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Nov. 13, 2018 - Making Sense - Sam Harris

47:16

#142 — Addiction, Depression, and a Meaningful Life

Sam Harris speaks with Johann Hari about his books "Chasing the Scream" and "Lost Connections." If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.

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	Welcome to the Making Sense Podcast.
	This is Sam Harris.
	Just a note to say that if you're hearing this, you are not currently on our subscriber feed and will only be hearing the first part of this conversation.
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	So if you enjoy what we're doing here, please consider becoming one.
	Today I'm speaking with Johan Hari.
	Johan is the New York Times bestselling author of Chasing the Scream, which is being adapted into a feature film.
	He has been twice named Newspaper Journalist of the Year by Amnesty International UK.
	He's written for the New York Times, the Los Angeles Times, and many other journals.
	His TED talk, Everything You Think You Know About Addiction Is Wrong, has more than 20 million views.
	And his most recent book is Lost Connections, uncovering the real causes of depression and the unexpected solutions.
	And we talk about both his recent books, Chasing the Scream and Lost Connections.
	So we mostly speak about the dynamics of addiction and depression, but this leads us to talk about politics and the state of the world and humanity's search for meaning.
	Anyway, Johan is interested in many things and I was very happy to get him on the podcast.
	So, now I bring you Johan Hari.
	I am here with Johan Hari, Johan, thanks for coming on the podcast.
	Thanks so much, Sam.
	You're one of the very few people I know who said my name right first time.
	I once waited for six hours in an emergency room because they were calling for Joanna Harry to come forward.
	I've always been impressed by that.
	So I forget how we...
	First connected.
	I think what happened is I noticed you wrote a review of my first book, The End of Faith, that I didn't hate.
	I got a feeling we met through Richard Dawkins, but that might be a completely false memory.
	I don't know.
	I don't know.
	But you must have been 14 when you wrote that.
	I just have a weird baby face.
	I'm actually tragically old.
	It's just... How old are you?
	I'm nearly 40.
	I'm 40 in a few months.
	I've got a friend who has a baby and for some reason babies always react positively to me and she thinks it's because babies think I'm their king when they see me.
	I'm just like a bigger version of them.
	So you have two books.
	Unfortunately, I've only read one of them.
	You have a new book out that I haven't read, but I believe I have the gist from seeing some of your public utterances.
	But they seem clearly connected.
	The first book, Chasing the Scream, was a call to sanity with respect to the war on drugs and the way we think about addiction.
	And now you have this new book, Lost Connections on depression.
	Right, and it seems to me that the connection there, correct me if I'm wrong, is that you're arguing that we are not just bags of chemicals that can be best thought of as suffering chemical imbalances with respect to addiction and depression.
	There's much more to be understood about our circumstance to account for both of these problems.
	And while it seems to me that you're often assume to be discounting any neurophysiological understanding of these problems.
	I don't think you're doing that in either case.
	But neurophysiology isn't the whole language game we need to play with respect to talking about these problems and talking about solutions.
	That's a really good way into it.
	And I think I came to the second book, they were both quite personal journeys for me.
	So I wanted to understand addiction, because we had a lot of addiction in my family.
	One of my earliest memories is of trying to wake up one of my relatives and not being able to, and I was too small then to understand why.
	But as I got older, I realized we had drug addiction in my family.
	So I ended up for my book, Chasing the Scream, going on this big journey all over the world to try to figure this out and to look at the war on drugs more generally.
	And I think the thing in that that led me to the second book was what I learned about the causes of addiction.
	So you're totally right.
	Biology is an important part of both addiction and depression.
	With all mental health problems, there's a very broad scientific consensus.
	There's three kinds of cause, right?
	There are biological causes, like your genes and brain changes.
	There are psychological causes, how you think about yourself.
	And there are social causes, your environment and how we live together.
	And they play out in all mental health Problems to some degree.
	Think about something like dementia, right?
	Dementia has clearly got a very heavy biological component.
	But even with dementia, we know your psychology can slow it down significantly if you speak more languages, for example.
	And we know your environment can have a massive role in slowing it down.
	People who are socially connected, have a strong sense of meaning and purpose, can develop dementia much more slowly.
	And there's good evidence for that.
	So one thing that surprised me is what I learned about addiction in relation to that.
	And you and I talked about this a few times before, but I think about this.
	It was a real moment that changed my life.
	It made me realize I had misunderstood even what I thought I'd seen in front of me with some of the people I love.
	So if you'd said to me when I started doing the research for Chasing the Scream, what causes, for example, heroin addiction, I would have looked at you like you were an idiot.
	And I would have said, well, the clues in the name dummy, right?
	Obviously, heroin addiction is caused by heroin.
	For a hundred years, we've told this heavily biological story about addiction, which is that addiction is caused by the chemical hooks in the drug.
	We think, you know, I would have thought if we'd kidnapped the first 20 people to walk past this hotel and I would have injected them all with heroin every day for a month, like a villain in a Saw movie.
	As one does?
	At the end of that month, they would all have been heroin addicts for a simple reason that there are these chemical hooks in heroin that their bodies would start to desperately physically need.
	They would in fact be hooked.
	This is where we get the word hooked from.
	And that's what addiction is.
	And I actually learned that while chemical hooks are real, and I can talk about the real role of them, it's important to stress they're real.
	Actually, I went and interviewed a wonderful man in Vancouver called Professor Bruce Alexander, who's really changed how we think about addiction and led to some really amazing changes all over the world.
	So Professor Alexander explained to me the story we've got in our heads that addiction is caused just by the chemical hooks.
	It comes from a series of experiments that were done earlier in the 20th century.
	They're really simple experiments.
	Your listeners can try them at home if they feel a bit sadistic.
	You take a rat, you put it in a cage and give it two water bottles.
	One is just water, the other is water laced with either heroin or cocaine.
	If you do that, the rat will almost always prefer the drugged water and almost always kill itself quite quickly.
	You might remember the famous ad in the 80s, the Partnership for Drug-Free America advert that showed this experiment and said something like, it will happen to you.
	But in the 70s, Professor Alexander came along and said, well, hang on a minute.
	You put the rat alone in an empty cage where it's got nothing that makes life meaningful for rats.
	What would happen if we did this differently?
	So he built a cage that he called Rat Park, which is basically heaven for rats, right?
	They've got loads of friends, they can have loads of sex, they've got loads of cheese, they've got loads of coloured balls, they've got loads of wheels, anything a rat can want in life that the rat finds meaningful, it's there in Rat Park.
	And they've got both the water bottles, the normal water and the drug water, and of course they try both.
	This is the fascinating thing.
	In Rat Park, they don't like the drug water very much.
	None of them ever use it compulsively.
	None of them ever overdose.
	So when rats don't have the things that make life meaningful, you get almost 100% compulsive use and overdose.
	When they do have the things that make life meaningful, they don't develop problematic use.
	And there's lots of human examples of this that I'm sure we'll get to.
	But for me, the core of this Is I realised that the opposite of addiction is not sobriety, the opposite of addiction is connection.
	As you totally rightly point out, it doesn't mean there aren't real biological dimensions to addiction there are.
	There's biological, psychological and social aspects.
	But I realised how much I'd underestimated the role of these social aspects.
	And when I started talking about this all over the world and that line got a lot of traction, the opposite of addiction is connection, people so totally reasonably started saying to me, Well, what do you mean by connection?
	You can't just mean social connection.
	And I had never meant that.
	I'd written about how Portugal had taken the lesson of Rat Park and applied it to their drug policy.
	I'm sure we'll get to that.
	And they didn't just give people friends.
	They did a lot more than that.
	But it's very conscious.
	I guess it was this mystery that was hanging over me, which was partly what does connection mean?
	And I was thinking about that through these two other mysteries that were really paying out for me, right?
	As we said, I'm nearly 40.
	Every year I've been alive.
	Depression and anxiety have increased here in the United States and across the Western world.
	And loads of indicators of despair have been increasing.
	Suicide, addiction and so on.
	And I want to figure out why.
	Partly because I myself have been quite depressed.
	So I ended up going on this journey and I realized there was a real, if you excuse the pun, connection between the mystery I was trying to understand with addiction and the mystery I was trying to understand with depression and anxiety.
	Does that make sense?
	Yeah, yeah.
	Just to seize on the last data you referenced, do you recall what the metrics are and how much depression, anxiety, and suicide have gone up?
	And we know what the metric of suicide is.
	Suicide is much easier to measure.
	With depression and anxiety, it's hard to measure.
	For several reasons.
	What we can measure relatively easily is reported depression and anxiety.
	So people going to the doctor.
	Those are probably not the best figures in the sense that, for two reasons, there's been a significant decrease in stigma, which means more people are willing to come forward.
	That's a great thing.
	Also, because we've got much lower threshold treatment for depression, right?
	It used to be, if you think about When, you know, my grandmother was the age I am now.
	Firstly, it would have been too stigmatized.
	She would not have gone to her doctor.
	But if she had, the only treatments they had were really very potent things that kind of knock you out, right?
	Now, obviously, someone can go to the doctor, they can be given much kind of still very powerful and potent drugs, but much lower.
	It's much easier to get hold of them.
	There's much less weight put around taking those drugs, partly because they're still potent, but they're less potent than the drugs that people used to be given.
	So I don't think that's a great metric.
	I think there are other metrics we can use.
	People describing themselves as depressed is important, but the reason why I feel fairly confident that depression has risen is because when I went all over the world, interviewed the leading experts about this, I learned that there's scientific evidence for nine causes of depression and anxiety.
	Generally, people, when they go to their doctors, are told a very simplistic story.
	I mean, when I was a teenager, I went to my doctor and I said that I had this feeling like pain was kind of leaking out of me and I couldn't control it.
	I couldn't regulate it.
	And my doctor said to me, well, we know why people feel this way.
	There's a chemical called serotonin in people's brains.
	Some people are naturally lacking it.
	You're clearly one of them.
	All we need to do is give you these drugs, you're going to feel better.
	So I started taking an antidepressant that's marketed in the US as Paxil.
	I felt significantly better for a few months, really a lot better.
	And then this feeling of pain started to come back.
	So I went back to my doctor, my doctor gave me a higher dose.
	Again, I felt better a little bit less time.
	Again, the pain came back.
	I kept being given higher and higher doses until for 13 years I was taking the maximum Possible dose and really believing this story that it was just about serotonin, which was leaving me rather confused about why I kept this depression was coming back.
	But what I learned is there's in fact scientific evidence for nine causes.
	Two of them are indeed biological, although I don't think a chemical imbalance is the right way to characterize them.
	And lots of those factors, those factors that we know cause depression and anxiety, have been rising.
	So given that we know that they cause depression and anxiety, I'm sure we'll get to them, and given we know they've been rising, given we know they cause depression and anxiety, and given that significantly more people are describing themselves as depressed and anxious, I think you can reasonably put all that evidence together and say there has been a real increase in depression and anxiety.
	And we see this in all sorts of indicators, you know, suicide has significantly increased.
	I mean, it's extraordinary fact that when you put together suicide and opioid deaths, average white male life expectancy has fallen for the first time in the peacetime history of the entire United States, right?
	So there are all sorts of indicators of depression for which we have very robust numbers, which I think, which not coincidentally are clustering together in the same places, right?
	So why is If depression was just a chemical imbalance in the brain, if addiction was just a response to accidental chemical hooks, why would we see that depression clusters in the same places as suicide, in the same places as addiction, in the same places as antidepressant use?
	That wouldn't make sense.
	The fact that these indicators are in the same places as support for President Trump, interestingly, in a lot of them, we wouldn't see these things clustering together if they weren't densely related, right?
	Well, some of those things are clearly causally related.
	So if you're depressed, and you're being prescribed antidepressants, or you're addicted to opioids and suffering the consequences of that, that's a cluster of problems and subsequent dysfunction.
	Clinical depression begets all kinds of other dysfunction in your career, in your relationships.
	So it is that you do have a chicken and the egg phenomenon that you have to tease apart there.
	That's a really important point.
	I think it helps if we see it in the context of clustering with something else.
	And this is something that unites a lot of the causes of depression and anxiety that I write about in Lost Connections.
	Everyone listening to your podcast knows they have natural physical needs, right?
	Obviously, you need food, you need water, you need shelter, you need clean air.
	If I took those things away from you, you'd be in real trouble real fast.
	But there's equally strong evidence that all human beings have natural psychological needs, right?
	You need to feel you belong.
	You need to feel your life has meaning and purpose.
	You need to feel that people see you and value you.
	You need to feel you've got a future that makes sense.
	And our culture is good at lots of things.
	I'm extremely glad to be alive today.
	I love dentistry.
	I love gay marriage.
	There's a whole range of things that I'm thrilled to be alive now.
	My ancestors in many ways had, you know, Irish peasants and Swiss peasants had, you know, significantly worse lives in all sorts of ways.
	But we've been getting less and less good at meeting these deep underlying psychological needs.
	I think there's good evidence for that.
	And while it's certainly not the only thing that's going on, I think it's the thing that is driving these crises.
	So that can sound a bit weird in the abstract, I'll give you a specific example.
	This is the loneliest society there's ever been.
	There's a study that asks Americans, how many close friends do you have you could turn to in a crisis?
	And when they started doing it years ago, the most common answer was five.
	Today, the most common answer, not the average, but the most common answer is none.
	There are more people who have nobody to turn to than any other option.
	This is part of an enormous array of social science that shows there's been an explosion in loneliness, isolation.
	I spent a lot of time talking about this with an amazing man called Professor John Cassiopo at the University of Chicago, who sadly just died.
	He was the leading expert in the world on loneliness.
	I remember him saying to me, Why are we alive?
	Why do we exist?
	In part, it's because our ancestors on the savannahs of Africa were really good at one thing.
	They weren't, in a lot of cases, bigger than the animals they took down.
	They weren't, in a lot of cases, faster than the animals they took down.
	They were much better at banding together into tribes and cooperating.
	Just like bees evolved to need a hive, humans evolved to need a tribe.
	And if you think about those circumstances where we evolved, if you were separated from the tribe, you were anxious and depressed for a really good reason, right?
	You were probably about to die.
	You were in terrible danger.
	Those are the physical responses we still have to feeling isolated.
	Yet we are the first humans ever to try to disband our tribes and tell ourselves that we can do it all alone.
	And it's a key factor in why we're so distressed.
	One issue is there are no bright lines between biology and psychology and social phenomenon and culture.
	At every point, it is coherent to think about an individual as being entirely the inheritor of whatever neurophysiological states are being kindled on his brain as a result of all of the influences and the underlying genetic propensity he's got to respond to those influences.
	So what you have is your brain and its states in each moment producing the character of your mind.
	And the cash value of any cultural meme or presence or lack of healthy relationships, anything that's getting in, is getting in by virtue of making some impression physiologically on you as a system.
	So, it's always tempting to think the nearest lever to hand is making a change directly in the person, right?
	So, if we could get a pill that would truly cancel depression, it's not incoherent to think that such a pill could exist, right?
	Because depression, you know, to arrive and be expressed has to be a matter of what your brain is doing.
	But that's true with anything.
	I mean, that's true with any other state of mind that you could experience.
	We're sort of meandering into a time where the possibility of intruding on ourselves technologically and pharmacologically is going to become more precise and more tempting, and we could become untethered to the more certainly traditional, more normal, probably more normative mechanisms by which we regulate our state.
	So it's one thing to regulate your state by diverting yourself with social media or a video game or some entertainment, something that further isolates you but may actually scratch some kind of psychological itch for the time being.
	It's another thing to actually establish a real connection to another person that begets its own ways of regulating your state.
	It's conceivable that we could find ourselves on a path to an Aldous Huxley-like terminus, where we essentially all self-medicate in a way that becomes more and more effective.
	What you're bemoaning here is how ineffective the status quo is for most people.
	We're very lonely.
	We're very isolated.
	There's lots of addiction to things that are obviously unhealthy.
	But it's conceivable that we're just kind of getting over the hump of all of these less-than-optimal ways of isolating ourselves pleasurably, and heading toward a future where there are more ideal ways of becoming isolated and yet arguably happier.
	I'm not wishing for that future.
	I think, as I said, you could imagine a better place to arrive than that, but it seems to me that there's a lot of energy and effort directed at solving the problem in that direction.
	I think that's a brilliant way of putting it and it's something I kind of tried to think about a lot.
	There's a lot in what you just said that I want to think about.
	So I went to see this South African psychiatrist called Derek Summerfield, who's a great guy.
	And Derek happened to be in Cambodia in 2001, I think it was, when they first introduced chemical antidepressants in that country.
	And the local doctors, the Cambodians, had never heard of these drugs.
	So they were like, what are they?
	And he explained.
	And they said, oh, we don't need them.
	We've already got antidepressants.
	And he said, what do you mean?
	And he thought they were going to talk about some kind of like herbal remedy, like, I don't know, St.
	John's wort or something.
	Instead, they told him a story.
	There was a farmer in their community who worked in the rice fields.
	And one day he stood on a landmine and he got his leg blown off.
	So they gave him an artificial limb and he went back to work in the rice fields sometime later.
	And the guy started to cry all day, didn't want to get out of bed.
	He developed classic depression.
	Apparently it's very painful to work underwater when you've got an artificial leg.
	And I'm guessing it was traumatic for obvious reasons, right?
	And they said to Dr. Somerville, well, so we gave him an antidepressant.
	And Derek said, well, what was it?
	And they said, well, they went and sat with him.
	They listened to him.
	They realized that his pain made sense, right?
	That it wasn't some purely some biological malfunction.
	They figured if they bought him a cow, he could become a dairy farmer.
	He wouldn't be in this situation that was screwing him up so much.
	So they bought him a cow.
	Within a couple of weeks, his crying stopped.
	Within a month, his depression was gone.
	And they said to Derek, well, you see, you see, doctor, that cow, that was an antidepressant.
	That's what you mean, right?
	Now, if you've been raised to think about depression the way we have, that sounds like a joke.
	I went to my doctor for an antidepressant, he gave me a cow.
	But what those Cambodian doctors knew intuitively is what the leading medical body in the whole world, the World Health Organization, has been trying to tell us for years.
	If you're depressed, if you're anxious, you're not crazy, you're not, you know, a machine with broken parts, you're a human being with unmet needs and you need real love and help and support to get your needs met.
	And what I think is interesting is we've spent so much time And so much of our money and resources as a society, trying to find a physical, technical fix, where we have not succeeded very well.
	Chemical antidepressants have some role to play, but the best long-term research into chemical antidepressants, the STAR-D trial, shows most people taking them do become depressed again.
	I want to stress again, that doesn't mean they have no value, they have some value.
	But we've just got to be honest, we've been massively increasing these attempted technical fixes for the last every year, for the last 35 years.
	And every year, depression and anxiety has continued to rise.
	There's clearly something we're missing in those pictures.
	And one of the things that struck me going all over the world and trying to find who has built solutions based on the best evidence.
	Actually, the people who admire the people doing the technical biological work, it's really important.
	But they have so far yielded quite limited results.
	Actually, the places that have yielded the best results have often been the people who were doing very low-tech things.
	I'll give you an example.
	One of the heroes of the book is an incredible man called Dr. Sam Everington.
	He's a doctor in a poor part of East London where I lived for a long time.
	And Sam was really uncomfortable because he had loads of patients coming to him with terrible depression and anxiety.
	And like me, he thinks chemical antidepressants have some valuable role to play, but he could also see that they were not solving the problem for most of his patients.
	And he could also see that they were depressed and anxious for perfectly understandable reasons, like the one we're talking about.
	They were acutely lonely.
	So one day he decided to pioneer a different approach.
	A woman came to see him who I got to know quite well called Lisa Cunningham.
	And Lisa had been shut away in her home with just crippling depression and anxiety for seven years.
	And Sam said to Lisa, don't worry, I'll carry on giving you these drugs.
	I'm also going to prescribe something else.
	There was an area behind the doctor surgery that was known as Dog Shit Alley, which gives you a sense of what it was like.
	It was just kind of scrub land where dogs would Go and shit.
	And he said, what I'd like to do is come and turn up a couple of times a week with a group of other depressed and anxious people.
	I'm going to come because I've been quite anxious myself and we're going to turn this into something nice.
	Right.
	So the first time the group met, Lisa was literally physically sick with anxiety, terribly sick and anxious.
	But as the group met, they decided what they were going to do is turn this scrubland into a garden, right?
	These inner city East London people, they knew nothing about gardening, right?
	This is how they're going to teach themselves.
	And a few things happened.
	The first was they started to get their fingers into the soil.
	They started to learn the rhythms of the seasons, right?
	There's a lot of evidence, enormous evidence that exposure to the natural world is a really powerful antidepressant.
	But even more importantly, they started to form a tribe.
	They started to form a group.
	They started to care about each other.
	If one of them didn't turn up, someone would go to their house and check they were okay.
	The way Lisa put it to me, as the garden began to bloom, we began to bloom.
	There was a study in Norway of a very similar program, which is part of a growing body of evidence, that found it was more than twice as effective as chemical antidepressants.
	This is something I saw all over the world.
	The most effective strategies for dealing with depression and anxiety Are the ones that deal with the reasons why we're so depressed and anxious in the first place.
	And yet what we've done as a society and as a culture is both when it comes to drugs and when it comes to, although drugs can provide relief to people, not just antidepressants.
	I mean, heroin will provide you some relief.
	There's all sorts of drugs that will provide you with some relief from pain for a time while it also extracts a cost as well.
	But I think more generally, I think what you said about these growing technologies, I thought a lot about this.
	And one of the ways I want to understand this was, I went to the first ever internet rehab center in the United States, just outside Spokane in Washington.
	I have to admit that when I arrived, it's a clearing in the woods, I get out the car.
	The first thing I did totally instinctively was look at my phone and feel really pissed off.
	I couldn't check my email.
	It was like, you're in the right place, right?
	So I arrive and they get all kinds of people in this, it's called Restart Washington, they're great people.
	They get all kinds of people there, but they disproportionately get young men who've become obsessed with multiplayer role-playing games like World of Warcraft and Fortnite.
	And I remember talking to these young men and then talking to the woman who runs it, who you should have on your show, you'd really like her, she's fascinating.
	A woman called Dr. Hilary Cash who runs this centre.
	I remember her saying to me, these aren't her exact words, they're on the website, She said something like, you've got to ask yourself, what are these young men getting out of these games, right?
	They're getting the things they used to get from the culture but they no longer get.
	They get a sense of tribe.
	They get a sense that they're good at something and they can rise at being good at something.
	They get a sense that people see them and notice them.
	They get a sense they can physically roam around.
	A study in Britain that found the average British child now spends less time outdoors than the average maximum security prisoner.
	Because by law, a maximum security prisoner has to have 70 minutes a day.
	But of course, as she put it, what they're getting is like a parody of those things, right?
	In the same way I started thinking about it, I think the relationship between social media, which only become more and more advanced as VR, virtual reality develops, The relationship between social media and social life is a bit like the relationship between porn and sex, right?
	I'm not against porn.
	Like almost all men, I look at it sometimes.
	It meets a certain basic itch, but if your entire sex life consisted of looking at porn, you'd be going around pissed off and irritated the whole time because you didn't evolve to wank over a screen, you evolved to have sex.
	In a similar way, we did not evolve to interact with each other through screens.
	We evolved to actually do what we're doing, sit face to face, see each other.
	But I think the crucial thing I learned from Dr. Keshe, you have to think about the moment the internet arrived, right?
	For most of us, it's the late 90s.
	I think I sent my first email in the year 2000, which seems incredible to me now.
	I lived most of my life without it.
	But at that, a lot of the causes of depression and anxiety that I'm writing about, that I learned about from these scientists, were already supercharged by that point, right?
	Think about loneliness, which we've talked about already.
	Massive increase in those, well before the internet.
	What happens is, the internet arrives and it looks a lot like the things we've lost, right?
	You've lost friends.
	Here's some Facebook friends.
	You've lost status because there's been a huge rise in inequality and humiliation at work.
	Well, here's some status updates for you.
	But what we've got is a kind of simulacra of those things, a parody of those things.
	I think you're totally right.
	We're going to be offered better and better simulacra of the things we've lost.
	But what I would argue is the things we've lost are right there in front of us, right?
	We don't need simulacra.
	We don't need billion dollar simulacras.
	A small number of people will need brain interventions, but the vast majority of people who are distressed Do not.
	And in a way, what I'd argue for is a kind of return to much more obvious insights rather than a turn to very expensive and more easily monetizable kind of parodies or simulacras of those things.
	Let's talk about the generic solutions to depression.
	Again, I haven't read your book, so I'm just going to guess what you would recommend.
	I'll just add to the list you've already started here.
	So engagement with the natural world is A net positive for many of us, most of us.
	I would imagine physical exercise should be on the list.
	Getting enough sleep must be on the list, although you do have a chicken and egg problem here where depression begins to erode sleep.
	Social connection is the primary thing you've mentioned.
	I would guess finding meaning in one's work, but doing work that one finds meaningful rather than doing work that one finds synonymous with drudgery.
	What am I missing?
	Well, let's develop a few of those because I think the solution, you've identified the problems there, but it can seem daunting to people.
	So let's look at work, for example.
	This is a huge one.
	I noticed that lots of the people I know who are depressed and anxious, their depression and anxiety focuses around their work.
	So I started to look at, well, what's the evidence about this?
	How do people feel about their work?
	And it was quite striking.
	So Gallup did the best research on that here in the US and across the world.
	Massive three-year detailed study.
	What they found is 13% of us, 1-3% like their work most of the time.
	63% of us are what they called sleep working.
	You don't like it, you don't hate it, you just kind of get through the day.
	And 24% of people fucking hate and fear their jobs, right?
	I was really struck by that.
	87% of people don't like the thing they're doing most of their waking life, right?
	So I think, could this have some role to play in our mental health problems?
	So I started to look at all the evidence around this and I learned there was an incredible man I went to meet called Professor Michael Marmot.
	He's an Australian social scientist and he discovered in the 1970s, it's not the only one, but the single biggest factor that causes depression at work.
	He discovered if you go to work tomorrow and you have low or no control over your job, You are much more likely to become depressed and anxious by a really significant amount.
	And at first when I was talking to him and learning what he'd said, I actually misunderstood what he was saying.
	I thought he was saying...
	Okay, you've got this 13% of people at the top who get to have nice jobs, they're going to be okay, but they control, and everyone else is condemned to this kind of misery, right?
	And I thought about my family, right?
	My dad was a bus driver, my brother's an Uber driver, my grandmother's job was to clean toilets.
	I thought, wait, hang on a minute, are we saying these people are condemned to this misery?
	And he kept stressing, it's not the work that makes you depressed, it's being controlled at work.
	And so I think, well, what's the kind of solution for that?
	What's the antidepressant for that?
	I learned there's really good evidence for this.
	I went to meet, in Baltimore, a woman called Meredith Keogh.
	She's a totally interesting person.
	Meredith used to go to bed every Sunday night, just sick with anxiety.
	She had an office job.
	As she would tell you, it wasn't the worst office job in the world.
	She wasn't being bullied or harassed or anything, but it was really monotonous and she couldn't bear the thought, this is going to be the next 40 years of my life until I retire.
	Whatever it would have been, 45 hours a week.
	So one day with her husband Josh, she decided to do this quite bold thing.
	And at first when listeners hear me say this, they're going to think I'm saying this is what you should do.
	Then they're going to think I can't do that.
	And they're right, they can't do that.
	This reveals the wider insight that we can act on together.
	So Josh, her husband had worked in bike stores since he was a teenager in Baltimore.
	And you know, as you can imagine, it's insecure work.
	You've got very little control over, you don't have any rights at work really.
	You don't even get paid vacation time.
	And one day Josh and his friends, who worked in the store, just asked themselves, what does our boss actually do?
	They liked their boss, he wasn't a terrible person, but they were like, we seem to fix all the bikes and he seems to make all the money.
	They decided they were going to set up a bike store of their own that worked on a different principle.
	So where they had worked before was a corporation.
	Very recent human invention, goes back to the 19th century.
	This is, you know, people will know it because most people listening to this will work in a corporation.
	You know, you've got like the boss at the top and he's like the commander of the army and everyone below them is like a soldier that takes their orders and sometimes the commander is nice and asks your opinion, sometimes he doesn't.
	They decided they were going to open a bike store that worked on a different principle, an older American principle.
	It's a democratic cooperative.
	So they don't have a boss.
	So they fired their boss and he had to go on antidepressants.
	He was a sad, broken figure.
	So they opened this bike store and so they take the decisions together by voting, like once every couple of weeks in practice, they agree on almost everything anyway.
	They share out the profits, they share out the good tasks and the shitty tasks.
	I know we'll get stuck with the shitty tasks, but they're one of 10,000 democratic cooperatives in the US.
	It's a growing number.
	But what was fascinating spending time with the people in Baltimore Bicycle Works, their Which is totally in line with Professor Marmot's findings, is how many of them talked about how they've been depressed and anxious before, but were not depressed and anxious now.
	And what's interesting is, it's not like, you know, they didn't quit their jobs fixing bikes and go off to become like Beyonce's backing singers, right?
	They fixed bikes before, they fix bikes now.
	The difference is now they've got control over their work.
	Now, if they have an idea, they can translate it into It's a practice that if they can persuade their colleagues, it's a very different way of being in your daily life, right?
	Now, there's no reason why we should be structuring the way we work, the thing we do most of the time, you know, in a way that depresses and humiliates so many people, right?
	Every corporation could be turned into a democratic cooperative.
	That sounds like a big thing.
	We've lived through enormous changes, you and I.
	That is about understanding a deep cause of depression and anxiety.
	People are soaking up a huge amount of humiliation or just plain boredom at work and we can, by restoring control to people, they can infuse their work with meaning in a way you, which of course doesn't mean, of course there's still going to be some jobs that have to be done that are not the best jobs in the world when it comes to creativity, but the more you get, and there's scientific research about this, the more you give people control over their work, the more they find meaning in that work.
	Did you write about or research meditation at all in this?
	Yes, I was really interested in a few kinds of both meditation and psychedelics.
	I actually came to the evidence about meditation and I loved what you wrote about this in Waking Up and I came to the mystery of meditation actually through the psychedelic stuff and it led me back to reread Waking Up.
	So, your listeners will know because you've talked about this a lot on the show, but until the mid-1960s or a little bit later There was lots of evidence, lots of research into giving people psychedelics that was, you know, not done to the standards we want scientific research to be done today for sure, but was very promising about giving it to people who had alcohol addictions, giving it to people with depression that seemed to have quite striking results.
	And then the Nixon administration shuts the whole thing down and the research goes dormant.
	Until eight years ago, a man I interviewed, incredible guy called Professor Roland Griffiths at Johns Hopkins University, really reopened this whole field of research.
	Subsequently, there's been a huge reawakening of it.
	I went to interview the teams that have done this new research here in Los Angeles, at UCLA, at UCL in London, some of the people from NYU, at Johns Hopkins, in Sao Paulo in Brazil, and in Aarhus in Denmark.
	There are loads of fascinating things about psychedelics, which you know much better than I do.
	There was one subset of the findings that I found particularly fascinating.
	And I think reveals a lot and leads us into the debate about meditation.
	So, they did a smoking trial.
	They took people who were chronic long-term smokers.
	And I think about this a lot.
	My mother smokes 70 cigarettes a day.
	There's an incredible photo.
	There's a photograph of me and my mother when I'm six months old.
	She's breastfeeding me smoking and resting the ashtray on my stomach.
	Wow, she would wind up on 60 Minutes and then swiftly carted off to jail.
	This was 1970s Scotland, where you were sent to jail if you didn't do that, right?
	Actually, when I showed her this photograph, when I found it a few years ago, she said, you were a difficult fucking baby, I needed that cigarette.
	So they take people like my mother, who'd been chronic long-term smokers, and they gave them three doses of psilocybin, the active component in magic mushrooms.
	And they followed them over time.
	What was incredible was 80% of them stopped smoking.
	80%.
	To give you a comparison point, the next most successful smoking cessation tool we have, nicotine patches, have a 17.17% success rate.
	And a year later, more than 60% of them had still stopped.
	It's important to stress this was a relatively small trial, but a very striking result.
	But there's a sub-finding of all these results.
	They did them with long-term meditators.
	They did them in London.
	They've done it with depression.
	That I think is really, really important.
	So, when people take psychedelics, the majority of people have something that they would describe as a spiritual experience, right?
	And that's interpreted broadly.
	You and I are both atheists.
	I don't mean you see God.
	But it turns out there's a big range in how intensely people have a spiritual experience.
	So some people will have an extraordinarily potent spiritual experience, and some people, a minority, have no spiritual experience at all.
	It turns out the positive effects, things like smoking cessation, reduction in depression, and so on, correlate very closely with how intense your spiritual experience is.
	If you have a very intense spiritual experience, you have all sorts of positive outcomes.
	If you do not have an intense spiritual experience, you have very few positive outcomes.
	And I think this tells us something that fits with the wider evidence that we're piecing together in this conversation, which goes back to the opposite of addiction is connection.
	There's a fascinating guy in Mississippi who's doing work giving psilocybin to people with cocaine addictions, and he's having really striking results.
	What the psychedelics do, we don't want to get into a debate where we act like we talk about it the way people talked about antidepressants in the 90s, like it flips a switch in your brain and that transforms your brain.
	That's way too simplistic.
	Of course, there's a physical effect in your brain when you take a psychedelic, obviously.
	But what it does is it gives you a spiritual insight.
	It gives you a moment, a taste of deep and profound connection if it goes well.
	Right.
	As Bill Richardson, an incredible guy, who also would be a great guest for you, he's the only person who was doing the scientific research in the 60s who was still around for the reawakening eight years ago, and he's like the Yoda of psychedelics.
	I love him.
	He said to me, I think it was him, It breaks your addiction to yourself.
	It breaks your addiction to the ego, right?
	We live in a culture that's constantly like kind of itching powder for the ego.
	It's constantly getting us to think egotistically.
	It gives you a moment of what life is like to not be that way.
	But then you have to find ways to sustain it.
	So I remember speaking to Robin Carhart-Harris, who's the professor who led, along with Professor David Nutt, the depression trial in Britain.
	So they gave chronic long-term depressed people psychedelics, and again had an extraordinary effect.
	But there was a kind of catch to this that Robin explained to me.
	So I'll give you an example of a woman.
	She takes the psychedelics, been depressed for a long time.
	The depression goes away.
	It's incredible.
	She realizes she's deeply connected to the natural world, to other people.
	And then she goes back to her job as a receptionist in a shitty English seaside town.
	And she simply cannot live in a way that is consistent with these lessons, right?
	If you go around your office in an English seaside town or Atlantic City or whatever, thinking that you're deeply connected, we're all the same, you know, you're not going to have your job for very long, right?
	So we've built an environment that in many ways militates against the insights that psychedelics provides us with.
	And I think in a way what psychedelics are, because most people are not going to want to take psychedelics at all, and a lot of people are not going to take them repeatedly, It's more like setting a direction or a compass in which we want to travel towards a more connected and meaningful life, right?
	What you then have to do is figure out, well, how do we develop these insights away from the drug or with the drug?
	You know, maybe people want to carry on taking it again and again, and if they do, I'm all on their side.
	But And that's where it led me to look at the research on meditation and so on.
	Do you see what I mean?
	Yeah, you bring up a few interesting things there.
	One is that this notion that real change, permanent change, can be anchored to an insight.
	Having a reference point outside of your usual routine of unhappiness can actually give you a tool, cognitively and emotionally, to change the way you feel.
	And I think many of us would be familiar with this.
	It might not even be a peak experience, like a psychedelic experience.
	It could just be a conceptual reframing of the experience that you have been finding so oppressive.
	The experience itself may not change.
	There's a few examples of this that I'll just float by.
	One is One I often think about and have referenced on the podcast before is that if you take the physical symptoms that are unpleasant, they don't actually have intrinsic significance until you frame them conceptually.
	So you can have... imagine what it's like to be at the peak of a very intense workout, right?
	Where you're just, you know, you're either lifting weights or you're running, so you're having some anaerobic or aerobic extreme experience.
	If you simply woke up in the morning and felt those bodily sensations, you would call 911, you know, and just wait for the ambulance, right?
	But because they're happening in the context of a workout, Not only are they... it can still be negatively valenced.
	I mean, I think we would all notice them as still as unpleasant in some sense, but the framing, our knowledge of the context, and the meaning of being able to push yourself to that degree is positive, and therefore many of us are even to some degree, quote, addicted to exercise, right?
	It's one of the best things we do with our days, And yet, the moment-to-moment character of the sensory experience can be negatively valence, and yet it's a totally positive experience.
	Again, it's just if your beliefs about what you're feeling are scary, well then those symptoms can be... I mean, to be told that that ache in your stomach is You know, almost certainly indigestion, or it's very likely cancer, right?
	I mean, those are just ideas.
	The sensations don't change, but one's experience would be impressively changed by the framing.
	Another, I guess even more extreme example for me, it does come from meditation, and it offers a kind of edge case to many of the things we've been talking about.
	So, for instance, I totally concede the importance of connection in our lives.
	And the quality of your life, it seems to me, in most people's cases, is almost entirely defined by the quality of the relationships in it, right?
	Social isolation for most people, most of the time, is just perfectly correlated with degradation in the quality of their life.
	But It is also true to say that some of the most ecstatically happy and wisest people I've ever met have spent a good portion of their lives in total isolation, in some cases literally in caves for years at a time, right?
	And so it is possible to be completely isolated, and isolated in a way that most people would consider the realization of their worst nightmares.
	This is a point I've made before that it's telling that solitary confinement is considered a punishment even inside a maximum security prison, and most people prefer the company of rapists and murderers to being locked in a room alone with their minds.
	And yet it's possible to, in the context of isolation, experience profound well-being, and the difference there is being able to meditate or not, right?
	And meditation, in this case, is really just being able to notice what the mind is like when you're not continuously identified with and lost in thought, and, you know, so much of our thinking is negative, the character of one's identification with thought is, you know, almost entirely painful.
	But meditation, kind of in the normal range of people's experience, forget about isolation and caves for a moment, this can happen very, very quickly.
	I mean, literally in like your first 10 minutes of attempting it, You can discover that it can be quite pleasant, and even profoundly pleasant, to simply pay attention to the breath, or to any simple object in your experience.
	The breath is a very common one that people use for training mindfulness.
	And yet, in reality, there's nothing more boring than the breath, right?
	It's like if your job was just to sit and pay attention to your breath, that would be the most boring job on earth.
	And yet, if you know how to pay attention, boredom is not a problem.
	Boredom really is just a lack of attention, and it's not to say there's not a distinction between profoundly interesting and creative and easily rewarding jobs and more classically boring and oppressive ones, but there's something about—I mean, just based on these two examples,
	I would expect that being able to reframe what one is doing, even if one has to do it, which is to say think differently about one's situation, and pay attention more carefully to one's experience, which is to say actually become interested even in what is routine and repetitive,
	Again, I'm not discounting the fact that making substantive changes to what one is doing may in fact be warranted, but it is just possible to not be unhappy doing something that is classically boring and menial and without purpose.
	Ironically, what happens when you look at what people do when they join, you know, religious cults or religion traditionally, they submit themselves to some course of training that is about crushing or at least rebuffing their egocentricity and their notion of deriving meaning from their extrinsic accomplishments and the story they're telling themselves about how, you know, they're not normal, they're extraordinary in some way.
	And so you have these, you know, Ivy League-trained attorneys and businessmen going to, you know, Rajneesh's ashram, and they're being asked to scrub toilets and dig ditches.
	I mean, it's a cliché of what happens to a self-important person who's successful when he or she gets into the company of some religious adept, whether he's a fraud or not.
	But the truth is, it actually works for people.
	People are not pretending to have punched through to some new level of well-being and happiness.
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