Feel Better, Live More with Dr Rangan Chatterjee - #94 Is Everything You Know About Depression Wrong? With Johann Hari

Episode Date: January 22, 2020

RE-RELEASE: This episode originally aired last year as a two-part episode. 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. Johann 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, how social prescribing can transform lives, 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. We talk about the role of the workplace and how having autonomy and choices can reduce the likelihood of depression and anxiety. Johann goes on to share the incredible heart-warming story of the people from Berlin district called Kotti – a story of how an unlikely community was borne out of desperation and the unbelievable transformations that occurred for the whole community as a result of it. Finally, Johann shares some truly inspirational top tips. This really is a captivating and incredibly important conversation – I hope you enjoy it!   Show notes available at drchatterjee.com/94 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.

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? What happens when we tell an exclusively or extremely heavily biological story, 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, makes perfect sense. Hi, my name is Rangan Chastji, GP, television presenter and author of the best-selling books,

The Stress Solution and The Four Pillar Plan. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated. With this podcast, 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 back to episode 94 of my Feel Better Live More podcast. My name is Rangan Chatterjee and I am your host. This week marks exactly two years since I released the very first episode of this podcast

and what a two years it has been. The podcast has now had well over 10 million downloads since it started and regularly tops the Apple podcast charts in the UK. I really wanted to mark the two-year anniversary by releasing a special episode and I'm very aware that over the past few weeks the show has got a lot of new listeners. So to celebrate this my team and I have decided to re-release a previous episode that I think is one of the best conversations I have had so far on this podcast. And that is my conversation with the inspirational author, Johan Hari. About one year ago, I released this conversation as a two-parter, but many of you have actually asked me to re-release this as one complete,

uninterrupted episode, and I'm delighted to do so for this week's show. Now, for the past few decades, almost every year, levels of depression and anxiety have increased in Britain and across the Western world. But why? Well, my guest today, Johan, 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. He shares the fascinating findings of his research in this week's podcast. Johan 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. Johan 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. He believes that societal values

have been corrupted and explains the effects that this is having on our health. We talk about the role of the workplace and how having autonomy and choices can reduce the likelihood of depression and anxiety. And at the end of our conversation, Johan shares some truly inspirational tips. This really is a captivating and incredibly important conversation. I hope you enjoy it. Now, just a quick note of caution, this podcast does contain some swearing and themes of an adult nature, so if you are listening with little ones, it may be worth doing so in another room or at another time. Now, before we get started, as always, I do need to give a quick shout out to some of the sponsors of today's show who are absolutely essential in order for me to continue putting out weekly episodes like this one.

Vivo Barefoot, the minimalist footwear company, continue to support my podcast. I am a huge fan of Vivo Barefoot shoes and have been wearing them for many years, well before they started supporting my podcast. And I've seen incredible benefits both for myself and for many of my patients. For problems like mobility, back pain, hip pain, knee pain, balance, and so much more. I really like this brand and everything that they stand for. Vivo Barefoot makes shoes for all occasions and for adults as well as children. Barefoot makes shoes for all occasions and for adults as well as children. In fact, my whole family, including my children, wear Vivo Barefoot shoes anytime that we are not literally barefoot. For listeners of my show, they continue to offer a fantastic discount. If you go to

vivobarefoot.com forward slash live more, they are giving 20% off as a one-time code for all of my podcast listeners in the UK, USA and Australia. Importantly, they offer a 100-day try-off for new customers. So if you're not happy, you can simply send them back for a full refund. You can get your 20% off codes by going to vivobarefoot.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 twitter actually and uh 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 uh book festival or something last year it's all blurred into some massive wadge in my head of wherever this was but 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, Yvonne. I mean, 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 quite a few, 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 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 were so enthusiastic about the book, right? Like, 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, you know, like the leading host on Fox News, who's right the opposite side of Hillary Clinton. 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 was on a panel discussion, Wagamamas, the food chain at Earl, partnering with MIND, the mental health charity, to try and raise awareness of 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 was such a diverse range of people there. But there's a statistic that Mind used, 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% 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 it 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 there? Well, this goes to exactly why I wrote Lost Connections. There were these two kind of mysteries that were hanging over me. 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 had, 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 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 high dose. Again, I felt better. 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? Which is not to say there's no value in chemical antidepressants. There is, and I'm sure we'll get to that, 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 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, 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 but that's really a genetic susceptibility exactly 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 you know the environment in which you surround yourself with you know the society in which you're living 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 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 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. I didn't know that, actually. Gutted, yeah. But he was an amazing guy. And he was the leading expert in the world of loneliness, basically. And Professor Cassioppo 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 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. Sorry, 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 the 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. But that's an appropriate response to the environment in which we were in. This to me is the most 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 what happens when we tell an exclusively or extremely heavily biological story 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 on that topic of loneliness, I think it's really important that people understand that actually loneliness causes physical changes in our body.

The science shows that, some research suggests that being lonely may be as harmful as smoking 15 cigarettes a day. When I talk to people and say, are you surprised by that? They say, 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 outside, then we were vulnerable to attack. So what happens? Your body responds. 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 the brilliant psychoanalyst and writer Stephen Gross says, you know, if you touch your hand 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. 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? I didn'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 in my book is an amazing man called Dr. Sam Everington. He'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, 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, they weren't the ultimate solution. So Sam decided one day to pioneer a different approach. One day, a woman came to see him called Lisa 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 in 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 Dogshit Alley, which gives you a sense of what it was like, right? Just scrub land, basically. 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 at Dogshit Alley. I'm going to come too, 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 was called social prescribing. The idea of 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? She found it unbearable, but the group started to talk about, okay, what can we do together? They decided to learn gardening. These are inner city, East London people like me don't know anything about gardening, right? They decided to, they started to 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 that exposure to the natural world is a really powerful antidepressant. 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'd 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 Norway, 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? It's 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, you know, these are such great stories to hear. And this is, you know, for me as a doctor who sees, you know, know mental health problems but also sees a whole 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 their hand up and say, I'd like to get to the root cause, please.

But somewhere 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 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 using the term depression, and there's something, we're both obviously 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, 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 century now, social prescribing is really taking off here in the UK. It's become a thing. The Royal College of GPs are supporting it. And, you know, I spoke to a couple of people about Parkrun previously on this podcast. I don't know if you know much about Parkrun, but 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, 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 of smallpox which killed untold millions of human beings right

no human being in the world today has smallpox this is an incredible model and you rightly very proud to be part of it transferring that model to mental health has not been very successful, right? 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 certainly can't be dealt with in a 10 minute session or seven minute session. To some degree, some of them are things that can't be dealt with by doctors at all't be dealt with in a 10 minute session or seven minute session. 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.

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? It's no disrespect to doctors to say none

of that's to do with doctors, right? That's something we do as a 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, then you can see, oh right, we need a bigger social response. And again, that's about saying to depressed people, 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 individualising of the problem, pushing it onto the individual is one of the things that actually makes depression worse, right? Once you become depressed, it's much harder to get out of that whole way of thinking. Yeah. I think it's such a valuable point that to 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 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, uh, 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. Um, just to say about that, there's a doctor's intervention that I learned about and it was quite, I found it quite difficult to learn about this, but I think it's worth explaining to people because it's, this was a relatively small doctor's intervention that had an extraordinary effect for, I think, a really interesting reason. So one of the causes of depression and anxiety that I found hardest to learn about for personal reasons, I can tell you, was discovered in a slightly weird way and I had to tell you a 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 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 um well actually 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,

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'd 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 nine or 14, anything that year? And Susan looked down and said, yeah, that's where 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 aftermath of being sexually abused, which is obviously so much higher than the general population. He was just really puzzled what could be happening here. 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 realised 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. 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, 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, oh, 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 figures were calculated out by the CDC, they thought there was an error in the calculations. For every category of childhood trauma you experienced, you were two to four times more likely to become depressed than 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, right? 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. Felitti, the reason this is difficult for me, I remember when I went to go and see Dr. Felitti. If you met him, 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, 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 don't want to touch. Right.

And 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 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 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, 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 Johan I mean first of all thank you for sharing the personal story that happened to yourself. You know, compassion is something that I think about when I hear the stories you're talking about, when we talk about 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, including, 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 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, but in many people it will be. 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. Even that can result in an improvement. And you know what's really

interesting about that is I remember 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. 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 she fulfilled the criteria and I should have considered an antidepressant, but I don't know. For me, in that early stage of my GP career, which is probably about 10, 11 years ago, I thought, I need to understand this. What's going on here? And actually, we ended up having, I was a young GP. 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 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 a, from a very early part of my career that actually some of, not some, 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 someone who she didn't have a personal connection with. So she could just be open without, without fear of judgment. And, um, 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, that can provide value. I love that. And one of the things I think is so great about your books and the work you do is 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 my lost connections the more i 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 20s. 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're 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. I know, it's incredible, isn't it? 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 actually a nice little experiment that was done before Professor Kasser, actually, in 1978. It's a really simple little experiment that I think shows this corruption of values that is implanted in us. 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 best for their kids. 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, 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. 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. Yet 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 with a guy interview 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 realizes 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? What, 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 Crenshaw would go, where did that thought come from? 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? Have you actually looked at Nike sneakers and done an analysis of Nike sneakers? Of course, no one's done that, right? That's not what it is. done like an analysis of Nike sneakers. Of course, no one's done that, right? That's not what it is. It didn't take long for people to start to become sceptical 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'd 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 that people would talk about that and they 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 analyse them, you realise 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 click 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. 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's not rocket science, is it? And I say, no, it's not. It really isn't. Some of it is, you know, basic common sense 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. So it's almost like we need a reminder of how to live well in the 21st century.

how to live well in this, you know, in the 21st century. I sort of, I did a radio interview when, with a chap called Nihal on Radio 5, 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. It's not trying 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 you... 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 got 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. 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 centre

that's making a little bit of money out of that programme. I hope so. 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 courses 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. Just taking a quick break in today's conversation to give a shout out

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They did that in Cambodia and he went back to work in the rice fields after a while. And 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 in 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? So I noticed that loads of people I know who are depressed and anxious, their 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% of what they called 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? It's not a nine to five anymore, is it? It's gone, right? It doesn't exist anymore. So that we can, that 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, 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 the Press and Parliament 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 explained 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, 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 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, 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. 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 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. They decided they were

going to set up a bike store that worked on a different principle, actually an older idea. 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 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 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 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, you know, of... 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, patients 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 use their creativity as a human being. And some people would patronisingly 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, who's not got a glass of water? Who wants to have a little chat, right? 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.

Do you see what I mean? Yeah, absolutely. I think autonomy is something I think is critical. It's a critical component of our wellbeing. It's something that I've written about many times that in one of my previous jobs, one of the previous GP practices I worked at was taken over by a private corporation

who ran, I think, 12, 13 practices. And 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 see what's clinically urgent, we get that stuff done, and then we make sure we get it done, but we do it our way. And there were all these rules that came in from management. So it's all got to be done the same way. I mean, 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 the new bosses were said, you know, you got to stop doing that. I said, why? They said, 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, 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, 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? I 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? I said, I'm working for myself. It's my own terms. I can work as long as I want. I could 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 know this porter who would say, you know, 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 sort of reframing their day into the bigger picture of 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. to sort of look at the bigger picture. So I think this is- I love that because I think,

just like you were saying, if you think about when you were initially thinking of being specializing in, it was kidneys, wasn't it? 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. Of course, exactly. We're not disputing that. 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 is we're strongly in favor of those interventions but you wanted to have a what see the deeper connections between um you know the individual and their physical health. And there were these very deep, deep connections. And in a way, I think the theme of connection is really important because you're saying,

we know this, when individuals see themselves as part of a kind of connected tapestry of wider meaning, just like which would have happened in the tribes in which humans evolved. They feel much better about their lives. They feel much more satisfied. Naturally, I learned so much from scientists, some of the leading scientists in the world and reading loads of studies. I think the place that taught me the most

about depression and anxiety were not those people actually. And I'll just tell you the story of what happened in this place, if that's okay, because it's something I think about every day. So in the summer of 2011, on a big anonymous council estate in Berlin, a German-Turkish woman called Nuria Cengiz climbed out of her wheelchair and put a sign in her window. She lives on the ground floor. The sign said something like, I got a notice saying I'm going to be evicted next Thursday. So

on Wednesday night, I'm going to kill myself. Now this is a council estate. It's in a funny area. It's called Cotty. It's a poor part of what used to be West Berlin. And basically no one wanted to live there for years. It was a mixture of recent Muslim immigrants like Nuria, gay men and punk squatters, right? As you can imagine, these three groups didn't get on very well, but no one really knew anyone, right? No one knew who this woman was. People are walking past her window and they're worried about her. And they're also pissed off because their rents are going up. Loads of people are being evicted. So they know they might be next. People start to knock on Nouria's door. They said, do you need any help? And at first Nouria said, fuck you. I don't want any help. Shut the door in their faces, right? They're like, we shouldn't just

leave her. What should we do? And this was actually the summer of the revolution in Egypt. And one of them was watching it on the telly and they had an idea, right? They thought, well, if we, there's a big road that goes through Cotty into the centre of Berlin. And he said, you know, if we just blocked the road for a day, it goes right through this council estate. He said, if we just block the road for a day and, you know, we protest and we wheel Nouria out. There'll be a bit of a fuss. The media will probably come. They'll probably let us stay. They'll probably, you know, there might even be a little bit of pressure to keep our rents down, right? So they decide to do it. They're like, why not? They block the road. Nouria's like, oh, I'm going to kill myself

anyway. I may as well let them push me into the middle of the street. And they sit there and they protest. And the media does come. It's a little bit of a kerfuffle that day in Berlin. And then at the end of the day, the police come and they say, okay, you've had your fun. Take it all down. And the people there are like, well, hang on a minute. You haven't told Nuria she gets to stay. Actually, we want a rent freeze for this whole council estate. So when we've got that, then we'll take it down. But of course they knew the minute they left the barricades that they put up, the police would just tear it down anyway.

So one of my favourite people at Cotty, Tanya Gartner, who's one of the punk squatters, she wears tiny little mini skirts even in Berlin winter. She's quite hardcore. Tanya had this idea. In her flat, she had a klaxon,

you know, those things that make a loud noise at football matches. So she went and got it. She came down and she said, okay, here's what we're going to do. We're going to drop a timetable to man this barricade 24 hours a day until we've got what we want. If the, until Nuria gets told she can stay in until we get a rent freeze. Um, and if the police come to take the barricade down, let off the klaxon, we'll all come down from our flats

and stop them. So people start signing up to man this barricade, people who would never have met, right? So, uh, it was very unlikely pairing. So Nuria, who's very religious Muslim in a full hijab, was paired with Tanya in her tiny little miniskirt, right? And I can't remember what night shift they got. It might be Tuesday nights. So they're sitting there, Tuesday nights, super awkward. They're like, what have we got in in common we've got nothing to talk about as the weeks went on they started talking and tanya and nuria realized there's something really profound in common um nuria had come to berlin when she was 16 from her village in turkey and she had two young children and her job was to raise enough money to send back for her husband to come and join her and um sitting there in the cold in Cottey, she told Tanya something she never told anyone in Germany. She'd always told people. So after she'd been in Berlin for 18 months, she got word from home that her husband was dead. And she'd always told people that he died of a heart attack. He'd actually died of tuberculosis, which was seen as a kind of shameful disease of

poverty. That's when Tanya told Nuria something she never talked about. She'd come to Cotty when she was even younger, when she was 15. She'd been thrown out by a middle class family. She made her way. She lived in this punk squat and she got pregnant not long after she arrived. So they both realised that they had been children with children of their own in this frightening place they didn't understand. They realised they had loads in common. There were loads of these pairings happening over Cotty of people who would never have taught. There was a young lad who kept being a Turkish-German lad who kept being nearly thrown

out of school. They said he had ADHD. He got paired with a very grumpy old white German guy called Dieter, who said he didn't believe in direct action because he loved Stalin. But in this case, he'd make an exception, who started helping him with his homework. He started doing much better at school. Directly opposite this council estate there's a a gay club called zud block it's run by a man i love called rick hardstein who to give you a sense of what he's like um the previous place he owned was called cafe anal okay this is pretty hardcore gay club right and when they when they opened it about two years before the protest began you know there's a lot of religious muslims there some of them had smashed the windows people were really pissed off and when the protest began they the Zudblock the gay club gave gave all their

furniture to the protest um and after a while they said you know you guys could have all your meetings in our club you could you know we'll give you drinks we'll give you free food um and even the lefties at Cotty were like look we're not going to get these very religious Muslims to come and have meetings underneath posters for things so obscene, I won't describe them on your podcast, right? It's not going to happen. But actually it did start to happen. As one of the Turkish-German women put it to me, we all realised we had to take these small steps to understand each other. After the protest had been going on for about a year, one day a guy turned up at the protest called Tunkay, who was in his early fift. And Tung Kai, when you meet him,

it's obvious he's got some kind of cognitive difficulties and he'd been living homeless, but he has an amazing energy about him. And he started asking if he could help out. Everyone liked him. And by this time, they'd actually, the barricade had turned into a physical structure with a roof, right?

A lot of them are construction workers. So they started saying to Tung Kai, you know, you should come and live in this thing we've built, right? It's quite nice. We don't want you to be homeless. He started living there, became a much loved part of the protest camp. And after he'd been there for nine months, one day the police came. They would come every now and then to inspect. And Tungkay doesn't like it when people argue. So he went to hug one of the police officers, but they thought he was attacking them. So they arrested him. That was when it was discovered. hacking them. So they arrested him. That was when it was discovered. Tungkay had been shut away for 20 years in a psychiatric hospital, often literally in a padded cell. He'd escaped one day, lived on the streets for a couple of months and made his way to Kotti. At which point the police took him back to the psychiatric hospital. So this entire Kotti protest turned itself into a

free Tungkay movement, right? They descend on this psychiatric hospital at the other side of Berlin. And these psychiatrists are like, what is this? They've got, you know, had this person shut away for 20 years and suddenly they've got all these women in hijabs, these punks and these very camp gay men demanding his release. They're like, oh, they don't understand it. And I remember Uli Hartmann, one of the protesters said to them, yeah, but you don't love him. He doesn't belong with you. We love him. He belongs with us. And many things happened at Cottey. I guess the headline is they got a rent freeze for their entire housing project. They then launched a referendum initiative to

keep rents down across the entire city. They got the largest number of written signatures in the history of the city of Berlin. They got Tunkai back. He lives there still. But the last time I saw Nuria, I remember her saying to me, you know, I'm really glad I got to stay in my neighborhood. That's great. I gained so much more than that. I was surrounded by these incredible people all along and I would never have known. And so many of the people there, these insights were just below the surface. I remember Neriman Tanker, who's another one of the Turkish German people there, these insights were just below the surface. I remember Neriman Tankeir, who's another one of the Turkish-German women there, saying to me, you know, when I grew up in Turkey, I grew up in a village and I called my whole village home.

And I learned when I came to live in the Western world that what you're meant to call home is just your four walls. And then this whole protest began and I started to call all these people my home, right? And she said she realised in some sense in this culture, we are homeless, right? There's a Bosnian writer called Alexander Heyman who said, home is where people notice when you're not there. By that standard, lots of us are homeless. And it was so clear to me in Kotti, think about how unhappy these people were, right? Nuria was about to kill herself. Tunkai was shut away in a padded cell. Loads of them were depressed and anxious. In the main, these people did not need to be drugged. They needed to be together. They needed to be seen. They needed to be loved and valued.

They needed to have a sense that they were part of a tribe, that they had purpose and meaning in their lives. And I remember sitting with Tanya one time outside Zublock and her saying to me, you know, when you feel like shit and you're all alone, you think there's something wrong with you. But what we did is we came out of our corner crying and we started to fight. And we realised we were surrounded by people who felt the same way. And to me, this is the most important thing I learned, right? I love these people in Cotty, as I'm sure you can tell. But in one sense, they are not exceptional. They were entirely randomly selected people, right? That could

have been anyone. This hunger for reconnection and for rediscovery of meaning and other people and meaningful values is just beneath the surface for all of us, right? And arguably, it's the most important thing as a society we should be trying to promote. And arguably, it's the most important thing as a society we should be trying to promote. That quote is profound. I can't stop thinking about it. Home is when someone notices when you are not there. I know that that's going to sit with me all day and maybe for the next week.

I'm going to be reflecting on that because I think it's so profound. And I've been thinking about this a lot. I've got three teenage nephews, a teenage niece and two young godchildren. I was thinking about, you know, sometimes you have these kind of philosophical thoughts where you think, what do you want for them in their lives, right? I don't want them to be rich. It's nice if they're rich. I'm not going to stop them if they want to make money, but I want them to be in a place like Cotty. I want them to know that they have a home where people see them and value them and want them to be there. And I see that in this culture, and we've got all sorts of problems like people interacting primarily through screens. This does not give you that sense, right?

Digital interaction is not the same as human connection. No. But they're two completely separate things. Yeah. And we've got to stop, you know, for many of us, unfortunately, we're replacing real life human connection with digital transactional sort of behavior. And again, this is not about demonizing screens necessarily. We can use things like social media to do a lot of good in the world. We are both active on social media.

You know, I'd like to think that what we are doing is helping society in some way. You know, other people can be the judge of that, of course, but I think social media and screens can be used in very, very helpful ways. But I think many of us are using it as a substitute for, you know, what it really means to be human. And as you were describing that story, it made me think, you know, we are living isolated lives these days. You know, many people have moved for work. We're getting more and more urbanized. We don't have, you know, we often don't, you know, often two, there are often two working parents now who are trying to raise children without parents nearby, without family nearby.

Of course, that's going to be stressful, actually. It's inherently stressful to try and do that for many people. And in some ways, are we, in the 21st century, conducting a social experiment that the actual, the resulting effect of it is that we're going to have poor mental health? In many ways, is it almost not inevitable, the way that we've constructed society now, the way many of us are living, that mental health problems are going to be otherwise? Yeah, I think that's so important. If we think about, we've created a society that is not meeting many basic psychological needs for most people, right? And there are all sorts of indicators of distress that are related to that, right? way we're talking about depression that's called chasing the scream and and you know if you look at just in the u.s at the moment the figures about addiction so white male life expectancy has fallen for the first time in the entire peacetime history of the united states and that is overwhelmingly

driven by suicide and opioid addiction right and overdoses from opioid addiction and the the people who've done the best research on this um sir angus Deaton and Anne Case, call those deaths of despair, right? That's exactly what we're seeing, a massive rise in deaths of despair. And if you create a society where people are profoundly lonely, where they are controlled and humiliated at work, where they're taught that life is about buying crap

and displaying it on screens, that is going to be a society with terrible mental health. And it's going to have terrible mental health, not because those people are weak or stupid or biologically broken. It's because of the society, you know, Krishnamurti, the great Bengali philosopher said, it's no sign of good health to be well adjusted to a sick society. I don't mean this glibly. If you don't feel you belong in a society where the most powerful person in the world is as profoundly sick as Donald Trump is, that's not a sign you're crazy. That's a sign you're sane, right? And if we think about these, and I think the rise of political

extremism all over the world is very closely related to this. If people are living in a culture that doesn't meet their needs, you're going to get a significant number of people who are going to say well burn the fucking house down then you know um and and the worst thing we can do in response to that is to tell those people they're thick or just that they're racist or that they're they're stupid that that that is profoundly wrong they're not actually it's not it's not this is not an individual issue, is it? It's a societal issue. And we've got to start taking it much more seriously as a societal issue.

Exactly. I think one of the worst... You know, since you mentioned obesity before, right? And when I started promoting this book a year ago, there's an analogy I would use, and I've stopped using it because it was too problematic. Right. And I think the reason why is really interesting. So I used to say, okay, so depression, like we're talking about, depression is risen for social reasons, largely for social reasons.

And we all know, if you look at a photograph of British people on a beach in 1970, everyone is what we would call skinny now. There are no fat people, right? We know that obesity has massively risen. And obviously, it's not that just suddenly everyone in Britain got lazy or suddenly became gluttonous, right? What happened is our food supply changed. It's very hard to walk and bicycle around our cities. A whole range of things that kind of very extreme couldn't be more well documented, right i'd say just like social causes have driven up obesity not just weakness and laziness or not not weakness laziness at all um social causes driven up depression i have stopped saying that because really often people would reply going but fat people are really lazy i mean you would just

i would have thought it's so obvious that social... I mean, compare Copenhagen and Kansas City, right? They are both humans. There's no significant biological difference between the people in Copenhagen and the people in Kansas City. There is epidemic obesity in Kansas City and virtually none in Copenhagen. Why? Copenhagen's a different environment. It's easy to walk. It's really easy to get delicious fresh food. A whole range of reasons. Right. Social norms around these things. And it's almost impossible to do those things in Kansas City. Right. You can't walk anywhere. Thatcher said, there's no such thing as society. There's only individuals and their families. And I think we have so deeply internalized that idea, right? So that when someone comes along, and I don't say this in any sense of superiority, as you could probably guess, I never liked Margaret Thatcher, but I was depressed all those years. I had literally studied social sciences at Cambridge

University and it never occurred to me that there were these deep social forces playing out in my life. So even someone who thought they'd consciously rejected this, you know, Thatcherite vision that we're all just isolated individuals and maybe you've got your family if you're lucky. I had internalized that. So I think you've gone to the absolute core of the problem, which is if you think about yourself primarily as an individual, you are going to feel like shit, right? There's a really interesting piece of research about this. A woman I went to interview called Dr. Brett Ford, who was at Berkeley in California, did really interesting research with her colleagues. It's really simple. They wanted to figure out if you decided you were going to spend more time trying to be happier, would you actually become happier? Let's say you said,

I'm going to spend two hours a day making myself happy, right? Would it actually work? And they did this research in four countries. It was in the US, Taiwan, Russia, and Japan. What they found at first seems really weird. In the US, if you try to make yourself happier, you do not become happier. In the other countries, if you try to make yourself happier, you do become happier. And they're like, what's going on? Right? How can that be? When they looked at it more, what they discovered was in the US, if you try to make yourself happy, I'm pretty sure this would be true for us. Generally, it's exceptions, of course, but generally you would do something for yourself. You buy something for yourself. And this is definitely true of me. I think now when I felt myself becoming depressed years ago, I would

earn more money. I would show off. I would get some kind of external achievement. I would buy something for myself. But in the other countries, generally, if you tried to make yourself happier, you did something for someone else, your friends, your family, your community, right? So we have an instinctively individualistic idea of what it means to be happy and they have an instinctively collective idea of what it means to be happy. And they have an instinctively collective idea of what it means to be happy. And it turns out our vision of happiness, the one that we've been sold, that we're impregnated, you know, impregnated, we're bombarded with from birth, just does not work. A species of individualist would have died out on the savannahs of Africa.

We wouldn't be sitting here now, right? If they'd said there's no such thing as society, there's only individuals and their families, you know, this would just, London would just be wild, empty fields, right and you you've you've said that you've suffered from depression in the past it's been very well documented that um are you still depressed no i'm careful in how i put in the book because i don't want to do that very american thing of like hey dear reader i did this and you can too but for a range of reasons. Firstly, I was in an incredibly privileged position where I could change lots of things about my life. One of my closest relatives is a struggling single mum who works every hour she can to keep her kids in their home and gets home and is so knackered she can't watch Coronation Street. So the idea

of saying to her, hey, I did this, you can, your job now is to join a gardening program, democratize your workplace fight for a universal basic i mean it would be grotesque to say that to her right so a big part of the book is about how we can change the society to free up people like my relative to do the things they want to do that would make their lives better and reduce their depression and anxiety but in terms of myself yeah i made a lot of changes that massively reduced my depression anxiety and actually the one we were just talking about the thing that flows from Brett Ford in some ways that I remember interviewing Brett and it's such a simple insight and yet it was so transformative for me I started

to picture don't know if you remember this but um I can't find it online so if anyone's listening can knows where it is tell me I remember when I was a kid seeing a short, a silent film that I think was Buster Keaton and he's sinking in quick, it might've been Laurel and Hardy actually, I can't remember. He's sinking in quicksand and his legs are sinking and to get out of it, he reaches in with his hands to try to pull out his legs, which of course means he sinks faster. And then he reaches in with his head to try to pull out his legs, which of course means he sinks faster. And then he reaches in with his head to try to pull out his arms and then he's gone. Right. And I realize now my strategy for dealing with depression was a bit like that. I would start to feel bad partly because for all sorts of reasons and some of the ones we've touched on.

But you know, for example, my values were wrong. I was pursuing happiness in all the wrong ways. Right. So what did you change there? So if something as simple as when I feel those acutely painful feelings coming and I do feel them sometimes, instead of trying to do something for myself, I will leave my phone at home and go and just try to do something for someone else, right? And I'm not like Oprah, I can't turn up with a car for them, but just turn up and just listen to someone, right? In a culture where people are not seen and not heard, the greatest gift you can give someone is turn up and listen. And don't every five minutes look at your phone and don't be partially present, right? Just be present with

someone. It's such a simple tip, isn't it? That obviously you felt the benefits. You know, I think what's great about your book is that you've, you've, you have researched it so deeply. You've gone all around the world. As you said, what was it? 40,000 miles you traveled yeah it really is an incredible insight for people i think if you want to dig deep into this and really understand what the the root causes of many cases of depression are in society i was thinking about what you said i think it's really interesting about screens because there was one experience i had on that journey that really helped me to understand this it was um i went to the first ever internet rehab center in the world. It's in, it's outside Spokane in Washington state. I remember when I arrived there,

it's been clearing in the woods. I get out of the car and I instinctively looked at my phone and felt really pissed off. I couldn't check my emails because there was no reception. I was like, oh wait, you're in the right place, right? You came to the internet rehab center.

But I think it's totally important what you said. So I spent a lot of time there talking, they get all kinds of people. It's called Restart Washington. They get all kinds of people there, but they disproportionately get these young men who are obsessed with multiplayer role-player games like World of Warcraft. It would be Fortnite now,

but Fortnite didn't exist then. And I remember talking to these young men and the woman who runs it is an amazing person. You should have her on your podcast. She's brilliant. Dr. Hilary Cash said to me, you know,

you've got to ask yourself, what are these young men getting out of these games, right? They're getting something. They're getting the things they used to get from the culture, but they no longer get. They get a sense of status. They get a sense of identity. They get a sense of a tribe, right? They get a sense that they can roam around because most teenagers are like prisoners in their own home. They can't go out. They don't go out. But what they're getting, I started to think as I listened to it, it was almost like a parody of those things. I started to think the relationship between social media and social life is a bit like the relationship

between porn and sex, right? I'm not opposed to porn, but no one spends an hour looking at porn and feels like valued and satisfied the way you do after you've had sex, right? Because we didn't evolve to look at sexual images on screens. We evolved to actually have sex, right? And if your whole sex life consisted of looking at porn, you would be going around pissed off and irritated the whole time because your deeper needs as a human being would not be being met, right? And in a similar way, it's not that there's no place for social media, right? Of course there's a place for it. You know, Professor Cassiopo said to me, gave me a good little rule of thumb. He said,

if social media is a way station for meeting people offline and staying in touch with people who you know offline, it's a good thing. If it's the last stop on the line, something's gone wrong there. Right. It's really good, isn't it? Yeah,

it's really good. But I think, I think this move towards, I had an unbelievably depressing conversation. I have to check out if it's true, but someone I was at university with, I hadn't seen since we left and I bumped into them. It's just 20 years now, nearly 20 years. And when we were students at the college we were at,

everyone would meet in the bar, right? It was the gathering bar. It was a big social area. And he's still there in Cambridge. And I said, oh, you know, what's it like when you talk to the students in the bar now? And he said, oh, they know, what's it like when you talk to students in the bar now? And he said, oh, they've actually, they're shutting down that bar

because no one goes there anymore. And I said, well, what? I don't understand. Is there an alternative social space? They're like, no, they're just, they're just talking to each other on screens. They're just, the physical meeting. And that's like when you're a student,

when you actually do live really close to it, that's a real hijacking of values, right? Yeah, it really is. It's incredible how many themes you've written about that I also cover, particularly in my latest book on stress and stress solution. I've got this section on how to become a regular, really, and lots of tips for people. How do you become a regular again? As pubs are closing down across the country, as churches, you know, these areas where we used to congregate, you know, were pubs there to be places where we used to drink or were they there places for community and unwinding? You know, maybe it's

a bit of both, but I think we've lost something. And I think there are many ways that we can start to become a regular again. The first quarter of the book is on meaning and purpose. And I really thought long and hard about this. I thought, I can't write a book on stress without covering this really important topic, which is we need meaning and purpose. And we don't have time to go through it now, but I created a new framework called the Live Framework, L-I V E on how, and how we can start to get more meaning and purpose in our lives, because it's all very well to say we need more meaning and purpose, but some people will be listening and go, yeah, well, how the hell do I do that? Absolutely.

And L I V E stands for love, intention, vision, and engagement. And, you know, maybe we can talk about this on a, on a, on a future podcast, but that the engage piece is about doing something with others, doing something for others. And if you're feeling down, as you say, you just go and do something for someone else. Or you know what? I say to people when I've been going around the country talking about this book, I say, look, the simple thing you can do is at your work office, make someone a cup of tea, right? Do it for someone else. Even better, make someone you don't like in your office a cup of tea. And I feel there is really something powerful about doing

things for other people. We've become far too individualistic as a society. I think there's also something that you mentioned about, I guess in many ways it's about intrinsic motivation versus extrinsic motivations. And so it's, you know, so much of what I see now is that we're doing things so that we can post them on social media, right? In many ways, I talk to a lot of people who, if they don't post about it on social media, it didn't happen. It didn't exist. What was the point of experiencing that if I can't go and share that? And look, again, I'm not, I'm, I'm not criticizing it. I'm not standing on my high horse, right? I will do things sometimes and post them on social media, but I'm very conscious that I don't post everything I do on social media. Um, I, you know, there's, I don't know if you,

how much you use Instagram, but, uh, Insta stories is, um, you know, something that lots of people are using all the time. And it's where you document various parts of your day and you show things. And I've got on one level, I have a real issue with it because I actually post a lot on Insta stories when I'm away. So I'm in London at the moment, so I'll be posting. As soon as I get back home later today, you won't see me on Insta stories for a few days because I'm around my kids, I'm around my wife. I don't want to model that sort of behavior to my children that every moment in life has to be captured and shared with the world.

What's incredible is it's a catastrophic hollowing out of experience, right? You see this at, so for example, recently, whenever it was, not that recently, about four or five months ago, I was just, because I happened to be there for a different reason. I was, no, it's more than that,

it might be a year ago now. I was at Elton John's last ever residency in Caes's palace in vegas right incredible like and he's the most incredible and literally a third of the audience did not look at elton john they're just looking at their iphone screens right and you the person people either side of me literally did not look out and i want to tell them go no one wants to see your shitty little iPhone video about John. You will never see this again. Put your phone down. Right. But it's that thing about, we talk a lot actually about, um, envy, right? We talk a lot about the experience of feeling envy, but people do talk about that. What we don't talk about as much is

living in a way that is designed to invite the envy of others right and actually i think that is the more important conversation so much of how we live now is designed it's like you're in an envy contest you you look at instagram and i feel it myself you look at instagram you think of that person's in fucking fiji right well i've got a show that i'm and you this i had a funny experience perfectionist presentation yeah exactly and there's an interesting thing so we know if what we say about professor casser and junk values we know the more you live your life like that the more you're living your life to display it rather than to be in the moment and to enjoy the thing itself the more likely you will be depressed this is actually a cause

of depression and anxiety and i had a moment that to me was like a kind of surreal illustration of this. One of my nephews loves Elvis. I've never quite understood why. So I took him to Graceland. I've been promising for years in Memphis where Elvis lived. And we arrived and when you arrive in Graceland, there's no physical guide to show you around anymore. They give you an iPad, right? So you put in headphones and the iPad says, you know, turn left. This was Elvis's front room or whatever. And we're standing in the jungle room, which was like one of Elvis's famous rooms. And what happens is everyone just walks around a ghost land looking at the iPad because there's a representation of the room in front of you in the iPad, right? So we're in the jungle room, the actual jungle

room, Elvis's actual room, and everyone is looking at their iPads. And a guy turns to his wife and goes, honey, this is amazing. If you swipe left, you can see the jungle room to the left. And if you swipe right, you can see the jungle room to the right. And I almost thought he was joking. And I looked at him and I said, right, but sir, there's an old fashioned form of swiping you can do. It's called turning your head because we're actually in that room. And he looked at me like I was completely mad and carried on looking at the iPad. And I thought we've lost the ability to literally look at the thing that's right in front of us and occasionally i've been in like uh touristy places where people have to leave their phones i went to victoria

falls a few years ago just i was doing some research nearby and it was so fascinating to me because um you can't take your phone into the waterfall right if the spray comes up and it would ruin your phone and there's almost like a moment of blissful relief when people, you're like, oh, leave that for a minute. You can be present and you can be in this extraordinary thing. That's why I'm such a huge fan of promoting swimming, actually, because I think swimming is one of the last forms of exercise where you're sort of forced to be mindful. You can't, well, actually, I'm sure you can now, but you can't really go in the water. I know you can. Please, no one design that thing right where you could do that yeah yeah i mean it's it's just how can you enforce how can you cut yourself how can you do an activity that forces you to switch off i just want to say on the thing about concerts

um i think i think just to be sort of with the understanding and kind and compassionate to people who are doing that because i think it's a reflection of where we've got to in society. I understand why people do that. You know, I'm a bit of a music, I won't say addicts, but music's a huge part of my life. I've been to thousands of concerts. I love going to concerts. I, you know, I passionately dislike this whole new trend of that. It's, I think it ruins the, I think it spoils the experience of people around us.

I don't think people are meaning to do that, just to be clear. I'm not, I'm not blaming people. I do understand that. I don't think they're meaning to do that. But I know very, a lot of artists now actually say at the start of their concerts, please guys, put your phone off. We want you to really be present and enjoy this. I think, I think Eddie Vedder from Pearl Jam says that at his concerts, I believe,

which I think is incredible. I think some people get really frustrated by that. They say, well, you know, I've spent X amount of pounds on this concert ticket. I want to document it. So I think there's something about that, that it's really a societal issue that we need to talk about. And for people who do do that, all I would ask them is to think about, well, why do you do that? You know, is it something you genuinely want,

you know, to get that bit of video footage and watch it about later? Okay, fine. You know, fair enough. I think we need to sort of ask ourselves those questions. Are we doing it because everyone else is doing it? We think, actually, we have to do that. I don't know. I think these are complex, you know, issues. It's so interesting you said that, because I remember talking to Dr. Hilary Cash in that internet rehab center about some of these questions. And she said something really important, I think, which is you have to think about, in relation to social media and this desire to share these things on social media, you have to think about, it's too simplistic to blame it on social media. There's a complex thing going on here. If you think about the moment when the internet arrives in human history, right? So most of it's the late nineties, the early two thousands,

a lot of the things we're talking about, a lot of these causes of depression and anxiety were already supercharged by then. So loneliness had gone up well before the internet comes along right um what what happens is the internet arrives and it looks a lot like the things we've lost yeah right so you've lost friends but here's facebook friends you've lost status here's some status updates right but it's not the thing we've lost and i think like all all addictions are partly the core of addiction is not trying to i'd say the core of addiction is trying trying to i'd say the core of addiction is trying not to be present in your life because your life's too painful but it's also an attempt to fill a hole right it's an attempt to and so we both share a mutual friend in gabble matty

love you know gabble's amazing he was on the podcast it was episode 37 on the podcast i talked to him and i love his phrase which is we shouldn't be asking why the addiction we should be asking why the pain exactly exactly yeah i spent a lot of time with Gabor on the downtown east side in Vancouver for my previous book, Chasing the Scream. And he's an amazing person. I think it's exactly right that we think about the opioid crisis in the US, right? The temptation is to focus on the painkillers and there are real chemical hooks in painkillers that are a problem. But actually, if you want to understand why people are taking so many painkillers, you've got to understand why they're in such deep pain, right?

And I think we can understand this mobile phone addiction by thinking about the wider evidence about addiction itself, right? About what addiction is. We've had this very, and this is obviously something from my previous book, but, you know, this thing that really transformed

how I thought about addiction. I've been thinking about this a lot the last week. One of my relatives has gone into a rehab center in the last week, but I've been thinking about this again a lot, but you know, I grew up with a lot of addiction in my family and I thought I understood what I was seeing, right? So let's think about heroin addiction, which is something close to me. Most people, if we were sitting here in central London, if we stopped a load of people on the street and said, well, what causes heroin addiction?

They're going to look at us like we're thick and they're going to say, well, mate, the clue's in the name, right? Heroin causes heroin addiction. We've been told this story for a hundred years. It's become totally part of our common sense. We think if we kidnapped someone off the street and we injected them with heroin every day for a month, at the end of that month, they'd be heroin addicts because there's chemical hooks in heroin that their bodies would start to desperately physically need. And they'd have this terrible physical

hunger for heroin. And that's what addiction is, right? Now that's real, but it's a very small part of what's going on with addiction. It's actually, our understanding of addiction was really transformed by an incredible man, a friend of Gabbo's as well, and a friend of mine, an incredible man called Professor Bruce Alexander, who's based in Vancouver, who did this amazing experiment in the 70s. So Professor Alexander was, you know, looking at this theory that, you know, depression is just, sorry, that addiction is just caused by the chemical hooks. And he starts to look at where does this come from? And it comes from a series of experiments that were done earlier in the 20th century. They're really

simple experiments. Your listeners can try them at home if they feel a little bit sadistic. You take a rat, you put it in a cage and you give it two water bottles. One is just water. The other is water laced with either heroin or cocaine. If you do that, the rats will almost always prefer the drugged water and almost always kill themselves quite quickly, right? So there you go, it's our story. But in the 70s, Professor Alexander's looking at this and he goes, well, hang on a minute. You put the rat alone in an empty cage. It's got nothing that makes life meaningful for rats.

What would happen if we did this differently? So he built a cage that he called Rat Park, which is basically like heaven for rats, right? They've got loads of friends. They've got loads of cheese. They've got loads of coloured balls, they can have loads of sex. Whatever a rat can want in life, it's there. And they've got both the water bottles, the normal water and the drugged water. And of course they try both. They don't know what's in them. It's just the fascinating thing. In Rat Park, they don't like the drugged water. They hardly ever use it. None of them ever use it compulsively. None of them ever overdose.

So you go from 100% compulsive use and overdose when they don't have the things that make life meaningful to none when they do have the things that make life meaningful. There's lots of human examples that I could talk about, but to me, what I took from this is the opposite of addiction is connection, right? And we can think about that in relation to not just drug addiction, but things like mobile phone addiction, right? In an environment where you feel starved of the things that make life meaningful, there's a guy called Professor Peter Cohen in Amsterdam, who says we shouldn't call it addiction, we should call it bonding. Human beings have an innate need to bond and connect. And when we're happy and healthy,

we'll bond and connect with the people around us. But in an unhealthy environment where we're cut off from that, either because you're isolated or traumatized or you've been taught to value the wrong things, you will bond and connect with something that gives you some sense of value and meaning, right? Now, if the only source of meaning you've been given in your life or the primary one is the likes you get on Instagram, then yeah, it's not foolish or we don't want to be judgmental or sneering at people who have become addicted to that form of reinforcement in it it's understandable totally understandable again comes back to that thing we're talking about the whole way through your pain makes sense right these problems occur for reasons that are entirely understandable and I know they seem mysterious when you're in the middle of them right I could when you're in the middle of depression it feels like it has no meaning when you're in the middle of them, right? When you're in the middle of depression, it feels like it has no meaning. When you're in the middle of addiction, it doesn't feel like it's about these deeper things.

It feels like it is about the immediate object of the addiction and not the deeper causes. But there are these deeper causes. We know this. There's enormous amounts of scientific evidence for this. And, you know, maybe it's... Well, not maybe. This is where my thinking has got over the last few months is that it's not necessarily the drug or the technology that's the problem. As your rat study actually demonstrates quite nicely, it's how are you using that?

What are you using it for? So if, taking alcohol for an example, if you have a bit of alcohol now and again, when you're with your buddies, you have a meal and a glass of wine, let's say, right? As opposed to when you come back from work, you're super stressed, you feel isolated, you feel there's no meaning and you have no agency in your life and you're using alcohol to soothe that pain, the alcohol is going to have a different effect. And in some ways you can talk about that with social media in the same way. If you're using it, as you mentioned, to sort of keep in touch with people, interact with people, you know, build these sort of networks online where you share similar values, it can be a very valuable tool. But if you're using it every time you feel down to sort of get that connection, of course,

that can be helpful for some people, right? Just to to be clear but I think that's when it can start to be a slippery slope down um Johan look this has already become the longest conversation sorry I know not at all I've really enjoyed it and I feel like we've we barely scratched the surface so um I I hope we get the chance to do this again definitely because I think so much more we could talk about but but one thing I'd just like to finish on, if you don't mind, is the point of me setting up this podcast and the reason I call it Feel Better Live More is I genuinely feel that when we feel better in ourselves,

we get more out of life. And the goal with each conversation really is, yes, to challenge people, maybe think about things in a slightly different way, but I want to empower every listener as much as possible to become the architects of their own health. Now, I appreciate that's tricky in a society that can make it very hard for us to do the things that we want to do. But I wonder, with the deep levels of research you've done, the books you've written, do you have some sort of top tips for people who are listening to this? You know,

some sort of short and sweet tips for them that they can think about applying into their life that are going to help improve the way that they feel? Yeah, I think, remember, your pain makes sense. It has causes. We can understand those causes together. And if you cannot solve them as an individual, and it's likely you can't, connect with groups who can change them. And I think one of the reasons that can sound so daunting, one of the reasons I'm really optimistic about that is because I've seen the most unbelievable transformation in my lifetime. I'm 40 years old, I'm gay. One of the people I think about all the time is a friend of mine called Andrew Sullivan,

who a lot of your listeners will know, he is an amazing writer and journalist based in the US. And in 1993, Andrew was diagnosed as HIV positive. This is the height of the AIDS crisis. His best friend Patrick had just died. And it's a death sentence, as far as he knows. So he quit his job and he went to a place called Provincetown, which is a little town in Cape Cod, to die. And he decided he was going to do one last thing before he died. He was going to write a book about a completely crazy utopian idea that no one had ever book about was gay marriage right and when i get depressed because we're talking about these are big things we've got to fight right i try to

imagine going back in time to 1993 to andrew in provincetown saying to him okay andrew you're not going to believe me 24 years from now okay first thing you're going to be alive he wouldn't believe that for a moment secondly you'll be married to a man thirdly I'll be with you when the Supreme Court of the United States quotes this book you're writing now in its judgment, making it mandatory for every state in the United States to introduce gay marriage. And the next day you'll be invited by the president of the United States to a white house that will be lit up in the colors of the rainbow flag to celebrate what you and so many other people have achieved, gay people and straight people who sided with us oh and by the way that president is going to invite you he's going to be black right every aspect of that would have sounded like the most bonkers science fiction

25 years ago right yeah nothing right nothing though those transformation that andrew is alive he saw that happen right every everyone listening to your program has lived through incredible transformations the women listening don't need me to mansplain this to them but my grandmothers Saw that happen, right? Everyone listening to your program has lived through incredible transformations. The women listening don't need me to mansplain this to them, but my grandmothers, when they got married, weren't even allowed to have bank accounts in their own names, right? I mean, we've lived through incredible transformations. The main thing I would say is we are living at a moment

when people are deeply pessimistic for all sorts of understandable reasons. If we're broken up, if we're taught to value the wrong things, if we're controlled and humiliated all day at work, it's easy to get into a mode where you think we are powerless. The single most important thing I would say to anyone who's depressed and anxious or anyone at all listening to this is you are incredibly powerful, right? Ordinary people have changed the world time and time again. They don't do it by sitting at home alone. They do it by joining up with other people. Together, we can deal with the reasons why we have been made to feel so shit. These things were not ordained by nature.

They weren't like earthquakes. They were decisions that were made by human beings. And we can undo those decisions. We can build a much better world for ourselves and for our children. We don't have to live like this. And you have the power with other people to change and challenge that. Johan, what a wonderfully optimistic note to end this conversation on. Guys, I really would

highly encourage you to check out Johan's books, both of them actually. I think they're incredible. I think they will cause you to rethink some of the things you may have thought. Johan, I'm absolutely going to try and get you on the podcast again at some point in the future my publishers always tell me off if I don't so they gave me a script to read at the end which makes me sound like a psychopath so I'm not going to read it but anyone who wants any more information about where they can get the book or the audio book uh can go to www.thelostconnections.com and they can take a quiz to see how much they know about causes of depression and anxiety and they can listen to audio of loads

of the people we've been talking about and watch videos and do other cool stuff. Incredible. Guys, check it out. I just want to say as well that I'm really proud to have done this show with you. I think you are doing amazing work. I really urge people to read your books. And I just think you're doing exactly what we need doctors to do. And you should be really, really proud of the work you're doing because you're communicating in such a brilliant way. And there's such important and profound insights.

So I just feel really chuffed to have met you and really admire what you're doing. Johan, thank you so much. And we'll speak again soon. Hooray. That concludes today's episode of the Feel Better Live More podcast. So what did you think? I thought that was truly incredible. There were so many golden nuggets in that conversation.

What connected with you the most? What was the most impactful thing that you heard today? Please do let Johan and I know your thoughts on social media. Johan is most active on Twitter at JohanHari101 and Instagram at Johan.Hari. And I'm active on Twitter, Facebook, Instagram, and LinkedIn. Please do use the hashtag FBLM if you can, so that we can easily find your comments. As always, do have a think about one thing that really resonated with you in today's show. And think about how you might start applying that into your own

life. Everything that Johan and I discussed today is available for you to see in the show notes page for this episode which is drchatterjee.com forward slash 94. You will see links to articles, videos, blogs as well as Johan's amazing book Lost Connections. So if you want to continue your learning experience now that the show is over, please do head over to the show notes page. That is drchatterjee.com forward slash 94. Now, a big theme in today's conversation was connection and how important connection is in our lives. My brand new book, Feel Better in 5, has a huge section dedicated to the importance of human connection, connection with the world around us, connection to our families, connection

to work colleagues, friends, but also connection to ourselves. There are a wide variety of different five-minute exercises and activities that you can do to improve the quality of connections in your own life. Some can be done with other people, some can even be done by yourself. So if you think that this is something you or someone close to you needs help with, please do consider picking up a copy of my new book, Feel Better in Five. You see, this new book really is all about action. It is a simple but highly effective daily plan to help you take control of your health and well-being. Everything in the book takes a maximum of five minutes to do and I cover physical, mental and emotional health. or so five minute of what I call health snacks in the new book and all you have to do is choose three of them. The three that fit your lifestyle, your desires, your personality and your goals. It really is deceptively simple but I can tell you that it is simply one of the best ways to make

short-term and long-term changes to your lifestyle. You can pick up the book in all the usual places as a paperback, e-book or as an audiobook which I am narrating. As well as the UK up the book in all the usual places as a paperback ebook or as an audiobook which i am narrating as well as the uk the book is now also available in australia new zealand india and more countries will be following very very shortly it has only been out now for three weeks and has already had over 150 five-star reviews on Amazon, which is simply incredible. So if you're looking to make 2020 your year and are looking for a simple plan that is going to help you achieve your goals,

I really do think that my book, Feel Better in Five, is going to help you. If you enjoy my weekly shows, please do consider leaving a review on Apple Podcasts or whichever platform you listen to podcasts 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 the good old fashioned way and simply tell your friends and family about the show. Your support is very much appreciated. A big thank you to Richard Hughes for editing and Vedanta Chatterjee for producing this week's podcast. That is it for today. I hope you have a fabulous week. Make sure that you have pressed subscribe and I'll be back in one week's time with my latest conversation. Remember, you are the architect of your own health. Making lifestyle changes is always worth it. Because when you feel better,

you live more. I'll see you next time. Thank you.