The Real Causes Of Depression Have Been Discovered, And They’re Not What You Think.

By: Johann Hari

Across the Western world today, if you are depressed or anxious and you go to your doctor because you just can’t take it any more, you will likely be told a story. It happened to me when I was a teenager in the 1990s. You feel this way, my doctor said, because your brain isn’t working right. It isn’t producing the necessary chemicals. You need to take drugs, and they will fix your broken brain.

I tried this strategy with all my heart for more than a decade. I longed for relief. The drugs would give me a brief boost whenever I jacked up my dose, but then, soon after, the pain would always start to bleed back through. In the end, I was taking the maximum dose for more than a decade. I thought there was something wrong with me because I was taking these drugs but still feeling deep pain.

In the end, my need for answers was so great that I spent three years using my training in the social sciences at Cambridge University to research what really causes depression and anxiety, and how to really solve them. I was startled by many things I learned. The first was that my reaction to the drugs wasn’t freakish ― it was quite normal.

Many leading scientists believe the whole idea that depression is caused by a “chemically imbalanced” brain is wrong.

Depression is often measured by scientists using something called the Hamilton Scale. It runs from 0 (where you are dancing in ecstasy) to 59 (where you are suicidal). Improving your sleep patterns gives you a movement on the Hamilton Scale of around 6 points. Chemical antidepressants give you an improvement, on average, of 1.8 points, according to research by professor Irving Kirsch of Harvard University. It’s a real effect – but it’s modest. Of course, the fact it’s an average means some people get a bigger boost. But for huge numbers of people, like me, it’s not enough to lift us out of depression – so I began to see we need to expand the menu of options for depressed and anxious people. I needed to know how.

But more than that – I was startled to discover that many leading scientists believe the whole idea that depression is caused by a “chemically imbalanced” brain is wrong. I learned that there are in fact nine major causes of depression and anxiety that are unfolding all around us. Two are biological, and seven are out in here in the world, rather than sealed away inside our skulls in the way my doctor told me. The causes are all quite different, and they play out to different degrees in the lives of depressed and anxious people. I was even more startled to discover this isn’t some fringe position – the World Health Organization has been warning for years that we need to start dealing with the deeper causes of depression in this way.

I want to write here about the hardest of those causes for me, personally, to investigate. The nine causes are all different – but this is one that I left, lingering, trying not to look at, for most of my three years of research. I was finally taught about it in San Diego, California, when I met a remarkable scientist named Dr. Vincent Felitti. I have to tell you right at the start though – I found it really painful to investigate this cause. It forced me to reckon with something I had been running from for most of my life. One of the reasons I clung to the theory that my depression was just the result of something going wrong with my brain was, I see now, so I would not have to think about this.


The story of Dr. Felitti’s breakthrough stretches back to the mid-1980s, when it happened almost by accident. At first, it’ll sound like this isn’t a story about depression. But it’s worth following his journey – because it can teach us a lot.

When the patients first came into Felitti’s office, some of them found it hard to fit through the door. They were in the most severe stages of obesity, and they were assigned here, to his clinic, as their last chance. Felitti had been commissioned by the medical provider Kaiser Permanente to figure out how to genuinely solve the company’s exploding obesity costs. Start from scratch, they said. Try anything.

One day, Felitti had a maddening simple idea. He asked: What if these severely overweight people simply stopped eating, and lived off the fat stores they’d built up in their bodies – with monitored nutrition supplements – until they were down to a normal weight? What would happen? Cautiously, they tried it, with a lot of medical supervision – and, startlingly, it worked. The patients were shedding weight, and returning to healthy bodies.

Once the numbers were added up, they seemed unbelievable.

But then something strange happened. In the program, there were some stars ― people who shed incredible amounts of weight, and the medical team ― and all their friends ― expected these people to react with joy, but the people who did best were often thrown into a brutal depression, or panic, or rage. Some of them became suicidal. Without their bulk, they felt unbelievably vulnerable. They often fled the program, gorged on fast food, and put their weight back on very fast.

Felitti was baffled ― until he talked with one 28-year-old woman. In 51 weeks, Felitti had taken her down from 408 pounds to 132 pounds. Then ― quite suddenly, for no reason anyone could see ― she put on 37 pounds in the space of a few weeks. Before long, she was back above 400 pounds. So Felitti asked her gently what had changed when she started to lose weight. It seemed mysterious to both of them. They talked for a long time. There was, she said eventually, one thing. When she was obese, men never hit on her ― but when she got down to a healthy weight, for the first time in a long time, she was propositioned by a man. She fled, and right away began to eat compulsively, and she couldn’t stop.

This was when Felitti thought to ask a question he hadn’t asked before. When did you start to put on weight? She thought about the question. When she was 11 years old, she said. So he asked: Was there anything else that happened in your life when you were 11? Well, she replied ― that was when my grandfather began to rape me.

As Felitti spoke to the 183 people in the program, he found 55 percent had been sexually abused. One woman said she put on weight after she was raped because “overweight is overlooked, and that’s the way I need to be.” It turned out many of these women had been making themselves obese for an unconscious reason: to protect themselves from the attention of men, who they believed would hurt them. Felitti suddenly realized: “What we had perceived as the problem ― major obesity ― was in fact, very frequently, the solution to problems that the rest of us knew nothing about.”

This insight led Felitti to launch a massive program of research, funded by the Centers For Disease Control and Prevention. He wanted to discover how all kinds of childhood trauma affect us as adults. He administered a simple questionnaire to 17,000 ordinary patients in San Diego, who were were coming just for general health care – anything from a headache to a broken leg. It asked if any of 10 bad things had happened to you as a kid, like being neglected, or emotionally abused. Then it asked if you had any of 10 psychological problems, like obesity or depression or addiction. He wanted to see what the matchup was.

Once the numbers were added up, they seemed unbelievable. Childhood trauma caused the risk of adult depression to explode. If you had seven categories of traumatic event as a child, you were 3,100 percent more likely to attempt to commit suicide as an adult, and more than 4,000 percent more likely to be an injecting drug user.


After I had one of my long, probing conversations with Dr. Felitti about this, I walked to the beach in San Diego shaking, and spat into the ocean. He was forcing me to think about a dimension of my depression I did not want to confront. When I was a kid, my mother was ill and my dad was in another country, and in this chaos, I experienced some extreme acts of violence from an adult: I was strangled with an electrical cord, among other acts. I had tried to seal these memories away, to shutter them in my mind. I had refused to contemplate that they were playing out in my adult life.

Why do so many people who experience violence in childhood feel the same way? Why does it lead many of them to self-destructive behavior, like obesity, or hard-core addiction, or suicide? I have spent a lot of time thinking about this. I have a theory – though I want to stress that this next part is going beyond the scientific evidence discovered by Felitti and the CDC, and I can’t say for sure that it’s true.

If it’s your fault, it’s — at some strange level — under your control.

When you’re a child, you have very little power to change your environment. You can’t move away, or force somebody to stop hurting you. So, you have two choices. You can admit to yourself that you are powerless ― that at any moment, you could be badly hurt, and there’s simply nothing you can do about it. Or you can tell yourself it’s your fault. If you do that, you actually gain some power ― at least in your own mind. If it’s your fault, then there’s something you can do that might make it different. You aren’t a pinball being smacked around a pinball machine. You’re the person controlling the machine. You have your hands on the dangerous levers. In this way, just like obesity protected those women from the men they feared would rape them, blaming yourself for your childhood traumas protects you from seeing how vulnerable you were and are. You can become the powerful one. If it’s your fault, it’s ― at some strange level ― under your control.

But that comes at a cost. If you were responsible for being hurt, then at some level, you have to think you deserved it. A person who thinks they deserved to be injured as a child isn’t going to think they deserve much as an adult, either. This is no way to live. But it’s a misfiring of the thing that made it possible for you to survive at an earlier point in your life.


But it was what Dr. Felitti discovered next that most helped me. When ordinary patients, responding to his questionnaire, noted that they had experienced childhood trauma, he got their doctors to do something when the patients next came in for care. He got them to say something like, “I see you went through this bad experience as a child. I am sorry this happened to you. Would you like to talk about it?”

Felitti wanted to see if being able to discuss this trauma with a trusted authority figure, and being told it was not your fault, would help to release people’s shame. What happened next was startling. Just being able to discuss the trauma led to a huge fall in future illnesses ― there was a 35-percent reduction in their need for medical care over the following year. For the people who were referred to more extensive help, there was a fall of more than 50 percent. One elderly woman ― who had described being raped as a child ― wrote a letter later, saying: “Thank you for asking … I feared I would die, and no one would ever know what had happened.”

The act of releasing your shame is – in itself – healing. So I went back to people I trusted, and I began to talk about what had happened to me when I was younger. Far from shaming me, far from thinking it showed I was broken, they showed love, and helped me to grieve for what I had gone through.

If you find your work meaningless and you feel you have no control over it, you are far more likely to become depressed.

As I listened back over the tapes of my long conversations with Felitti, it struck me that if he had just told people what my doctor told me – that their brains were broken, this was why they were so distressed, and the only solution was to be drugged – they may never have been able to understand the deeper causes of their problem, and they would never have been released from them.

The more I investigated depression and anxiety, the more I found that, far from being caused by a spontaneously malfunctioning brain, depression and anxiety are mostly being caused by events in our lives. If you find your work meaningless and you feel you have no control over it, you are far more likely to become depressed. If you are lonely and feel that you can’t rely on the people around you to support you, you are far more likely to become depressed. If you think life is all about buying things and climbing up the ladder, you are far more likely to become depressed. If you think your future will be insecure, you are far more likely to become depressed. I started to find a whole blast of scientific evidence that depression and anxiety are not caused in our skulls, but by the way many of us are being made to live. There are real biological factors, like your genes, that can make you significantly more sensitive to these causes, but they are not the primary drivers.

And that led me to the scientific evidence that we have to try to solve our depression and anxiety crises in a very different way (alongside chemical anti-depressants, which should of course remain on the table).

To do that, we need to stop seeing depression and anxiety as an irrational pathology, or a weird misfiring of brain chemicals. They are terribly painful – but they make sense. Your pain is not an irrational spasm. It is a response to what is happening to you. To deal with depression, you need to deal with its underlying causes. On my long journey, I learned about seven different kinds of anti-depressants – ones that are about stripping out the causes, rather than blunting the symptoms. Releasing your shame is only the start.


One day, one of Dr. Felitti’s colleagues, Dr. Robert Anda, told me something I have been thinking about ever since.

When people are behaving in apparently self-destructive ways, “it’s time to stop asking what’s wrong with them,” he said, “and time to start asking what happened to them.”

What Not To Say To Those Struggling With Mental Illness.

For those who are grieving, the holidays are hardly “the most wonderful time of the year.” Not only are they navigating their pain, they’re doing it during a time that’s supposed to be joyous.

Loved ones often try to alleviate some of the grief a person may be feeling by offering helpful phrases or advice, but what may seem like a supportive statement could actually be exacerbating a person’s sadness, Dan Reidenberg, chair of the American Psychotherapy Association, told The Huffington Post.“Certain statements don’t take into account what the grieving person is feeling,” Reidenberg said. “They end up really focused on the person who isn’t grieving.”

Take a look at advice from Reidenberg and a couple of additional experts and avoid these common pitfalls:

1. “Smile, it’s the holidays.”

While this is a good intentioned way of trying to cheer someone up, it may come across as invalidating.

“Statements like these end up sending a message to the grieving person ‘hide your sadness’ or “’it’s not okay to be sad,’” Reidenberg said. “This hurts them, makes them feel more alone and that their grief might somehow be wrong.”

2. “Next year will be better.”

Grief often makes the future look foggy.

“The holidays are filled with memories of good times, happy times, when loved ones and friends shared experiences and made memories together,” Reidenberg said. “Those are now in the past for the person grieving and that is very hard on them.”
Include the individual in your holiday preparations and just spend quality time with them when they need it, Reidenberg suggested. A supportive presence goes further than you think.

3. Any questions about the details of the death.

Curiosity should be stifled in this case, according to Nancy Marshall, a licensed professional counselor and author of Getting Through It: A Workbook for Suicide Survivors.

“Don’t force anyone to tell the story over and re-expose the trauma,” Marshall told HuffPost. “Your right to the ‘news’ does not trump their need for well-being.”

4. “Let’s try not to think about them right now.”

“People have a hard time being around someone who is sad and grieving, so they often try to take their mind off it or somehow make it better and the reality is that sometimes it just can’t be better,” Reidenberg said.

Acknowledging a person’s loss is crucial. Instead, try asking the grieving individual about any traditions they used to love to do with the person who passed, Reidenberg advised. Allow the person to guide you on how much or little they want to discuss.

5. “They’re in a better place.”

It’s easy to default on cliches, but they often come across as impersonal. Phrases like “everything happens for a reason” and “they’re in a better place now,” can often make a person grieving feel even more isolated if they aren’t at a place where they can accept what happened yet, Reidenberg said.

Try saying something like “I can’t imagine how you must be feeling” or “Is there anything I can do for you?” instead. And never underestimate the power of saying that you’re sorry this happened to them.
Ultimately, grief will subside but your support through the process is vital for the person who is in pain.
“It certainly will never be ‘okay’ that this happened, but time will pass and the sharpest pain will recede from consciousness,” Marshall said. “Always be compassionate with yourself as an observer and with your friend who experienced a horrible loss.”


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A Letter to the Baby Nurses.

Right now, there is a baby nurse who is searching online and deep inside for an answer. There is a brand new member of the profession who is questioning her calling. There is a newly-minted graduate who wonders how school seemed to teach her everything and nothing all at the same time. There is a greener-than-grass new hire who is praying that she doesn’t kill somebody at work tomorrow, and wonders if she already did yesterday.

Dearest baby nurse, don’t let this scary new world drag you down. You’re going to have moments when you are sitting on a toilet seat for far too long, probably for the first time in your entire shift, and question why you even decided to become a nurse in the first place. That’s okay.

You’re going to have days — many of them — when you plop down in your car after leaving work two hours later than anticipated; and you’re going to turn off the radio; and you’re going to roll down the windows; and you’re going to cry the most painful and ugly cry. That’s okay.

You’re going to have shifts where your head is spinning and your hands are shaking and your brain is thinking faster than your fingers can type. That’s okay.

You’re going to have moments when you clean more bodily fluids in one 12-hour day than an average person might in a lifetime. You’re going to feel that — sometimes — you’re the only person on the entire unit, because everyone around you is just as busy as you are. That’s okay.

You’re going to have times when patients yell at you for something you didn’t know (that perhaps you should have). They will complain about you to anyone that might listen. They may even become so frustrated with their care that they threaten to leave. And this is going to bother the hell out of you. That’s okay.

You’re gonna listen for 20 minutes and still not hear a damn murmur. That’s okay.

You’re going to have moments when you feel like something “just isn’t right” with the patient in your care. You won’t have enough experience as a frame of reference for what may be happening, or why. You’re probably going to feel helpless in these moments — it’s a “tip of the tongue” phenomenon to the highest degree. That’s okay.

You’re going to feel devastated the first time a veteran nurse yells at you — even more so when their reaction is for something nit-picky and non-essential. You’re going to mumble something unsavory about them under your breath. That’s okay.

You’re going to call a doctor to clarify an order, and she’s going to complain. She’s going to want answers, details, vital signs, and a picture of what is happening with your patient, and you’re going to word-vomit something that probably makes very little sense to an angry cardiologist at 3 a.m. That’s okay.

You’re going to walk into a room expecting to pass your morning medications and come to find your patient unresponsive. Maybe she’s stopped breathing. Perhaps she’s lost a pulse. Either way, you’re going to bring forward everything you learned in every class, clinical, and scenario — and forget how to do any of it. You’re going to scream for help. You’re going to look like a deer in headlights. And you’re going to wonder, “When the hell am I ever going to be able to be as good as they are?” That’s okay.

You’re going to lose that patient, on an unexpected shift, and in an unexpected way. You’re going to think it was your fault. You’re going to be riddled with guilt and feel ashamed of how you reacted. You’re going to replay that scenario in your head over and over again, and every time wonder why you didn’t see it coming. You can’t always see it coming. You can’t always be the hero. And that’s okay.

Because someday you will be.

Someday you’ll understand the subtleties and nuances that no one can teach you except for time Herself.

Someday you’ll be able to balance the full-fledged mountain emergencies with the miniature mole-hill ones.

Someday you’re going to address a patient or family member who is frustrated with a sense of firm yet compassionate care, and will know how to redirect their emotions.

Someday you will call a doctor, and she will thank you for keeping such a close eye on whatever concern you’ve already handled.

Someday you’re going to finally take a lunch break, and it will actually be during lunchtime.

Someday you’re going to do chest compressions or inject medications or ventilate a patient, and your paralyzing fear will be replaced by sheer adrenaline.

Someday, somebody is going to die on your watch — but whether it’s through blood, sweat, and heroics or a quiet and accepted end — you will have made a difference in the journey of that patient and his or her loved ones.

And while some days you may still feel like a hamster on a wheel, going through the motions just to stay afloat — someday you will realize that you are not the one sinking and needing to be saved. Rather, you’ve grown into a life raft for another baby nurse, insecure and unaware of all of her untapped potential.

Someday you will understand that the nursing profession is perhaps the hardest of them all, but in so many different ways, the most rewarding.

And someday you will stand up for yourself; stand up for your patients; and stand up to the barriers that impact your highest capacity to care — this day will remind you why you trudged through every tear, scream, and exasperated sigh.

So do not give up, baby nurse: new to the world in which nurses beget nurses; still questioning why nothing ever ends up like the texts books might have said. No matter how bad it feels — no matter how hard it seems — always turn to the nurses who can teach you that one can have a brilliant mind and a beautiful soul; one can be funny when things feel too serious; one can be tough as nails and still be softened by the circumstances; one can make mistakes and still maintain integrity. Stand your ground, baby nurse; ask questions; study hard; prioritize what matters; own up when you don’t know; and don’t let anyone beat you down — especially that little voice in your own head. If you allow yourself to do it, you’ll be amazed by how quickly a baby nurse can grow.

Lovingly cheering you on,
A Former Baby Nurse

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Making a Difference in the World of Children's Mental Health.

Love that today The Duchess of Cambridge (or also known as Princess Kate) was highlighted as the guest editor for the UK edition of the Huffington Post. She was enlisted to bring attention to the #YoungLivesMatter edition of the website highlighting the issue of children’s mental health, an often neglected area of health care and education systems around the world. This new initiative seeks to encourage individuals of all walks of life to join in on the conversation surrounding mental health, particularly young individuals in ensuring that they are able to feel loved, secure, valued, and understood. Articles in this section will seek to help combat the stigma that is often associated with mental health issues (particularly in children) and discuss the causes and potential solutions that could be used to fight this health crisis.

Research has shown that mental health issues often start early.  In the United Kingdom, one young person in 10 is estimated to experience some form of emotional or mental health problem each year. These problems become significantly worse as the age demographics move up towards post-secondary education, with approximately 1 in 5 (in Canada) reporting some form of mental health issue (ex anxiety, depression, etc). Furthermore, half of young adults with mental health disorders first experience difficulties before they are 15.

As pointed out my the Duchess in her blog post today:

“What I did not expect was to see that time and time again, the issues that led people to addiction and destructive decision making seemed to almost always stem from unresolved childhood challenges……children – even those younger than five – have to deal with complex problems without the emotional resilience, language or confidence to ask for help. And it was also clear that with mental health problems still being such a taboo, many adults are often too afraid to ask for help for the children in their care. ”

Why are our systems reacting so slow to addressing these problems? Children are supposedly “our hope for the future”, yet we are failing many of the children in giving them a successful head start in developing healthy coping mechanisms.

Although not all forms of mental illness have specific cures, preventative efforts are crucial to giving people the support they need to live functional and fulfilling lives. We are all well aware the economic impact that mental illness has, yet for many who choose to seek help it if often mission impossible to even get on the waiting list for help. In Canada and the United States there is emerging concern about a shortage of child psychiatrists that is predicted to get worse. Even more alarming, a 1999 study indicated that there were 6,148 children with mental health needs per child psychologist in Ontario. Keeping in mind, there are only approximately 2,000 psychologists in ALL of Ontario. Even worse, in all of rural Ontario (a MASSIVE plot of land) there were only 21 practicing psychiatrists serving rural Ontario (Bazana, 1999). HUH??? I am well aware of the dilemmas of trying to recruit physicians to remote and rural areas, but we need to find ways to encourage more people to serve these populations. Mandatory rural/remote medical placements should be encouraged, possibly even another Northern medical school with a mandatory placement time up north should be encouraged. For many these are not ideal places to live, but as someone serving the medical community these people are in need of care and for many living on the reserves there is a dire need for more medical professionals and psychologists to address these long-standing problems.

We as a society need to do more to train a variety of individuals with how to identify and help those who may be struggling to navigate our often complex and fragmented system.  In the UK alone, more than 15,000 people working in a variety of schools have been trained as mental health first aiders. An excellent program to help spot potential warning signs and a method to provide children with access to an initial support system and guide in obtaining the resources needed to help them.

As Michelle Obama put it in her comission blog post for the Young Minds Matter edition:

“Sadly, too often, the stigma around mental health prevents people who need help from seeking it. But that simply doesn’t make any sense. Whether an illness affects your heart, your arm or your brain, it’s still an illness, and there shouldn’t be any distinction. We would never tell someone with a broken leg that they should stop wallowing and get it together…..We shouldn’t treat mental health conditions any differently. Instead, we should make it clear that getting help isn’t a sign of weakness – it’s a sign of strength – and we should ensure that people can get the treatment they need.”

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