people experience when they grieve the loss of an important relationship. Is it then possible that depression is actually a form of grief for other forms of lost connection?

    He writes, “When I interviewed social scientists all over the world … I started to see an unexpected picture emerge. We all know that every human being has basic physical needs: for food, for water, for shelter, for clean air. It turns out that, in the same way, all humans have certain basic psychological needs … . And there is growing evidence that our culture isn’t meeting those psychological needs for many—perhaps most—people. I kept learning that, in very different ways, we have become disconnected from things we really need, and this deep disconnection is driving this epidemic of depression and anxiety all around us.”

    When people are depressed, Hari writes, they are grieving lost connections in at least one of seven areas of vital human need. He urges depressed people to remember, “You aren’t a machine with broken parts. You are an animal whose needs are not being met. You need to have a community. You need to have meaningful values … . You need the natural world. You need to have meaningful work. You need to feel respected. You need a secure future … . You need to release any shame you might feel for having been mistreated.” You aren’t depressed because your brain is malfunctioning or because you are suffering from a mental illness. “You are suffering from a social and spiritual imbalance in how we live.”

    Take the area of work, for instance. Human beings need to feel that their lives are meaningful, and that they are doing something that matters. But between 2011 and 2012, Gallup conducted the most detailed study ever carried out of how people feel about their jobs. They found that 13% of people say they are “engaged” in their work—they find it meaningful and look forward to it. Some 63% say they are “not engaged,” which is defined as “sleepwalking through their workday.” And 24% are “actively disengaged”; they hate it. When 87% of the work force dislike what they do all day, is it any wonder that depression is rampant in our society?

    The epidemic of depression is not due to a mass outbreak of brain disorders, but to the fact that so much about modern life is soul-killing. Hari’s book is a meditation on the reality that when we are mired in sadness and grief, we are getting a wake-up call that we have some very basic needs that aren’t being met. We need to pay attention.

    Tom Moon is a psychotherapist in San Francisco. For more information, please visit his website