The prescriptions listed below are drawn from Johann Hari’s work. However, Hari’s ideas have a wide range of precursors. In considering these “social prescriptions” it is important to keep in mind that not unlike other prescriptions, compliance (actually implementing and persisting with the treatment/recommendations) is far more difficult than it may appear. Depression (as well as anxiety) in and of itself is an obstacle to change as individuals struggling with depression often have much difficulty motivating themselves. In addition, the loss of hope that frequently accompanies depression compounds this situation. The lack of hope (as well as anxiety) makes trying new things, taking risks, a much more daunting task. Finally, feelings of worthlessness are likely to interfere and hold people back from trying to form or re-establish or strengthen connections with others. Therefore, we suggest that one views these prescriptions as avenues or opportunities to improve mental health and well being, but that support, assistance, guidance, and even an examination of resistance to trying these prescriptions, is often needed, to assist people in giving these social prescriptions a chance. Finally, the Pandemic has added additional challenges to implementing these prescriptions.
The prescriptions (adapted from and modified at times) from Lost Connections
- Meaningful work
When I was in graduate school I can recall reading a detailed study of the impact of loss of meaningful work. This book (whose name I cannot recall) focused extensively on how assembly line jobs did not allow workers to view their efforts as contributing to a finished product and consisted of repetitive tasks that offered little if any psychological rewards. The book also identified how many of these workers aspired to own their own small businesses, where they would have control over their work day and find meaning in their work. The loss of meaningful work has continued to be flagged as negatively impacting our society, a point that Robert Putnam touches on in his most recent book, “The Upswing: How America Came Together a Century Ago and How We Can Do It Again“. Unfortunately, the social prescription, more meaningful work, is far easier to identify than to implement. While there are companies that are striving to give their employees a greater voice in controlling their work environment, we cannot all work for these firms. Therefore, the remaining prescriptions may be more useful.
2. Social support
Again, to harken back to my graduate school days, one of the areas/topics receiving much focus was “stressful life events”. This research focused on the impact of stressful events on mental health and wellbeing. This research can also be considered the precursor for work on the impact of stressful environments, social stressors, on mental health. Not surprisingly experiencing more stressful life events was found to be associated with poorer outcomes. However, one of the mediating factors was found to be social support: people with more support fared better. Hari emphasizes social support as a key factor in overcoming depression. Clearly, such support is related to/connected to building stronger connections with and engaging with others. This can range from helping/encouraging/supporting individuals in reaching out to others in their lives to finding new ways to connect with others, e.g., joining a group activity, joining a church, and volunteering.
3. Meaningful values
Acceptance and Commitment therapy has emphasized the importance of examining and being guided by one’s values. A number of social critiques, Robert Putnam’s among them, have emphasized how we live in an increasingly materialistic, consumer oriented, appearance oriented society, i.e., that what society is pressuring us to value is not healthy. The psychologist Jordan Peterson, in his book “12 Rules for Life: an Antidote to Chaos” makes a similar point and stresses the need for healthier values while the writer Thomas Friedman argues for living a more ethical life, based on the Golden Rule, treat others as you would like to be treated. Hari draws on the work of the psychologist, Tim Kasser, to highlight how materialism, consumerism and a focus on other more superficial values (an overfocus on appearance and social status) are unhealthy. He too calls for living a life based on more meaningful values, and for a rejection of the values of materialism and consumerism.
4. Back to nature or at least get outside
For those of us who dwell in the more northern parts of the United States getting outside, being in nature, is a challenge for a good number of months each year. The Pandemic has only added to this challenge. Conversely, there is a growing body of evidence suggesting that what many of our mothers told us as children, i.e., to go outside and play, was indeed really good advice (as well as giving our moms a needed break). Hari cites a number of researchers who argue for the mental health benefits of time spent outside.
5. Have a sense of hope
Jordan Peterson’s book, the 12 Rules for Life,” can be boiled down to be an argument for hope over despair. While Peterson is controversial for many of the positions he has taken, his argument for hope is difficult to reject. Many psychologists, as well as philosophers, have argued that we need to have hope, a belief that things can and will get better, for us. In fact depression has been considered a loss of hope, hopelessness being one of the main symptoms of depression. Hari also argues for maintaining a sense of hope and views hope as intimately related to having connections with others and finding meaning in life.
6. Get off your devices
While not explicitly discussed by Hari, social media and the proliferation of devices (smart phones, tablets, and even laptops) is likely part of the problem, and putting these devices down and lessening our consumption of social media, part of the cure. As a psychologist, I can think of a number of parents who have told me that after they had removed/confiscated their child’s phone/iPad/devices that their child’s behavior improved. While this evidence is anecdotal there is additional support for this argument from researchers who have found an association between increased time on screen/on social media and depression, anxiety and even eating disorders. While the work of these psychologists, specifically Jean Twenge, is correlational, there is good reason to believe that too much time online is not the cure for our ills. Moreover, if we intend to connect with others, avoid superficial values we need more time with people and less time with devices.
In Conclusion:
As noted in the previous blog discussing Hari’s challenges to the biological model of depression, it is not my aim to argue that we should categorically reject the idea that depression, anxiety and other psychiatric disorders have biological underpinnings. Rather, my purpose here is to highlight the importance of social factors, that we all too often seem to lose sight of, when considering how to best help ourselves and others in overcoming (and more effectively managing) depression, anxiety, and other mental health concerns. It is our hope that with the increased numbers of adults (and now teens) being vaccinated and with the increased availability of vaccines the Pandemic will hopefully be brought under control and we will be able to resume many of the activities that we have had to curtail over the past year. Hopefully, we also will come away from the Pandemic with a greater appreciation of the importance of our social connections and place greater importance on building and maintaining our connections to others.
References:
Rates of depression and anxiety during the Pandemic:
https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm, Additional evidence supporting these findings and detailing increases in substance abuse are found at:
A 2020 analysis of the remission rates for untreated depression: https://sciforum.net/manuscripts/9025/manuscript.pdf
Summary of how social factors impact mental health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181118/
A specific discussion of how loneliness impacts mental health: https://www.apa.org/monitor/2019/05/ce-corner-isolation
For a brief but solid summary of Hari’s book, “Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions” (which I do recommend you read in its entirety) see: https://www.allencheng.com/lost-connections-book-summary-johann-hari/
The work of Robert Putnam: Recommended books include “Bowling Alone” and his most recent work “The Upswing: How America Came Together a Century Ago and How We Can Do It Again“. An interesting interview with Putnam is also available at: https://www.youtube.com/watch?v=F3Cecvy1Z1k and a more detailed discussion of his newest book is at: https://www.youtube.com/watch?v=ed4btzeCKgc and finally a review of his most recent book: https://www.nytimes.com/2020/10/13/books/review/the-upswing-by-robert-d-putnam-an-excerpt.html
Thomas Friedman book Thank You for Being Late: An Optimist’s Guide to Thriving in the Age of Accelerations, is a lengthy and ambitious book. However, in the last chapters he focuses on his thoughts about the Golden Rule as a guiding principle.
Jordan Peterson book “12 Rules for Life: an Antidote to Chaos” details his arguments for a value-driven hopeful life. There are also a number of youtube talks and interviews by Jordan. A brief review of his work is available at: https://www.youtube.com/watch?v=ApC0faRYabI
Tim Kasser books: The High Price of Materialism, was published in 2002 (ISBN 978-0262611978); his second book (co-edited with Allen D. Kanner), Psychology and Consumer Culture, was released in 2004. His website is: https://www.timkasser.org/
Jean Twenge’s article in Atlantic magazine, “Have Smartphones Destroyed a Generation” provides a good summary of her work and thinking: https://www.theatlantic.com/magazine/archive/2017/09/has-the-smartphone-destroyed-a-generation/534198/.