Across the Western world, there is a rising epidemic of depression and anxiety—one that disfigured my life for over a decade. For years now, the United Nations has been trying to warn us that these problems are continuing to spike up in part because we have, as a culture, been responding in the wrong way. In its official statement for World Health Day last year, the UN explained that we need move from “focusing on ‘chemical imbalances’ to focusing on ‘power imbalances.’” At first glance, this sounds puzzling. What could they mean?
For several decades now, we have been taught to see our deepest forms of pain—our depression, our anxiety—as primarily problems with our internal brain chemistry: some missing serotonin here, some missing dopamine there. This is how I was told to think about my depression by my doctor. But the UN’s leading medical figures have warned that this view is “biased and selective use of research outcomes” that “cause more harm than good” and “must be abandoned.” There is, they claim, a different way of looking at this problem—one that offers meaningful solutions.
It was in Canada, in the 1970s, that one of the keys to this new way of thinking was first discovered. The Canadian government chose a town at random –Dauphin, Manitoba, a small town on the prairies– to conduct an unprecedented experiment. A large number of the people in the town were told something surprising. From now on, it was explained, we are going to give you the equivalent of $16,000 (in today’s Canadian currency). There is nothing you have to do in return for it; and there is nothing you can do that means we’ll take it away. You are a citizen of our country, and we want you to have a good life.
Then they stood back to see what would happen. Dr. Evelyn Forget, of the University of Manitoba, has carried out the most detailed research on this three-year experiment in a universal basic income. Many important things happened – there were significantly fewer low birth-weight babies, because mothers had better nutrition; people studied more and longer; hardly anyone gave up working, but some people turned down lousy jobs and held out for better ones, so overall work standards in the town improved. But the most important result? A big fall in depression, anxiety, and other forms of mental illness. In just three years, hospitalizations due to mental illness fell as much as 8.5 percent. Compare that to the past decade, where global depression rates have risen by 18 percent.
Why? If depression is primarily—as we have been led to believe by pharmaceutical company marketing campaigns—a problem with our brain chemistry, this makes no sense. The brains of the people of Dauphin did not suddenly evolve in those three years. But the World Health Organization, the leading medical body in the world, has explained: “Mental health is produced socially. The presence or absence of mental health is above all a social indicator and requires social as well as individual solutions.” In reality, depression and anxiety are produced by a broad range of factors. Some are biological—but many are social and psychological.
This requires us to think differently about how we respond to depression and anxiety. Dr Forget told me, after she interviewed many of the people who had been on the guaranteed income program, that it “works as an antidepressant.” Severe financial anxiety is one of several factors which has been proven to cause depression. Reducing that cause reduces the amount of depression. All over the world, I hunted for alternative antidepressants that should be offered alongside chemical antidepressants—and I kept seeing this key insight that had been discovered in Canada in the 1970s: the most effective strategies for dealing with depression are the ones that deal with the reasons why we are in such pain in the first place. This is why there is such excitement across the world that Ontario has now embarked on a new experiment in giving a guaranteed income to 4,000 people, to see the results.
To comprehend what the UN and the World Health Organization are telling us, we need to fundamentally adjust our picture of these problems. When depressed people are told that their pain is simply the product of impaired brain chemistry, what they are implicitly told is: your pain is meaningless. It’s like a glitch in a piece of computer code. But in fact, the emerging evidence tells depressed people: Your pain makes sense. It is, in part, a response to deep forces in our culture and our society. And that can be treated—with a very different kind of antidepressant.
Johann Hari is author of the controversial book Lost Connections, which challenges conventional understanding of anxiety and depression.