Thinking critically about Lost Connections 1: An introduction, of sorts

I forced myself to read Lost Connections: Uncovering the Real Causes of Depression by Johann Hari so you don’t have to.  Following my look at an extract published online, I was cursed enough to get my hands on a copy, and I have a lot of feelings about it.

I’ve taken it upon myself to review the book, to encourage the critical thinking that’s sorely lacking in the media reception of the text. Unfortunately, I’ve been struggling with this task on a personal level, and this is because there is so much wrong with it. It’s a fundamentally flawed text on almost every level, and it’s been difficult to even work out where to begin.

While I’ve always accepted environmental factors as a depressant and stressor, I feel like the experience of reading the book provides a very neat demonstration of the phenomenon.

How do you begin to criticise a book which claims to be about depression–it’s right there in the title!–when for a substantial portion of the book the author isn’t even writing about depression? How do you evaluate evidencing when you, a rando blogger who has a day job and a bit of a life, can’t click everything and check it says what the author is saying it says? How can you even begin to criticise the politics of the text? How do you point out that the book is telling us nothing new?

The book is divided into three sections: poking holes in the current model of depression and its treatment; Hari’s proposed real causes of depression; and remedies (“reconnections”) to alleviate the problem. The central thesis is that depression is a symptom of a sick society, and it’s a message that shouldn’t be damped down, but should instead be addressed using Hari’s proposed remedies.

And, sadly, the case isn’t made very well at all.

Of course, the very logic, that depression is a symptom, much like nausea, is flawed. It can be a symptom, much like nausea. That does not mean that one ought never to take a medicine to alleviate it. It also does not mean that it’d go away under the right circumstances. Indeed, something like nausea often needs treatment, because it’s often unhelpful.

The evidence presented in the first section is reasonably strong, although highly biased and by no means holistic. It also sets up a huge strawman: that the only way that doctors think about depression is pure chemistry. That simply isn’t true. Parts 2 and 3 have a different set of problems, being largely horribly-evidenced, with the bits that aren’t being things which we’ve all already known about a thousand times over.

What the book is is this: a self-help book for a well-off Guardian reader who fancies themselves as clever and educated about science. It’s badly-evidenced, largely inapplicable for the people who need societal interventions the most, and is nowhere near as groundbreaking as it thinks it is. It’s an unhelpful text, which is highly annoying to read if you’re someone who has a background in psychology; if I’d been marking it as a submitted paper, I’d probably fail it.

So I suppose what I’ll start with doing is warn you that this review is going to be five blogs long (including this one). I spent a bit of time dividing the methodological and political flaws into broad themes, and these were the things which seemed most egregious to me. These things are:

• The approach to evidencing and the double standard
• Conflation of depression with other mental health issues, and emotions.
• A false dichotomy as to how depression is thought about: science vs the real problem
• How we’re not actually learning much new from the text

I will also be questioning the largely-positive critical reception of the book, because it’s kind of annoying to me, but mostly because I want to ask questions about why it’s been so universally popular, and that I suspect there’s more at play than merely a well-oiled PR machine. My thoughts on this are circular, with problems feeding into one another: for example, bad evidencing means that bad solutions are presented, but this couldn’t happen if a false dichotomy strawman weren’t set up to present treatment as either drugs or meditation.

I won’t be delving into any point-by-point takedowns, because I am only human, and it would take approximately a million years for me to pick apart every incorrect reference, every misleading claim, every moment where he seems to have fundamentally misunderstood what he’s supposed to be talking about.

I’ll be posting a blog a day this week to cover the whats and whys of this book, so get yourselves comfortable, kids. Before we get started, I’d like to recommend a bit of reading for you, if you haven’t done it already. I don’t want to retread ground that’s already been trodden, and so here are some things which have already been covered:

• Five things wrong with Johann Hari’s comeback book that I spotted from the extract alone (me)- A quick look at evidencing and some very whiffy claims.
• Is everything Johann Hari knows about depression wrong? (Dean Burnett)- debunking myths about antidepressants.
• Twitter thread from Stuart Ritchie– Providing evidence ignored by Hari about efficacy of antidepressants.
• As a psychiatrist, I know that Johann Hari is wrong to cast doubt on antidepressants (Carmine Pariante)- A psychiatrist’s view–if only we’d see more psychiatrists being platformed!

Why does this matter? It matters because there is a very real risk that people might stop taking their medicine–something which may well be happening. It matters because it might deter people from seeking help from a qualified professional altogether. It matters because we need solutions that work for the people who need them most, not the people who enjoy moralising.

Please do not use Lost Connections to influence your personal health decisions. Speak to a doctor. The care available to you is better than you think. 

If this were some random internet person’s blog with 40 views, I wouldn’t be spending my time writing a takedown. But it isn’t. It’s a widely-promoted book, and with great reach comes great responsibility. I’d have loved to have not written this series, that someone else would have done this instead. But they haven’t, and so, here I go.

Part 2: The Evidencing Double Standard >

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