Johann Hari on "Deaths of Despair" and Rebuilding Connections in America

By Travis Lupick 04/30/18

Our deepest needs as human beings are not being met...and that will produce all sorts of things that appear to be pathologies but are in fact symptoms of a deeper pathology.

Johann Hari
A powerful interview with author Johann Hari on his book's themes of addiction, mental illness, and the nation's opioid epidemic. Image via Simon Emmett

In Johann Hari's bestselling book, Chasing the Scream: The First and Last Days of the War on Drugs, the British author explored misconceptions of addiction. It is not the drugs themselves that lead to dependence, he argued. Rather, it is one's environment and the attempt to self-medicate and alleviate pain that are the true causes of addiction.

Three years later, Hari's follow up, Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions, digs beneath addiction, into mental health. It comes as there’s new urgency for a more thoughtful understanding of why increasing numbers of Americans are turning to powerful opioids like OxyContin, heroin, and fentanyl.

"While I researched this book, I spent some time in the Rust Belt," Hari writes in Lost Connections. "A few weeks before the U.S. presidential election in 2016, I went to Cleveland to try to get the vote out to stop Donald Trump from being elected. One afternoon I walked down a street in the southwest of the city where a third of the houses had been demolished by the authorities, a third were abandoned, and a third still had people living in them, cowering, with steel guards on their windows."

Hari continued the anecdote during a recent interview over breakfast on a book-tour stop in Vancouver, Canada.

"We knocked on this door and there was a woman who, I would have guessed, was 60, to look at her," he said. "I discovered later she was the same age as me, and I was 37 at the time. And she was quite articulate and very angry. And she made this verbal slip that I'll never forget.

"She was talking about what the area used to be like for her parents and grandparents and talking about how you could leave school and have a decent life," Hari continued. "And she meant to say, 'When I was young.' But instead of saying, 'When I was young,' she said, 'When I was alive.'

"It really hit me. That's how a lot of people feel. A sense that, because they've been deprived of the things that make life meaningful, in some real way, they're not fully alive."

Ohio’s rate of drug overdose deaths ranks among the very worst in America. According to the state's Department of Health, there were 4,050 unintentional drug-overdose deaths in Ohio in 2016, a 33 percent increase from the previous year.

Across the country in 2016, there were an estimated 64,000 fatal overdoses, up roughly 20 percent from 2015. Drug overdose is now the number-one cause of death in America for people under 50.

In March 2017, a pair of researchers at Princeton University described drug overdoses alongside alcohol-related liver mortality and suicide as “deaths of despair." Their study found that fatalities in this category have grown to account for a sustained decline in life expectancy for the entire United States of America. For decades, Americans consistently lived longer than the generation before them. Now, the wealthiest country in the world is collectively dying earlier because people are unhappy.

In Lost Connections, Hari helps explain how we arrived at this sad place.

He recounts meeting Joe Phillips, a man who toiled in restless monotony, mixing paint at a hardware store in Philadelphia.

"Joe contacted me one day because he’d listened to some of my speeches online, and he wanted to talk about the subject of my last book, which was (in part) addiction," Hari writes. "He told me a story. After years of shaking paint, Joe went one night to a casino with one of his friends, and he was offered a little blue pill by one of them. It was 30 milligrams of the opiate-based painkiller Oxycontin. Joe took it and felt pleasantly numbed. And a few days later, he thought—maybe this would help me at work. When he took it, he felt the fading of those feelings that had been flooding his head….He would take some more when he got home with some beers, thinking: 'I can deal with that bullshit at work knowing that when I come home, I get to do this.'

"I wondered if this was because the Oxy made him as blank and empty as the job itself," the book continues. "It seemed to dissolve the conflict between his desire to make a difference and the reality of his life."

In our interview, Hari explained that Joe's response to his employment situation—that is, ingesting a powerful painkiller—was not explained by weak character or moral failure, but instead could be understood as a rational (though still problematic) response to human needs going unmet.

Hari described this point as "the most-important thing I learned through Lost Connections."

"That our pain makes sense," he emphasized. "It's not irrational pathology. It's not because our brains are malfunctioning. It is because our deepest needs as human beings are not being met for very large numbers of people in our society. And that will produce all sorts of things that appear to be pathologies but are in fact symptoms of a deeper pathology, which is the fact that our culture is not meeting people's needs."

Rising inequality. The decline of manufacturing in America. Less job security in sectors that are hiring (such as tech). And people are left feeling like Joe Phillips and the woman Hari met in Cleveland.

"All over the United States, people are in terrible and deep psychological pain,” Hari said. “There are many ways of coping with psychological pain. For some people, it will be suicide. For some people, it will be taking very powerful painkillers, because they don't just numb physical pain, they numb psychological pain."

By understanding why people are using drugs, we can begin a more effective conversation about how to respond to drug use.

"If you are profoundly lonely and there has been a collapse of social connection, if people are not offered any meaningful work, if they are taught that life is about junk like money and status, if they are taught that life is about screaming at each other through screens [social media], a lot of them are going to feel like shit, and that's for entirely understandable reasons," Hari said.

"Clearly, heroin is not a good solution to treat distress,” he continued. “But for many people, it is the best solution available in their environment at the moment. And so it's the job of the rest of us to help to change that environment. It's also the job of those individuals who can take part in changing it themselves."

In a TED Talk based on Chasing the Scream that's accumulated more than 12 million views online, Hari proclaims: “The opposite of addiction is not sobriety. The opposite of addiction is connection." In Lost Connections, Hari presents compelling anecdotes and ample academic research in support of those stories to offer seven paths away from emotional distress.

He argues that almost everything that we are told about depression is wrong, or at least incomplete, especially when it comes to prescribed solutions. He takes aim at the pharmaceutical industry and many of its most-lucrative products: antidepressants. Hari lays out evidence that shows pharmaceutical responses to depression are significantly less effective than we've been told. The industry, worth billions, often does not have the solutions it promises. Instead, Hari explains, people need to reconnect with one another and with themselves.

Since Lost Connection's publication in January, the book has become a bestseller. But denouncing corporations worth so much money, and challenging such ingrained assumptions on which their industry is based, has attracted critics. "Is everything Johann Hari knows about depression wrong?" reads one headline in the UK's Guardian newspaper. In other articles, Hari’s suggestions for better mental health have been dismissed as so obvious that they are unworthy of presentation in a book.

"I get these psychiatrists who say, 'Everyone already knew all of this,' and I'm like, 'Well why didn't you tell any of your patients?'" Hari says in response to those critiques. "I don't know anyone who went to their doctor with depression or anxiety and was told, 'There are three kinds of causes: biological causes, psychological causes, and social causes, and we need to deal with all three.' Nobody is told that.

"What I'm challenging is not what psychiatrists know; I'm challenging what they fail to tell the public. What I'm saying is at once both blindingly obvious common sense and also radical.”

Lost Connections recounts Hari's own life-long struggles with depression. It describes how his doctors told him that the pain he felt was the result of a chemical imbalance in his brain, and catalogues their failed efforts to alleviate his symptoms with pills like Paxil and Prozac.

"My doctor told me an entire biological story of why I felt that way. The tragedy of that is not that it's totally false. It's not that there aren't real biological factors. The tragedy is that if you tell people an exclusively biological story, firstly, what you're telling them is they're broken. And, most importantly, you're telling them that their pain doesn't make sense. That they're a machine with broken parts. My key message is, you're not a machine with broken parts. Your pain makes sense.

"We are distressed and anxious for very good reasons," Hari emphasized. "We are really lonely. We've been taught to value the wrong things. We're really insecure financially and it's making us feel terrible. We need to solve the problems there rather than just drug ourselves into submission."


Travis Lupick is a journalist based in Vancouver. His first book, Fighting for Space: How a Group of Drug Users Transformed One City's Struggle with Addiction, will be published in June 2018. You can follow him on TwitterFacebook, and Instagram.

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Travis Lupick is an award-winning journalist based in Vancouver’s Downtown Eastside. His first book, Fighting for Space: How a Group of Drug Users Transformed One City's Struggle with Addiction, will be published in June 2018. He has more than a decade’s experience working as a staff reporter and editor for the Georgia Straight newspaper. He has also written about drug addiction, harm reduction, and mental health for the Toronto Star and Al Jazeera English, among other outlets. For his reporting on Canada’s opioid crisis, Lupick received the Canadian Association of Journalists’ prestigious Don McGillivray award for best overall investigative report of 2016 and two 2017 Jack Webster awards for excellence in B.C. journalism. He has also worked as a journalist in Sierra Leone, Liberia, Malawi, Nepal, Bhutan, Peru, and Honduras.You can follow him on Twitter, Facebook, and Instagram.