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Some people said to Irving--so what? Okay, so say it's a placebo effect. Whatever the reason, people still feel better. Why break the spell? He explained: the evidence from the clinical trials suggests that the antidepressant effects are a largely a placebo, but the side effects are mostly the result of the chemicals themselves, and they can be very severe.

For millennia, humans have talked about something called the Golden Rule. It's the idea that you should do unto others as you would have them do unto you. Tim, I think, has discovered something we should call the I-Want-Golden-Things Rule.17 The more you think life is about having stuff and superiority and showing it off, the more unhappy, and the more depressed and anxious, you will be.

designed to make it extraordinarily easy to get a drug approved. All you have to do is produce two trials--any time, anywhere in the world--that suggest some positive effect of the drug. If there are two, and there is some effect, that's enough. So you could have a situation in which there are one thousand scientific trials, and 998 find the drug doesn't work at all, and two find there is a tiny effect--and that means the drug will be making its way to your local pharmacy.

But as doctors first started to apply this checklist, they discovered something awkward. Almost everybody who is grieving, it turns out, matches the clinical criteria for depression. If you simply use the checklist, virtually anyone who has lost someone should be diagnosed as having a clear mental illness.

The more unequal your society, the more prevalent all forms of mental illness are. Other social scientists then broke this down to look at depression specifically16--and found the higher the inequality, the higher the depression. This is true if you compare different countries,17 and if you compare different states within the United States. It strongly suggested that something about inequality seems to be driving up depression and anxiety.

you can ask people lots of other questions--and one of them is whether they are unhappy or if they are suffering (or have suffered) from depression or anxiety. Then--as a first step--you see if they match. Tim's first tentative piece of research was to give this survey to 316 students. When the results came back4 and were all calculated out, Tim was struck by the results: materialistic people, who think happiness comes from accumulating stuff and a superior status, had much higher levels of depression and anxiety.

If you worked in the civil service and you had a higher degree of control8 over your work, you were a lot less likely to become depressed or develop severe emotional distress than people working at the same pay level, with the same status, in the same office, as people with a lower degree of control over their work.

The people who turn up at this center have a strong incentive to pretend to have any condition they happen to be studying there--and the for-profit companies conducting the clinical trials have a strong incentive to pretend to believe them. Peter looked on as both sides seemed to be effectively bullshitting each other. When he saw people being asked to rate how well the drugs had worked, he thought they were often clearly just giving the interviewer whatever answer they wanted. So Peter concluded that the results from clinical trials of antidepressants--all the data we have--are meaningless. That means Irving is building his conclusion that their effect is very small (at best) on a heap of garbage, Peter declared. The trials themselves are fraudulent.

But Irving was also one of the leading experts in the world in a field of science that began right back in Bath when John Haygarth first waved his false wand. At that time, the English doctor had realized that when you give a patient a medical treatment, you are really giving her two things. You are giving her a drug, which will usually have a chemical effect on her body in some way. And you are giving her a story--about how the treatment will affect her.

And if the standards of the culture were wrong then, I realized, they can be wrong now. You can have everything a person could possibly need by the standards of our culture--but those standards can badly misjudge what a human actually needs in order to have a good or even a tolerable life. The culture can create a picture of what you "need" to be happy--through all the junk values I had been taught about--that doesn't fit with what you actually need.

As I sat with Meredith and watched the bike repairs happening all around us, I remembered what I had learned from Michael Marmot, the social scientist who carried out the research into British civil servants that showed the ways in which our work can make us sick, physically or mentally. He had explained to me: It's not the work itself that makes you sick. It's three other things. It's the feeling of being controlled--of being a meaningless cog in a system. It's the feeling that no matter how hard you work, you'll be treated just the same and nobody will notice--an imbalance, as he puts it, between efforts and rewards. And it's the feeling of being low on the hierarchy--of being a low-status person who doesn't matter compared to the Big Man in the corner office.

"publication bias."7 Of all the studies drug companies carry out, 40 percent are never released to the public, and lots more are only released selectively, with any negative findings left on the cutting room floor.

When you are depressed--as Isabel knows from her own experience--you feel that "now everything is about you." You become trapped in your own story and your own thoughts, and they rattle around in your head with a dull, bitter insistence. Becoming depressed or anxious is a process of becoming a prisoner of your ego, where no air from the outside can get in. But a range of scientists have shown that a common reaction15 to being out in the natural world is the precise opposite of this sensation--a feeling of awe. Faced with a natural landscape, you have a sense that you and your concerns are very small, and the world is very big--and that sensation can shrink the ego down to a manageable size. "It's something larger than yourself," Isabel said, looking around her. "There's something very deeply, animally healthy in that sensation.

Robert had discovered that having an insecure status was the one thing even more distressing than having a low status. So it seemed like there might be something in the theory that depression and anxiety are a response to the constant status anxiety many of us live with today.

So the authors of the DSM invented a loophole, which became known as "the grief exception."3 They said that you are allowed to show the symptoms of depression and not be considered mentally ill in one circumstance and one circumstance only--if you have recently suffered the loss of somebody close to you. After you lose (say) a baby, or a sister, or a mother, you can show these symptoms for a year before you are classed as mentally ill. But if you continued to be profoundly distressed after this deadline, you will still be classified as having a mental disorder. As the years passed and different versions of the DSM were published, the time limit changed: it was slashed to three months, one month, and eventually just two weeks.

Scientists measure the depth of someone's depression using something named the Hamilton scale, which was invented by a scientist named Max Hamilton in 1959. The Hamilton scale ranges from 0 (where you're skipping along merrily) to 51 (where you're jumping in front of trains). To give you a yardstick: you can get a six-point leap in your Hamilton score if you improve your sleeping patterns. What Irving found is that, in the real data that hadn't been run through a PR filter, antidepressants do cause an improvement in the Hamilton score--they do make depressed people feel better. It's an improvement of 1.8 points.

As they crunched the numbers, George and Tirril had discovered people living in poverty were more likely to become depressed--but the data showed it was too crude to say the poverty caused the depression. No: something more subtle was happening. People in poverty were more likely to become depressed because on average they faced more long-term stress, and because more negative life events happened to them, and because they had fewer stabilizers. But the underlying lessons were true for everyone, rich, middle-class, or poor. We all lose some hope when we're subjected to severe stress, or when something horrible happens to us, but if the stress or the bad events are sustained over a long period, what you get is "the generalization of hopelessness," Tirril told me. It spreads over your whole life,15 like an oil slick, and you begin to want to give up.

When you have a society with huge gaps in income and status, Richard told me, it creates the sense that "some people seem supremely important, and others seem of no importance at all." This doesn't affect only people at the bottom. In a highly unequal society, everyone has to think about their status a lot. Am I maintaining my position? Who's threatening me? How far can I fall? Just asking these questions--as you have to when inequality grows--loads more and more stress into our lives.

When he put lonely people into brain-scanning machines, he noticed something. They would spot potential threats within 150 milliseconds, while it took socially connected people twice as long, 300 milliseconds, to notice the same threat. What was happening? Protracted loneliness causes you to shut down socially, and to be more suspicious of any social contact, he found. You become hypervigilant. You start to be more likely to take offense where none was intended, and to be afraid of strangers. You start to be afraid of the very thing you need most. John calls this a "snowball" effect, as disconnection spirals into more disconnection.

Despair often happens, he had learned, when there is a "lack of balance between efforts and rewards."

The clinical psychologist Dr. Lucy Johnstone14 was more blunt still. "Almost everything you were told was bullshit," she said to me over coffee. The serotonin theory "is a lie. I don't think we should dress it up and say, 'Oh, well, maybe there's evidence to support that.' There isn't."

It's been known for a long time that all sorts of mental health problems5--including ones as severe as psychosis and schizophrenia--are considerably worse in cities than in the countryside,

"The more you think happiness is a social thing, the better off you are,"

Nobody claims that psychedelics work in the way we were told antidepressants did in the 1990s: they don't change your brain chemistry and therefore "fix" you. No. What they do is give you--when the experience goes well--a remarkable sense of connection, for a very short period. "The value of the experience," Andrew told me, is to "show you the possibility"--how connection can make you feel. Then, he says, "it's up to you to find other ways to maintain the experience." Its value is not as a drug experience but as a learning experience. And you need to keep practicing the lesson, one way or another.

Depression and anxiety are "not like a tumor, where something is growing in the brain because there is a real fuck-up in the tissue which precedes the psychological problems," he says. "It's not like that. They"--the distress caused by the outside world, and the changes inside the brain--"come together."

"The thing is that we are animals. We keep forgetting that," and as animals--she indicated toward her body--"this thing is made to move." When we look for solutions to our bad feelings, she says, we try to find it in language, and in the symbols we have created as a species. But these symbols are--in the long sweep of things--very recent. "We have been vertebrate for nearly five hundred million years now. We've been mammals for two hundred fifty, three hundred million years. We've been primates for sixty-five [million years]." All those years she spent in the Congolese rain forest, living and sleeping and eating with the bonobos, she explained, she was being educated in how close we are to them. "We have been animals that move for a lot longer than we have been animals that talk and convey concepts," she said to me. "But we still think that depression can be cured by this conceptual layer. I think [the first answer is more] simple. Let's fix the physiology first. Get out. Move."

Unhappiness and depression are totally different things. There is nothing more infuriating to a depressed person than to be told to cheer up, or to be offered jolly little solutions as if they were merely having a bad week. It feels like being told to cheer yourself up by going out dancing after you've broken both your legs.

Tim had shown before that materialism correlates strongly with increased depression and anxiety. This experiment showed, for the first time, that it was possible to intervene in people's lives in a way that would significantly reduce their levels of materialism. The people who had gone through this experiment had significantly lower materialism and significantly higher self-esteem. It was a big and measurable effect.

The grief exception revealed something that the authors of the DSM--the distillation of mainstream psychiatric thinking--were deeply uncomfortable with. They had been forced to admit, in their own official manual, that it's reasonable--and perhaps even necessary--to show the symptoms of depression, in one set of circumstances. But once you've conceded that,4 it invites an obvious follow-up question. Why is a death the only event that can happen in life where depression is a reasonable response? Why not if your husband has left you after thirty years of marriage? Why not if you are trapped for the next thirty years in a meaningless job you hate? Why not if you have ended up homeless and you are living under a bridge? If it's reasonable in one set of circumstances, could there also be other circumstances where it is also reasonable?

We grieve because we have loved."

Professor David Healy, in his clinic in Bangor, a town in the north of Wales. He has written the most detailed history of antidepressants we have. When it comes to the idea that depression is caused by low serotonin, he told me: "There was never any basis for it, ever. It was just marketing copy. At the time the drugs came out in the early 1990s, you couldn't have got any decent expert to go on a platform and say, 'Look, there's a lowering of serotonin in the brains of people who are depressed' ... There wasn't ever any evidence8 for it." It hasn't been discredited, he said, because "it didn't ever get 'credited,' in a sense. There wasn't ever a point in time when 50 percent of the field actually believed it." In the biggest study of serotonin's effects on humans, it found no direct relationship9 with depression. Professor Andrew Skull of Princeton has said attributing depression to low serotonin is "deeply misleading and unscientific."

A short while later, Irving was handed another leaked study. This one struck me especially hard when I read about it, because it was talking directly about a situation I had been in. Not long before I started taking Seroxat (also marketed as Paxil), the drug's manufacturers, GlaxoSmithKline, had secretly conducted three clinical trials into whether Seroxat should be given to teenagers like me. One study discovered the placebo worked better; one study showed no difference between the drug and placebo; and one study showed mixed results. None showed a success. Yet, in a partial publication of the results, they announced: "Paroxetine [another name for the drug] is effective for major depression in adolescents."

"When work is enriching, life is fuller, and that spills over into the things you do outside work," he said to me. But "when it's deadening," you feel "shattered at the end of the day, just shattered."

All of us have certain innate needs--to feel connected, to feel valued, to feel secure, to feel we make a difference in the world, to have autonomy, to feel we're good at something. Materialistic people, he believes, are less happy--because they are chasing a way of life that does a bad job15 of meeting these needs. What you really need are connections. But what you are told you need, in our culture, is stuff and a superior status, and in the gap between those two signals--from yourself and from society--depression and anxiety will grow as your real needs go unmet.

What if depression is, in fact, a form of grief--for our own lives not being as they should? What if it is a form of grief for the connections we have lost, yet still need?

Somebody once told me1 that giving a person a story about why they are in pain is one of the most powerful things you can ever do. Taking away the story for your pain is just as powerful: I felt like I was on a rocky ship and somebody had taken away the railings.

You aren't a machine with broken parts. You are an animal whose needs are not being met. You need to have a community. You need to have meaningful values, not the junk values you've been pumped full of all your life, telling you happiness comes through money and buying objects. You need to have meaningful work. You need the natural world. You need to feel you are respected. You need a secure future. You need connections to all these things. You need to release any shame you might feel for having been mistreated.