Is it possible for a writer whose credibility has been questioned in the past to deliver a credible message now? This is the query at the heart of deep division over Johann Hari鈥檚 new book, Lost Connections: Uncovering the real causes of depression聽鈥� and the unexpected solutions.
In it, Hari, who apologised over , relies heavily on personal and anecdotal experience to relay stories from across the globe about things that can stand as alternatives to antidepressant medications, such as community engagement and personal empowerment. He takes aim at the theory that depression is a brain-chemical imbalance and assigns most ownership of it to the pharmaceutical industry as a self-serving premise on which our entire understanding of this illness is built.
There from those who find hope in Hari鈥檚 take. But also strident criticism, from two distinct camps. First, there are those who disagree with him on the basis that his book cites , pointing to the many people who have benefitted from antidepressants. Second, there are those who find the content .
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But what if I told you that they are all right? Mostly.
It鈥檚 all individual
Depression is anything but a settled science. Despite extensive study, understanding remains elusive. So elusive, in fact, that a traditional biomedical approach to depression is still well out of reach. Right now, the concept of depression is a broad spectrum of types, subtypes and severity ratings, which are at least partially dependent on notoriously unreliable self-reports.
The origins of depression are similarly convoluted, with evidence growing for likely suspects such as gut bacteria, genetics, diet, hormones, , and yes, brain chemistry, among others. The answer is likely to be a sticky one: it鈥檚 probably a complex interaction of several factors and different for everyone.
One thing we do know is that for those who have depression, , it is a crushing experience, leaving them desperate for relief.
Right now, the standard clinical approach is some combination of behavioural interventions like diet or exercise changes, along with counselling and medication. For an even smaller percentage, brain stimulation therapies are available and have varying effectiveness.
Due to the very individualised nature of depression, treatment is a series of trials, errors and adjustments. And given the prevalence of the condition, it is needless to say that this does not work for everyone and we don鈥檛 know why. Some even estimate treatment fails for up to 50 per cent of people with depression.
Discussion in the open
This is the category we refer to as 鈥渢reatment resistant depression鈥� but we don鈥檛 even really know what that is. To this day, the , and there is certainly no resolution on treatment.
With so many people spending every day with a disorder so crippling, often without any relief, was Hari so terribly wrong to search for something more? Or something different? Is it worse that he found what he was looking for or that he had the nerve to tell us what he had found?
Then again, with so many lives at stake, and so much stigma and inaccurate information about depression keeping people from even reaching out for help when they need it, are Hari鈥檚 critics so wrong for giving his words extra scrutiny and holding him accountable for faulty assertions and overreach? Are they so wrong to want a more credible voice for a topic so crucial for so many of us?
No. But鈥�
The is a ray of hope that we should all take a moment to recognise as progress. For a moment, depression wasn鈥檛 something we were afraid to talk about. It wasn鈥檛 just specialists or advocates or brave patients willing to 鈥渂reak their silence鈥�. It was newspapers, Twitter users, bloggers, researchers, clinicians and patients just speaking their truth.
The debate is loud, unapologetic, personal, emotional, and so many of the points being made are crucial and correct for some鈥� but not for all. Because that鈥檚 depression.
Read more:聽Fixing broken brains: A new understanding of depression
