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Depression: A Social Problem?

The Mr. Perfect movement began because of a culmination of events. I have little to zero scientific or biological knowledge but knew deep down something was amiss.

In 2013/14 I first went to a GP but their reaction was a psychiatrist and medication, with no real education at all or other options (for the record I do not blame them at all). Just before this I had read a report about men’s connectedness (or lack of) and realised it was so obscurely marketed or promoted, not many other “everyday men” would have ever read it.

Just last week my brother-in-law’s partner (a big supporter of Mr. Perfect) sent me a text from the UK with a podcast link and exclaimed excitedly that it sounded so much like what we were doing.

I duly listened on my bus commute and spent the next 30 minutes nodding my head, scribbling notes, learning more than I ever did from the medical profession, feeling more empowered than ever.

I can only urge you to listen - thankfully perhaps it’s not just me accidentally concluding our connectedness is near to extinct, but now Johann Hari backs it up in style with in an easy to digest delivery.

As Johann states, there are 9 factors that can influence depression and just 2 are chemical. But if you cannot listen or prefer to consume your brain food in text, below is my summary of his findings, suggestions and new learnings for me:


  • Australia:
    • 2nd highest use of anti-depressants worldwide behind Iceland – 1 in 10 people
    • The use of anti-depressants has doubled in the last 2 decades
  • Illness or Not?
    • Is Depression an illness or an abnormal response to normal occurrences that we all face?
    • We need to reset the agenda around discussions on depression and anxiety
  • Medication:
    • Johann suggests some Doctors have oversimplified depression, following a process for example, a lack of serotonin? Take medication to stop this.
    • In the short-term, this worked for Johann but the cycle continued as he needed more over time which increased the bad side effects
    • For 13 years he was effectively told “it’s all in your head” but he suggests there are actually 9 factors involved in depression and anxiety and only 2 are biological
    • Depression is usually measured on The Hamilton Scale and includes anywhere from 17 to 29 items – interestingly anti-depressants generally only move people 1.8 points on the scale
    • The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) found that most people after using anti-depressants did at some stage become depressed again
    • Derek Summerfield, a Psychiatrist and Lecturer in London, spoke with Johann about his study of Cambodia, a country that only introduced anti-depressants in 2001:
      • When asking local farmers about them, one said “we already have anti-depressants”
      • He told the story of a farmer in their community that lost his leg from a landmine and when he returned to his job in the water of the paddy fields he became depressed due to the physical and emotional pain of not being able to do his job properly
      • The community bought him a cow so instead he could become a dairy farmer and his depression eased – a form of anti-depressant
    • Deeper Needs:
      • Despite the tendency to “chemicalise” depression, the World Health Organisation (WHO) have been promoting for a long time that we are humans with deeper, unmet needs
      • We all have basic needs of shelter, food etc but also need to belong, have purpose, have our future makes sense and other deep underlying psychological needs
    • Loneliness:
      • A study from the United States on loneliness found their own people used to have around 5 people to call on in times of need – recently they found most had no-one they could/would turn to
      • Loneliness leads to huge cortisol releases so it actually physically hurts
      • Humans evolved in tribes and herds, for example, to hunt together and achieve tasks that they could do on their own
      • However in this age we are the first humans ever actively trying to dissolve these physical tribes
    • Social Treatments:
      • Dr Sam Everington, a GP in the UK in a challenging area in East London, was uncomfortable with the depression epidemic and pioneered a different approach:
        • For one of his patients he would still prescribe drugs but also ask the patient to attend a social gathering of those with depression or anxiety that met a couple of times a week
        • They learnt gardening together and instead of the expected result of them talking about the darkness of their conditions, they turned it into something beautiful and bonded over growing this garden
        • In time, the severity of their conditions dropped
      • In society we generally put the onus of “fixing” depression on those suffering with the condition – but for example, car crash victims that are crippled are not expected to tackle the causes, we band together as a society and authorities and governments mandate speeding limits, increase safety measures and campaign etc
      • The NHS has started to introduce a “social prescribing program”
      • Not everyone can mentally or physically be in a condition to join a group and we need social interventions:
        • In Dauphin, Canada the government guaranteed each resident $16k per year regardless of background and no stipulation how to spend it
        • The result was a massive fall in depression and anxiety as it gave people the margin to change their lives
      • Values:
        • “Junk Values” are like junk food, they have made us mentally sick
        • Ancient philosophers deemed if your values were about material things and money then your life would be poor
        • In modern times no-one had truly investigated this theory
        • Intrinsic values are those we should be reaching for
        • Example, if you play the piano daily for the pure joy and no other gain, this is intrinsic
        • If you play the piano daily because your parents force you or in some dive bar to pay the rent but you dislike it, this is extrinsic
        • Professor Tim Kasser’s study summised that heavily weighted extrinsic values can lead to more depression and anxiety
      • Advertising:
        • Generally as more GDP is spent on advertising, anxiety also increases
        • Advertising makes you want to dislike yourself enough so you buy
      • Work and Employment:
        • It is not about being in the right job, it is about being in the right delivery of that work
        • A Gallup study found 13% like their jobs, 64% neither love nor hate and “sleep work” while 24% hate or fear their jobs
        • Australian Dr Michael Armour conducted a study in the 1970s that stated that deep illness come from being controlled and no autonomy, not the job task
        • A separate study of a bike repair shop showed that when controlled employees of a corporate store left to start their own, they adopted a democratic co-op structure and shared tasks, profits, decisions etc but ultimately, they still fixed bikes
        • Unfortunately there is deep pessimism in society that this is unattainable on a larger scale and is just a utopian view
      • Socially-produced Depression:
        • The WHO believes social and individual solutions are needed but importantly you do not necessarily have to be depressed to makes changes, small or radical, to lead a more contented life
        • In 2011 an anonymous housing project in Berlin saw rental rises and the largely immigrant and struggling residents could not take it any more
        • One resident, Nouria, put a sign in her window saying come Wednesday she was going to take her own life
        • Her community rallied, asked her if she needed help and eventually blocked their road at either end, wheeled her out and protested, with media arriving and highlighting their plight
        • The blockade lasted over a year and the blockade was manned 24/7 by paired residents on shifts – Nouria, the polar opposite of a short-skirted younger protester, bonded and shared their traumas, struggles and stories
        • At one police interference, Tuncay, a man with a cognitive issue, became scared and was arrested by police and locked back up again in a psychiatric hospital
        • The community rallied and marched to the hospital, demanding his release decrying “we love him, he belongs with us”
        • Ultimately the rent was frozen and the community became a family
        • In western culture, home is just a house but if we look a little deeper, connection is just below the surface
      • Social Media and Internet:
        • In a rehab centre in Spokane (US), they have lots of young men obsessed by video games as they get status, purpose, to be part of a tribe
        • The average British child spends less than 70 minutes outside a day, the minimum legal limit for a prisoner
        • Johann believes social media and social life are like porn and sex – solely porn would not be healthy for a good sex life
        • The internet asks questions of us – “Have you lost friends? Here is Facebook”.
        • Ultimately social media should not be the last destination when trying to connect with people in the real world, it should facilitate it
      • Trauma:
        • In the 1980s a Californian Dr Vincent Falleti got obese patients to stop eating and it worked for some time – they lost weight but then some returned suddenly to bingeing
        • One particular lady said she did it as she was “hit on” and it freaked her out as she was not used to it – it emerged as a child she started to put on weight after her grandfather began molesting her
        • 55% of the study participants went through similar trauma as children
        • Kaiser Permanente introduced questionnaires over a year period that asked if the patient had experienced a selection of childhood traumas and then which conditions they experience as an adult
        • The patient was 2-4 times more likely to be depressed as an adult if they experienced 1 category of trauma and if they ticked 6 categories they were 3100% more likely to attempt suicide
        • Dr Falleti discovered that when the patient next came back and the Doctor offered to talk about the trauma, on average a 5-minute conversation led to a fall in depression and anxiety
        • Shame destroys people and giving people a place to acknowledge trauma is an anti-depressant itself
        • A deeper response is needed today, of course preventing childhood trauma in the first place is key but child services across the world are having budgets cut
      • The 9 Causes of Depression and Anxiety:
        • These can play out in different combos and permutations
        • Despite patients being told this, no-one is genetically determined to be depressed but they can be more sensitive
        • Genes interact with your environment
        • You are taught you are weak or it’s purely biological – that’s wrong
        • Although he has been met with critics, Johann has the support of some leading Psychiatrists and Psychologists
      • Helping Others:
        • A study encouraged people to spend 2 hours per day doing things that they thought would make them happy
        • The people that were not happier did things for themselves – bought clothes, pampered themselves, posted selfies on Instagram etc.
        • The people that were happier helped others – for example, they sat down and talked to someone and gave them their undivided attention


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