Feel Better, Live More with Dr Rangan Chatterjee - BITESIZE | Is Everything You Know About Depression and Anxiety Wrong? | Johann Hari #393

Episode Date: October 12, 2023

CAUTION ADVISED: this podcast contains swearing. For the past few decades, almost every year, levels of depression and anxiety have increased across the Western world. But why?  Feel Better Live More Bitesize is my weekly podcast for your mind, body, and heart. Each week I’ll be featuring inspirational stories and practical tips from some of my former guests.   Today’s clip is from episode 94 of the podcast with the brilliant Johann Hari.  Johann went on a forty-thousand-mile journey around the world to interview leading experts about what causes depression and anxiety, and what solves them. In this clip he explains that although we’ve been told a story that drugs are the solution, in many cases the cause is not in our biology but in the way we live.  Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Show notes and the full podcast are 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. 

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10. And these packs are perfect for keeping in your backpack, office, or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. Welcome to Feel Better Live More Bite Size, your weekly dose of positivity and optimism to get you ready for the weekend. Today's clip is from episode 94 of the podcast with the brilliant Johan Hari. Johan went on a 40,000 mile journey around the world to interview leading experts about what causes depression and anxiety and what solves them. In this clip, he explains that although we've been told a story that drugs are the solution, in many cases the cause is not in our biology, but in the way that we live. Yes, there are some biological changes for some people, but is fundamentally modern society causing the increased rates of depression and anxiety?

Some key aspects are. 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. 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 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. I went to interview an amazing South African psychiatrist called

Dr. Derek Summerfield. And Derek happened to be in Cambodia in 2001 when they introduced chemical antidepressants for the first time in Cambodia for the people there. And the local doctors, the Cambodians had never heard of these things, right? They were like, what are they? And he explained and they said, oh, we don't need them. We've already got antidepressants. And he said, what do you mean? He thought they were going to talk about some kind of herbal remedy, right? Like St. John's wort or ginkgo biloba or something. Instead, they told him a story. There was a farmer in their community who worked in the rice fields. And one day he stood on a landmine and he got his leg blown off. It was left over by the American war.

So they gave him an artificial limb. They 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. He 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 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 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. We are the loneliest society there's ever been. We're just behind the Americans. There's a study that asks Americans, how many close friends do you have who you could turn to in a crisis? And when they started doing it years ago, the most common answer was five. Today, the most common answer is none. It's not the average,

but it's the most common answer. There are more people I have nobody to turn to when things go wrong than any other option, right? Half of all Americans ask how many people know you well, say nobody. And I spent a lot of time talking to an amazing man called Professor John Cassioppo, who was at the University of Chicago. He was an amazing guy and he was the leading expert in the world on loneliness, basically. And Professor Cassiopo showed a few really fascinating things. I remember him saying to me, you know, why are we alive? Why do we exist? One key reason why you, me, and everyone listening to this podcast exist is because our ancestors on the savannas of Africa were really good at one thing. They weren't bigger than the animals they took down. They

weren't faster than the animals they took down a lot of the time, but they were much better at banding together into tribes and cooperating, right? Just like bees evolved to live in a hive, humans evolved to live in a tribe. And we are the first humans ever to try to disband our tribes. If you think about circumstances where we evolved, if you were cut off from the tribe, if you had no one to turn to, you were depressed and anxious for a really good reason, right? You were in terrible danger. Those are still the instincts that we have. That's still how we feel. That's an appropriate response to the environment in which we were in. This to me is the single most important insight I learned from all these people.

If you are depressed, if you are anxious, you're not weak, you're not crazy, you're not a machine with broken parts. You're a human being with unmet needs. Your pain makes sense, right? 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. 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. You know, the science shows that, you know, 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 said, yeah, I'm surprised by that. But you explain, well, hold on a minute. If you think about evolution and you think about if we weren't part of that supportive tribe around us, as you say, if we were on the, on the outside, then, you know, we were vulnerable to attacks. So what happens? Your body responds, your, your stress response goes up,

your immune system gets ranked up. You become inflamed because your body is preparing you for when you get attacked. Absolutely. And there's a really good line that the brilliant psychoanalyst and writer Stephen Gross says, you know, if you touch your hand'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 because they can't feel that they're, for example, burning their hands or trapping in a car door or whatever. That's a necessary pain signal. The way Professor Cassiopo put it to me is,

loneliness is a necessary signal to push you back to the tribe, right? But if you've created a culture where people have disbanded their tribes, where actually we've told ourselves, you should live alone, you should be alone, do it yourself. We tell these toxic messages all the time

that the only person who can help you is you. Then what we've done is we've cut people off from understanding that deeper source of pain. And one of the things 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. 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. 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. She found it unbearable. 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, a 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. I remember when I was a kid seeing a silent film that I think was Buster Keaton. 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 arms and then he's gone. Right. And I realise 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? 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 it's going to 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 try 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 it turns out our vision of happiness, the one that we've been sold, that 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? It's such a simple insight. And yet it was so transformative for me. 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 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 hope you enjoyed that bite-sized clip i hope you have a wonderful weekend and i'll be back next week with my long-form conversational wednesday and the latest episode of bite science next friday Bite Science next Friday.