Mayim Bialik's Breakdown - Johann Hari: The Truth About Depression, GLP-1s and ADHD & Why Our Biology Is Not To Blame

Episode Date: July 29, 2025

Is Big Pharma really healing us — or profiting from keeping us sick? NYT best-selling author Johann Hari (Stolen Focus, Lost Connections, Chasing the Scream, Magic Pill) returns with a powerful breakdown of the real causes of depression, anxiety, and the global attention crisis. Johann Hari reveals why only 2 of the 9 causes of depression are biological, exposing how Big Pharma, social media addiction, and modern lifestyle traps are fueling mental health issues. He dives into the dark rise of GLP-1 drugs (like Ozempic) and society’s toxic beauty obsession, while uncovering the overlooked role of sleep, community, and social connection in healing. Hari shares his personal experience with antidepressants, and explores how childhood shame and trauma drive addiction, weight gain, and despair. You’ll learn why even pets are being diagnosed with ADHD, what Silicon Valley insiders confessed about attention-hacking technology, and how our loss of focus is sabotaging relationships, careers, and democracy itself. If you’re ready to challenge the myths of mental health, regain your focus, and take back control of your mind, don’t miss this eye-opening conversation with Johann Hari. Check out all of Johann Hari's Books: https://johannhari.com/ Our first episode with Johann Hari: https://youtu.be/JKFuI96biDU Follow us on Substack for Exclusive Bonus Content: ⁠⁠⁠https://bialikbreakdown.substack.com/⁠⁠⁠ ⁠⁠⁠BialikBreakdown.com⁠⁠⁠ ⁠⁠⁠YouTube.com/mayimbialik Learn more about your ad choices. Visit megaphone.fm/adchoices

Pain was kind of leaking out of me and I couldn't control it. My doctor said some people are just lacking a chemical in their brain called serotonin. All we need to do is give you this drug, you'll be fine. And I was taking higher and high doses until for 13 years I took the maximum possible dose and still felt like shit. People want a simple story. They want one thing to be wrong that involves one medication to fix it. The factors causing depression and anxiety and our attention problems are really fucking big.

human pain is not a malfunction. Human pain is a signal. There isn't even any evidence that people with depression have lower serotonin. It's agony. It's the worst thing I've ever experienced to be depressed.

But it's telling you something really important. And if we treat it as a malfunction, it's an inaccurate map of pain. This is a system built entirely around profit and entirely around these dysfunctional incentives. I'm constantly amazed that Americans don't burn down the system of healthcare in this country. If you're depressed, if you're 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. Hi, I'm I'm Bialik. I'm Jonathan Cohen. And welcome to our breakdown. We're going deep into the incentive structure that is keeping us sick and distracted today. Depression, anxiety, ADHD. If you think that you're experiencing any of these or know someone who is,

there are systems at play that may be increasing the likelihood. and we are going to talk about what to really do about them. So many of us think that we know what depression comes from. So many of us think that we understand why we're anxious. So many of us think we understand the new framework around ADHD and neurodivergence. Our guest today is going to talk about how so many of the things that we have been told to believe about how we become sick and how we can get better are actually distortions of a system that is designed to tell. tell a completely different story than the one that most of us are experiencing. Johann Hari is an incredible thinker and author and researcher.

His book, Chasing the Scream is what some people say is the best book about addiction. Lost Connections, Uncovering the Real Causes of Depression is, I think, one of the finest books written about the mental health crisis in this country. And stolen focus, why you can't pay attention. We'll focus a lot on this. Why is everybody being prescribed medication? Why is everyone saying that's the solution? There's nothing else I can do.

I'm just going to go on antidepressants. I'm just going to take this stimulant. And everything's going to be fine. Why do those medications not work? And what are the things you can do to actually get to the root of what is leading to what really is an epidemic of mental health complexity in this country? We've spoken to Johan Hari once before. His book, Magic Pill was, I believe, the first written about Ozempic. He discusses his experience with it.

And we'll touch on that a little bit. today. We're so excited to welcome in person, Johan Hari to the breakdown. Break it down. I'm like ridiculously happy to be here. We're so excited to have you in person. And if you didn't hear our first episode, we recommend that people

listen to it. Mainly because it was the peak moment of my life and my existence on the planet earth. Tell us what was so special for you about your first time with us. You know why. And I'll begin to cry. You say it because I'll cry. Deep in left field. This one came out. Johan is a huge. Beaches fan.

Deep cut. It was very deep cut. When I was 12, I played the Young Bet Midler in the movie Beaches. You're still playing her. It was not my first role, but it was kind of the thing that led to really the entirety of my life and career as we know it. It was after that that I did Blossom. But yeah, you were a huge Beaches fan.

I literally know, I almost literally know it by heart. The script. How many times have you seen Beaches? Like, so between the ages of 12 and 50. I think I watched it with my best friend like twice a week every single week. Why would you do that to yourself?

It's very sad. And it's tragic and weirdly I realized that I profoundly misunderstood the plot of beaches because when I then didn't watch it for many, many years until like maybe... Most people think Barbara Hershey's character had cancer. She did not. No, she has...

Oh, I know the name of it. What's it called? It's a brain disease. No, she had a heart. It was a heart thing. Cardiomyopathy. Is the name of what? Yes.

Yes, the Barbara Hush character has. But why did you miss the plot of the whole movie? So I was raised in a family. There was a lot of addiction and insanity and a lot of narcissism. And I now realize that the arc of beaches is that C.C. Bloom, your character, Betmiddler's character, is very narcissistic at the start. Enough about me. What do you think about?

Exactly. And the movie is partly the story of C.C. Bloom overcoming her narcissism through this friend with friendship with Hillary, right? I just thought she was admirable right from the start because I was raised in a environment with so much narcissism I was like wow she's great and then like I was like oh no wait she just sucks up all the energy in the room

I don't have to do anything I was like when she's a terrible person at the start of the movie and I'd completely miss this so yeah it was fascinating when I rewatched it as an adult and when actually weirdly my best friend was very very unwell and we thought she might die fortunately she didn't so it's like oh my god my life is like

turned into the film beaches Like, how has this happened to me? And so that's when I rewatched it. I got very emotional and realized I misunderstood it. And then we reenacted the iconic final moments. We did. Just to clarify, in the first episode, there is an reenactment where both of you are singing. So if people need to see that, that's where you find it.

So what we're going to do in this one, my understanding, is I have brought the script. We're going to do the entire movie from the beginning. No, but I was going to say, you'll be the man we fight over. As a nod to another layer of the movie and what, honestly, what a lot of your work and life is about is like what's that other layer? In the flashback scenes, which I am a part of, we see a dynamic between her and her mother, who's this very kind of larger than life personality

who's really kind of inserting herself into a lot of aspects of this child's life. So we also see some of the sort of like, the psychopathology, right? I mean, not to get too deep. No, yeah, Lenore. That's the name of the mother, isn't she? Lina.

Leona. That's it. Which is? It's my grandmother's name. Yeah. Grandmother's name. Played by Lain. Kazan and that's my mother's name and Lainee is his mother's name I know isn't that funny

hearing we talked with you kind of at the beginning of I'd say the early beginnings of you know an ozempic kind of revolution at that time I think it was still kind of new to talk about and we've now shifted I just want to touch on this briefly because it was what we talked about last time we've kind of shifted into what many people are saying is just the death of the body positivity movement with sort of, I mean, even when we spoke to you, I was like, oh, I'm hearing so many people. Now it's like in LA, you cannot swing a dead cat without hitting seven people. And the dead cat will also be on his own pick because it was being a bit fat shamed on his Instagram. And I also just recently read an article about the transparency with which celebrities now feel

it's sort of their like, I don't know, like their humanitarian responsibility to list all of the plastic surgeries, they've had, all the medications they're on. I think it was a Kat Rosenfeld piece from the free press. And she was like, is this the new feminism? To be like, you can't look like this naturally. Here's the way to do it. Here's the money you need, which is exorbitant. But I wonder, you know, from the time that we first spoke about it and when you wrote, you know, your book, what have you seen shift in not just the GLP one, is that what they're called, the GLP1 world, but sort of our perception of thinness, beauty. Are we beautiful at any size?

Apparently not. So I think there's a quite big division between two different groups of people. There's people who are overweight or obese, for whom I think there's a really strong case for taking these drugs, not for everyone, there's risks, like I think I'm in the book, because sadly, being overweight or obese

does significantly increase health harms. You know, I'm 46, I'm two years older than my grandfather ever got to be because he died of a heart attack when he was 44, loads of the men in my family, get fat, have heart attacks or have other health problems and die young. So there's that group of people. Then there's a group of people who are already a healthy weight or indeed skinny who are taking it to be super skinny. And for them, I have absolutely no criticism of those people because women are, you know, it's much better

than me, I'm made to feel like shit about their bodies, whatever they do. So this is not coming from a point of criticism. But I would urge that category of people, not to do it, because actually being super skinny is also bad for your health. And making yourself artificially thin is actually quite dangerous. Not so much now, say if you were at our age, but if you're super thin, you're much greater risk when you get older of breaking your bones, a condition called sarcopenia, it means you can't even get out of a chair because you're so physically weak. So I think there's two very different categories. And in a way that relates to the body positivity movement, because I thought very deep.

about the body positivity movement for the book. And while I was taking it, you know, I think we talked about one of the lowest moments in writing the book. It was when I had lost a load of weight. I was feeling really good. And I got a call from my niece. We were FaceTiming.

And she was going, oh, you look great. You know, I never knew you had a neck before, right? And then she said, will you get me some o Zen pic? And she was a perfectly healthy weight. And I thought she was kidding. And I laughed. And she looked down. And I realized, oh, fuck, she means it, right?

I'm undoing all these messages. So I think you've got to be a lot of it. look at the, we've got to look at the body positivity movement in all its complexity, because they make a range of arguments, some of which are unbelievably important. So the most important is, however you look, whatever your body's like, you should be protected from bullying and cruelty. And, you know, 42% of women who have a BMI higher than 35 get insulted every single fucking day, right? So absolutely they're right about protected people from bullying. They're also right that shaming people

is completely counterproductive for promoting health, right? Lindy West, the brilliant body positivity activist, says, you know, you don't take good care of a thing you hate. Teaching people to hate their bodies is not a way to help them be healthy. So all of that, I passionately

agree with them. There are some parts of the body positivity movement and it's a relatively small part that argue that it is not true that obesity increases the risk to your health, that that's a kind of fat-phobic myth. I was open-minded about that.

I looked at the evidence. I looked at the leading science on this. We just have to be honest. That isn't true. The evidence that obesity increases the risk to your health is one of the most proven facts in the whole of science. Doesn't mean you should bully people. It doesn't mean anyone should be ashamed.

It's actually not their fault that we gain weight. I'm saying this is someone who's obese most of my adult life. That's the result of industries that have fucked us up from even before birth because we're exposed to this stuff in utero. So it doesn't give any weight to the people who want to shame them. So we've got to be honest to the complexity of that. We want a movement that says we want people to love their bodies. We want people to be healthy.

We want to be happy. We want to help people be healthy, not shame them. But we can't pretend that being overweight or obese doesn't harm your health because unfortunately, on average it does. My MNBialx breakdown is supported by Superpower. We all know the feeling of leaving a doctor's office and kind of feeling like we didn't get anything out of the experience that was useful. Maybe they're like, you're fine, drink more water.

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This leads us to the idea of happy, healthy, and what we're seeing that these drugs have an impact on addictive tendencies. I'm curious to, you know, how that relates to what we're seeing. right now because often, you know, there's an emotional component of eating. There's an emotional component to addiction. Maybe that's where we tie in here. Yeah, there's a lot in that. I mean, there's kind of two halves of what you said there as well. So one of the fascinating things about these drugs is it's becoming increasingly clear that these drugs actually don't work primarily on your gut. They work primarily on your brain. I interviewed the leading neuroscientists or working on

this. We don't actually know how it changes your brain, which is slightly disturbing, but we know it is primarily a brain effect, although there is a gut effect as well. And that opens up some additional risks. It's like a much more intimate thing to have your brain change than to have your gut change, or it feels that way to me, but also opens up some potentially positive aspects. So what we do know is lots of people who have been given these drugs are now saying that in addition to losing weight, it's reducing their addictive behaviours. This started with alcohol. We know that people drink a lot less alcohol, but then they thought, well, there's calories and alcohol. It might be that That's what's going on there.

But actually, so there's a lot we don't know, but there's a lot we do know. We do know that when you get rats and you get them to heavily use any class of drugs, cocaine, heroin, alcohol. I don't know why I find the other rats using cocaine, so, like, hilarious. But it's just like the, you get them to do that. You then give them these GLP 1 agonists, these drugs. They massively reduce the amount of all of the different types of drug they use, which is really eye-catch. They're like, I'm just not hungry for it. Just like, I don't want this line anymore.

I don't know why we imagined the rats would have like these weird cab plug, sex of the city voices, but that is weirdly how I imagine rats. Like, oh, bitch, no more cocaine for me. We now know anecdotally lots of humans are saying this. There's now a shitload of scientific studies going on to figure out, okay, is this also going to help with treating addiction, compulsive behaviors? We don't know yet. We need the human research.

But that's kind of exciting. And there was a second bit of what you asked, and I don't want to neglect it. It was, you said, oh, about emotional eating, which is really important. Because for me, the first six months, I was getting everything I wanted. I lost a shitload of weight. My back pain went away. My neighbour's hot gardener kept hitting on me.

Like, loads of really good things happened. And I did not feel better. If anything, I felt slightly worse. I don't want to overstate it, but I felt slightly worse. Actually, this is weird. What's going on here? And then for my book, Magic Pill, I did all this research about, why do we eat? And there's scientific evidence for five factors why we eat.

eat. The only one of them is the super obvious one that like, you know, feed your body. Thessonance. Exactly. All the rest are emotional drivers of eating. And for me, so I grew up in a family like we were saying where there was a lot of addiction and craziness. I grew up in this environment and I realized, and I had some awareness of this before the OZempic, but I realized then the way I coped with that was by stuffing myself, by overeating. You don't have a lot of agency in a family like that when you're a kid, but you can control your eating. right, I could. And when I started taking the OZN pick,

you can't stuff yourself and overeat when you're on these drugs, you would throw up. And I had a real epiphany about this. I was in a branch of KFC in Vegas. I was there because I'm writing a book about a series of crimes that are happening there, and I had this awful,

it was seven months into taking the drugs, and had an awful day. I was investigating the murder of someone that I knew and really loved, so it was hard. And I went to this branch of KFC that I've been in like a thousand times before. It's the one on West Sahara.

if you know, Vegas. And it's a really skeezy, brought to KFC. And I went in, and I did what I would have done before I was taking the drugs. I ordered a bucket of KFC, a big bucket of fried chicken.

I had one of the pieces of the fried chicken, and I remember looking at the bucket and thinking, oh, fuck, I can't eat this. Right? Like, I couldn't. And I remember Colonel Sanders was on the wall, and it was like he was looking at me going like,

what happened to my best customer, right? And I remember in that moment just thinking, oh, you're just going to have feel bad then. And obviously there are better ways for me to deal with emotional distress that I've subsequently learned than, you know, Colonel Sanders. But one of the things that happens with these drugs, which is really connected to emotional eating and the other factors in eating they're right about, is these drugs massively disrupt your ability to eat the way you did before. That's obviously why they work, which is a very good thing for your health if you overweight or

obese at the start. But that disrupts your emotional relationship with food in ways that can people really need to know about in advance. And I hope the book kind of helps them prepare for that. Well, so and that's actually sort of what I wanted to focus on today. Sure, sure. It's a perfect bridge because, you know, besides like this sort of like hand ringing that people do of like, oh, what if you have to be on that medication forever. I'm not interested in that. What I'm interested in is what happens when we are given medications, in many cases, in place of the actual mechanisms of support and transformation that are needed for us to actually feel better? And by feel better, I mean, realize our potential, be in touch with something greater than ourselves, feel like we

have purpose, feel like there's a reason for us to be here, feel like we have a reason to get up every day. And it's a bit of a common thread. I happen to have some of your books right here. I felt it a lot in lost connections and obviously stolen focus. I think it's a different threat, but it's like the same tapestry. So when I think about our conversation about a ZemPEC about these GLP-1 drugs. I can't help but then think about the number of people I know who are on an SSRI, an SNRI, any number of medications to make them stop feeling bad. And as an extension, this diagnosis, right, of ADHD gets thrown in there.

Well, maybe we need a stimulant, right? Maybe we need Adderall. And now we have this other wave, which I don't know what your next book will be, of neurodivergence. And you have this sort of like Venn diagram of anxiety, ADHD, and neurodivergence. Some people are all of them. Some people are one of them. But we're kind of playing this like pinball of medication with symptoms. And it feels like a very similar conversation in terms of, oh, you're feeling these symptoms. Psychiatry has the answer.

they've got the answer. We will give you the pill that closes the channel, right, that releases the hormone that makes you feel that way and act this way. And when you take these medications, it's very hard to work on the things to actually heal because in many cases you don't have the motivation because like everything's fine, right? There seems to be in all these different diagnoses of I can't focus. I'm feeling depressed. I'm overeating. an undercurrent of emotional distress under all of this. And it seems as though while this diagnosis and the approach to fixing it is changing through a different medication, everyone is just trying to distract themselves or distracted or unable to focus or feeling badly or disconnected in some way, which you cover in all of your books. So maybe we can sort of a little bit of a lay of the land of where society, and I know that's a broad umbrella finds themselves, but this really is almost like a gut check of where we are right now.

For me, this was a really personal journey because, you know, this is partly what my book lost connections was about depression and anxiety is about. When I was a kid, I remember going to my doctor when I was a teenager and saying that I had this feeling like pain was kind of leaking out of me and I couldn't control it. I didn't understand it. And my doctor was a super nice person said, oh, we know why you're like this. Some people are just lacking a chemical in their brain called serotonin. You're clearly one of them. All we need to do is give you this drug.

You'll be fine. So I started taking an antidepressant called Paxil. And I felt much better. And then this feeling of pain came back over the next few months. I went back. I was given a higher dose. Again, I felt better. Again, the feeling of pain came back.

And I was taking higher and higher doses until for 13 years I took the maximum possible dose and still felt like shit. And I was like, well, what's going on here? Because according to this story that we're told in our culture, I'm doing everything right and yet I still feel like this and I look around me and I'm surrounded by people

in the same situation so I ended up going on this big journey for the book all over the world I interviewed over 200 of the leading experts I think I was about to turn 40 when the book was finished you know every single year that I've been alive depression and anxiety had increased

in this country in Britain where I'm from as you can tell from my weird downtown Abbey accent and in fact across the Western world and I was like well human biology doesn't evolve that quickly. Something's going on here. So there are definitely biological contributions,

and I'm sure we'll unpack some of them, and absolutely the distress that people are experiencing is real. And I want to stress that because a lot of people, and certainly me, when you hear the story being widened, I experienced that at first people saying, you're saying what I was told isn't real or what I'm feeling isn't real.

That is not what the people offering a way. perspective as saying it took me a while to absorb that. So there's a lot that underpins the various things that we're going to talk about and actually go through in the book, there's scientific evidence for nine factors that cause depression and anxiety. Only two of them are in our biology. And what unites the rest of them broadly is the way I would put it is everyone listening, everyone watching knows that you have natural physical needs. Obviously, you need food, you need water, you need shelter, you need clean air. If I took those things away from you, you'd in real trouble, real fast. 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 have a future that makes sense. And this culture we built is good at lots of things. I'm glad to be alive today. But we have been getting less and less good at meeting these deep underlying psychological needs for a very long time now. Well, and on Maslow's kind of hierarchy of needs, pyramid, right? Like, you go for the first things first. Do I have enough food? Do I have enough shelter?

In many cases, people see these things as a luxury, right? Romantic love in my family as a luxury, right? You were just arranged, like you were, and for most of human history, right? So there's also, there's been this evolution, right, of an understanding of these needs in an increasingly complex world that we're trying to fit them into. It was a moment. I had a real epiphany about this, really shifted my perspective and shifted actually my own life. I went to interview this South African psychiatrist called Dr. Derek Somerfield, a great guy.

And he told me this story. He happened to be in Cambodia in 2001 when they first introduced chemical antidepressants in Cambodia. They'd never had them before in that country. And the local doctors hadn't heard of them. So they said to him, he wasn't there to study this. He was there working on something else. But they were like, what are antidepressants? And he explained and they said to him, oh, we don't need this.

then we've already got antidepressants and he was like what do you mean he thought they were going to tell him about some kind of like herbal remedy like st john's water 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 land mine and he got his leg blown off so they gave him an artificial limb and after a while he went back to work in the rice fields but apparently it's super painful to work underwater when you got an artificial limb and i'm guessing it's pretty traumatic to go back and work in the field where you got blown up the guy started to cry a lot. After a while, he refused to get out of bed. He developed what we would call kind of classic depression. That's when the Cambodians said to Dr. Somerfeld,

well, that's when we gave him an antidepressant. And he said, what was it? They explained that they went and sat with him. They listened to him. They realized that his pain made sense. You only had to listen to this guy for five minutes to see why he was so distressed. One of them figured, if we bought this guy a cow, he could become a dairy farmer. He wouldn't be in this position that was screwing him up. So they bought him. him a cow, within a couple of weeks his crying, stop, within a month, his depression was gone, it never came back. They said to Dr. Somerfield, so you see, doctor, that cow, that was an antidepressant. That's what you mean, right? Now, if you've been raised to think about depression

the way we have, that it's entirely or primarily a biological malfunction in your brain, that sounds like a weird joke. I went to my doctor for an antidepressant, she gave me a cow. But what those Cambodian doctors knew intuitively is what the leading medical body in the whole world, the World Health Organization, has been trying to tell us for years now. you're depressed if you're anxious, you're not weak, you're not crazy, you're not primarily a machine with broken parts, you're a human being with unmet needs. And what you need is practical love and help to get those deeper needs met. So the question we need to be asking with every depressed and anxious person is, what's the cow for the problems that are facing you? What are

your unmet needs? How can we together help you to get those needs met? And when I went to places that have built their response around depression around that, and I can talk about them, they have incredible results. So the nefarious part here, because I completely agree with everything you're saying in terms of unmet need, is that our systems seem to be increasingly designed to not meet and actually keep people in a state of suffering. So if you think about amount of GDP spent on public spaces, it's plummeted to like 0.2% versus what it used to be at over 3% of public spaces. Incentive structures on building apartments to keep people as separated as possible with no communal spaces to maximize square footage is designed to keep people in little boxes.

The way that the economy is set up is the same. Our tech platforms are designed to keep people siloed in algorithms, increasing enragment to drive engagement. There seems to be more and more obstacles to even considering what it means to have emotional needs as a core, which, you know, I can go into why and we can unpack that. But it feels harder and harder to even start to look at people to say they have needs, let alone thinking of the systems of our economy that thrive on us being broken. And also the healthcare system, which is not designed to actually, you know, provide more than 15 minutes of care for most, you know, for most people who are being run through a system. There's a person I spoke to with that insight. Some people will hear that and think, struggle with it. There's a woman who really helped me to grasp that core point you're making. You should have her on, by the way, amazing person.

She's called Dr. Joanne Cassiottore. So Joanne must be 24 or five years ago now. She gave birth to a daughter called Cheyenne who died during childbirth. And almost immediately, the doctors offered her antidepressants and drugs. And she said, but I'm not depressed. My baby died. Like, I should feel sad. You should be destroyed.

In fact, grief is a form of love, right? If you tell me that your neighbour died yesterday, I'll feel sad. in a sort of vague way, but I won't feel sad the way you tell me my neighbor died because I know my neighbor and I care about them, right? Grief is a form of love. It's also a form of healing. Exactly. And absolutely necessary and essential psychological process.

Indeed, one of the ways we would know someone was a psychopath was if they did not grieve for someone they loved, right? So she said, this is, she found this bizarre. Anyway, she then began to research this, like obviously later. She discovered, I forget the figure it's in the book, but if I remember rightly, a majority of people whose children die are drugged almost immediately in this country, right? And she began to think, well, A, this may interfere

with the grieving process, but B, is a profound misunderstanding of what being human is, right? So she then began to research this and discovered this really interesting thing that I think leads to an insight about what you're asking. So she looked at the history of this. It's really interesting. Back in the 60s, 50s and 60s

when they were first formulating the DSM, the diagnostic and statistical manual, Up to then, there was no agreed definition of depression in this country, right? Doctors would just use the term meaning different things. So quite sensibly, they came up with a definition. And it was a panel psychiatrist. And they basically came up with a checklist. I think it was from a rightly 10 things.

And they said, if your patient has more than five of these 10 symptoms for more than two weeks, they're depressed, do what you can to help them, right? And it was obvious things like crying all the time or a lot, you know, feeling hopeless, kind of things you would guess. So they send this out, and psychiatrists all over the country start using it. But then the doctors come back after a while and go, oh, we've got a bit of a problem here. If we use this definition of depression, we're going to have to diagnose every grieving person in this country is depressed because these are the symptoms of grief, right? And they were like, oh, shit, that's not what we meant.

So they created what was called the grief loophole or the grief exception, where it said, if someone they love died, then it's normal, but if it's not, then they're depressed. But that began to beg the question, well, why is someone you love dying in the only situation in life where you're allowed to feel like shit? What if you've lost your job? What if you're homeless? As Dr. Cassiatoria put it to me, the minute you start asking those questions, you have to let context in. And this is not a system designed for context.

This is a system based on a very different model. It's based on the model of tropical diseases. If you've got malaria, you go to the doctor, you don't want the doctor to go, what was your mother like? Tell me about your childhood. Don't give you a little test. They figure out if you got malaria. they give you the treatment for malaria, right?

And you don't have malaria. Exactly. There's a pathogen that you identify. It's a technique. Malaria is a, you might think of it as a malfunction in your body that you can get rid of, right? Human pain is not a malfunction. Human pain is a signal. It's telling you something really, really important. It doesn't mean it's a good thing.

It's terribly painful to experience it. It's agony. It's the worst thing I've ever experienced to be depressed. But it's telling you something really important. And if we treat it as a malfunction, I want to stress this is not the intention. of any of the doctors who do it at all, who are good people. But what you're saying to people unintentionally is your pain is just a like a bit of malfunctioning code.

It doesn't mean anything. Think about when I was a kid. What I needed to be told by my doctor was, tell me about your life. Oh, wow. Your earliest memory is trying to wake up one of your relatives and not being able to because they were so severely addicted. Oh, you grew up in an environment where you were violently attacked

throughout your childhood by adults. Oh, there's nothing wrong. with you. There was something wrong with your environment and what you need is help to release the shame around that environment. But because I was told a very different story, again, with very good intentions and I'm not saying the drugs didn't help me a little bit for a while they did, along with side effects. What that did is it gave me, and the way I came to think of it is it gave me an inaccurate map of my pain. And if you don't have an accurate map, like we're sitting here in Studio City, if I didn't have, I mean, I've got Google Maps, actually, Uber took me here,

But like, if that Uber driver didn't have a map of this city that was accurate, if she'd taken me to Santa Monica, you know, we wouldn't be having this conversation. And in a way, what I feel like is we're being given these maps that don't take us to the destination we need to get to. They may help, right? I don't have anything against chemical antidepressants. There are benefits and side effects, as with all complicated things. But telling people a purely biological story about their distress. Firstly, it isn't true. Every medical textbook will tell you that is not, it is not correct to say that the cause is.

of depression are purely biological, although your biology can contribute to it. But then, crucially, it leads us to miss the bigger solutions, the cows that are waiting for all of us, right? 100% agree with you. We just released an episode on the biology of trauma, on how those experiences that you're talking about cause stress in the body over time when continued and for prolonged periods can cause, quote unquote, trauma, although that's a definitional phrase. And what we see is that those long extended periods of time actually impact a person on a cellular level, reducing their ability to produce basic energy, reducing their ability for their systems of their body to function properly, which then has an impact on their psychological state because they're not producing the fundamental energy that they need to exist and run the systems of their body.

And medical doctors are telling this story differently, but very, very few because there is, are no tools to intervene and navigate this. But that's the second bit. So it's really important. You've told half of a really important story there, right? Untreated trauma can really fuck you, right? And a lot of depression and anxiety and indeed attention problems can be the result of that untreated trauma.

So for a long time, I backed away from looking into this. Because I heard the bit that you just said, and I thought, oh, so it's just saying, I'm f***ed then, right? You're just broken. And what's really important is we do have tools to deal with the second part. There's a guy who made an incredible breakthrough about this, an absolute hero, one of the most amazing people I've ever met, actually. Man called Dr. Vincent Felitti. If it's okay, I'll just tell you the story, you've probably heard of him.

He's famous for he discovered what called the adverse childhood experiences study. Oh, yeah, ACEs, yeah. So the story of how he discovered this, for a minute, when I tell it to you, for about two minutes, you're going to think, what the fuck is he talking about? This has nothing to do with what he just said. But it led to the breakthrough, and I don't think you can understand it as well if you don't understand the story. So in the early 1980s, Kaiser Permanente, the big not-for-profit medical provider, here in California, one of them, they had a problem, which is that obesity was really rapidly rising. It was actually incredibly low by today standards, but it was rising. They would

give people diet plans. They would even give people personal trainers sometimes. It just wasn't solving the problem. So they approached this guy, Dr. Vincent Felitti, and said to him, will you just do blue sky's research and figure out what would actually reduce obesity? And he's like, okay, and he's like, what can I do? So he started to work with 200 severely obese people, people who weighed more than 300 pounds who tried everything. And he's like, well, what can I do? He had an idea that sounds and actually is kind of dumb. He said, what would happen if severely obese people literally stopped eating?

And we gave them like, you know, vitamin C shots that didn't get scurvy or whatever. Would they just burn through the fat supplies in their body and lose weight? So obviously with a shit ton of medical supervision, they tried it. And incredibly, at first, it worked. There's a woman who I'm going to call Susan, not her real name, who went from being, I think it was more than 350 pounds to 138 pounds. It was extraordinary. You know, her family were ringing Dr. Felitti saying,

you saved her life. And then one day something happened that no one expected. Susan Crack. She went to KFC. Actually, I don't know what's KFC? It's me projecting. Some fast few plays started overeating and quickly went back to her being overweight, not where she was, but a...

And Dr. Felitti called her in. And he said, Susan. what happened? And she looked down, she put really ashamed. She said, I don't know. He said, well, tell me about the day you cracked. Anything in particular happened that day? Turned out something happened that day that had never happened to her. She was in a bar and a man hit on her, not in a nasty way, in a nice way. And she suddenly felt really freaked out and went and started eating. That was when Dr. Felitti said to her question, he'd never thought to ask his patients. He said, Susan, when did you start to gain your weight? In her case, it was when

she was 11. He said, well, did anything happen when you were 11 that didn't happen when you were 12? Anything in particular happened that year. And she looked down and she said very softly, well, that's when my grandfather started to rate me. Dr. Felitti interviewed everyone in the program. He discovered that 60% of the women in the program had made their significant weight gain after being sexually abused or assaulted. And he was like, this is weird. What's going on? And Susan put it to him very well. She said, overweight is overlooked, and that's what I need to be. And he realized this thing that appeared so dysfunctional was performing a profoundly protective function for these women, right? Of course, people get sexually assaulted at any size, but you're more likely... Well, and also,

you convince yourself psychologically that if I can't be, quote, attractive the way, you know, our society deems, that might be protective for me. Exactly. But the reason this led to this breakthrough with depression, addiction and the other questions was. So Dr. Fuliti's had this result in this small group. He's like, but it's a small group. It seems like such an unusual finding that he went to the Centers for Disease Control and got funding to do a much bigger study, which led to this incredible breakthrough. So every single person who came to Kaiser Permanente in San Diego for a whole year, don't matter what for, broken legs, schizophrenia, anything, was given a questionnaire. And the first part said, did any of these bad things happen to you when you were a kid?

I'd be like, just fix my broken legs. Exactly. God damn it. Bring me the fucking morphine. I had sexual abuse, physical abuse, neglect, that kind of thing. And the second part asked, we initially was just going to ask about your weight. But luckily for us at the last minute, they added, you know, have you had an addiction problem, suicide attempts, depression. And at first, when they added up the figures, they were like, this just can't be right.

Do it all again. but they were correct. For every category of childhood trauma you experienced, you were two to four times more likely to be depressed, anxious or addicted. But when you got into the multiple categories, the figures just went wild. 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 injecting drug problem, which is you very rarely get figures like that. And Gabor Maté, you know, confirmed this in his, you know, in his extensive studies of addicts and realized most every addicts had been, especially the women, had been sexually abused and grew up in abuse and addiction. Yeah, I spent a lot of time with Gabour on the downtown side of Vancouver. And what they discovered next, I think is really important. After the study was over, they had all these people who had indicated in a medical form that they'd experienced sexual abuse or neglect or whatever it was. So their doctors were told, don't call them in. but the next time they come in, say to them something like,

I see when you were a child you was sexually abused, I'm really sorry that happened to you, that should never have happened. Would you like to talk about it? And 40% of people said I don't want to talk about it, but 60% of people did want to talk about it, and they want to talk about it on average for five minutes. And then it was randomly assigned. Some of them were told you can come back and have to see a therapist.

What's incredible is just those five minutes of an authority figure saying that should never have happened to you. I'm so sorry. You should have been protected. That alone led to a significant decline in depression and anxiety. Somebody cared. Well, what this shows is it's partly about someone caring

and it's partly about shame. What we know is, as a brilliant scientist here in LA who did a lot of research, if you look at the AIDS crisis, closeted gay men died on average two years earlier than openly gay men, even when they got healthcare at the same stage of the disease,

because shame f***s you. It's not the trauma that fucks you. It's the shame about the trauma. And giving people a way to release that shame is an antidepressant. It's a cow, right? The way I think of it is anything that reduces depression

should be regarded as an antidepressant. For some people, that will be chemical antidepressants, but there needs to be a much wider menu of options. Precisely because the causes are much wider than just in your biology, although there are some in your biology, the solutions need to be much wider.

So one of them is releasing people for shame, but there's, I go through more than 20 in the book, ways we can do this. But it's about you've got to honor the complexity of the problem and its causes in order to find the solution. What we've been doing is with often good intentions telling people an insanely oversimplified story about their pain and their distress. And that has led us to trap people and prevent us from seeing these wider solutions that are all around us. That really hits it right on the head. people want a simple story. They want one thing to be wrong that involves one medication to fix it.

What is it about this nuance that we're not able to capture right now? Yeah, I mean, that's not the thought that when you're in pain, you want, you know, you want to pull a lever and make it stop, right? And they're absolutely right to want that, and that's what I wanted. And some people get relief from the drugs. Some people don't. Sadly, over time, the only long-term study of chemical antidepressant shows most people taking them do become depressed again. But that's not everyone, right? So, um, it's, when you're in pain,

you want it just to stop, right? And any tool that makes it stop is fine by me. Um, and people should seek out the solutions they can. But the problem with the simplistic story, so there's lots of reasons for this simplistic story. Obviously one is big farmer. There are many good things that Big Pharma has done for us. I'm pro-drug across the whole category of many drugs. We live much longer lives because of the breakthroughs in scientific medicine, some of which, many of which come from Big Pharma. You know, it's a more than a billion dollar industry to drug people for depression. And obviously, they're invested in promoting the simplest possible story that means that people turn primarily to the drugs. But here's my question. Do they know that they don't work

and they're still making those advertisements so that I watch them and say, I want that life? I want run through the water. They're always running through the water. I want to run through the water. I want that drug. I mean, I know it sounds like I'm a five-year-old asking it, but am I supposed to operate in the world with an understanding that there's an enormously, you know, profit-heavy portion of our existence that knows that things don't work or hides the adverse effects so that we will just buy them like candy? So with chemical antidepressants, it's not that they don't work. It's that they have a limited effect, right? So they're oversawed, not that there's no effect.

So there's lots of studies of this. For example, there's something, there's a way of measuring depression called the Hamilton scale. I've always felt really sorry for whoever the hell Hamilton was, that we only remember him by measuring how miserable we all. He's not Alexander Hamilton. He's definitely not. He got a whole different story.

We should do a Hamilton scale musical. We're just people on stage, just hugging themselves slowly. But they are going to take their shot. Is that too distasteful? Just do, wait. Just you. Okay, sorry. We're going to an improv, Hamilton scale musical.

at the end of this episode. Okay, go ahead. Sorry. But the Hamilton scale, so it goes from one to 51. I think one is where you are suicidal and 51 is where you're dancing around in ecstasy. Maybe on ecstasy, whatever it is, right?

So to give you a sense of movement on the Hamilton scale, if you improve your sleep patterns, you generally will move six points up the Hamilton scale. On average, when you take chemical antidepressants, you move up two points on the Hamilton scale. So it's about a third of improving your sleep. Now, it's important to say that as an average. For some people, it's much more. For some people, it's less. For me, initially it was much more than it was less. So that gives you a sense, though, that saying to people, this is the answer, the solution. Most people, it will help a little bit at first. Some people, it will massively help. But some people will help a little bit, but some people it doesn't help and indeed harms. But the telling people, that's the answer, that's all you need to know. This is the end of the story. Now, do they know this? It's very interesting. that story I was told by my doctor, that depression is just caused by a lack of a chemical called serotonin.

That was never a scientific theory. That's a story that was invented by the PR departments of the drug companies, right? There isn't even any evidence that people with depression have lower serotonin than everyone else. Which is like a complete head fuck, right? And one of the things I find a slightly gaslighty is a lot of the doctors who said that before, a lot of the people who promoted that theory now go, oh, we never said that, right? even though polling shows most people still believe that, that depression is caused by a lack of serotonin.

You don't have enough serotonin, so we'll give you this drug, and then you'll have enough. And again, stressing there's real value in the drugs for some people, anyone who's taking these drugs. There's also real value in placebo. Yeah, sure, sure. And some element of this is placebo, and some of it may be beyond that,

and I believe it's more effective than a pure placebo, although that may be because people figure out that they're not on a placebo. And anyone who's taking these drugs, if they're helping with your depression, my advice is to carry on taking them. If they're not helping, absolutely do not stop abruptly. You can have terrible withdrawal. Go to your doctor, discuss it very carefully with your doctor.

You know, do not just stop, right? If you're listening to us, you think, oh, wow, it's not working for us. It can be really quite dangerous to just abruptly stop. So go and have a conversation with your doctor. But what we need to do, a lot of people we're listening and going, okay, I get all of this, but I don't have any better options on the table. So what we need to do is help people to put better options on the table. to give you an example of an amazing additional option that to me was really transformative.

So one of the heroes of my book about this, Lost Connections, is an amazing doctor called Sam Everington. And Sam is a doctor in a poor part of East London where I lived for a long time, though sadly he never got to be my doctor. And Sam had loads of patients coming to him with terrible depression and anxiety. And like me, he's not opposed to chemical antidepressants, but he could see that most of the people he gave the chemical antidepressants to took the edge off, but they were still pretty depressed. So one day he began to pioneer a different approach, now spreading all over Europe. A woman came to see him called Lisa Cunningham,

who I also got to know, who'd been shut away with crippling depression and anxiety for seven years. And Sam said to Lisa, don't worry on, don't worry, I'll carry on giving you these drugs. But I'm also going to prescribe something else. I'm going to prescribe for you to come here to the doctor's offices a couple of times a week to meet with a group of other depressed and anxious people

not to talk about how shit you feel. Do that if you want, but that's not the point of it. I want you guys to meet and find something meaningful to do together. The first time the group met, Lisa literally started vomiting with anxiety because she was so overwhelmed being around people. But the group started, people rubbed her back. The group started talking. They were like, what could we do?

There was an area behind the doctor's offices that was known as dog shit alley. It was where dogs were going to shit. They were like, hey, we could turn dog sally into a garden, right? But these are inner city East London people like me. They knew nothing about gardening. So they start to watch clips on YouTube. They started to go and get books out the library. They started to get their fingers in the soil.

They started to learn the rhythms of the seasons. You know, there's a lot of evidence that exposure to nature is a really powerful antidepressant. But they started to do something even more important. They started to form a tribe. They started to form a group. They started to care about each other. If one of them didn't show up, the others would go looking for them. be like, hey, are you okay? Do you need some help? The way Lisa put it to me was as the garden

began to bloom, we began to bloom. There was a small study in Norway of a very similar program, found it was more than twice as effective as chemical antidepressants in reducing depression and anxiety. For me, this approach is called social prescribing, right? It's where we are the loneliest society in human history. 42% of Americans agree with the statement. No one knows me well, and that was before the pandemic, right? One of the first things that should happen when you come and you explain that you're depressed is, oh, are you lonely?

You're lonely? Great. We got a, we got a prescription for that. Exactly. We've got a prescription for that, right? And then we should go down the list of the other nine factors that have been proven scientifically to contribute to depression and anxiety of the other eight, sorry, because that's one of the nine. We go down that list.

We have to have a broad menu of options, right? But this should be the first step. It costs nothing to prescribe people to a gardening program. It's free. It costs nothing. The incentive structure doesn't provide options for that because it's not profitable. We're going to hit pause here. There is so much more to our conversation with Johan Hari that we would love to share with you in part two of this episode.

We'll be talking more about, in particular, ADHD, why are people struggling to focus? why has your attention been stolen from you? Who's behind that? What can we do? And what is the link between things like diet and attention span or other features that can help you gain your attention back? We can't wait for you to hear part two of our episode. So make sure to tune in. If you aren't already subscribed to the podcast anywhere you are listening, please do so now.

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