PDF Summary:Lost Connections, by Johann Hari
Book Summary: Learn the key points in minutes.
Below is a preview of the Shortform book summary of Lost Connections by Johann Hari. Read the full comprehensive summary at Shortform.
1-Page PDF Summary of Lost Connections
You may have learned that a chemical imbalance in the brain causes depression, but that’s only part of the story. Biology lays the foundation, but trusted sources like the World Health Organization agree that your life experiences and the society you live in are the biggest causes of depression.
In Lost Connections, journalist Johann Hari investigates the psychological and social factors that contribute to mental illness (which he calls “disconnections”), as well as innovative social and environmental treatments for depression (or “reconnections”). Learn the questionable history of antidepressants, why Amish people hardely ever get depressed, and how mushrooms might be the antidepressants of the future.
(continued)...
Genetics
Studies show that depression is roughly 37% inherited, meaning genetics are a big piece of the mental illness puzzle. However, they’re not the biggest piece: Roughly 63% of the basis for depression comes from somewhere outside of biology.
Even if you have genes that increase your vulnerability to depression, those genes alone aren’t enough to actually cause depression—the genes have to be “switched on” by the environment. In other words, if you have a perfect life with no major disconnections, you won’t become depressed, even with a genetic predisposition to the illness.
The Placebo Effect
All of this evidence about the causes of depression points to one thing: If biology isn’t the only problem causing depression, then medication shouldn’t be the only solution to the illness. So why is medication so popular?
The placebo effect is partly to blame. The idea behind the effect is that every medical treatment actually has two parts: the treatment itself and the story that goes with it. For example, when you take medicine for a headache, you don’t just swallow a pill—you swallow a story about how that particular medicine can cure headaches. Your belief in that story can sometimes create the same physical results as the treatment itself.
For antidepressants, studies show that only 25% of their positive effects were due to the chemicals themselves. Natural recovery accounted for another 25%, and the additional 50% came down to the placebo effect. Most people have never heard those statistics because in the U.S., pharmaceutical companies control every step of the drug research and development process. Every drug they release brings in more money, so they continue to sell the idea that chemical antidepressants are the most effective treatment for depression.
Reconnect to Others
So, what non-biological treatments could we use to tackle depression? The solutions—or “reconnections”—below are promising new ways to treat depression through reconnection to other people.
Build Genuine Relationships
Depression creates an ego-centric worldview—you’re unhappy, you don’t feel good enough—so countering that narrative by focusing on the group and building relationships with people is more powerful than looking for a quick fix on your own. Focusing on other peoples forces your attention out of your own head and creates the mental breathing room you need to genuinely connect to others.
The idea that depression is a personal issue that should be dealt with alone is a symptom of Western individualist values. In the West, we see happiness as an individual thing, so we address it on an individual level. We engage in “self-care” and read books from the “self-help” section, but never ask for help or allow ourselves to be truly vulnerable around others. However, in Asian countries, if you set out to make yourself happy, you'll most likely engage in communal care because you see your happiness as intrinsically tied to the happiness of your community.
Case Study: The Kotti Neighborhood Protest
The power of connecting with others is evident in the example of Nuriye Cengiz, an elderly woman living in Kotti, a working-class neighborhood in Berlin. Nuriye was facing eviction because she couldn’t afford the most recent rent increase in her area. Distraught, she hung a note in her window explaining to her neighbors that she intended to kill herself before being forced out of her home. Neighbors from all different walks of life reached out and quickly recognized that their housing situation (and resulting depression) was a collective issue, not an individual one.
As a result of that realization, elderly Muslims, single mothers, teenage punks, and retired Communists banded together to call for justice for people like Nuriye in a makeshift protest camp—all under an umbrella donated by a local gay bar. Their individual experiences of depression were created by a force bigger than any one individual could fight alone, but taking action together created real change that improved everyone’s individual mental health, including Nuriye’s: She didn’t kill herself.
Let Go of Your Ego
Depression has a way of shrinking your worldview down until all you can see is your own pain, so finding ways to step outside that narrow focus can be a powerful antidepressant. A type of meditation practice called “sympathetic joy” can relieve depression by breaking the grip of the ego. Sympathetic joy is the practice of intentionally feeling genuine happiness for other people. Over time, this trains your body to produce a rush of joy whenever you see someone else succeed, which connects you to an unlimited source of happiness (because at any given moment, someone, somewhere, is succeeding).
New research on the clinical effects of psychedelic drugs (like LSD) offers another way to let go of the ego. Early research from the 1950s showed that psychedelics could have all kinds of benefits for mental health, from helping people break lifelong addictions to healing chronic depression. More recent research shows that giving people psilocybin (the psychedelic chemical found in “magic” mushrooms) in a supervised, clinical environment can sometimes induce intense spiritual experiences in which people feel deeply connected to all living things. For some people, that sense of connection can permanently alleviate depression.
Use Social Prescribing
Reconnecting to other people can be difficult. Some doctors are trying a radical idea to help—what if, in addition to drugs, your doctor could prescribe social connection with a range of structured programs (like group volunteering) designed for that exact purpose?
This idea is called social prescribing, and it gives doctors back the power to fully care for their patients’ health on the biological, psychological, and social levels. Doctors who use social prescribing also prescribe antidepressants, but they see them as a temporary tool to ease the pain so people can make bigger lifestyle changes. This isn’t a solution anyone can necessarily take on alone, but you can advocate for it with your own doctor or as part of larger healthcare reforms.
Reconnect to Your Past and Future
In addition to connecting with others, recovering from depression requires acknowledging past trauma and reclaiming a hopeful future.
Work Through Childhood Trauma
Talking openly about childhood trauma is painful, and it’s understandable to want to avoid that pain. However, research shows that it’s not just trauma itself that causes depression—it’s the experience of keeping that trauma buried inside for years. In a way, opening up about past trauma is like disinfecting a wound: It’s painful in the short-term, but it saves you from an infection that would continue to cause problems down the road.
The medical field can play an important role in addressing trauma on a community level. In one study, doctors expressed empathy for patients’ childhood trauma and asked if they’d like to talk about it. As a result, patients were 35% less likely to need follow-up care for any condition, mental or physical. Another study offered patients the option to discuss their trauma with a therapist—those patients were 50% less likely to need follow-up medical care from a doctor.
Create a Hopeful Future
To restore a hopeful future, you need to advocate for a collective economic safety net that prevents anyone from falling through the cracks. That way, even if you work an unstable job without guaranteed hours, you’ll still have at least some control over your future because there’s a base level of support you can always count on.
Universal Basic Income
In the 1970s, a small town in Canada experimented with a groundbreaking economic policy called universal basic income, in which the government directly paid every citizen the bare minimum they needed to survive (in today’s money, roughly $19,000 U.S. each), no strings attached. The hope was that public health would improve when people no longer had to worry about having enough to eat or a roof over their heads. It worked: After three years, school retention and performance improved, parents took longer parental leave, and gender gaps evened out as personal income allowed women to afford higher education.
The experiment also had a powerful impact on community mental health, including a 9% drop in hospitalizations for depression and anxiety during that time. Other communities around the world have replicated this experiment with similar positive results: For example, a Native American tribe saw a 40% decrease in childhood behavioral and mental health problems after implementing a universal basic income. Parents in the tribe had more time to focus on their children as a guaranteed income removed the need to be constantly working.
Objections to Universal Basic Income
Despite this promising research, many people see universal basic income as a radical, amoral, and completely unfeasible idea. Here’s how experts in the field respond to the three most common objections to universal basic income:
- “It will make people lazy—they’ll just watch Netflix all day.” If you ask people what they would do with a guaranteed income, almost everyone says they would pursue a dream, like finishing a degree or starting a business. In other words, most people have ambitions beyond Netflix.
- “No one wants to scrub floors, but it has to be done. If people don’t need the money, nobody will take those types of jobs.” That’s true, but it’s a good thing. It means employers in service industries will have to provide higher pay and better benefits to attract workers—in other words, they’d have to start actually valuing their employees.
- “It’s expensive.” Yes, it is. This is the most common criticism of universal basic income, and it’s a valid concern. However, the evidence from early studies suggests that a basic income could actually save government money in the long run by reducing healthcare costs from physical and mental illnesses caused by constant financial stress, lack of access to resources, and poor work environments.
Reconnect to a Meaningful Life
In addition to reconnecting to your past, your future, and others, to heal from depression, you also need to reconnect to a sense of meaning and purpose in everyday life.
Create Democratic Workplaces
Being forced to work at a job you hate just to pay the bills is a surefire recipe for depression—but when job prospects are limited and rent is due, quitting a soul-sucking job isn’t an option for most people, nor is it necessary for this reconnection. Instead, as a society, we need to reexamine our approach to work so that fewer people hate their jobs in the first place.
One way to do this is through democratic cooperatives like Baltimore Bicycle Works. This bike shop is collectively owned by a group of friends and works like any democracy: Employees elect leaders, make decisions, and share profits as a group. The lack of hierarchy means that anyone can propose an idea, and everyone’s opinion counts—providing reconnections to meaningful work and to positive social status. That equal footing means that everyone has at least some control of their work, leading to happier employees.
Curb Materialism
Reconnecting to meaningful and enjoyable work is important, but when you’re inundated with harmful, materialistic messages the moment you step outside, it’s hard for those positive effects to carry over. For that reason, we need to curb materialism.
Advertising Makes Us Miserable
The biggest culprit in the rise of materialism is advertising. Advertisers manipulate consumers by selling them a story that there’s something “wrong” with them that only the newest product can fix. This creates a cycle of misery: You get the message that you’re not good enough as you are, so you buy whatever the ad is selling, but it doesn’t make you happy (because there was nothing wrong with you in the first place), and that misery primes you to be more susceptible to harmful advertising messages.
One approach to stop this cycle is to ban advertising altogether. It may seem like a radical step, but several countries have banned different types of advertising with encouraging results. In Brazil, the city of São Paulo banned all forms of outdoor advertising in 2007 with the widely popular “Clean City Law”—now, 70% of residents believe it’s made the city a better place to live.
Refocus on Intrinsic Motivations
Another way to curb materialism is to refocus on intrinsic motivations. For example, in Minneapolis, an experimental group of sixty parents, their teenage children, and a professional financial advisor met regularly for three months to discuss their relationship to money and materialism. The advisor guided them through a series of exercises designed to help them reconnect to their values. Participants discussed their spending habits, listed their intrinsic motivations, and held each other accountable to only spend discretionary cash on things that actually made them happy (instead of just more “stuff”).
At the end of the study, the group who dug into their money habits and refocused on their values had significantly lower levels of materialism and significantly higher self-esteem than the control group.
Collective Change
As we’ve seen, depression is a societal issue, not an individual one—so we can’t expect to conquer it individually. Even if you could cure depression on your own, if you’re working endless hours at a dead-end job just to make rent, you’re unlikely to have the time or energy to do so!
Instead, to tackle depression, we need large-scale societal changes, including a fundamental restructuring of personal, cultural, and economic priorities. That’s a daunting task—but so was marriage equality, not to mention women’s suffrage, the Americans with Disabilities Act, and the election of a Black president. With enough momentum, big changes are absolutely possible.
Want to learn the rest of Lost Connections in 21 minutes?
Unlock the full book summary of Lost Connections by signing up for Shortform.
Shortform summaries help you learn 10x faster by:
- Being 100% comprehensive: you learn the most important points in the book
- Cutting out the fluff: you don't spend your time wondering what the author's point is.
- Interactive exercises: apply the book's ideas to your own life with our educators' guidance.
Here's a preview of the rest of Shortform's Lost Connections PDF summary:
PDF Summary Part 1 | Chapter 1: Depression Is More Than a “Chemical Imbalance”
...
In Lost Connections, Johann Hari investigates the psychological and social factors that contribute to depression (which he calls “disconnections”), as well as innovative social and environmental treatments for depression (or “reconnections”).
In Part 1 of this summary, you’ll learn how the medical field views depression and why many psychiatrists now use the biopsychosocial model to talk about mental illness. Then, we’ll discuss the history of antidepressants, the shaky science behind them, and why biological treatments alone can’t cure depression. Part 2 will cover the seven social disconnections that lead to depression as well as the real role of biology in mental illness. In Part 3, you’ll learn about innovative solutions for each of the seven disconnections and why treating depression is a cultural, political, and economic issue.
The History of the Medical Model: Depression as a “Chemical Imbalance”
The “medical model” of mental illness is the idea that a serotonin imbalance in the brain causes symptoms of depression and anxiety, with no influence from the outside environment. Serotonin is one of several chemicals in the brain called neurotransmitters, which...
PDF Summary Chapter 2: The Arguments Against Antidepressants
...
The chemical imbalance theory as a whole started to fall apart. If depression is truly caused by an imbalance in the brain, then either resolving or increasing that imbalance should have created different results; either decreasing or increasing depression levels. However, it didn’t, suggesting the whole hypothesis is false. In spite of this, most modern antidepressants are still designed to address imbalances by raising serotonin.
The Grief Exception
Another piece of evidence that calls the medical model into question is the former existence of the “grief exception,” which prohibited psychiatrists from giving someone an official diagnosis of depression if they were grieving the loss of a loved one. The exception (sometimes called the “bereavement exclusion”) was a caveat to the official diagnostic criteria for depression, which are laid out in the official manual for diagnosing mental health conditions known as the Diagnostic and Statistical Manual (DSM).
The grief exception existed because grief and depression have nearly identical symptoms, to the point that people who are grieving a recent loss usually meet the official diagnostic criteria for depression in...
PDF Summary Part 2 | Chapter 3: Disconnections From Others
...
After coming out of hypnosis, the participants completed the personality tests a second time. The results were conclusive: People who remembered feeling lonely were significantly more depressed than they had been before undergoing hypnosis, and people who remembered feeling connected were significantly less depressed. In other words, this study showed that loneliness is a cause of depression, not just a result, because making people feel more lonely also made them feel more depressed.
Evolutionary History
If you think about loneliness in the context of evolutionary history, it makes sense that being isolated from other people would lead to depression. Millions of years ago, humans were much further down the food chain than we are now. The only way for early humans to avoid becoming a tasty snack for a predator was to band together into tribes. People who felt miserably depressed when they wandered off on their own were more motivated to stick with the tribe, and so they were more likely than loners to survive long enough to pass on their genes. **In other words, the inability to tolerate loneliness due to the depression it triggered is what kept our ancestors...
What Our Readers Say
This is the best summary of Lost Connections I've ever read. I learned all the main points in just 20 minutes.
Learn more about our summaries →PDF Summary Chapter 4: Disconnections From Your Past and Future
...
Instead of simply moving on without these participants, Felitti reached out to them to ask what happened—why would they suddenly run away when they’d already achieved so much? In a series of interviews, he discovered that almost all of these participants first began to put on weight after experiencing abuse as a child. They’d gained weight as a subconscious attempt to protect themselves from feeling that vulnerable again. The extra weight provided a sense of security in three ways:
- For women in particular, gaining weight reduced the perceived threat of sexual assault. Traditional Western beauty standards value thin bodies over fat ones, so women who’d been assaulted in the past felt that being heavier would make them less attractive to men and therefore safe from sexual violence.
- In a similar way, carrying extra weight provided a sense of physical protection. For example, two male prison guards in the program felt that extra weight made them look more intimidating to inmates who might get violent. Losing that weight made them feel far more vulnerable and less confident that they could defend themselves if they had to.
- Lastly, **being overweight lowered...
PDF Summary Chapter 5: Disconnections From Meaning and Purpose
...
This finding contradicted the popular assumption that people at the top of the ladder would have more health problems because they made more important decisions and therefore had more stress. In fact, a second study of the British civil service showed that people who have more control over their work are far less likely to be depressed than people who have less control, even when they work in the same office and have the same salary. In other words, the degree of control you have over your job is a better predictor of depression than where you work, how much status you have, or even how much money you make.
This lack of control affects people even after they clock out. People who feel they have a sense of control over their work tend to feel more fulfilled at the end of a work day, so they have the energy to spend time with friends and family. On the other hand, people who have very little control over their work lives tend to be so drained by the end of a work day that they have no energy to invest in their relationships. Over time, that lack of investment creates disconnections with other people that only worsen depression.
Another control-related factor that...
PDF Summary Chapter 6: The Real Role of Biology
...
1) For most people, depression creates changes in the brain—not the other way around. Social, psychological, and environmental disconnections deprive the emotion centers of the brain of the happy experiences they need in order to stay in good working order. If those disconnections persist, that unhappiness grows into depression, which makes it even more difficult to establish those connections and ultimately results in further changes in the emotion centers of the brain.
2) The good news is, neuroplasticity also means that depression isn’t a static state, so it’s possible to stop the brain changes depression makes from snowballing out of control. No one is born with a brain that is fundamentally, structurally depressed. Life and environmentally-based changes to your brain may have knocked it into that state, but the right combination of treatments can knock it back out, because changes to the brain aren’t necessarily permanent.
Genetics
The other major player in the biology of depression is genetics. There is no single “depression gene,” but there is a particular variant of a gene called 5-HTT that significantly increases your vulnerability to...
PDF Summary Part 3 | Chapter 7: Reconnecting to Others
...
Build Genuine Relationships
In an increasingly digital world, many of our connections are superficial and don’t allow for meaningful connection, leading to loneliness and, ultimately, depression. To heal that depression, we need to build genuine relationships based on vulnerability and mutual support that restore us to our natural, healthy state as social animals living in close-knit communities.
Self-Care vs. Communal Care
One way to build such relationships and benefit from the healing power of connection is to engage in communal care: helping others around us, and receiving help ourselves in turn. Right now, the fatal flaw in depression treatment is that, as a society, we think of it as an individual endeavor. If you’re sick, you go to a doctor who gives you pills that make you better—nobody else needs to be involved. But as we’ve seen, depression is not just an individual issue. The societal structures that got us into this mess weren’t created by one person, and it will take a communal effort to reshape them into something new and soothe our collective depression.
The idea that depression is a personal issue that should be dealt with alone is a...
PDF Summary Chapter 8: Reconnecting to Your Past, Your Future, and a Meaningful Life
...
This research is only a first step, but it builds on a history of medical research showing that bottling things up because of internalized shame can make people physically ill. For example, at the height of the AIDS crisis, openly gay men lived an average of two to three years longer than closeted gay men, even when they got the same quality of medical care.
Another important takeaway from this research is that there are ways to change the healthcare system to help everyone overcome their trauma. If all doctors asked their patients about their trauma history and gave them the chance to talk about it (as they did in the study above), it could drastically improve the mental and physical health of their entire communities.
Create a Hopeful Future
To heal depression, we can’t just deal with the past—we also have to restore hope for a meaningful future. When your personal trauma history is making you depressed, that’s an individual problem with a mostly individual solution. On the other hand, the loss of a hopeful future is a collective problem caused by systemic economic inequality, so solving it requires a structural societal overhaul. Specifically, **restoring a...
Why are Shortform Summaries the Best?
We're the most efficient way to learn the most useful ideas from a book.
Cuts Out the Fluff
Ever feel a book rambles on, giving anecdotes that aren't useful? Often get frustrated by an author who doesn't get to the point?
We cut out the fluff, keeping only the most useful examples and ideas. We also re-organize books for clarity, putting the most important principles first, so you can learn faster.
Always Comprehensive
Other summaries give you just a highlight of some of the ideas in a book. We find these too vague to be satisfying.
At Shortform, we want to cover every point worth knowing in the book. Learn nuances, key examples, and critical details on how to apply the ideas.
3 Different Levels of Detail
You want different levels of detail at different times. That's why every book is summarized in three lengths:
1) Paragraph to get the gist
2) 1-page summary, to get the main takeaways
3) Full comprehensive summary and analysis, containing every useful point and example
PDF Summary Conclusion: The Need for Collective Change
...
Except, to his own surprise, Sullivan survived. The book, Virtually Normal, attracted serious backlash, but it also started a conversation that evolved into a full-blown civil rights movement. Twenty-five years later, the majority opinion for the Supreme Court ruling that legalized gay marriage quoted the book directly as part of the rationale for writing marriage equality into federal law.
Andrew Sullivan’s absurd, not-quite-deathbed dream became a reality for the entire United States. Perhaps one day, the dream of restructuring society to address the way it causes depression can become a reality, too.