Lost Connections

Lost Connections argues that depression and anxiety are, for many people, responses to the conditions of their lives rather than a simple fault in brain chemistry. Johann Hari organises the book around nine causes, most of them forms of disconnection: from meaningful work, from other people, from values beyond money and status, from a secure childhood, from status and respect, from the natural world, and from a hopeful future.

The mechanism he proposes is social rather than molecular. If low mood often signals unmet needs, the response should include reconnection: closer communities, work with autonomy and purpose, treatment for childhood adversity, and what British clinicians call social prescribing, where a physician refers a patient to a community garden or group project alongside conventional care. Hari visits these programmes, interviews the researchers behind them, and writes openly about his own long use of antidepressants.

It is for readers who sense their low mood is bound up with how they live and work, and for clinicians interested in the social determinants of mental health.

On the evidence, this is journalism with a thesis, and it presses that thesis hard. The critique of the simple serotonin-deficiency story is fair. That model was never the full picture, and specialists had moved past it well before 2018. But Hari's reading of the antidepressant trial literature is more selective and more negative than the field as a whole supports, and several psychiatrists said so when the book appeared. Antidepressants help a meaningful number of people, and stopping them without medical supervision can be harmful. The social and environmental contributors Hari describes are real and genuinely under-discussed. The conclusions he draws about treatment run ahead of the data.