Feel Better, Live More with Dr Rangan Chatterjee - #51 Uncovering the Real Causes of Depression with Johann Hari PART 1

Episode Date: February 27, 2019

CAUTION ADVISED: this podcast contains swearing and themes of an adult nature. For the past few decades, almost every year, levels of depression and anxiety have increased in Britain and across the Western world. But why? One of the most important voices in this area, Johann Hari, went on a forty-thousand-mile journey across the world to interview the leading experts about what causes depression and anxiety, and what solves them. He shares the fascinating findings of his research in this week’s podcast. Johann explains that although we have been told a story that drugs are the solution to depression and anxiety, in many cases, the cause is not in our biology but in the way we live. He argues that being depressed or anxious does not mean that you are crazy, weak or broken, rather, that your natural psychological needs are not being met. And it’s hardly surprising - we are the loneliest society there has ever been. We discuss how loneliness affects us and how social prescribing can transform lives. We delve into the role trauma plays and how shame is both physically and emotionally destructive. Johann believes that societal values have been corrupted and explains the effect that this is having on our health. Finally, we talk about the role of the workplace and how having autonomy and choices can reduce the likelihood of depression and anxiety. This is a gripping conversation and Johann's anecdotes are truly captivating - I hope you enjoy it! Show notes available at drchatterjee.com/51 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Hosted on Acast. See acast.com/privacy for more information.

This to me is the most single most important insight I is we say to people this pain you feel doesn't mean anything right it's like a glitch in a computer program but that's not true if you look at the evidence now there are biological contributions to be sure i want to stress that again but when you look at the evidence actually the reasons why people are distressed in this culture why it's rising year after year makes perfect sense. I aim to simplify it. I'm going to be having conversations with some of the most interesting and exciting people both within as well as outside the health space to hopefully inspire you as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe that when we are healthier we are happier because when we feel better, we live more.

Hello and welcome to episode 51 of my Feel Better Live More podcast. My name is Rangan Chatterjee and I am your host. So I'm recording this intro feeling super refreshed and recharged following a bit of a break. As I mentioned in the last episode with Cal Newport on digital minimalism, I was feeling a little bit burnt out and exhausted after a really busy start to 2019. I had a 16-date book tour around the UK to promote my new book, The Stress Solution, and also a trip to Sweden as my first book, The Four Pillar Plan, has just been released over there. I planned to have a little bit of a digital detox to help me recharge by coming off emails and social media for 10 days. However, I was feeling so good and calm that it ended up being over two weeks. Now, look, I love social

media as much as the next person. It's not about saying social media is good or bad. For me, as the next person. It's not about saying social media is good or bad. For me, it's simply about asking myself the question, am I using it in a way that is serving me or harming me? If you have never had a prolonged break from the digital world, whether social media or emails, I would highly recommend that you try it out sometime and see how it makes you feel. Today's podcast is all about trying to uncover the real causes of depression in society. For the past few decades, almost every year, levels of depression and anxiety have increased in Britain and across the Western world. But why? Today's guest on the podcast is the brilliant Johan Hari, who whilst researching his latest book, Lost Connections, went on a 40,000 mile journey

across the world to interview the leading experts about what causes depression and anxiety and what solves them. For me, Johan is one of the most important voices in this area. And I have to say that this conversation is probably one of my most enjoyable that I've ever had on the podcast. conversation is probably one of my most enjoyable that I've ever had on the podcast. To be honest, there was so much to talk about that we ended up speaking for nearly two hours. And so I've decided to split up our conversation into two parts. Next week on episode 52 of the podcast, you can hear the second part of our conversation. But today is all about part one, where Johan shares the fascinating findings of his research. He explains that although we've been told a story that drugs are the solution to depression and anxiety,

in many cases, the cause is not in our biology, but in the way that we live. He argues that being depressed or anxious does not mean that you're crazy, weak, or broken, rather that your natural psychological needs are not being met. And it's hardly surprising. We are the loneliest society there has ever been. We discuss how loneliness affects us and how social prescribing can transform lives. We delve into how societal values have been corrupted and the effects that this is having on our health. values have been corrupted and the effects that this is having on our health. Finally, we discuss the role of the workplace and how having autonomy and choices can reduce the likelihood of depression and anxiety. Now, I do need to let you know that there is a fair bit of swearing in this podcast.

So if you do listen to the podcast with your children, I would highly recommend that this episode may be one that you should listen to yourself or solely in the company of adults. This really is a gripping conversation and Johan's anecdotes are truly captivating. I hope you enjoy it. Before we get started, I do need to give a very quick shout out to our sponsors who are essential in order for me to be able to put out weekly podcast episodes like this one. Athletic Greens continue their support on my podcast and as you know I prefer that people get all of their nutrition from food but for some of us this is not always possible. Athletic Greens is one of the most nutrient-dense whole food supplements that I've come across and contains vitamins, minerals,

prebiotics and digestive enzymes. If you are looking to take something each morning as an insurance policy to make sure that you are meeting your nutritional needs, I can highly recommend it. For listeners of this podcast, if you go to athleticgreens.com forward slash live more, you'll be able to access a special offer where you get a free travel pack box containing 20 servings of Athletic Greens, which is worth around £70 with your first order. You can check it out at athleticgreens.com forward slash live more. Now, on to today's conversation.

So Johan, welcome to the Feel Better Live More podcast. Oh, I'm really chuffed to be with you Rangan, thanks very much. Hey not at all, so look I've been wanting to get you on the podcast for a number of months now and I think I reached out to you on Twitter actually and I was surprised when you got back to me that actually A you wanted to come on and B you'd heard me speak before so where was that actually? We both spoke on the same day at the Cambridge Book Festival or something, it's all blurred into some massive wodge in my head of wherever this was. So it might not have been Cambridge, it might have been like Australia or something. But in my head, it's Cambridge.

Yeah. And I really admire the work you're doing. I think it's so important to have people who are stressing and explaining to people, especially doctors, that we need to have a broader conversation about what causes depression and anxiety and what solves them and I really admire the work you're doing I think it's amazing and absolutely what we need right now yeah I mean thanks I mean and and likewise I think you know I think you're arguably one of the most important voices in this arena globally potentially in terms of what you're doing with your work and your books you know there's there's

quite a well there's two books we could talk about, but I really want to sort of focus a little bit on the newer one, Lost Connections, which, you know, the sort of reviews and quotes you've had from, from esteemed people all over the world. It's pretty incredible actually. But I think it's kind of depressing that the one thing that unites us all is the fact that we're so miserable. Right. But i think there's a real power in that it was surprising to me that such a crazy mixture of people uh were so enthusiastic about the book right like um i

would have expected kind of people who were in my corner but to have like you know it was the first book hillary clinton praised after the election or the the you know like the leading host on fox news who's right the opposite side of hillary. And I do think that that tells something that's not actually about my book, it's about the fact that people know there's something wrong in how we've been talking about this massive amount of pain and distress in our society, and are really hungry for new ways of talking about it and new solutions. Yeah, I absolutely agree. It's such a great point that this is something that I think unifies everyone. Last night, we're here in London at the moment having this conversation. Last night I did, I was on a panel discussion, Wagamama's, the food chain at Earl, partnering with Mind,

the mental health charity, and to try and raise awareness and mental health, particularly in a younger age group. And we were on a panel discussion last night. And one of the incredible things for me is that there's such a diverse range of people there but there's a statistic that mind use which is that in the uk one in four people in any given year are going to have a mental health problem now let's just think about that that's 25 percent of the population so i don't think anybody any longer is immune from this in the sense that you may not be suffering yourself, but almost certainly somebody you know, a friend, a family member, a work colleague will be suffering from a mental health problem. So I think it is something that does touch us all. But I think we have to

just broaden out a little bit and go, what is going on that in 2019, a quarter of our population, certainly here in the UK, have got issues with their mental health. So what is going on that in 2019 a quarter of our population certainly here in the UK have got issues with their mental health so what is going on there well this goes to exactly why I wrote Lost Connections there were these two kind of mysteries that were hanging over me um the first is that I'm 40 I just turned 40 a week ago and every year that I've been alive depression and anxiety have increased here in Britain right and across the Western world, actually. And I was asking myself, well, why? Why are so many of us finding it so hard to get through the day? What's going on?

And there was a more personal mystery. When I was a teenager, I'd gone to my doctor and I'd explained that I remember putting it that I felt like I had pain leaking out of me. I couldn't control it. I couldn't regulate it. I felt very ashamed of it. And my doctor told me a story. My doctor was very well-meaning, good person, and told me a story that I'm sure he believed that I now realize was really oversimplified. It's not, there's no truth in it, but it's really oversimplified. My doctor said, we know why people feel this way. There's a chemical called serotonin in people's brains, naturally makes them feel good. Some people are naturally lacking it There's a chemical called serotonin in people's brains, naturally makes

them feel good. Some people are naturally lacking it or have a chemical imbalance in their head. That's why you feel like this. All we need to do is give you some drugs, you're going to feel better. So he gave me an antidepressant called Seroxat, which did give me a really significant boost. For a few months, I felt radically better than this feeling of pain started to come back I went back to my doctor again he gave me a he gave me a high dose again I felt better um again the feeling of pain came back I went back again I was really in the cycle jacking up my dose a lot and then for 13 years I took the maximum possible dose you're allowed to take at the end of which I was still really depressed and I was asking myself well I'm doing everything I'm being told according to this story that I've been given why do I still feel so bad um which is not to say there's no value in chemical antidepressants

there is and I'm sure we'll get to that but but it wasn't solving my problem and so I ended up for this book going on a really big long journey all over the world it took three years I traveled over 40,000 miles I wanted to sit with the leading experts in the world about what causes depression and anxiety and people pioneering solutions based on those deeper causes and I wanted to sit with the leading experts in the world about what causes depression and anxiety and people pioneering solutions based on those deeper causes. And I wanted to sit with people with just really different perspectives from an Amish village in Indiana, because the Amish have very low levels of depression, to a city in Brazil where they banned advertising to see if that would make people feel better, to a lab in Baltimore where they're giving people psychedelics to see if that would help. And I learned a huge number of things. psychedelics to see if that would help. And I learned a huge number of things, but the core of what I learned is that there's scientific evidence for nine causes of depression and anxiety. There may well be other causes we don't know about, but there's already scientific evidence for nine

causes. Two of those are in our biology, right? There are real biological contributions to this, and you know this much better than I do. Your genes can make you more vulnerable to these problems, just like some of us find it easier to put on weight. And there are real brain changes that happen when you become depressed that can make it harder to get out. But most of the causes of depression and anxiety that I learned about are not in our biology. Exactly as you've been explaining to people, they're in the way we're living. And once you understand that, that gives us a very different explanation for why we're in such distress, for why it's rising and for how we get out of it. Yeah. I mean, you've clearly done an incredible amount of research in this book and talked to so many different people.

And, you know, we're either going to be able to scratch the surface today because, you know, it would probably take two full days of conversations to almost get through all that. You know, it's fascinating for me that you mentioned genes there. And, you know, one thing I think is really important that people understand is that not just for mental health, but for many other chronic conditions we're now seeing, you know, our genes can play a role, but that's really a genetic susceptibility. And just because you have a genetic susceptibility. And just because you have a genetic susceptibility, it does not necessarily mean you're going to manifest with that condition because it depends on the environment in which you surround yourself with, the society in which

you're living. And there's a field of science which you're familiar with, epigenetics, how the environment interacts with our genes to change their expression. And so I guess the question is for me, yes, there are some biological changes for some people. But is fundamentally modern society causing the increased rates of depression and anxiety? Some key aspects are, and that actually interacts with the genetics. We can come back to that if you like, something that's really fascinating. So I'll give you a few examples, right? I mean, there's loads that we can talk about

in relation to this. I think it's important to say this is not modern society, it's some aspects of modern society and aspects that we can fix. So we are the loneliest society there's ever been. We're just behind the Americans. There's a study that asks Americans, how many close friends do you have who you could turn to in a crisis? And when they started doing it years ago, the most common answer was five. Today, the most common answer is none.

It's not the average, but it's the most common answer. There are more people I have nobody to turn to when things go wrong than any other option, right? Half of all Americans ask how many people know you well, say nobody. And I spent a lot of time talking to an amazing man called Professor John Cassioppo, who was at the University of Chicago, who was the leader, isn't he? I know his work, incredible. He just sadly just died, actually. It's an unbelievably sad loss because he wasn't an old man. It's really sad. Oh, I didn't know that, actually.

Gutted, yeah, yeah. But he was an amazing guy and he was the leading expert in the world on loneliness basically and and professor cassioppo um showed a few really fascinating things i remember him saying to me you know why are we alive why do we exist one key reason why you me and everyone listening to this podcast exist is because our ancestors on the savannas of africa were really good at one thing they weren't bigger than the animals they took down they weren't faster than the animals they took down a lot of the time. But they were much better at banding together into tribes and cooperating, right? Just like bees evolved to live in a hive, humans evolved to live in a tribe. And we are the first humans ever to try to disband our tribes. If you think about circumstances where we evolved, if you were cut off from the tribe,

if you had no one to turn to, you were depressed and anxious for a really good reason, right? You were in terrible danger. Those are still the instincts that we have. That's still how we feel. That's an appropriate response to the environment in which we were in. This to me is the single most important insight I learned from all these people. If you are depressed, if you are anxious, you're not weak, you're not crazy, you're not a machine with broken parts, you're a human being with unmet needs, your pain makes sense, right? as my doctor told me with the best of intentions is we say to people this pain you feel doesn't

mean anything right it's like a glitch in a computer program but that's not true if you look at the evidence now there are biological contributions to be sure i want to stress that again but when you look at the evidence actually the reasons why people are distressed in this culture why it's rising year after year make perfect sense right everyone listening to your program knows they have natural physical needs right you need food you need shelter you need clean air if i took those things away from you you'd be screwed really quickly right but there's equally strong evidence that all human beings have natural psychological needs you need to feel you belong you need to feel

your life has meaning and purpose you need to feel that people see you and value you you need to feel you've got a future that makes sense and this culture we built is good at all sorts of things. I'm really glad to be alive. I had to go to the dentist the other day. Believe me, I'm glad to be alive in this year. But we've been getting less and less good at meeting these deep underlying psychological needs. And people aren't crazy or broken or weak to feel the pain of that. Yeah, I think you put it beautifully well. And, you know, on that topic of loneliness, I think it's really important that people understand that actually loneliness

causes physical changes in our body. You know, the science shows that, you know, some research suggests that being lonely may be as harmful as smoking 15 cigarettes a day, which is, you know, which when I talk to people say, are you surprised by that? I said, yeah, I'm surprised by that. But you explain, well, hold on a minute. If you think about evolution, you think about if we weren't part of that supportive tribe around us, as you say, if we were on the on the outside, then, you know, we were vulnerable to attack. So what happens? Your body responds, your your stress response goes up, your immune system gets ranked up. You become inflamed

because your body is preparing you for when you get attacked. Absolutely. And there's a really good line that, um, the, the brilliant psychoanalyst and writer, Stephen Gross says, you know, if you touch your finger to a, you touch your hand on a, to a burning stove and pull it away, right? That's very painful, but that's a useful pain signal, right? It's a necessary pain signal. When people with leprosy don't have that, that's how they get so badly injured because they can't feel that they're, for example, burning their hands or trapping in a car door or whatever.

That's a necessary pain signal. The way Professor Cassiopo put it to me is loneliness is a necessary signal to push you back to the tribe, right? But if you've created a culture where people have disbanded their tribes where actually we've told ourselves you should live alone you should be alone do it yourself we tell these toxic messages all the time that the only person who can help you is you then what we've done is we've cut people off from understanding that deeper source of pain and one of the things i really wanted to understand is you know because obviously most of my book is not about the problem it's about the solution right because i don't want to just it's not true to just say oh we're just screwed

then right so and one of the things that's to me so beautiful and so inspiring is how close to the surface the answers are once you understand the problem correctly so one of the heroes of my book is an amazing man called dr sam everington it'd be a great guest for you. Sam is a GP in East London, where I lived for a long time, a poor part of East London. Although sadly, Sam was never my doctor. And Sam was really uncomfortable because he had loads of patients coming to him like you do with just terrible depression and anxiety. And like me, like you, he thought there was some role for chemical antidepressants, but he could also see a couple of things firstly um the people coming to him were depressed and anxious for perfectly good reasons like loneliness and secondly chemical antidepressants were taking

the edge off for some people but most of them did become depressed again so while he thinks they have value that they weren't the ultimate solution um so sam decided one day to pioneer a different approach one day a woman came to see him called l Cunningham, who I got to know quite well later. And Lisa had been shut away in her home with crippling anxiety for seven years, just a terrible state, barely leaving the house. And Sam said to Lisa, don't worry, I'll carry on giving you these drugs. I'm also going to pioneer something else. There was an area behind the doctor's surgery called Dog Shit Alley, which gives you a sense of what it was like, right? Just scrub land, basically uh sam said to lisa what i'd like you to do is come and turn out a couple of times a week we're going to meet a dog shit alley i'm going to come to because i've been

anxious we're going to meet with a group of other depressed and anxious people we're going to find something to do together right it's called social prescribing the idea if the problem is loneliness we're going to prescribe a group the first time the group met lisa was literally physically sick with anxiety right um she found it unbearable but the group started to talk about okay what can we do together they decided to learn gardening these inner city east london people like me don't know anything about gardening right they decided to they started look at youtube they started reading books they started to get their fingers in the soil they started to learn the rhythms of the seasons there's a lot of evidence the exposure to the natural world is a really powerful antidepressant absolutely and even more importantly i think they started to form a tribe they started to form a group they started to look out for each

other right one of them didn't turn up they go looking for them i'll give you an extreme example one of the people in the group had been thrown out i think by his girlfriend he was sleeping on the night bus right everyone else was like well of course you're going to be depressed if you're sleeping on a bus they started pressuring tower hamlets council the local authority to get him a home they succeeded it was the first time they'd done something for someone else in years and it made them feel great the way lisa put it to me as the garden began to bloom we began to bloom there was a study in, small study, but it's part of a growing body of evidence that found that this kind of thing, social prescribing, particularly with

gardening, was more than twice as effective as chemical antidepressants. I think for an obvious reason, right? Something I saw all over the world from Sydney to Sao Paulo to San Francisco, the most effective strategies for dealing with depression and anxiety are the ones that deal with the reasons why we feel so bad in the first place yeah and and you know these are such great stories to hear and this isn't you know for me as a doctor who sees you know mental health problems but also sees a variety of other problems but there are some real similarities between other chronic illnesses that i see in the sense that are we looking to suppress symptoms or are we looking to get to the root cause of the problem and if you ask most people um you know what would

you like to do with your problem would you like to for me to put a sticking plaster on your symptoms or would you like me to help you get to the root cause you know everyone's going to put the hand and say I'd like to get to the root cause please but somewhere along the line I think the medical profession um which I'm very proud to be along the line, I think the medical profession, which I'm very proud to be a part of, and I think we do lots of fantastic things, particularly for acute illness. I think somewhere we've sort of fallen off track a little bit. I think the system that we work in, these 10 minute appointments here in the UK, which, you know, in reality is more like six or seven minutes, is frankly incapable of dealing with the complexity of

these issues that come in with us now. I think that needs changing for sure, but it's looking for the root cause. And, you know, using the term depression, and this is something, you know, we're both obviously very passionate about this, using the term depression, of course, it's a useful term to a certain degree, but in some ways it's not useful in the sense that, you know, 10 different people could have symptoms of depression for 10 different reasons, right? So therefore, those 10 people might need a different strategy to tackle this complaint rather than the same strategy. So as you say, one person might benefit from a chemical antidepressant, but maybe the other nine, actually, that's not the strategy for them. Maybe they need social prescribing. And it's great to see that, you know, in the 21st Parkrun is just exploding around the world, particularly here in the UK. And it's this weekly, timed, free run that people do. But actually, when I spoke to the CEO of Parkrun recently on the podcast, he said, the interesting thing about Parkrun is that it's a social intervention,

masquerading as a running event. It's about community. It's amazing, right? I love that. It makes me think about community yeah it's amazing right i love that it makes me think about and there's so many things in what you're saying i think you're totally right that our system of medicine is largely built around a model that was uh and was miraculously successful and is one of the greatest things in the world when it comes to treating infectious disease right so you you know you identify the pathogen you identify the problem you know that did things like for example get rid smallpox, which killed untold millions of human beings. No human being in the world today has smallpox.

This is an incredible model, and you're rightly very proud to be part of it. Transferring that model to mental health has not been very successful. We've just got to be honest about that. It's not that it's had no value when it comes to those things. There are real biological causes. There's all sorts of things where it has been useful. But it hasn't worked particularly well. As we can see from the fact that something's going wrong because depression is still rising every year, even though we're following this model more and more, we're diagnosing and drugging more and more people

every year, and yet the problem continues to rise. Something's missing from that picture. What's missing is the actual causes. And I think there's a challenge in this because partly a lot of those things you're right that these are things that can't be dealt with in certainly can't be dealt with in a 10 minute session or seven minute session um to some degree some of them are things that can't be dealt with by doctors at all and have to be dealt with by the society we know that about that can sound a bit odd but we know think about car accidents right car accidents biggest cause of death in britain um most of what we do to hold down car accidents is not done by doctors, right? Obviously, if someone gets mauled in an accident on the M25, they get taken to casualty and amazing work is

done to help them by amazing doctors and nurses. But actually, most of what we do to prevent car accidents is a social response, right? We have driving tests, we have seatbelts, we have airbags, we arrest drunk drivers we impose speed limits right um it's no disrespect to doctors to say none of that's to do with doctors right that's that's something we do as society once you understand that depression has these social causes massive social causes that are the reason it's rising they're not the only reason it exists um then you can see all right we need a bigger social response and again that's about saying to depressed people i one of the cruelest things we've done

about depression and anxiety is we've put the job of solving it entirely onto the depressed and anxious person, right? And maybe their family, if they're lucky. We don't do that with car accidents. We don't say, oh, you just got mauled in a car accident, right? Well, it's your job next week to impose the speed limits and arrest drunk drivers, right?

That would be bonkers. We have a deeper understanding. I think precisely this individualizing of the problem pushing it onto the individual is one thing that actually makes depression worse right once you become depressed it's much much harder to to get out of that that that whole way of thinking yeah i think i think it's such a valuable point that uh sort of sit with and think about because you're right, a lot of these are social problems and actually they end up at the doctor's door. And, you know, we think the medical profession are going to fix it for us, but maybe, you know, in many cases, we're not the right people to do that, potentially.

Putting blame on people so people feel isolated. Oh, there's something wrong with me, as you said before. You know, they're not broken, but they feel as though I'm broken. I need fixing, you know, fix me, doctor. Just to say about that, there's a doctor's intervention that I learned about. And I found it quite difficult to learn about this. But I think it's worth explaining to people because this was a relatively small doctor's intervention that had an extraordinary effect for, I think, interesting reason so one of the causes of depression anxiety that i found hardest to learn about for personal reasons i can tell you um was discovered in

a slightly weird way and i had to tell you story of how it was discovered and for a minute your listeners are going to think what the fuck is he talking about there's got nothing to do with depression and anxiety why is he talking about in this context but i don't think you can understand it if you don't understand this so in the mid- 1980s, a doctor who I got to know much later, Dr. Vincent Felitti, was given a quite difficult task. He was approached by the big medical provider in San Diego, Kaiser Permanente. And they were like, look, we've got a big problem here. Obesity is just going up and up every year. Nothing we're trying is working. We give people diet plans. They don't stop. Everything we do has failed, right? So they gave him quite a

big budget and said, look, just figure out what the hell we can do. So he starts working with 250 really severely obese people, people who weighed more than 400 pounds. And he's interviewing them and interviewing them. And one day he has an idea that sounds, and in some ways is a bit stupid he asked himself what would happen if really obese people just stopped eating and we gave them like vitamin c shots so they didn't get you know scurvy or whatever we gave them nutritional supplements would they just burn through the fat stores in their body and and lose weight right so obviously with tons of medical supervision they they tried this and in one way initially crazily it worked so there's a woman who i'll call susan

to protect her medical confidentiality it's not her real name who went down from being more than 400 pounds to 138 pounds right everyone's celebrating it's happening to loads of people in the program and that was one of the outliers but people losing enormous amounts of weight right and everyone's celebrating people are telling dr felitti he saved susan's life and then one day something happened that no one expected. Susan cracked. She went to KFC or whatever it was, starts obsessively eating. Quite quickly, she's back to a dangerous weight. Not quite where she'd been, but a dangerous weight.

And Dr. Felitti calls her in and he's like, Susan, what happened? She looked down. She said, I don't know. I don't know. He said, well, tell me about that day. Did anything happen that day that didn't happen on any other day? She said, well, tell me about that day. Did anything happen that day that didn't happen on any other day? She said, well, actually it was something. So she'd say it happened to Susan that day, actually, that had never happened to her.

She'd gone to a bar and a man had started chatting her up, right? Not in a horrible or predatory way, in quite a nice way. But she felt really frightened. She'd gone to start obsessively eating. That's when Dr. Felitti asked her, when did you start to put on weight? He never thought to ask her it before. For her, it was when she was 11. He said, well, did anything happen when you were 11 that didn't happen when you were 9 or 14?

Anything that year? And Susan looked down and said, yeah, that's when my grandfather started to rate me. Dr. Felitti interviewed everyone in the program and found that 55% of them had put on their extreme weight gain in the in the aftermath of being sexually abused which is such obviously so much higher than the general population he was just really puzzled what could be happening here what why would that be Susan explained it to him quite well she said overweight is overlooked and that's what I need to be he realized this thing that seems so irrational and of course is really bad for you obesity was for some of these people performing a really important function right it was protecting them from frightening sexual attention that they had

good reason to be afraid of but this is a pretty small study right it's whatever it was 250 people it's hard to draw a big conclusion so dr fel. Felitti went to the Center for Disease Control, the CDC, one of the biggest bodies funding medical research in the world, and he got a ton of funding. So everyone who came to Kaiser Permanente for healthcare in an entire year, didn't matter what for, headaches, schizophrenia, broken leg, whole lot, was given two questionnaires. First questionnaire asked, did any of these 10 bad things happen to you when you were a kid? Things like physical abuse, sexual abuse, neglect, neglect extreme cruelty and then the second part asked have you had any of these problems as an adult and initially it just said obesity and then they thought all right let's add some other stuff so at the last minute they added suicide attempts depression addiction all sorts of other

problems and at first when the fingers were calculated out by the cdc they thought there was a an error in the calculations For every category of childhood trauma you experienced, you were two to four times more likely to become depressed and anxious. But when you got into the multiple categories, it just blew up. If you'd had six categories of childhood trauma, you were 3,100% more likely to have attempted suicide and 4,600% more likely to have an addiction problem. As you know very well, you rarely get figures like that in health studies. And Dr. Robert Ander, who did this study, put it to me really well. He said he realized when he saw these figures

that when you're looking at depressed and anxious people or obese people or so many of these problems, we need to stop asking what's wrong with you and start asking what happened to you. And I remember when I went to go and see Dr. The reason this is difficult for me. I remember when I went to go and see Dr. Felitti, if you met him, you would, I guarantee you would really like him.

Right. He, and I'm sure all your listeners would. He's a lovely person. He's a good, admirable man. And I remember finishing the interview early because I was so angry like I was almost shaking with anger and I was like why am I why am I so angry at this really good man who's done all this amazing work and I realized it had me to understand I think why I had stayed so tied to this biological story this very simplistic

entirely biological story that I was told by my doctor, right? So when I was a child, my mother had been very ill, my dad was in a different country, and I'd experienced some very extreme and horrific things from an adult in my life over a period of time. And I didn't want to think about that. I didn't want to give this individual power over me as an adult. I didn't, I think if someone had asked me, does this have any relationship to your depression? I don't think at any point I would have said no, but I had it in a box in my head. I didn't want to touch. Right. And, and, and the, the, the act of being forced to integrate this by meeting Dr. Felitti was very, very painful. But one of the reasons I'm really glad that I did is because of what Dr. Felitti discovered next.

And it goes exactly to what you're saying about doctors, right? So if someone indicated on their form that they'd experienced some form of childhood trauma, their doctor was told, their GP was told, don't call them back in. But next time they come in with any problem, say to them something like this. And the script was just really simple. It was something like, I see that when you were a say to them something like this. And the script was just really simple. It was something like, I see that when you were a child, you were sexually abused or whatever the abuse was. I'm really sorry that happened to you. That should never have happened. Would you like to talk about it? And 40% of people did not want to talk about it.

They said, no. 60% of people did want to talk about it. And they wanted to talk about it on average for five minutes. And this was was monitored scientifically what was incredible was just those five minutes of an authority figure saying i'm really sorry that should never have happened to you that alone led to a really significant fall in depression and anxiety and then it was randomly assigned some of them were told you can go and see a therapist to talk about this more and they had an even bigger fall and this fits with a whole bigger body of evidence from people like professor james pennebaker at florida state university which shows it's not the trauma that destroys you it's the shame about the trauma right that so if we know for example during the aids crisis openly gay men died on average two years later than closeted gay men

even when they got health care at the same time right shame is physically and mentally destructive toxic emotion shame isn't it i mean there's so many facets i want to touch on there i mean first of all thank you for sharing the personal story that happened to yourself um you know compassion is something that i think about when i hear the stories you're talking about when we talk about this this obese lady who had been abused and there was a defense mechanism, you know, it really helps change the social narrative around all kinds of problems to, instead of one of blame,

to one of understanding and compassion. And I think that's super, super important. And I think sometimes society can be quite toxic in the way we demonize people with various problems. I'd say obesity is one of the prime examples of where we really demonize people as a society who are obese. We put a lot of blame on them. We think that they're lazy. And, you know, even the stories you just shared there just show that clearly is not the case for so many people.

That may not be the cause of everybody. Of course, yeah. But in many people, may not be the cause of everybody of course but in many people it will be um i guess the other thing you said about when an authority figure acknowledges something that's happened and says look i'm really sorry that should never have happened to you um even that can can can result in an improvement and you know what's really interesting about that is i remember um i initially tried to be a specialist so i was doing kidney medicine and did all my specialist exams and i personally was getting a bit frustrated that I felt medicine was getting super reductionist.

That's so interesting. And we look at, you know, we're starting to look at all these body parts are separate and as if, you know, there's no connection between them all. And I actually, I think for my father, at least a very unusual step of moving from being a specialist to a generalist because I wanted to see everything. And I remember I did my GP training, I did those exams. And then in my first week as a GP, I remember at some point in that week, a young lady came in and she had all the classic symptoms of depression. I've not thought about this case in years, but it's really just sprung into my mind. And I remember looking at the sort of protocol sheets we had and, you know, she fulfilled the criteria and, you know, I should have considered an antidepressant. But I don't know, it just didn't, for me in the early stage of my GP career, which is probably about 10, 11 years ago, I thought, you know, I need to understand this, what's going on here? this? What's going on here? And actually we ended up having, you know, I was a young GP, you know, still, you know, well, I still am full of optimism for the future, but I probably spent about 25 minutes with her chatting and I was just listening. I was actively listening. I was showing her

kindness and compassion. And I, I didn't actually come up with a solution for it at the end of it. We just said, okay, look, should we continue this next week and i learned from it from a very early part of my career that actually some of not some and a lot of what i now do with my patients is listen with kindness and compassion and that has value because it's transformative yeah over the next few weeks she would come in and she started to improve in many ways simply from talking to me simply from talking to me, simply from talking to someone who she didn't have a personal connection with. So she could just be open without fear of judgment. And, you know, a third party who had no sort of emotional connection with her,

who could almost be a sounding board. And I thought, actually, you know, yes, I'm a doctor, but do I need to be a doctor to do this? Or could I just be a warm, compassionate human being? And maybe, you know, maybe there is some value for them to hear that from a doctor, you know, an authority figure in the public. But I think it's really interesting that just by opening up and talking to someone and having your voice heard heard that can provide value i love that and i one of the things i think is so great about your books and the work you do is that you're very attuned to the meaning of these forms of pain right um and i think that's that's really important because the more research i did the lost connections the more i could see the meaning in so

so much of it that that that we're we're experiencing these crises for a reason so i'll give you an example of another one um that i think has a similar dynamic to what you're talking about or the solution does at least so everyone knows that junk food has taken over our diets and made us physically sick right don't say it's within the sense of superiority i basically lived on kfc in my 20 twenties. But there's equally strong evidence that a kind of junk values have taken over our minds and made us mentally sick. For thousands of years, philosophers have said, if you think life is about money and status and showing off, you're going to feel like crap, right? It's not an exact quote from Confucius, but that is the gist

of what he said, right? But weirdly, no one had actually scientifically investigated this until this incredible man I got to know called Professor Tim Kasser, who's at the Knox College in Illinois. And he showed something really important. So he showed, firstly, the more you think life is about money and status and showing off, the more you're like Donald Trump, to put it crudely, the more likely you are to become depressed and anxious by really quite a significant amount. Because living that way doesn't meet your needs as a human being. He's also shown as a society, as a culture, we have become much more driven by these junk values, right? What I would call junk values. We've become much more driven by believing life is about money and status and showing off. This has been particularly catastrophic for teenagers. You know, as you know very well, the suicide rate for teenage girls has doubled in the

last eight years. The proportion of teenagers saying life is not worth living has doubled in the last eight years, last 10 years, sorry. Precisely, I think, well, there's many things going on, but one key reason is, I think, this deep corruption of values. And in some ways, you know, this is like a really banal insight, right? Everyone listening to your program knows they are not going to lie on their deathbed and think about all the things they bought or all the likes they got on Instagram, right? They're going to think about moments of love and meaning and connection in their lives. But as Professor Kasser put it to me, we live in a machine that is designed to get us to neglect what is important about life, right? We are immersed in a hurricane of messages that says, if you don't feel good, the solution is to go shopping, buy worthless crap, display it on Instagram, make your friends jealous, so they'll go and buy the worthless crap, right? More 18-month

old children know what the McDonald's M is than know their own surname. So we are immersed in this way of thinking from the moment we're born. That blows me away. No, it's incredible, isn't it? Yeah. It absolutely blows me away hearing that. Yeah. And I think one of the things that is extraordinary and there's so many figures about the poisoning of children's minds and there's such a nice little experiment that was done this before professor casser actually in 1978 it's a really simple little experiment that i think shows this corruption of values that is implanted in us um so they get a group of five year olds and they split them into two groups.

And the first group is shown two adverts for whatever the equivalent of Dora the Explorer was in 1978. I can't remember what it is. And the second group was shown no adverts. And then all the kids are given a choice. They said, hey kids, you've got a choice now. You can either play with a nice boy who doesn't have the Dora the Explorer toy or whatever it was, or you can play with a nasty boy who's got the toy if the kids had seen the ad they overwhelmingly chose the nasty boy with the toy and if they hadn't seen the ad they overwhelmingly chose the nice boy right so just two adverts was enough to prime those kids to choose an inanimate lump of plastic over the possibility

of fun and friendship right everyone has seen more than two ads today, right? We're bombarded with these messages. I mean, you know, as a father myself, hearing this sort of stuff really, really scares me. It really concerns me. And it sort of reiterates to me that what I am trying to do with my children may be the right thing for my children. Look, I've got to say, all parents, I believe, are trying to do the my children may be the right thing for my children. Look, I've got to say, all parents, I believe, are trying to do the best for their kids. You know, many people have got busy lives, stressful lives. Everyone's trying to do the best that they can based on the values that they think, that they've been taught by society. Over the last few years, I've been on a bit of an emotional journey myself. And as I start to understand myself better and as I start to clear some of the emotional baggage

that I picked up throughout my life, which we were talking a little bit about before we came on air today, I sort of look now, when I watch, I don't actually watch that much television, which is remarkable considering that I'm on television, but I actually don't watch much television at all. And when you switch it on sometimes and you see adverts,

I find it quite intrusive to my brain. You can see quite clearly what is going on here. So what, again, people are going to think I'm maybe a little bit extreme here, but I really don't let my children watch anything with adverts i'm really stressed on that if i go around and there are my mums and they're watching so i said mum please i don't want them watching adverts because and sometimes i think you know i think some of my family think i'm being a bit extreme here but your study just there that you demonstrated shows that maybe I'm not being extreme. Oh, you're totally right. Professor Jill Twenge did a study that showed when the proportion of American GDP,

so the amount of wealth in the country that is spent on advertising, goes up, that tracks exactly with teenage depression, right? If they spend more on advertising, teenage depression goes up. Now, there's other things going on as well, but there's a really strong correlation between these things. Yeah, you wouldn't let your child be poisoned with sugar, right? You wouldn't let your child be poisoned. Why would you allow your child?

Most people would not allow their children to be poisoned with junk food every day, right? And yet we are poisoned with junk values every day. And one of the things that was totally fascinating about what Professor Kasser discovered is there's actually a way to undo this. There's a kind of, what I would think of as kind of antidepressant for that, right? I think anything that reduces depression should be regarded as an antidepressant. For some people that's chemicals, but it needs to be a much broader menu of things. And he did this really simple little experiment with a guy I interviewed called Nathan Dungan.

So Nathan was a financial advisor in Minneapolis. And his job was to advise adults on budgeting, right? And one day he was called in by school, and it was kind of a middle-class area, it wasn't super fancy school, and it wasn't in a poor area, and they were like, look, we've got a problem here. The kids are getting really enraged if their parents can't buy them like Nike trainers or some particular designer thing, they're really getting distressed and angry. Can you come in and explain budgeting to them, right? Talking about their parents' budget. So Nathan comes in and very quickly realises these kids don't give a shit about budgeting, right? There's just something else going on here that explaining the logic of a budget is not going

to deal with, right? So he teamed up with Professor Kasser. They did a really simple little experiment that people listening to this can do in their own lives. So what they did is they arranged a group. The group would meet, I think it was once every two weeks for like four months, might have been a bit longer. And it was teenagers and their parents, or at least one parent. And at first meeting, they literally just said, draw up a list of what you've got to have in life right and quite quickly people would you know obviously people say the obvious things like food and a house and stuff but quite quickly the teenagers would say like nike sneakers and the parents would say you know often would say they needed a fancy car or whatever and they would just home in on those things and they'd say well

why do you need Nike sneakers? How would your life be different if you had them? And very often the kids, it was just below the surface, the kids would say things like, well, I would be respected by people. I'd be part of the group, right? Charles Crosby would go, where did that thought come from? Right? It doesn't take long for them to go. Everyone thinks they're smarter than advertising, right? It's bad for other people, but I'm smarter, right? where did that come from you didn't have you actually looked at nike sneakers and done like a an analysis of nike sneakers are they better of course no one's done that right that's not what it is um it didn't take long for people to start to become skeptical of these junk bannings because we don't actually hold them up for scrutiny very

often but the next bit was really interesting so once they've done that in the future sessions they would say what do you actually think is meaningful about life? Right? We don't have these conversations very often in our culture, right? What do you actually think is important? What are moments that you have felt valued and loved and satisfied and like life was meaningful to you? And the people would talk about that and they'd say, well, how could you build more of that into your life? And they would just report back to each other. So some people, it was playing the guitar some people it was running some people it was writing some people it was you know helping a sick person whatever it was how can you do more

of how can you spend more of your life focused on that and less of your life focused on chasing these junk values that actually when you analyze them you realize don't even make you feel good right and what's fascinating was this was obviously scientifically monitored by Professor Kasser. What they found was just having those conversations and checking in with each other, a kind of AA for consumerism and junk values, led to a really significant shift in people's values, a measurable and significant shift in people's values, which we know leads to lower levels of depression and anxiety. And again, that's an intervention that comes back to the theme of a lot of what we're talking about. Once you understand that the problem has many dimensions, right? You can begin to deal with those individual

dimensions in a much more sophisticated and complex way. And it's weird because in some ways, these insights are quite banal, right? If you'd said to your granny or my granny, hey, if you're really lonely, if you think life is all about money, are you going to feel better or worse? My grandmother would have given me a clip around the ear and said, don't ask such a stupid question, right? And yet as a culture, other stories have hijacked our common sense understanding of why we feel like such pain. It's not there's no truth in those other stories. There is some truth in them, but they have eclipsed much more sensible understandings that i sometimes feel like with my book what i'm doing is giving people there's lots of things

people wouldn't know of course but a lot of it is just giving people permission to know what they know in their own hearts right do you feel like that with your absolutely you know people sometimes say it was not it's not rocket science is it and i say no it's not it really isn't it really isn't some of it is um you know basic common sense um that unfortunately it's not that common anymore because society has changed i say to people all the time that the rules of good health have never changed they've been the same for thousands of years the only thing that's changed is the modern environment right so it's almost like we need a a reminder of how to live well in this you know in the 21st century um i i sort of i did a um a radio interview when um with a chap called nihal on radio five when my first book the four

pillar plan came out. And he said, you know, Rangan, look, I've read through this. It's brilliant. I really love it. The way you've simplified things, made it really actionable for people. This, in many ways, is a blueprint of how we all live well in the 21st century. And I thought, yeah, I mean, you sort of, you know, it was a nice to hear that back from him to go, yeah, that's all I've tried to do. I've not tried to reinvent the wheel or anything. But have you found, I'm interested in that because I remember, I mean, this is an extreme example, but I remember doing one interview where I was talking about what I think is surely the least controversial thing in what we're talking about, which is loneliness causes depression, right?

And I remember an interviewer saying to me, well, this is a very controversial theory. And I remember just sitting there and thinking, how did we get to the point where you could say such a ridiculous thing? I didn't say that because it would have been too rude. But do you bump up against people? Yeah, it's almost as if we've lost a bit of common sense. And now I think, look, I'm a doctor, right? And what I'm about to say might be controversial to some people. I'm not a scientist. I'm a doctor. And people go, what do you mean by that? I'm like, well, I use science to guide what I do with my patients, but it doesn't dictate what I do with my patients.

Science does not have all the answers or there aren't trials that are going to be relevant for every single patient in front of me. I have to be clever. I have to use the science that's available, but then know what's relevant from that for the person in front of me. And I kind of feel that, you know, on a human level, we know that loneliness is going to make us not feel very good, right? Now, if, and I would argue the science is actually there on that, but let's say the science wasn't there. Well, as humans, you know, we've got some intuition. We've sort of, I think, overly put stock in what does the scientific research say? Is there a trial to prove what you have just said? And I think that's where medicine has gone a little bit off track because you can design beautiful trials to determine if a drug is going to work. You know, you take 100 people, 50 people get

the drug, 50 people don't. Is there a significant difference in the outcomes? Right, great. We can sort of measure that and go, yes, actually, this drug works for this condition. But the conditions we're talking about when we talk about mental health are so complex, are so multifactorial, that often those sort of clean trials, you know, have been more difficult to perform. Although I'd argue a lot of them are coming out now, I would say. I think you're raising a really important point. And I think one of the interesting things is when, so precisely because it's easier to measure and test some of the biological things, the research has been extremely heavily skewed. Think about that gardening program, right? That

I was talking about. If you think about Lisa who was on it, there is a $10 billion industry to tell Lisa that she's depressed just because there's something wrong with her brain and the only solution is drugs, right? There's a $0 billion industry to say, hey, do you want to go gardening

and make some friends, right? Now, that's not to say, I want to stress again, it's not to say there's no value in that $10 billion industry. There is some value. But you've had this massive skewing. research budgets are dictated by what we can profit from right no one i mean maybe there's a gardening center that's making a little bit of money out of that program but i hope so yeah but you know it's a minuscule amount of money but what

you're saying made me think about because one of the interesting things is when these scientific trials are done they are very often finding that and obviously I go through nine causes in the book, so loneliness is just one of them, but they are finding that these intuitive things are in fact backed by the science. So I'll give you an example of a moment that really helped me to think about this. I went to interview an amazing South African psychiatrist called Dr. Derek Summerfield. And Derek happened to be in Cambodia in 2001 when they introduced chemical antidepressants for the first time in Cambodia for the people there. Obviously, they'd given it in other countries before. And the local doctors, the Cambodians, had never heard of these things, right? They were like, what are they? And he explained and they said, oh, we don't need them.

We've already got antidepressants. And he said, what do you mean? He thought they were going to talk about some kind of herbal remedy, right? Like St. John's wort or ginkgo biloba or something. Instead, they told him a story there was a farmer in their community who worked in the rice fields and one day he stood on a landmine and he got his leg blown off it was left over by the american war so they gave him an artificial limb they got that in cambodia and he went back to work in the rice fields after a while and um apparently it's really painful to work underwater with an artificial limb i'm guessing it's traumatic because he's in the field where he got blown up.

The guy starts to cry all day, doesn't want to get out of bed, developed classic depression, right? The Cambodian doctor said to Dr. Summerfield, well, that's when we gave him an antidepressant, and he said, what? They explained that they, exactly what you did with your patient, they sat with him, they listened to him, they realized that his pain made sense it had causes they figured if they bought him a cow he could become a dairy farmer he wouldn't be in this position that was screwing him up so much so they bought him a cow within a couple of weeks his crying stopped within a month his depression was gone they said to dr summerfield so you see doctor that cow that's an antidepressant that's what you mean right now if you've been raised to think about depression the way that most people in this

culture have, that sounds like a joke. I went to my doctor for an antidepressant, she gave me a cow. But what those Cambodian doctors knew intuitively is precisely what the World Health Organization, the leading medical body in the world, has been trying to tell us for years, based on the best evidence, that there are three kinds of cause of depression and anxiety. There are biological causes, there are psychological causes, and there are social causes. And we need to deal with all three, right? In a sense, the key question I started asking the book then is, okay, what's the cow for the things that are making us feel so bad, right? What are the cows that solve our crises and our problems? And I think there's a lot of really deep causes of depression

and anxiety in our culture that we kind of have started to see as if they were like the weather just something that happens to us right and a lot of them are not like the weather so can i give you an example about work sure so i noticed that loads of people i know who are depressed and anxious the depression and anxiety focuses around their work, right? So I started to think, okay, other people I know are unusual. How do people feel about their work? So Gallup, the big opinion poll company, did a massive study of this over years about how people feel about work in Britain and other countries in Europe. What they found was 13% of us, 1-3%, like our jobs most of the time. 63% are what they call sleep working. You don't like it, you don't hate it, just kind of get through it. And 24% of people hate and fear their jobs.

I was quite struck by that. That's 87% of people who don't like the thing they're doing most of the time. And this thing they don't like is spreading over more and more of the day. The average British person now answers their first work email at 7.43am and leaves work at 7.15pm, right? Yeah, it's not a 9-5 anymore, is it? It's gone, right? It doesn't exist anymore. So the weekend and everything, we're doing work email still. Exactly. We've regressed beyond the progress made in the late 19th century. You get to clock off and then you're not at work anymore, right?

God, I crave back to that era so much now. People used to moan about the nine to five. And now I'm thinking, actually, nine to five sounds pretty good for most of the population now. Totally. And that was really why I was asking, well, what do we know about whether this is having an effect on our mental health? So I started looking around and I learned and went to interview a man who made an incredible breakthrough about this in the 1970s. Australian social scientist called Professor Michael Marmot, who discovered the key, he's not the only one, but the key factor that causes depression at work. So if you go to work tomorrow and you have low or no control over your job, you're much more likely to become depressed and anxious, right? And this is going beyond what Professor Marmot says now, but I think that's related to what we were saying about people having needs, right?

You need to feel your life has meaning. And if you are controlled, you can't create meaning out of what you're doing. If you have choices and autonomy, you can create meaning out of your work. And at first, when I was learning this, I actually misunderstood what this evidence said. So I thought it was saying, okay, you've got this elite 13% of people at the top who get to have nice jobs and they get to be where they have control and they get to be happy. And then everyone else is condemned to this misery, right? And I was thinking about, you know, my brother is an Uber driver, my dad was a bus driver, my grandmother's job was to clean toilets. I was like, wait, are we saying that they're just condemned? But Professor Marmot, explain to me, it's not the work that makes you depressed. It's being controlled at work. And it

turns out there's a kind of cow for that, if you like, right? And at first, if I explain this, people listening are going to think I'm saying, you should now go, dear listener, and do this yourself. And they're going to think, I can't do that. And that's true. Most people can't. This is an argument for bigger social change, right? So I went to interview a woman called Meredith Keogh in Baltimore. And Meredith had an office job. It wasn't the worst office job in the world, as she would tell you. She wasn't being bullied or anything. But it was really monoton monotonous she was controlled she couldn't bear the thought this was going to be the next 40 years of her life so one day with her husband josh she did this quite bold thing

josh had worked in bike stores in baltimore since he was a kid teenager and especially in the us this is really insecure you're controlled all the time but you don't even have sick pay anything right like your boss might give it to you if he's nice but there's no legal requirement for it uh it's really insecure controlled work and one day josh and his colleagues are sitting in this bike shop and they asked themselves one of them just said what does our boss actually do they weren't like their boss wasn't a horrible person they quite liked him but they were like we seem to fix all the bikes and he seems to make all the money right it doesn't seem like a great deal for us so they decided they were like, we seem to fix all the bikes and he seems to make all the money, right? It doesn't seem like a great deal for us. So they decided they were going to set up a bike store of their own that worked on a different principle, right?

So they set up a place called Baltimore Bicycle Works where I spent a fair bit of time. The previous place they worked was a corporation, right? Most people listening to your podcast work in corporations. So you know how it works. You know, you've got a boss at the top who's like the chief of the army. And sometimes the boss is nice and sometimes he's not but basically you have to do what the boss says right or you're out you can't defy the boss for very long um they decided they were going to set up a bike store that worked on a different principle actually an older idea uh their bike store is what's called a democratic cooperative they don't have a boss they take the decisions about running the business together they persuade each each other. In practice, they have a meeting like once every couple of weeks. They share out the good tasks and the crappy tasks and no one gets stuck with the crappy tasks. They share, obviously, the profits. They control their shop collectively, right? They don't have a boss, right? Anyone who has an idea, if they can persuade their colleagues, they can turn it turn it into practice right and no one gets stuck with the worst stuff and one of the things that was totally fascinating

to me spending time there and it was completely in line with professor marmot's research is how many of them have been depressed and anxious before but were not depressed and anxious now and it's not like they quit their jobs fixing bikes and went off to become something like i know beyonce's backing singers or something they They fixed bikes before they fixed bikes. Now, what's the difference? Now they control their work. That was the factor that was driving, that we know drives depression and anxiety. And sitting there at Baltimore Bicycle Works, I started thinking about how many people I know who are depressed and anxious, who would feel so differently if they knew that tomorrow they were going to a workplace that they controlled with their colleagues, where no one

gets stuck with the shitty stuff, where if there has to be a boss, he's elected by them, accountable to them, not just the other way. That's a very different way. Think about NHS cleaners. There's a really interesting study of NHS cleaners. So prior to privatisation, NHS cleaners saw their job obviously primarily as cleaning the ward, but also a big part of their job in hospitals was to banter with the patients, to get them a glass of water if they were thirsty, all those things, right? And there was a study that followed cleaners from before privatization to after privatization. After privatization, it was much more controlled. They were told, don't bother with any of that stuff that's not your job clean and leave right and what happened is a patient's got a much worse service

because like actually it was really good to have a pair of eyes that wasn't the nurses who could help you out if you had a problem but actually job satisfaction among nhs cleaners massively fell right you can see why because when people had less control they actually could they could use their creativity as a human being and some people would patronizingly say oh a hospital cleaner is a low-skilled job that is not true at all right you want someone on that ward who's alert to okay what's going who's not who's not got a glass of water who wants to have a little chat right that that was not fat that could be cut right giving those people that control meant they found something meaningful and really important to do

and taking away that control made them more depressed made all the people around them more unhappy did you see what i mean yeah absolutely i think autonomy is something i think is critical it's a critical component of our well-being um it's something that i i've written about many times that in one of my previous jobs, you know, one of the previous GP practices I worked at was taken over by a private corporation who ran, I think, 12, 13 practices. And, you know, doctors have always had a lot of autonomy in their role. You know, we know there's a lot of work to get done, but we can sort of manage our workload and do it as we see fit you know we we see what's clinically urgent we get that stuff done and then we we make sure we get it done but we do it our way and uh there are all these rules that came in from management say it's all got to be done the

same way i mean what one example is i used to um one of the practices where i used to work at where there was a lot of people on on social security a lot of people on benefits a lot of them were doing shift work um and a lot of them would work through the night and i would often come in um early because actually these guys wanted to sleep in the day and i thought well i can see them on the way home at half seven quarter to eight in the morning before my actual clinic starts at 8 30 so i would come in early sometimes and see them on the way back and um the new bosses were said you know you got to stop doing that i said why so we've got to have uniform times across every practice you can

see your first patient at 8 30 like all the other doctors and i said look i'm still happy to do that clinic at 8 30 but i just want to some of these guys i want to they want to have a kip in the day i just want to make sure that you know it works for me it's not a problem and i said no you can't do that it's got to be uniform. And I really started to resent them. And I used to, my job satisfaction went down significantly because of that. Now I've written about how I sort of changed that. And one of the things, you know, so I agree autonomy is a big issue.

I travel a lot like you do these days. And I always, I'm very chatty. I always talk to the cab drivers if I'm on a taxi. And one thing that always strikes me is I say, you know, how's work going? How's business? They said, oh, you know, it's quite slow at the moment. I said, oh, you know, and what did you used to do? And they would say things and say, you know, I'm not making that much at the moment.

You know, it's not been a great year for work. But they said, I wouldn't go back. I said, why? They said, I'm working for myself. It's my own terms. I can work for as long as I want. I can take a day off when I want. I don't go back. I said, why? They said, I'm working for myself. It's my own terms. I can work for as long as I want. I can take a day off when I want. I don't have to answer to anyone.

And you hear that over and over again. And you think, wow, there is something. And you hear this a lot from self-employed people. Yes, of course, there's a lot of pressure with being self-employed. But there's also some benefits that actually people have autonomy. And so I see that quite a lot. The other thing I wanted to touch on there is this whole idea of reframing. And so I've also seen some studies

with NHS cleaners, NHS porters, and how actually they sort of, you know, yes, it could be regarded as a low skill job, right? Which I disagree with. I completely disagree with. But often they felt they were part of something bigger like i i know this porter who would say you know i i do a really important role these patients are sick and i need to take them to the x-ray department so they can get their test done and really really sort of reframing their day into the bigger picture of how you know how what they do is in service of other people i think that whole reframing part i think it's a really nice thing for us to as a society think about how can we reframe what we're doing to sort of look at the

bigger picture um so i think i love that because i think just like you were saying if you think about what you know when you were initially thinking of being you're specializing in his kidneys wasn't it yeah yeah so you were frustrated with this idea of seeing the kidney in isolation from everything else right from the holistic sense of the individual and the patient and their needs right of course there's a place for the people who specialize exactly we're not disputing that anyone just wasn't for me exactly and there's a real place in you know identifying okay this person has this sinus problem we give them this you know this steroid spray and then they're going to be good, right? So no one is, we're strongly in favour of those interventions.

But you wanted to see the deeper connections between the individual and their physical health and there are these very deep, deep connections. And in a way, I think the theme of connection is really important because you're saying, you we know this when individuals see themselves as part of a kind of connected tapestry of wider meaning right just like which would have happened in the tribes in which humans evolved um they feel much better about their lives they feel much more satisfied naturally that concludes today's episode of the feel better live more podcast i was blown away after my time with johan i hope you found the conversation as enjoyable as i did don't forget that this is only

part one of a two-part conversation next week you can hear the second part where we continue discussing the importance of connection in our increasingly isolated lives. We also delve into the causes of addiction, the role that technology and screens play in the decline of our mental health, as well as how we can all make ourselves happier. Next week's episode also finishes off with some of Johan's top tips to improve the way that we feel. Do let Johan and I know what you thought of today's conversation. Johan is active on Twitter at JohanHari101 and on Instagram at Johan.Hari. Please do tag me as well and use the hashtag FBLM

or the hashtag FeelBetterLiveMore so that I can easily find your comments. You can see everything that Johan and I talked about today on the show notes page for this episode, which is drchastity.com forward slash 5151. Do check it out. There are plenty of links to other articles that Johan has written that I think you will find super interesting. Many of the themes that Johan and I discussed today

are things that I have written about in my new book, The Stress Solution. A whole quarter of the book is on the importance of relationships, whether that be nurturing our friendships, the importance of intimacy, as well as the primal importance of human touch. I know that many of you have fed back to me

that this section of my new book is your favorite. If you have not picked up a copy yet, you can order The Stress Solution in all the usual places in paperback, ebook, and the audiobook, which I am narrating. If you enjoy my weekly podcasts, one of the best ways that you can support them is by leaving a review on whichever platform you listen to the podcast on. You can also help me spread the word by taking a screenshot right now and sharing with your friends and family on your social media channels. Or you can do it a good old-fashioned way

and simply tell your friends and family about the show. Your support is very much appreciated. That's it for today. I hope you have a fabulous week. Make sure that you have pressed subscribe and I'll be back in seven days time with part two of my conversation with the brilliant Johan Hari. Remember, you are the architect of your own health. Making lifestyle changes always worth it because when you feel better, you live more. I'll see you next time.