The biologically dysfunctional brain narrative protected him, so Hari testifies, from painful adult self-examination. Preeminent here is scrutiny of the sense of shame over one’s disability, as if it were one’s moral failing for being mentally incapacitated or fault for having been traumatized by childhood abuse. But adult inspection and mature reflection unveils a paradox: even such tacit shame is a phony if largely unconscious effort to maintain an impoverished control over one’s sorry state as provided by the broken-brain narrative. Such paradoxical hiding away of humiliation at one’s plight in order to maintain some semblance of control over it is manifestly self-defeating, as seems obvious to those who are not depressed, since it only reinforces the isolation which is at the root of depression. Overcoming it in the depressed person, however, comes about only by the painful work of courageous self-examination, equivalent, Hari remarks in passing, to the sacrament of confession.
Yet one wonders how those sunk in the pit can ever come to such courage, awareness and renewed agency. Perhaps out of this perplexity come some of the hostile reactions to Hari’s book that ironically mirror his own angry dismissal of the discovery of the placebo effect of antidepressant medications when first he came upon it. The loss of fictitious faith in a pharmacological explanation and solution is a wrenching experience, to be sure, particularly acute in that this authoritative fiction has given meaning to a life reeling in darkness under the loss of meaning.
It may be helpful then to note here that Hari explicitly acknowledges that there are in fact brain diseases like bipolar disorder and schizophrenia and that medications for depression, moreover, can catalyze a path upward from out of the psychic pit of deep depression. There is some biological causation. Twin research reveals a genetic factor in the propensity to depression but at the same time indicates that the environmental triggers matter.
Granting all this, Hari’s discovery of the placebo effect was initiated when he learned of the “grief exception” in the diagnostic inventory used by therapists, the Diagnostic and Statistical Manual. At least some depression, in other words, was acknowledged in the prevailing narrative as occasioned externally by loss in life of something precious. “We grieve because we have loved” and therefore “to say that if grief lasts beyond an artificial time limit, then it is a pathology, a disease to be treated with drugs, is to deny the core of being human” (41). Love of and for others is what is truly valued in human life. Grief is the price we pay for love of mortal creatures such as ourselves. So it is that the grieving only reluctantly give up the pain of their loss because the pain is indexed to the love still connecting them to the departed. The sting of the pain diminishes with time but it remains until the bereaved’s own death extinguishes it.
This discovery caused Hari to ponder the problem of depression more deeply. Could the fact that “almost everybody who is grieving, it turns out, matches the clinical criteria for depression” (40) mean that depression more generally is grief variously disguised? Could depression in these unrecognized formations snowball, moreover, just because it is grief, unaware and unacknowledged, at lost connections to what is really humanly vital and thus valuable?
This discovery of grief and the research inquiries it generated issued in the basic claim argued in Hari’s book, that depression begins its snowball descent into psychic paralysis in unrecognized grief over lost connections to others, to nature and indeed to one’s own body and its signals, especially the signal of pain. Such grief is rational, not irrational; “it is sane to be depressed” if the problem is not a broken brain but the brain’s broken but vital relationship to its environment. Of course, it is not sane to remain depressed, if things can be changed. It is not sane to remain depressed because, as mentioned, the paradox of depression is that it is a self-defeating defense against the world perceived or experienced as hostile.
In a summary passage, Hari writes: “The evidence shows there are three different kinds of causes of depression – biological, psychological, and social. Right at the start I talked about how the biological interventions we currently have – antidepressants – don’t do too much for most of us. Then, up to now I’ve been talking about the environmental or social changes that might be able to help us” (223), since it is not sane to remain depressed. This summary leads him to discuss next the “psychological change” which can help the depressed, although the possibility of such self-change raises a daunting set of problems. How are the blind to see their own blindness, the bound to break free from their own bondage, the lost to find missing connections?