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Joining the dots of depression


I read with interest an extract of a forthcoming book on the causes of depression. The author, Johann Hari, takes issue with the popular view that depression is related to imbalances in neurotransmitters in the brain. Specifically he targets a substance called serotonin, that is released in our brains during pleasurable acts such as eating chocolate, sex and England winning the Ashes. The idea is that we can alleviate depression by taking drugs that keep the serotonin from being reabsorbed into our neurons. This might be thought of as a biological explanation for depression and such anti-depressant drugs are now frequently prescribed.

Hari argues persuasively in Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions that we have focused too much on biological causes, and points to critiques of the evidence supporting the efficacy of such medications. He argues instead that we have overlooked “the context” in which depressive emotions may form.

Illustration: Mick Connolly Illustration: Mick Connolly 

In particular, Hari highlights the role of psychological needs, power imbalances and control in depression and argues that examining these may provide a better remedy. Belonging, being valued, security and mastery, as well as purpose, are some of the key factors. Inevitably work can play a major role in the degree to which these needs are met.

One can raise concerns about the validity of some of these factors and indeed there have been significant debates in the scientific literature regarding them. For instance what is really meant by a “psychological need”? When does the psychological need for belonging segue into dependency or narcissism?

Similarly, the concept of meaningful work is also more complex than it might appear. People can find meaning in doing the most menial tasks if they are adept or encouraged to see a bigger picture. Washing dishes in the service of feeding the hungry may not utilise all of a graduate’s cognitive potential, but may provide more satisfaction than triple entry bookkeeping. However, for another person, washing dishes might be boring meaningless drudgery. They say variety is the spice of life, and it is likely that variety gives a fuller flavour to meaning.

Meaning can be ephemeral. What is meaningful and therefore engaging at one time in your life can seem trivial or tedious at another time, or even later the same day. No work is inherently meaningful in all regards, or at all times. In other words, meaning does not come solely from “the context” in the sense of being external to the person.

Mastery is another commonly mentioned idea in relation to mental health and work. Is it mastery we strive for, or a sense of challenge or achievement or all three? Once a task is mastered is there any further meaning to be had? It is like successfully completing a crossword and then attempting the same puzzle straight after. It is unlikely to be satisfying the second time around unless one was a very literate goldfish.

There is ample evidence that a person’s perception of their level of control or discretion at work is strongly related to levels of perceived stress. However, while this may be the case, it is not always straightforward to increase everyone’s personal control at work. One person’s liberating discretion, can be another person’s limited control. It also assumes that everyone wishes to find meaning through high control work. However some might find meaning in tasks that for one reason or another, society is not prepared to offer remuneration – like going bushwalking or surfing. For such people, they work to afford to pursue their hobbies or interests, or to support their family. They may not wish to have a greater say in how things are run.

Hari does not totally exclude biological mechanisms in depression, and so he shouldn’t. It is probably a mistake with a condition as complex as depression to look for simplistic answers either in biology or indeed in the external context such as work. It seems to me more plausible that the causes and consequences of depression are likely to be more complex and changeable requiring careful case by case consideration of personal circumstance and constitution. However anything that supports meaningful work, social connection and purpose are worthwhile, and here lies this book’s useful contribution.

Jim Bright is Professor of Career Education and Development at ACU.


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