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Johann Hari鈥檚 experience with depression is something of a lightning rod within mental health circles. Some cheer his nuanced views of the disorder, grateful for a take on mental health that emphasizes the impacts of environment and experience. Others argue that the British journalist is too dismissive of medication. 鈥淚s everything Johann Hari knows about depression wrong?鈥� that ran in a U.K. newspaper.

The extreme reactions to the best-selling author of Lost Connections: Uncovering the Real Causes of Depression鈥攁nd the Unexpected Solutions also speak to the binary way people tend to view mental illness and mental health. You either have it or you don鈥檛.

will experience a mental health disorder at some point in life. Every single person, every day, passes through the continuum that is mental health, from building resilience to dealing with challenges such as anxiety and depression to recovering from trauma to living with severe disorders that need constant medical care.

When Hari was a teenager in the 1990s, he felt a debilitating sadness that he couldn鈥檛 explain or even understand. 鈥淢y doctor told me a story that was entirely biological. He said, 鈥榃e know why people feel this way. There鈥檚 a chemical called serotonin in people鈥檚 brains. Some people lack it, you鈥檙e one of them, and all we need to do is drug you and you鈥檒l be fine.鈥欌��

Paxil, a selective serotonin reuptake inhibitor, or SSRI, corrected the serotonin imbalance in his brain that was causing him to feel sad. Hari says his mood improved. But, he learned a few months later, it only worked for a while. Then the sadness returned. His dose was increased, feelings of melancholy receded, but again only for a time. A pattern set in and continued for years.

When he was researching Lost Connections, Hari says, he began to understand the roots of his depression and discovered lasting solutions to the mental health challenges with which he had struggled for so many years.

Social stress. Lack of community. Childhood trauma. 鈥淚t was a combination of social factors,鈥� he says. 鈥淕rowing up in a culture where you鈥檙e taught that what matters most is money and status. Growing up in a place with no community. 鈥� And I鈥檇 gone through childhood trauma, and childhood trauma can lead to adult depression.鈥� With a fuller picture of his mental health, Hari realized he focused too much on himself and self-promotion. He began making a conscious effort to spend time helping others 鈥渁nd to just be present with the people I love,鈥� he adds.

鈥淩eally, it was a radical transformation.鈥�

The personal story Hari recounts in Lost Connections reveals emotional well-being as significantly more complicated than a binary system that oscillates between resilience and illness.

鈥淭here are three different kinds of causes of depression, and we鈥檝e been focusing way too much on the biological ones and not anywhere near enough on the social and psychological ones,鈥� Hari says.

This broader understanding of mental health鈥攁s a continuum, and one that is deeply and continually affected by environment, circumstance, and experience鈥攊s further revealed in the many statistics repeated after the suicides in June of celebrities Anthony Bourdain and Kate Spade. A by the U.S. Centers for Disease Control and Prevention shows that from 1999 to 2016, suicide rates have steadily increased in nearly every state to create a national rise of 30 percent. 鈥淚n 2016, nearly 45,000 Americans age 10 or older died by suicide,鈥� it reads. 鈥淪uicide is the 10th leading cause of death and is one of just three leading causes that are on the rise.鈥�

If we are all in this mental health thing together, then there鈥檚 a large role for each of us.

What has happened to Americans over those decades? Thinking that biological chemistry alone has undergone significant changes is unreasonable. Our environments have changed. Our food. Our stress. Our relationships鈥攐ur 鈥渓ost connections,鈥� as Hari puts it.

According to the Cooperative Institutional Research Program鈥檚 annual Freshman Survey, in 1985, 18 percent of first-year college students said they 鈥渇elt overwhelmed.鈥� In 2000, that number was 28 percent. In 2016, it was 41 percent.

The portion of American children ages 6 to 17 who experience a lifetime diagnosis of anxiety or depression was 5.4 percent in 2003 and 8.4 percent by 2011鈥�2012, according to an published in the Journal of Developmental and Behavioral Pediatrics. 鈥淵outh mental health is worsening,鈥� reads a blunt assessment by Mental Health America. According to the nonprofit, the rate of youth with 鈥渟evere depression鈥� increased from 5.9 percent in 2012 to 8.2 percent in 2015.

As troubling as these numbers are, a small positive exists. If mental health challenges are so common, if we are all at various stops on the continuum of resilience to illness, no one should feel ashamed for experiencing one.

A Normal Response to Abnormal Circumstances 

There鈥檚 another takeaway, too. If we are all in this mental health thing together, then each of us in the wider community plays a large role in prevention and healing.

In 2008, Dr. Gabor Mat茅 published In the Realm of Hungry Ghosts: Close Encounters With Addiction, a seminal book on the subject that explains problematic drug use as a common response to childhood trauma. Or, as he explained addiction in a recent interview, 鈥渁 normal response to abnormal circumstances.鈥�

鈥淛ust about every mental affliction is actually an adaptive response that then becomes a source of problems later on,鈥� Mat茅 says. 鈥淧eople push down their feelings in childhood when the environment of their childhood cannot receive those feelings. In order to stay acceptable to the nurturing environment, the child pushes down their feelings. Thirty years later, they are diagnosed with depression.鈥�

Mat茅 is working on a book that鈥檚 tentatively titled The Myth of Normal: Pathways to Health in an Insane Culture. 鈥淎 society that erodes communities and isolates people, which this society does in major ways, that itself is going to create insanity,鈥� Mat茅 says. 鈥淭hat is insanity.鈥�

鈥淢eaningful social connection, and the pain we feel without it, are defining characteristics of our species.鈥�

To explain, he takes a step back in time: 鈥淲e evolved as communal creatures,鈥� Mat茅 says. 鈥淲e could not have survived on our own [in prehistoric times]. No human being could have survived.鈥�

Imagine a small tribe of indigenous people living in Central America some 2,000 years ago. Positive feelings of community kept humans in groups large enough to foster collective security. Now think of the ways so many of us live today: in 30-story apartment towers where introducing yourself to your neighbors has become a social oddity, and in gated communities where massive parcels of personal property keep families in geographic isolation from those nearby.

Mat茅鈥檚 reference to premodern humans is reminiscent of the work of John Cacioppo, a social neuroscientist at the University of Chicago who dedicated his life to the study of loneliness. He established that 鈥渘egative鈥� emotions such as loneliness were actually necessary to our success.

鈥淢eaningful social connection, and the pain we feel without it, are defining characteristics of our species,鈥� Cacioppo wrote in his 2008 book, Loneliness: Human Nature and the Need for Social Connection. 鈥淚n the same way that physical pain serves as a prompt to change behavior鈥攖he pain of burning skin tells you to pull your finger away from the frying pan鈥攍oneliness developed as a stimulus to get humans to pay more attention to their social connections, and to reach out toward others, to renew frayed or broken bonds.鈥�

In Central America 2,000 years ago, a solo hunter with pangs of loneliness would return to his tribe, to relative physical safety, and to a comforting feeling of belonging in his community. Today, in a society that encourages isolation, it鈥檚 as if we鈥檙e forgetting that sort of solution is still available to us.

Depression Is Political 

Of course, it鈥檚 not that simple. The relationship between community and an individual鈥檚 mental health is  complicated. And political. Sometimes you鈥檙e White and feel capitalism is isolating and making you depressed. Sometimes you鈥檙e Black and afraid for your teenage son to leave the house wearing a hoodie.

鈥淚 am here sitting in my bed fighting my depression, trying not to bask in somberness for too long, pondering how I鈥檓 going to shatter ceilings with three generations on my back,鈥� wrote Bobby London, a writer and journalist who often covers social movements including Black Lives Matter, in a 2015 essay, 鈥淒epression is, at least for me, something that is structurally created,鈥� she continues. 鈥淚 am depressed because I live in a White-supremacist, patriarchal, capitalist world. I am depressed because people that look like me are constantly being murdered.鈥�

The politics of depression and anxiety at the community level looks like this:

According to apublished in the Lancet, police killings of unarmed Black people harm the mental health of the victims鈥� entire communities. And researchers noted that the mental health impacts were not observed among White people and resulted only from police killings of unarmed Black Americans, not unarmed White Americans or armed Black Americans.

For several years, Ashley Yates has candidly shared her experiences with depression and anxiety on social media under the handle @brownblaze. She鈥檚 also become an advocate for self-care and for dialogue around the mental health challenges that are especially pronounced in communities of color, from violence to invisibility.

鈥淪omething that happens a lot in activism is that people forget we have lives outside of it.鈥�

鈥淭he ways in which we are treated when we access social services is completely different from other races. The ways in which we are treated in our health care system is completely different from other races,鈥� Yates says. 鈥淚t is really stressful. It creates depression 鈥� when you know that you are going to have to fight doubly or triply hard just to get normal care, just to get your necessities, just to be seen.鈥�

In August 2014, 18-year-old and killed by a White police officer in Ferguson, Missouri. It was one of several fatal police shootings that collectively gave rise to Black Lives Matter and a re-energized movement for civil rights. In Ferguson, Yates participated in protests for police accountability for several months. She recounts how she became a part of something in which she found strength but which paradoxically presented simultaneous challenges for her mental health.

鈥淒ealing with that sort of repression, dealing with that sort of violence鈥攖he only thing that I can think to compare it to is active warfare. You are having war waged against you by your government,鈥� she says.

Yates remembers that she first scoffed at the idea she would experience post-traumatic stress disorder. 鈥淚 don鈥檛 know if it was cognitive dissonance or just ignorance on my part, but I had no clue that it would impact us so deeply. But every single person that spent significant time in Ferguson absolutely suffers from PTSD.鈥�

Yates didn鈥檛 always speak so openly about mental health. 鈥淎t first, it was definitely like, 鈥榃ill I be stigmatized?鈥� And there was stigmatization,鈥� she says.

Then a comrade killed himself.

In February 2016, 23, a prominent member of the Black Lives Matter movement, shot himself on the steps of the Ohio statehouse. 鈥淚t told me that it was time to speak out no matter the cost,鈥� Yates says.

鈥淲hen I remembered that healing is a process 鈥� it became a more tangible reality.鈥�

At the same time, Yates began a conscious effort to take better care of herself, which she says was not easy. 鈥淭here are a lot of barriers when it comes to access to therapy or mental health services for Black people,鈥� Yates explains. 鈥淐oming from a Southern Baptist religion, there is not a lot of space for me to do something other than to take it to Jesus. And so that was a huge barrier that I had to overcome. Another one was cost and insurance and all of the things it takes to find a therapist who understands racism and structural inequity.鈥�

Yates began with small steps she describes as 鈥渁ccessible鈥� and 鈥渁ffordable.鈥�

鈥淔inding my joys in life was a huge thing,鈥� she says. 鈥淪omething that happens a lot in activism is that people forget we have lives outside of it. We forget to do pleasurable things. So for me, it was getting back to writing, getting back to drawing, getting back to reading, getting back to just seeing a movie sometime, and remembering that we live full, well-rounded lives. Those were some of my very first steps.鈥�

Yates also reconceptualized her mental health as more nuanced than either 鈥渦nhealed鈥� or 鈥渉ealed.鈥�

Because she had so much trauma, she says, a state of 鈥渉ealed鈥� seemed impossible. 鈥淏ut when I remembered that healing is a process 鈥� it became a more tangible reality, and something that is a lot more feasible than flipping a switch.鈥�

Sometimes People Get Stuck 

Recovery from an oppressive situation takes time, according to Dr. Bessel van der Kolk, author of The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. He is a clinician and researcher who specializes in post-traumatic stress and is founder of the Trauma Center in Boston. Van der Kolk says that for a child living in an abusive household, for example, or a person of color who has repeatedly experienced unjustified interactions with police, healing will be a process, and often a long one.

鈥淧eople adapt to very bad situations,鈥� he explains. 鈥淭he response to trauma is the mind鈥檚 way of coping with whatever is going on, to help you to survive. But sometimes people get stuck.鈥�

At the Trauma Center, van der Kolk and his team make less-traditional treatments available alongside mainstream therapies. A child can play a video game that promotes for example, where they interact with a visual representation of their own brainwaves to relieve anxiety and promote a better mood. There鈥檚 trauma-sensitive yoga that promotes self-awareness of the relationship between body and mind.

鈥淎fter a collective trauma has happened, people tend to sing and move and dance and eat.鈥�

Van der Kolk also emphasizes the powerful role of community both to harm and to heal.

鈥淭rauma is, in many cases, about a breakdown of community,鈥� he explains. 鈥淚f the very source of protection becomes a source of danger, that is really very bad for people. The community is protective, but if the community turns against you, we become very vulnerable.鈥�

He recounts how the significance of community healing became clear to him during work for South Africa鈥檚 Truth and Reconciliation Commission, which was convened in 1995 to help heal the wounds of apartheid.

鈥淎fter a collective trauma has happened, people tend to sing and move and dance and eat,鈥� he says. 鈥淣one of that is incorporated into [North American] mental health systems, but most of us who have worked with other cultures, or who have worked with refugees, see how much comfort people get from singing, moving, and dancing. 鈥� Songs and communal sounds that we make let us feel at one with the people around us and are very powerful, very comforting ways of re-establishing connections with human beings.鈥�

A Life-Saving Connection In Community 

In an impoverished neighborhood of Vancouver, British Columbia, called the Downtown Eastside, the Vancouver Area Network of Drug Users is a sort of union that advocates for drug policy reform, operates harm-reduction programs such as needle exchanges, and gives drug users a voice in Canadian politics.

Hugh Lampkin is a board member, former president of the organization, and a prominent community activist who鈥檚 taken a lead role through VANDU in Canada鈥檚 response to North America鈥檚 epidemic of drug overdose deaths. For Lampkin, a drug user himself, the road to helping others has been a journey, one that began with childhood trauma. 鈥淚 grew up in Toronto,鈥� Lampkin begins. 鈥淚 always had issues, being a person of color. I used to get beaten up a lot and chased around by other kids who were White.鈥�

A number of incidents of abuse led him to self-medicate with heroin and other drugs. 鈥淚t allowed me to shut myself off, to not feel anything,鈥� he says.

鈥淚 didn鈥檛 feel I had any sort of connection with anybody,鈥� he remembers.

After nearly three decades lost to drugs, Lampkin traveled across the country to Vancouver. 鈥淚 didn鈥檛 want to be around my family and friends, because I understood that I was going to make them hurt. So I decided to come out here [to Vancouver] to kick off 鈥� to off myself.鈥�

鈥淚 wanted people鈥攕omebody, even if only one person鈥攖o feel what I felt that day.鈥�

Lampkin describes one evening in 2006 or 2007, when he prepared his last meal.

鈥淚 went and bought a bottle of 12-year-old Scotch,鈥� he recounts. 鈥淚t was $180 for the bottle. And a bottle of wine that was $200 or $300. I had prime rib and lobster鈥攕urf and turf鈥攚ith scalloped potatoes. And some dope. And dessert, tiramisu.鈥� Lampkin ate, drank, and then injected the heroin鈥攅nough to kill himself, he was sure.

鈥淎nd then I remember hearing birds chirping,鈥� he continues. It was 13 or 14 hours later, and Lampkin was lying on his apartment floor, exactly where he had fallen the night before. 鈥淥K, I鈥檓 still here,鈥� he remembers thinking. 鈥淚t was a relief.鈥�

Shortly after, Lampkin was walking through downtown Vancouver and bumped into a small group of people who were smoking cigarettes outside what looked like a cross between a community center and homeless shelter. 鈥淭hey looked like the sort of people I could hang around with,鈥� he says. 鈥淚 felt comfortable. I felt at ease.鈥� Lampkin had found VANDU.

鈥淎nd I鈥檝e been here ever since, with our little clubhouse of losers,鈥� he adds with a smile.

At a subsequent VANDU meeting, Lampkin shared some of what had happened to him as a child. 鈥淎nd there was more support than I had been given my entire life,鈥� he says. 鈥淚 saw people with tears in their eyes, and there was an acknowledgement. What had happened to me had happened to them.鈥�

Today, nearly 10 years later, Lampkin practically lives at VANDU. He volunteers countless hours, leading training sessions for overdose response, holding meetings on political developments that affect drug users, and generally keeping VANDU鈥檚 headquarters running. It鈥檚 a supportive, nonjudgmental atmosphere of organized chaos.

What鈥檚 kept him there? Lampkin says that in the drug users community he found a home, one where he feels valued and useful.

鈥淚 wanted people鈥攕omebody, even if only one person鈥攖o feel what I felt that day,鈥� he explains. 鈥淭o give a person someone to talk to without wanting anything from them. To just listen. Because for a lot of people, that鈥檚 all they want. For a lot of people, that鈥檚 lifesaving.鈥�

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If you鈥檙e having suicidal thoughts, or know someone who is, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).