Several years ago, Hari was a user of - and staunch advocate for - anti-depressant medications; but he gradually became aware of the limited efficacy and disagreeable side effects of these drugs. And as he learned more about the science of mental health, he came to realize the inadequacy of the 'chemical imbalance' theory of depression and became increasingly concerned that the psychological and social underpinnings of the condition are being largely ignored in Western culture. Indeed, Hari's book is a powerful indictment of the highly circumscribed nature of our public discourse about depression, which has for many years been pressed into a biomedical straitjacket.
Depression, according to today's standard medical narrative, is caused by a faulty brain and best treated with pharmaceuticals. Hari rejects this script. Mental health, he proposes, depends largely on our ability to connect with other people and with nature, to have meaningful work and values and to understand the part played by childhood trauma in conditioning adult thoughts and behaviours. Yet these connections and understandings are largely frustrated in our society, which, even for those of us living in the 'developed' world, is characterized by an endless cycle of overwork and ruthless, individualistic competition that leaves us with little time to care for others or ourselves. These social stresses, Hari points out, play an enormous role in generating illness. As Hari puts it, 'the primary cause of all this rising depression and anxiety is not in our heads. It is, I discovered, largely in the world, and the way we are living in it' (p.14). Overcoming mental distress therefore requires not just 'insight', but also, to borrow a term from the British psychologist David Smail, 'outsight' into the ways in which our minds are moulded by our prevailing social arrangements.
Of course, this emphasis on the psychological and social determinants of mental distress is hardly new and - contrary to the allegations of some of his critics - Hari does not claim that it is. In fact, he acknowledges that his argument rests on an existing body of research, albeit one that is well-known to anybody familiar with the sociology of mental health. What makes Hari's book so valuable is the elegance with which it synthesizes that research for the lay reader and the power of its journalistic reportage and personal reflections on depression. Drawing on interviews with researchers as well as sufferers, Hari intersperses passages explaining academic findings with moving accounts of the depressive experience. Crucially, too, he details how some sufferers have managed to 're-connect' to themselves and others through self-analysis and involvement in collective, community-based projects.
This book is a tonic, since we so seldom reflect on either the psychological or socio-political determinants of mental distress. Scientific research has established that depression has biological, psychological and social causes and the so-called 'bio-psychosocial model' of mental health is now unassailable; yet contemporary medical practice focuses almost exclusively on depression's biological correlates. The same is true, in fact, of popular culture: as I argued in my own book Madness, Power and the Media, the biomedical model of depression prevails in the contemporary media, from soap operas to high-profile television documentaries like Stephen Fry: The Secret Life of the Manic Depressive. In our society, the understanding and treatment of mental distress, as the late Mark Fisher argued, have been privatized and many of us have come to regard depression, as Hari once did, as an idiopathic brain disease.
This view is not only hopelessly reductive, but socially damaging: a substantial body of research suggests that people who subscribe to it are more inclined to stigmatize sufferers. But challenging the biomedical paradigm requires us to adopt a radically different perspective on health and illness - one that acknowledges that individuals are inseparable from their environments. Here it is worth pondering the words of Gabor Maté, whose ideas underpin many of Hari's own reflections:
We should, I think, be more radical. Our task today must be to eliminate wage labour and the exploitation and suffering it entails. In the nineteenth century, Marx recognized that capitalism alienated human beings from nature, from themselves, from work and from others (more or less the same set of disconnections that Hari discusses). Even then, Marx saw that this system would have to be overthrown after a certain point in its development. In the twenty-first century, capitalism has gone global and, having made possible a world of plenty, now shows the morbid symptoms of a system in terminal decline, with devastating consequences for human health. The people of the Global South are in a desperate struggle for survival, facing poverty, starvation, war and environmental chaos. But even in the relatively affluent West, depression, anxiety and addiction are rife; the proliferation of disorders such as ADHD, meanwhile, seems too rapid to be attributable to 'genetics' or improved methods of diagnosis. All of these conditions are best seen not as diseases, but as adaptations to the manifold social and political pressures of contemporary capitalism.
As William Morris put it in his 1884 lecture How We Live and How We Might Live, the socialist society of the future will be one of 'combination, not competition'. We have now developed the productive capacity to do away with capitalism, along with the massive stress, neglect and abuse it engenders, and to create a truly human society of material abundance and mutual aid. In a world without wage labour and money, human beings will need to work for perhaps just a few hours a week; we will then have time to develop our connections with others and to explore our innate creative potential. But until we come together to create this new kind of society, our miseries will only multiply.