Let’s avoid talk of ‘chemical imbalance’: it’s people in distress

https://psyche.co/ideas/lets-avoid-talk-of-chemical-imbalance-its-people-in-distress

by rbanffy • 6 years ago

511 383 6 years ago

psyche.co

Ericson2314• 6 years ago

Rampant inequality ruins everyone's mental health, but not equally and now it's a weird status symbol.

- homeless <=> crazy, bad

- Some anxiety <=> type A hustler, good

- And now: a little depression + access to healthcare <=> "it's just bug", neutral

ixtli4• 6 years ago

I dont know if this is true of everyone but I definitely see this in online communities. People who have access to basic health services still blame themselves for their own conditions and seek individual solutions to collective problems :/

realharo6• 6 years ago

She told me she welcomed the diagnosis of a neurobiological disorder, which confirmed her problem was ‘real’ – brought on by a physiological force external to her volition – and that it showed she’s not ‘just a slacker’.

That is such an arbitrary distinction. As if being "just a slacker" doesn't have a number of deeper reasons behind it as well. Brains are just machines at the end of the day, every behavior is a result of something material...

bladegash• 6 years ago

Dr. K (a Psychiatrist who is also a Twitch streamer) recently touched on this subject with a very popular streamer (write-up/video linked below). He explains some of what you're saying and I tend to agree with you.

Dr. K suggests the brain is optimized for efficiency. If something is not seen by the brain as being unnecessary, then the brain is unlikely to trigger a response that motivates you to complete the task. The example used was going to the restroom - your bladder fills up and your brain tells you it's time to go. Motivation in areas of life was seen as being similar.

In the case of laziness, the bladder filling up is analogous to, let's say, shame reaching a level to where you're prompted to finally clean your room. Obviously increasing shame would be less than ideal, but there are other means for motivating yourself (e.g., purpose in service to others, duty, dharma, etc). He also draws a distinction between apathy and detachment, which are also part of the problem.

Anyways, I'm not sure I agree with everything he said/says, but it's worth checking out and an interesting perspective nonetheless!

Source: https://www.healthygamer.gg/asmongold-talks-to-healthygamer-...

thomasahle2• 6 years ago

Just shows that most people are not hard materialists.

realharo6• 6 years ago

I think many are if you ask them, they just conveniently forget about it in their daily lives.

partyboat15863• 6 years ago

Brains are not machines like your phone is a machine or your car is a machine. They are complex systems and the result of an emergent process rather than designed systems with discrete components.

The analogy that brains are like machines is harmful because it makes it sound like there is some operating manual and simple cause effect relationships that are known. Our knowledge of the brain is in fact very little. It's a false reassurance and reductionist view to see the brain as a machine simply because it is made of material parts that seem to act in a reliable way towards some end.

luckylion2• 6 years ago

The analogy that brains are like machines is harmful because it makes it sound like there is some operating manual and simple cause effect relationships that are known.

Why? We have complex machines and systems as well, where nobody would claim that there are only simple cause effect relationships and you only need a two-page owner's manual.

Drugs work pretty reliably. While you can't predict what exactly is going to happen when you take LSD, you can be pretty sure that something is going to happen. Why, if not because the brain reacting to some chemical?

This idea of "don't say it's a machine, you're oversimplifying it" is what's harmful in my eyes. It leads to anti-scientific positions, mysticism and fatalism. If there's nothing we can do to help, and nothing we can learn because it's so super hyper duper complex and "emergent", why bother. It's not, of course. While we don't know everything, we do know something. And we should extend our knowledge. Pretending that we can't know isn't useful.

realharo6• 6 years ago

I don't think calling it a machine is implying that we understand how it works internally (to a much greater extent than we actually do). Or even that we fully understand how it tends to behave in practice, out there in the "real world", as part of larger systems. But I guess if many people view it that way, then using slightly different language might be better.

What I was getting at is the fact that there is no fundamental difference between "I did it" and "my illness caused me to do it" (other than maybe probability).

Or in other words, no "free will", in the way that some people view that term.

cheerlessbog• 6 years ago

If a space probe discovered some vast alien structure clearly acting fulfilling some strange purpose by some opaque means... would we not usefully describe it as a machine?

bserge5• 6 years ago

They are much more complex, but ultimately, a machine. Without admin access or an operating manual. We don't understand how it works.

It's kind of like trying to put a rocket into space in the stone/bronze age. Or figuring out the Google codebase if it was handed to you in Assembly.

centimeter• 6 years ago

Consequentialists often point out that whether things like laziness are moral failings or are physiological problems with no moral bearing, it still makes sense to treat them as a moral failing, because it’s usually more likely to result in incentives and social pressures that lead to the moral failing/physiological problem being fixed, mitigated, or worked around.

There was an SSC article that had some good discussion on this at some point, but thanks to NYT I can no longer link it.

realharo6• 6 years ago

it still makes sense to treat them as a moral failing, because it’s usually more likely to result in incentives and social pressures that lead to the moral failing/physiological problem being fixed, mitigated, or worked around

When compared to doing nothing and tolerating them, I can definitely see that. But I still think there have to be more effective approaches than either (even if we don't know what some of them are yet).

kqr• 6 years ago

You might be able to go through archive.is which contains a large part of SSC. I find the argument weird because we tend not to handle moral failings very constructively.

css• 6 years ago

to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language

This is a pretty big assertion that the piece casually drops without backing. The reasoning as to why "chemical imbalance" is a bad descriptor is apparent* from the study [0] the author cites, but there is nothing that backs up this statement, which seems to be the crux of the whole piece.

*Even the study cited about placebo affects on depression doesn't _really_ prove the author's point that "chemical imbalance" is a bad term, it just proves that we do not yet understand the processes by which drugs treat depression. If we do not understand the processes, how can the author make the assertion that the characterization they are against is wrong? At most, they could claim "we don't know yet" but certainly not that "chemical imbalance" is categorically false.

[0] https://www.frontiersin.org/articles/10.3389/fpsyt.2019.0040...

DataWorker2• 6 years ago

If we don’t know then we don’t know. Calling it a chemical imbalance implies knowledge that does not exist.

fit2rule• 6 years ago

In fact, isn't the point that the 'ideation' of mental illness as a chemical process seems to further the process somewhat, and therefore some degree of refactoring needs to be done of the language used so that we 'un-know' the details well enough to treat it subjectively?

Fascinating conundrum.

akurzon• 6 years ago

This is a pretty big assertion that the piece casually drops without backing

My understanding was that the results of the author's interviews were the backing for this assertion:

As the interviews made clear, people adopted the biogenetic account because they thought it was based in science. The interviews also show how this account undermines the kinds of introspection and self-examination that can lead to meaningful self-knowledge. Mental health treatment needs to re-engage with the language of persons. This means suspending the detached, third-person stance toward patients, and attending to their actual experience and circumstances. And it means encouraging patients themselves to avoid this stance and draw on the normal ways that people make sense of their emotions and actions.

Or do you mean that the conclusion the author reaches, that we should be attending to people's experiences instead of using "biogenetic causal language," isn't justified by the results of the interviews?

jml7c5• 6 years ago

I'd like to pull the full quote, which is more nuanced:

As I argue in my book Chemically Imbalanced (2020), to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language. Psychiatric research doesn’t support the notion of simple cause and effect in mental health, instead uncovering a far more complex and indeterminate picture of vulnerabilities. There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’. Nor does the beneficial use of psychiatric medicines require it. In fact, their precise mechanism of action and relation to troublesome experience remains a mystery. It would be more truthful for mental health professionals and public health campaigns to acknowledge this.

It's helpful to note the flipped the burden of proof here: the author argues there is no evidence for "chemical imbalance" language, not that there is evidence against "chemical imbalance" language. I see it as an admission of uncertainty rather than claim of knowledge; the use of the somewhat tepid phrases "need to move away from", and "complex and indeterminate picture" are a further sign the statements are not categorical.

Though I could have misunderstood their thesis. I'll find out once I've read the book, I suppose. :-)

Barrin922• 6 years ago

'Chemical imbalance' as a causal explanation seems to me almost useless because every severe change in behaviour pretty much by definition corresponds to change in the brain. How else is it supposed to be manifest? Is there supposed to be drastic change in psychology without change in the brain?

There can be a company pouring lead into a river, psychological hazard during a civil war, and it will always manifest in the brain, what kind of explanation is this? Of course these things can be found in the brain, it would be crazy if they didn't.

That's not to say there's no diseases that are actual individual pathologies of the brain of course, but to use 'chemical imbalance' as a sort of first order response to what may have actual social or environmental reasons say, is entirely circular reasoning.

numpad0• 6 years ago

“It’s not a bug, it’s electronic misplacement”

koheripbal3• 6 years ago

"People in distress" is even more useless. "in distress" could mean anything from having fallen down the stairs, to running out of gas on the highway.

I don't mind changing language, as long as we're become more precise, not less.

If "chemical imbalance" is bad, suggest something better.

I think a bigger problem is that people are fixated on word definitions and offending others instead of solving problems.

Supermancho3• 6 years ago

How else is it supposed to be manifest? Is there supposed to be drastic change in psychology without change in the brain?

There is an implication inherent to "chemical imbalance" that assumes a normative range. Modern medicine is universally based on normative ranges. If you are outside this range, it is considered a problem. Chemical imbalance is a generic and apt descriptor.

A4ET8a8uTh0• 6 years ago

Yes, but you have to see it in the historical context. Not that long ago, mental sickness was caused by various demons, curses and so on. Things change a lot faster now, but it is still taking a while. Hell, being gay was a mental sickness was only 30 years ago.

In other words, it is not useless. It may seem obvious now, but it is not useless.

abnry• 6 years ago

It's interesting the author argues dropping the term to reduce stigma because many people argue for using the term in order to reduce stigma. That is, if you can explain what is going on with you with some biological case, it seems so much less of a personal indictment than if the case is considered to be psychological.

That said, I completely agree that the explanation should be dropped because we really have little to no evidence for it.

bjornsing• 6 years ago

If we do not understand the processes, how can the author make the assertion that the characterization they are against is wrong?

Generally, in a scientific context, characterizations are wrong if they lack any scientific basis.

aantix3• 6 years ago

Magnesium is used by the body to cope with stress.

I've noticed in the past, that when I've been under a ton of stress, I drink coffee, soda, ruminate a ton, and things get worse, much worse.

I've started taking magnesium l-threonate the past few months and it's literally made me a better person. Thoughts come and go. The rumination, the "voices" are much less.

One scoop, three times a day during stressful periods (166mg of elemental magnesium).

The only other solution that's had this profound of an affect on me was Lexapro, but it had too many side effects.

I've done years of therapy but nothing ever seemed to stick. But the l-threonate, the diminished anxiety, those affects seem to stick. Better than any therapy session I've had.

I'll give this much more time to see how it plays out. But I have had the thought wondering if my mental anxiousness and depression all of these years was just a mineral deficiency.

Not that I wouldn't have gotten really sad or ruminated, but that it didn't have to be so bad. I was stressed. I needed lots of magnesium. I definitely was not getting it.

sva_• 6 years ago

Although it is probably not a cure in severe cases as that described in the article, I would also recommend paying attention to one's magnesium intake. However, I found that taking supplements is not necessary. Just find a mineral water that has a high magnesium content (100mg/L +), and it should get you covered as water has a pretty high bioavailability for Mg.

aantix3• 6 years ago

Interesting, I'll have to take a look.

I use to take a large dose of Magnesium Glycinate, which did improve my anxiety. And sleep.

And I've taken epsom salt baths as well. Which helped me relax and sleep better as well.

But none of those have approached the even keeled feeling that the mg l-threonate provides. Maybe it's because l-threonate crosses the blood-brain barrier? Placebo affect? Unsure.

tcj_phx4• 6 years ago

It's easy enough to make your own magnesium water, using magnesium hydroxide (as the laxative Milk of Magnesia) and carbonated water: http://www.afibbers.org/Wallerwater.pdf

Milk of Magnesia is in every grocery store. I buy from Fry's (Kroeger), because their version doesn't have any additives.

amake• 6 years ago

Sorry to reply off-topic, but I wanted to let you know that in response to your request here (which I can no longer reply to): https://news.ycombinator.com/item?id=23677225

I’m about to release an update to Orgro with LaTeX support powered by KaTeX. More info here: https://reddit.com/r/emacs/comments/hsa3ik/orgro_update_inli...

I don’t use LaTeX much, so if you would be willing to test with the kinds of documents you write, or even send me a file to test with, that would be greatly appreciated.

Trasmatta2• 6 years ago

If you're drinking lots of caffeine I'd also recommend taking l-theanine. It's a compound found in some teas and has a very calming effect that counteracts the anxiety and jitters of caffeine. It's really amazing at allowing me to have the concentration boost of caffeine while avoiding many of the negative side effects.

You should do your own research on it first of course, but it's been shown to be very safe.

aantix3• 6 years ago

I have taken l-theanine as well and did like its calming abilities.

But it felt like I became acclimated to it quickly - did you experience this?

Same for CBD - I felt very calm, like my normal self, but also became acclimated after a while.

nkingsy• 6 years ago

This is a beautifully written article with devastating implications. I have no idea if it’s correct.

My summary: psychiatrists have been orchestrating a campaign of disinformation aimed to remove the stigma of mental illness from our culture, but it appears they may have made the stigma worse.

TheAdamAndChe• 6 years ago

Anyone who speaks of psychological issues with absolute conviction is wrong. Psychological processes and coping mechanisms are affected by hormones, neurochemicals, and lifestyle. Hormones, neurochemicals, and lifestyle are affected by psychological processes and coping mechanisms.

While drugs aren't a panacea, they can help many with fixing psychological processes that are messed up.

UnpossibleJim• 6 years ago

Exactly. What I think people lose sight of is that people with chemical imbalances do, is to create all sorts of behavioral coping mechanisms in their daily lives before they ever see any type of chemical intervention. Once they get that chemical intervention, they then need to deal with the psychological and behavioral issues built up over the years of dealing with a chemical imbalance.

This isn't like a simple infection, where you take a pill and it will go away.

Nav_Panel• 6 years ago

Yes. Psychology must be treated cybernetically, as a historical system of self-environment relationships, which produce state changes within the self.

For anyone interested in "chemical imbalance" theory, I highly recommend reading Carhart-Harris and Friston's paper "REBUS": http://pharmrev.aspetjournals.org/content/71/3/316 -- the basic gist of Friston's model is that the brain functions as a prediction engine, whose "prior probabilities" are "programmed" by past experience (within some environment). This paper addresses the role of serotonin: it reduces the "weighting" of our "prior probabilities" which gives them some malleability, meaning we can allow ourselves to adjust more fully to a new environment (or, if you flood yourself in serotonin, like with psychedelics ... it can nudge your highest-level priors, such as "who am I"?).

So from this perspective, we can see depression as a mis-adjustment between one's self (i.e. adaptation to past environments) and one's current environment (no chemicals involved here), and serotonin can provide a little nudge toward re-adapting.

golemotron• 6 years ago

I miss the term neurosis. It seems like we're taking another step on Pinker's Euphemism Treadmill.

mtgp10002• 6 years ago

Came here to make a similar comment. Scientists are not supposed to be activists - focusing on eliminating words that carry stigma from popular (or scientific) use makes me question not just objectivity but qualifications as a scientist.

Is there any space that ideologues haven't infested yet?

RaptorJ• 6 years ago

No, I'm very sorry report that there are exactly zero areas of human action, practice, or thought that aren't infested with ideology.

thomasahle2• 6 years ago

Can that be avoided? Eventually any term loses its connection with the best available knowledge, and becomes a way to avoid thinking - an euphemism. We then need a new updated term. Eventually that term too will be outdated, but at least it was useful for a while.

nsl733• 6 years ago

I find the chemical imbalance metaphor for mental illness the opposite of empowering and an easy well to sell pharmaceuticals.

There is some truth to the metaphor, but I wonder if it’s doing more harm than good.

asveikau3• 6 years ago

If you have been close to a psychotic person who refuses to take antipsychotic medication (a common enough problem that I have faced with multiple people), the "just trying to sell drugs" story gets old very fast. A lot of people really do need the drugs in order to stop harming themselves.

I think this article does a disservice by suggesting that people on such drugs are trying to get over a minor breakup. And actually that does a disservice to very depressed people and somewhat misunderstands them too. (There is also such thing as psychosis in severe depression, btw.)

It might be true that a trauma and stress that appears benign to someone else triggers such a terrible condition. But once the sufferer gets stuck in that loop... The drugs are very often the best idea available. Avoiding them can be harmful to the health of the sufferer.

opportune3• 6 years ago

There’s a difference between antipsychotic medication and medication like SSRIs or anxiety medication. Not only in effects/potentially in necessity, but antipsychotic medication can be very dysphoric and sedating, whereas some people experience SSRIs positively and others negatively, and where anxiety meds are generally well liked (to the point of dependence becoming a real risk). Also whereas antipsychotics and anti anxiolytics are generally quite effective at treating their specific purpose, SSRIs are relatively ineffective, and anti anxiolytics are often not considered long term solutions (at least to GAD) in part because of the tolerance/dependence/addiction effects.

So I don’t think it makes sense to paint all psychiatric medicine with the same brush

CivBase• 6 years ago

I get where you're coming from, but we cannot just ignore the obvious incentives at play here. Pharmaceutical companies do want to sell drugs and many have a history of being not-so-ethical about it.

Of course there are people who legitimately have disorders who legitimately benefit from the drugs. But we also need individuals who cast a critical eye on drug prescriptions. The hard part is making sure those critical individuals are sufficiently trained.

If you have a friend who refuses to take drugs prescribed by a medical professional, maybe it would be best to get a second or third opinion from another medical professional.

nsl733• 6 years ago

Please don’t consider my initial statement questioning a metaphor to mean that people that have suffered a psychotic episode or are likely to suffer a psychotic episode in the near future should avoid medication. The threshold for considering medication should be lower than a psychotic episode.

My concern is the metaphor in which many people are viewing mental health, not in the treatments themselves.

aka1234• 6 years ago

"There is some truth to the metaphor, but I wonder if it’s doing more harm than good."

In my experience, whether the metaphor does more harm than good really depends on the individual patient.

When faced with the chemical imbalance metaphor, some people will bristle and say they're not "broken." Or they'll feel disempowered because they feel like they can't do anything but take a pill (or three).

---

For others, it lifts a weight off their shoulders. Most people battling with mental illness have struggled and tried various coping mechanisms to feel "normal." The understanding that the issue chemical, not behavioral, lets some people forgive themselves.

Instead of "not being normal enough", the cause is external; it's something they can't just brute force their way out of. Externalizing the issue lets the person stop feeling guilty that they weren't able to solve their own issue. This clears the slate for the person and leads them to a path toward recovery from mental illness.

NOTE: I'm not a doctor. But everyone in my immediate (and most of my extended family has been diagnosed with a chronic mental health issue. So has my wife, our girlfriend, and many others in my life. So it's well-founded anecdotal evidence. And, for what it's worth, I'm in the second cohort I described above.

PragmaticPulp7• 6 years ago

an easy well to sell pharmaceuticals.

It's easy to forget that modern generic SSRIs are dirt cheap.

$4-5/month is typical. These compounds are trivial to produce. Many pharmacies don't even operate as money makers. They just want you to pick up groceries while you're in the store.

Picking up a couple of apples while you wait for a prescription to be filled might cost more than the medicine itself.

It's true that there are more expensive on-patent medications available, but it's reasonable (and encouraged) to start with the cheap generics first.

sillysaurusx• 6 years ago

they struggled against the dehumanising notion that their thoughts, feelings or behaviour were mechanistically caused.

Finally, a thread where I can point out my own experiences.

Around four years ago, it would be fair to call me slightly crazy. It was a harmless sort of crazy, but it was quite self-destructive. I used to wake up wishing to die, genuinely, and not knowing why.

All of that changed after going on Prozac. I don't know why, and I've heard from many others that Prozac was harmful to them. But from my point of view, it was nothing short of a lifechanging miracle. I can't remember the last time I've had suicidal ideation.

Most people keep this sort of thing quiet, and I think silence is part of the problem. When I was younger, I might have looked down on someone for saying what I just said. When you have a broken leg, everyone notices and can relate; when you have a broken mind, no one can see it, and so no one can feel sympathy, let alone empathy.

So what's the takeaway here? One: do not lose hope. I came very close to losing hope, and it would have denied me so much. Two: make a doctor's appointment. There's a chance that you'll wind up on something that makes the situation worse; you need to make a followup appointment ahead of time.

Support networks only got me so far.

PragmaticPulp7• 6 years ago

All of that changed after going on Prozac. I don't know why, and I've heard from many others that Prozac was harmful to them.

SSRIs are some of the most widely-used medications. Tens of millions of people in the United States alone use SSRIs regularly with good results.

No medication is perfect, obviously, and at scale we're bound to see a percentage of people have negative experiences. The problem is that when tens of millions of people have tried SSRIs, even 1% significantly negative reactions adds up to a very large number of people. If 1% of those negative reactions make a point of blasting their negative experience all over the internet, we'll see thousands of negative reports everywhere.

Combine this with the fact that few people are willing to publicly admit that SSRIs helped them, and the bias toward negative reviews online is huge.

SSRIs are a particularly difficult topic, because they have a noticeable treatment lag (can take up to 1-2 months for positive effects, with positive effects increasing up to 6 months out) and can, in some cases, temporarily worsen symptoms during the initial ramp-up period.

Even more difficult, not all SSRIs are the same. It might take 2-3 trials before someone finds the SSRI that works best for them. It might also take several dose adjustments to find the right tradeoff between efficacy and side effects. Unfortunately, many people go online and seek out horror stories before they have a chance to go through a few rounds of medication adjustments to make it work for them.

Thanks for sharing your positive success story online. SSRIs aren't for everyone, but it would be a shame for people to spend years suffering from depression when a few SSRI trials might reveal an easy improvement to their lives. Worst case, they can taper off (tapering helps avoid discontinuation effects) and move on to different treatment avenues.

slfnflctd• 6 years ago

Great comment, I mostly agree. There are clearly many people who've been helped.

Some of the other contraindications (for the disparate group in that 1% you mentioned) are still important to mention, I think.

If you're not certain you'll always have health insurance. If you may ever want to try MDMA therapy, or just about any type of psychedelic therapy (or use them recreationally). If you're uncomfortable with being on something like this super long term and/or are concerned about withdrawal issues. If you can't stand the thought of risking becoming a happy-ish, functional zombie with no sexual interest in your partner. If you're worried the doctor won't diagnose you correctly. If you're not sure you can emotionally handle going through potentially a year or more of trial & error and having to wait months each time for results. Then think twice.

I am extremely glad for the people SSRIs have saved, especially those who wouldn't have made it otherwise. It is also incredibly clear to me that despite my continuing issues with depression, they are probably the wrong approach for me.

tcj_phx4• 6 years ago

When a patient's symptoms are treated instead of the cause, most people will have subpar results.

The SSRI Lexapro [0] helped my girlfriend relapse on cocaine, before i met her. Cocaine is a much stronger anti-depressant than the SSRI's due to its effects as a Mono-Amine Oxidase Inhibitor [2] (1st generation anti-depressants).

Eventually the professionals figured out she is a poor methylator, and can't convert folic acid into Folate. Folate (Vitamin B9) is important for DNA synthesis. Food companies fortify with folic acid because it's more stable than other forms of Vitamin B9, even though we now know that some people are harmed by this fortification [1]. On the whole, fortification seems to be beneficial (fewer deformed babies), but poor methylators and old people seem to have negative side effects from getting their vitamin B9 from folic acid.

She said adding the L-Methyl-Folate was like flipping a switch between "depressed" and "normal". Her involuntary medical professionals didn't say, "hey sorry we made a mistake, you're not actually broken", and continue to ignore the actual causes of her condition.

[0] https://en.wikipedia.org/wiki/Escitalopram

[1] https://now.tufts.edu/articles/folic-acid-too-much-good-thin... / https://www.futurity.org/folic-acid-too-much-of-a-good-thing...

[2] https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor

(edit - added bit about cocaine being an MAOI)

richardlblair2• 6 years ago

You make a lot of great points.

If I could add anything to the SSRI topic it would be that mental health treatment is incomplete without a form a therapy. If a person's treatment plan includes SSRIs, that's great, but it should always include therapy.

cmehdy• 6 years ago

There are also other categories of medications which people forget, with the spotlight being on SSRI. Off the top of my head there's also SNRI[0], NRI[1], MAOI[2], RIMA[2], and TCA[3].

Arguably for low to moderate depressive disorders there hasn't been conclusive evidence that psychiatric prescriptions work, however there IS conclusive evidence that for major depression the benefits are at a minimum "small" and up to "substantial" ([4],[5]).

So as soon as we discuss depression, everyone might mean something different. It's a sad state of affairs because now people think they're talking about the same things but they're really not - they just happen to have had different psychiatrists who assessed things and behaved perhaps differently, and where one might have really mostly needed therapy and the other both therapy and antidepressants, in the end everyone went home with a prescription for the fancy SSRI of the year. Psychiatrists as a whole need to reevaluate the rate of prescriptions, the tools to assess major depressive disorder, and the actual array of treatments that are available to them.

I've had wrong diagnoses. I've had appointments that my doctors missed without rescheduling even though I was there. I've had those 15-minutes-and-you're-out meetings with a psychiatrist, whose prescriptions for what conveniently is the "newest pill" were given along with free samples until one day you have to pay for something you can't afford or switch treatment and deal with weeks of uncertainty, and so on.

I have been saved from death and cycles of immense self-destruction by a healthy relationship with a knowledgeable and experienced psychiatrist willing to take me, when my legal troubles had by then reduced my options and driven me further to the edge. Some real discussions, a carefully explained switch from SSRI to RIMA, which worked. "Is that what it is to feel somewhat normal? I can't believe people feel like that most of the time!!"

It allowed me to truly know what therapy is, because there was more to the day than being unconscious or wanting to be dead or death-by-proxy. Therapy gave out some tools to live and interact in a healthy way with myself and others, and to seek more tools too.

The struggle still exists entirely and comes back in heavy waves some days. A lot more difficulties are now an inherent part of my life and rebuilding things will take time and struggles. But psychiatric treatment gave me legs I had lost for nearly all of my life, and therapy taught me to walk again, and I'm well intent on walking out of everything I fell into - regardless of how long and arduous the path is. And whenever I'm able to, to take others out of the pit too.

[0] https://en.wikipedia.org/wiki/Serotonin%E2%80%93norepinephri...

[1] https://en.wikipedia.org/wiki/Norepinephrine_reuptake_inhibi...

[2] https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor

[3] https://en.wikipedia.org/wiki/Tricyclic_antidepressant

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712503/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253608/

vharuck• 6 years ago

I was "lucky" to have been majoring in psychology right before getting diagnosed with major depression. So I went into treatment knowing things like this that helped me stick with it.

Which was a literal lifesaver, because the first SSRI I took gave me severe stomach pains. I spent at least 2 hours every night spitting into the dorm room sink with the lights out.

Instead of quitting, I knew to ask for a different SSRI. I also knew to switch therapists when the first one just talked at me the whole time. I then got one who listened a lot at first, then started challenging things I said after we had some trust.

And one more helpful thing J knew: medication was like a crutch. And, despite that usually being a negative metaphor, I saw it as a positive. If you break your leg, you use a crutch while it heals. Your treatment should be the crutch (meds) and therapy. The therapy works better when you can think better.

I ended up not needing my meds anymore. I still have overall flattened affect and bouts of depression, but I can deal with them. To torture the metaphor, it's like having a slight limp from the broken leg. I'll never be "back to normal" but still find life worth living.

ryneandal2• 6 years ago

That's fantastic you found the right SSRI for you immediately, that's incredibly rare. I second the sentiment that when you find the one for you and everything clicks, it's a truly life-changing experience.

One thing to watch out for with Prozac is diminishing sensitivity in the nether regions, that's probably the biggest reason I tried a few others and transitioned to another medication.

PragmaticPulp7• 6 years ago

That's fantastic you found the right SSRI for you immediately, that's incredibly rare.

It's not accurate to say that it's "incredibly rare". Most people can expect at least some dosage adjustments, if not a few trials of different medications.

However, most people will see some improvements from any antidepressant treatment, even if it's not full remission. Getting to full remission is the challenge that requires fine-tuning.

Practically speaking, antidepressant medication shouldn't be viewed as a one-stop solution to depression treatment. It should be used as a larger treatment regimen involving therapy (ideally professional, but even self-directed with books is helpful) and lifestyle changes to identify and address the source of the problems.

As such, even a minor boost from an antidepressant can help move a person in the right direction, even if it isn't a one-stop cure for the depression. We need to collectively get past this idea that antidepressants are an all-or-nothing cure all and start viewing them as an adjunct to getting back on your feet and staying there.

thelittleone2• 6 years ago

Thanks for sharing. I've always been firmly grounded and positive person. And then a few years ago riding my bike down the road, I felt a immense wave of anxiety coming over me so intense that I felt like jumping off my bike and running away from myself. As an ex army special forces guy I found this particularly disturbing. And this was just the beginning. My situation continued in that general direction until I started experiencing pain in my liver area. I hoped it would go away but it didn't, so two months ago I decided to face it head on and get full tests done. Xrays, CT scans, ultrasounds, blood work. urinalysis the works. All came back clear. But I just felt it was not me... and searching my symptoms pointed to parasites. So I did a 6 day liver cleans (cant recommend this enough) followed by adjusted diet and two rounds of combantrin I'm please to be back to a very good place.

Depression and anxiety are nasty. I was surprised to learn they are symptoms of parasites. They've evolved in such a way that they can manipulate the host into craving foods that are beneficial for them (not for the host). Symptoms among others include anxiety, depression and irritability.

johnchristopher2• 6 years ago

What parasites are we talking about and what's a 6 day liver cleans ? (I mean, the procedure).

Do you mean to say you had depression for a few months (with anxiety on top) ?

wincy5• 6 years ago

Wow, this is a very interesting story. Another person might have just resigned themselves to their angst-ridden fate, and never gone beyond psych meds. It seems like generalist doctors (I’m sure lot all!) think, or at least act, as if there’s no link or causal relationship between mind and body. I did a three day fast which reduced my anxiety symptoms immensely for months, glad you sorted this out.

numakerg• 6 years ago

Symptoms among others include anxiety, depression and irritability.

It wasn't until the late 1800s that the miasma theory of disease was overturned in acceptance by germ theory. At some point in the next century, computers will become powerful enough to closely simulate the entire human body. We'll be able to hook up our bodies and compare them to a common model in a sort of "debugging" process. I think what we'll find is a diverse host of viruses and parasites, or other curable abnormalities that are responsible for mental health problems.

wincy5• 6 years ago

I started having disturbing, invasive thoughts a few months before the pandemic hit. I’d be watching a movie with my family after dinner then boom, I’d feel insane. It wasn’t suicidal just things like “soon you will be DEAD!” kind of stuff. Turned out it was me reacting to some of the food we were eating at home.

The GP I saw suggested Lexapro which I’ve taken before and it’s not for me. I told him the problem had a strong correlation to food; if I fasted I didn’t get these thoughts. Doctors look at you weird when you say you think asparagus is driving you mad. He just sort of ignored me, I think the fact I saw him right after the pandemic hit just made him assume I was depressed and anxious because of the lockdown.

The really crazy thing to me is that Nexium has basically made the problem go away (Prilosec worked but wasn’t quite as good) I saw a GI specialist and he showed me the low FODMAP elimination diet and suggested I eat low FODMAP foods and that has helped it the rest of the way. So crazy how much our gut can affect our mood and psychological profile.

calibas• 6 years ago

Many neurological disorders are at least linked to gut bacteria, including autism and schizophrenia.

https://www.sciencemag.org/news/2019/05/gut-bacteria-may-con...

https://www.psychologytoday.com/us/blog/balanced/201903/schi...

maksimilian• 6 years ago

You should check out this company studying the gut brain axis :)

https://www.kallyope.com/

77pt772• 6 years ago

So crazy how much our gut can affect our mood and psychological profile.

This is anything but crazy. It has been well known for a very long time and is very well supported.

jquery2• 6 years ago

I started taking Prozac a few months ago. It might just be a coincidence but I checked myself into drug addiction treatment a couple months later. I’ve stopped taking almost everything but the Prozac and my life is immeasurably better and my depression is gone. I’m happy for the first time in many years.

This to me hints at the effect of Prozac possibly being far more complex than “chemical imbalance”. I’ve never found that terminology that useful. Fixing my depression required a lot of chemical changes yes, but also major changes in my voluntary behavior. All of it was connected in an intricate tapestry and Prozac only plays one part. If I tapered off Prozac, I suspect I would still be happy, but I don’t know that my depression would have ever resolved properly without Prozac. The side effects are mild so I am in no rush to discontinue.

pantaloony• 6 years ago

Hold up. Is the specter of existential angst, rising to outright horror if left unchecked, not just, like, a normal part of life that rises to conscious thought as soon as you’re not distracted, for the entire non-religious population?

andreilys• 6 years ago

they struggled against the dehumanising notion that their thoughts, feelings or behaviour were mechanistically caused.

The realization that thoughts think themselves was one of the most profound moments of my life.

Identification with your thoughts is a recipe for unhappiness.

hoorayimhelping• 6 years ago

You don't have to listen to everything your brain tells you

duderific• 6 years ago

I've seen bumper stickers: "Don't believe everything that you think."

donatj• 6 years ago

My wife just started Prozac after years on other medications, and has had a similar “miracle”. Her mood has been the stablest of the last 10 years I’ve known her. It’s been life changing for her and thus myself, as selfish as that feels. Anyway just really glad to hear another’s similar story.

tcj_phx4• 6 years ago

One of the ways that Prozac helps people is by increasing allopregnanolone in the brain [1]. This is a well-known effect of Prozac, and perhaps the other SSRI's. Allopregnanolone "is a neurosteroid and acts as a positive allosteric modulator of the GABA-A receptor, the major biological target of the inhibitory neurotransmitter γ-aminobutyric acid (GABA)" [0]. GABA -> relaxation [2]. GABA supplements don't work very well on account of the blood brain barrier...

An evil pharma company recently got their version of allopregnanolone approved to treat postpartum depression. Cost of treatment: $34,000. It's cheaper to go upstream: progesterone, pregnenolone, or figure out why the body is having trouble making pregnenolone from cholesterol... Vitamin A? Thyroid?

One theory of why women experience postpartum depression is that their progesterone levels "fall off a cliff" after they give birth. In theory supplementing progesterone would help postpartum depression better than allopregnanolone. No one can afford to do that study because there'd be no pay off, as all the important patents have expired.

[0] https://en.wikipedia.org/wiki/Allopregnanolone

[1] https://scholar.google.com/scholar?q=allopregnanolone+fluoxe...

[2] https://en.wikipedia.org/wiki/Gamma-Aminobutyric_acid

stainforth• 6 years ago

So market incentives are provably not the way to best outcomes for humanity?

GordonS• 6 years ago

I've suffered with depression my entire life, or at least as far back as I can remember. Even as a young child I felt that way - despite the fact that my mother was a manic depressive (with multiple suicide attempts and stays in psychiatric hospitals over the years), I didn't recognise it as depression until I was much older; firstly because it was how things had always been, and secondly I guess because I got so good at hiding it that I'd subconsciously convinced myself.

I was always sad, and saw little meaning in my life, or in life at all, really. I cried lot. I frequently fantasised about killing myself, though I never got close to actually doing so.

I never talked about the way I felt. I felt ashamed, and I felt that people wouldn't understand - I've often heard "normal" people talk of how depressed people should "man up" or "get over it". Over the years, I got very good at hiding my true feelings. AFAIK, nobody ever guessed.

Maybe 5 years ago I started taking 5-HTP, which I believe has an SSRI effect (but one that is more short lived than pharmaceutical SSRIs). I actually started taking it for another reason (neuropathic pain, which has of course not helped with depression!), as I'd never considered treating the way I felt with chemicals, but within a few weeks the difference in me was incredible - I realised I hadn't cried in a while, and hadn't felt the immense lows that I felt every couple of weeks or so.

I still take 200mg twice a day, and get immense benefit from it - it's not a cure by a long shot, but after a lifetime of feeling miserable, the change is amazing. I seldom cry for no reason, and I rarely experience extreme lows (and when I do, they are less severe and shorter lived).

More recently I also started taking ketamine for my neuropathic pain, but it's actually further enhanced the anti-depressive actions.

I've tried SNRIs and SSRIs for my neuropathic pain, but am unable to tolerable them. If anyone else is in the same position, I'd very strongly recommend reading about 5-HTP and thinking about trying it. If you've tried SSRIs and they've failed for you, then it might be worth looking into ketamine (though I realise that may not be an option depending on where you live).

chasd00• 6 years ago

I'm the same way with ADD, getting on medicine changed my life. Unfortunately, i waited until my 30s to actually go to a doctor (at my poor wife's demand, i mean suggestion). All my life I had been told i wasn't smart enough nor studious enough to do the things i wanted and so struggled through it all. Getting on a medication changed everything for me. I use the analogy of imagining your day as a good, solid, sprint. You finish tired but you did it and feel good about it. For an unmedicated person with ADD it's a good, solid, sprint but up hill. Everything is just that much harder and exhausting than for a normal person.

ADD drugs obviously get abused and so I think they get a bad reputation and, for sure, can be dangerous and have side effects.

Same goes for pain medication. For real, genuine, chronic pain sufferers Oxycontin and the others are life changing. However, the drugs also get abused and are addicting so the real benefits can get masked.

The last thing i'll say is it takes a disciplined prescriber when dealing with these kinds of drugs. As software engineers, I'm sure we're all guilty of just throwing code at a problem. Many prescribers are guilty of just throwing Adderall at a problem or throwing Oxycontin at a problem without really understanding the root issue.

throwaway_kufu2• 6 years ago

When you have a broken leg, everyone notices and can relate; when you have a broken mind, no one can see it, and so no one can feel sympathy, let alone empathy.

This hits home and almost moved me to tears. I went through a trauma about 3 years ago, I was Kidnapped/abducted from a gas station at gun point and was forced to drive my attacker for nearly 30 minutes at gun point under threat of death before opening the door and diving out of my moving vehicle to escape. During that experience I considered purposely crashing my car believing it would kill both me and my attacker, but I wanted to live and ultimately took my chances diving onto the street from the moving car knowing I might get run over.

I can’t explain it other than I know I should have been thankful/grateful/happy I escaped with my life, but I knew immediately the trauma was real and sure enough it has been a downward spiral of cutting off every single relationship in my life and extreme isolation/avoidance. I’ve sought help/treatment (both therapy and meds) to no real benefit.

Even 3 years later I have to relieve the trauma because I’m suing the gas station for negligent security (turns out the guy had been loitering at the gas station for 2 hours prior to targeting me, even hanging out in the store talking to employees without ever making a purchase). The insurance attorneys are victimizing next worse than my kidnapper, they have destroyed the surveillance video, Claimed the kidnapping didn’t happen on their property (when I was literally approached while at the gas pumps), and telling me my damages aren’t real. This goes directly to your point, if I were shot they would have settled the policy limit ($2M) but because it’s not visible damages they are doing everything to claim it didn’t happen on their property, if it did they aren’t liable, and if they are liable the damages aren’t real but self inflicted. They either have no clue what kind of additional trauma they are causing or they actually do and are trying to cause me self harm so this goes away for them.

I humbly admit while I always felt for people who went through traumas (soldiers, child abuse, sexual abuse) I realize now I was incapable of actually empathizing...I won’t say I have suicidal ideations, but I often feel I’d have been better off not surviving.

jquery2• 6 years ago

I’m so sorry to hear that. Keep fighting the good fight. Don’t give up. You survived for a reason. You have a purpose. Only you can figure out what that purpose is.

cyberdrunk• 6 years ago

I'm very sorry to hear about your ordeal, it sounds absolutely horrible. However, it's surprising to me that a commercial outlet in the US is basically responsible for keeping the bandits away. In my country I really doubt such thing claim have any chance in country, as public security is seen as a role of the police. I'm not 100% sure on the law, but I believe that, here in Poland, the security guards are there to protect the company's property and have no legal obligation to protect anyone else.

billman• 6 years ago

Thank you for sharing. I'm glad your still here to relate your story. I think speaking these things is an important part of the healing process. Pax et bonum.

Bx6667• 6 years ago

I also got ptsd in a domestic setting. Please remember it gets better with time. I’m sure you already know this, but MDMA has been shown to be effective in treating ptsd. I was personally able to get rid of most of the symptoms with large doses of propranolol. Try both of those before killing yourself.

gnulinux• 6 years ago

I had a similar experience with Prozac, albeit less extreme. I was depressed and very anxious about anything and everything. Started Prozac + CBT therapy, it had no side-effects and I was feeling really much better in a matter of weeks.

LibertyBeta• 6 years ago

This plays nicely into the idea that human consciousness is really just our brain meats way of resolving the internal understanding of the world with the outside understanding of the world.

Mental health, and any issues you have with it, are a hitch in that system. But to assume that you can fix is by only affecting one part(the internal understanding of the world) seems flawed for me. Same can be said, like in the article, of only fixing the outside understanding of the world (chemical changes).

So let me add my voice to your message, don't lose hope! We are a ball of walnuty textured jelly that tracks changes between the inside view of the world with the outside input of the world using lightning and chemicals. Its complex, hard, and the fault surface is huge.

Keep going, try new solutions, find someone one who helps you build the solution for you. But please, _try_.

_h7ky• 6 years ago

Most people keep this sort of thing quiet, and I think silence is part of the problem.

For the sake of this, I post about it online on occasion when the topic comes up -- an SNRI, Effexor XR, was life-changing for me, too. I suffered from crippling anxiety; my therapist diagnosed me with generalised anxiety, social anxiety, and major depressive disorders. Cognitive-behavioural therapy helped me live me life instead of letting it be controlled by these issues, but the issues were still there, and quite intense. There were some nights it just totally overwhelmed me. On Effexor XR, that never happens. Anxiety and depression are not only no longer constantly looming over me, but they are completely gone.

However, the first thing I tried was citalopram, an SSRI. It mostly got rid of them too, but I never felt quite like 'myself'. I felt like a zombie and like a bit of my soul had been taken out. Plus it wasn't entirely effective like Effexor.

(For what it's worth -- diet, exercise, and so on were tried too. No benefit to my mental health. I've also given more time than they're worth to various supplements that people report as helping their own issues.)

xivzgrev2• 6 years ago

I’m glad you got help. Sometimes the only thing keeping me going is that suicide is a permanent solution to a temporary problem, and there is something else to try. Medication also helped to prevent me from going too low

richardlblair2• 6 years ago

I'm glad it helped, and I think offering up stories from all angles is really beneficial, especially when it comes to mental health. The reality is, there is no one size fits all solution, so the more people talk the better off everyone is.

I took one of the offshoots of Prozac for three months and it took my suicidal thoughts to a whole new level. For me it's all about therapy. A lot of what I'm facing is less about hormones and more about emotional trauma, so these pills are trying to fix the wrong thing. It's like fixing your breaks when the engine doesn't start. Sure, they are both parts of a car, but they couldn't be doing more different jobs.

My experience with therapy has been really eye opening. I think everyone can benefit from some form of therapy. I think the world would be a much better place if people were able to feel their emotions, explore them with curiosity, and learn from them.

Lastly, take care of yourself, friends. If you're not feeling well, please talk to a professional. They can help you.

AnIdiotOnTheNet2• 6 years ago

As a counter point, I was on prozac (fluoxetine) for about a year after being diagnosed with major depression. Everything seemed better at first, but my personality changed in a way that, when I looked at it objectively, I did not like and eventually I felt as though the drug was merely masking depression that never actually went away.

My personal opinion having talked to doctors, therapists, and other depression sufferers is that the medical industry's treatment of depression is basically just throwing darts and hoping. They only kinda have a rough idea of how to treat some of the symptoms of depression and care not for any potential underlying causes. The "chemical imbalance" language, in my considered opinion, really does enforce this world view that depression is something you just throw drugs at until you're fixed, and I don't think that's helpful.

Kalium• 6 years ago

As far as I can tell, there isn't a clear consensus on the precise causes underlying depression. It's challenging to treat causes when you lack a mechanistic understanding. So, yes, they've developed treatment protocols that use the tools they have available that sometimes work.

I don't think anybody considers this ideal, but many consider it preferable to no ability to treat at all. A world in which a deeper understanding of fundamentals enabled full treatment would be best for everyone.

It's not like nobody is trying! But setting a bone doesn't require a deep understanding of how bone knitting happens, and therefore comes well before.

apollopower• 6 years ago

The book "Lost Connections" by Johann Hari (which I discovered through HN) has helped me a lot in understanding so much of the context of what makes so many of us feel depression and anxiety at many points in our lives. A big part of the narrative is that we are too quick to diagnose and provide ourselves with medication without really understanding environmental variables that have impacted our overall well-being.

While I do believe our understanding of how the brain functions still has a long way to go, which includes treatments for mental illness, there is something to be said about acknowledging more the external factors of our modern day lives that fill us with so many problems.

Personally, realizing where I have "disconnected" from people, values, and truly human experiences has been a large step forward in improving my mental health. I hope it's something that others who feel so many emotional challenges can try as well to see if they can make progress with their own mental health.

thex10• 6 years ago

From TFA:

There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’.

The Lost Connections book, which I read a few years ago, really helped hit this home for me. Totally made me reconsider my view of depression and treatment.

heavyset_go2• 6 years ago

'Chemical imbalance' is an oversimplification used to explain mental disorders to the layman, along with the fact that certain medications that effect neurotransmitters are effective treatments for said disorders.

I agree that, often, these disorders are a product of environment, along with economic, social and material conditions. However, medications can and do improve the quality of life for people who cannot change those conditions due to their station in life.

mcnamaratw• 6 years ago

I'm not technical in this field. But "reductionism" shows up all over.

In solid state physics, where reductionism is definitely a powerful and useful tool, the following article seems to be interesting. It's a possible reminder of what you maybe can and can't get from reductionism. https://science.sciencemag.org/content/177/4047/393

No clue how much of that (if any) might apply to psychology.

clevergadget• 6 years ago

I use chemical imbalance as a convenient terms for friends to explain that there is nothing they can really 'do' at the time in that particular expression of symptoms. "It's Chemical" is something they can understand.

amINeolib• 6 years ago

A major issue is that a single cartel controls medical(physicians/AMA). It's not necessarily science backed, so this leaves non science issues filled with tradition and authority.

Are lifetime outcomes really better on all these Drugs? Maybe after you already created drug addictions, a different drug would help.

Prior to drug use, I imagine therapy, monetary support, education, etc... Would all be better than 2020s brand name Adderall.

standardsam• 6 years ago

If anyone else struggles with anxiety I highly recommend the DARE book. It's essentially CBT but framed in a way that finally really clicked for me.

PragmaticPulp7• 6 years ago

Many depressed people are very resistant to accepting treatment. In a perfect world, people would have no hangups about scheduling an appointment with a therapist and/or trialing antidepressant medication as an adjunct to their recovery.

However, in the real world many people are resistant to the idea of therapy and/or medication as it feels like admitting defeat. Or perhaps they've read cherry-picked horror stories of bad therapists or medication side effects on the internet.

Giving people the "chemical imbalance" narrative is a way to short-circuit many of those internal objections. It gives people a notion that the depression isn't their fault, but rather they are a victim of a chemical change in their body not unlike getting the flu or having low testosterone levels.

In terms of getting people to accept treatment, it's a win. Getting past the ego can be surprisingly hard, but the idea that we're treating chemicals instead of treating the person is a clever trick to sidestep that obstacle and shortcut to the treatment.

In terms of giving people the tools to address their problems, it's not so clear. The more we reinforce the idea that depression is simply chemicals in the brain, the longer it takes for people to realize that they do have some power to influence their thought processes and voluntarily replace negative thought processes with positive ones.

However, it's important to remember what a typical course of treatment looks like. If someone is suffering from depression, getting them to commit to weekly therapy sessions with another person as well as following up with the therapy homework (that is, actually implementing what was discussed at therapy) can be a difficult proposition. Getting someone to stop by the pharmacy on the their way home and spend 10 seconds taking a pill every morning for the next 30 days is an easier proposition. The medication is often the jolt that gets people into a place where they're receptive to therapy, or they start making life changes to improve their depression. It's a quick and easy way to give people space to solve their problems, which is why the "chemical imbalance" sales pitch has become the entry point to getting people on board with treating their depression. Get them to lower their guard, get them started on the easiest treatment, and then work on scaling the treatment up to a more intensive, longer-term plan after they've seen hints of success.

I don't particularly like the "chemical imbalance" sales pitch either, but it really does function as a decent hook for getting people over their objections to starting treatment.

DataWorker2• 6 years ago

It seems like anybody familiar with the history of the profession would be wise to not so easily “accept treatment.” But then again, even insiders like Jordan Peterson will “accept treatment” that nearly kills them. The hubris isn’t unique to any one branch of medicine, but consider that not very long ago shock treatment for homosexuals was the accepted treatment. That should give you pause if nothing else.

PragmaticPulp7• 6 years ago

It seems like anybody familiar with the history of the profession would be wise to not so easily “accept treatment.”

It's amazing how mainstream the anti-psychiatry movement has become. Please ignore it and focus on the modern science. The attempts to dismiss modern science with questionable historical references is non sequitur.

But then again, even insiders like Jordan Peterson will “accept treatment” that nearly kills them.

Jordan Peterson is not an insider. He's not even a good representative of the industry. Please don't interpret anything he says or does as representative of the field. He's a social media star, not a recognized expert.

chrisandchips• 6 years ago

However, in the real world many people are resistant to the idea of therapy and/or medication as it feels like admitting defeat. Or perhaps they've read cherry-picked horror stories of bad therapists or medication side effects on the internet.

This is hugely compounded by the fact that even when people do decide to go for treatment like therapy, they discover that its painfully inaccessible. As in, if you don't have enough money to afford the 100$+ hour sessions, you feel like you completely run out of options.

There are more services trying to address this cost issue but from my experience (in Canada), they leave a lot to be desired

PragmaticPulp7• 6 years ago

Often true, but it's also true that many people don't realize how affordable therapy can be under their insurance plans. YMMV, obviously.

Depression is notorious for making people assume the worst. Many depressed people will assume therapy is inaccessible or too costly without even checking. I would encourage everyone to at least take a few minutes to look it up or call their insurance.

For example, I've walked several people through the process of finding a therapist, checking with their insurance, and scheduling appointments to get them started in the past few years (United States, corporate insurance). For most of them, therapy visits were billed with a $20 copay with a limit of 24 visits per year, which is more than accessible.

However, even if it's not, it's important to put the costs in perspective. How much would you pay for a magic pill that improved your problems? Does $1000/year sound worth it? That's 10 x $100 therapy sessions.

If professional therapy is out of reach, self-directed CBT using books or self-help resources have been shown to be effective as well. Not as fast or effective as professionally-guided therapy, but certainly a worthwhile starting point.

tristor• 6 years ago

The mental health stigma is systemic as well. Did you know that one of the things asked on an application for a CHL in Texas, as an example, is a list of every single time you've received psychiatric treatment and it's a disqualifier. Similarly the Form 4473 has mental health questions required prior to purchasing firearms. If you've ever been admitted for treatment, you're disqualified.

My purpose isn't to re-litigate gun control as an issue, but to point out that our policies and laws reflect our attitudes about mental health directly on access to things which are enshrined as fundamental rights in the US, already. It's a perfectly reasonable supposition to say: "I don't want truly crazy people to have guns.", it's another to say "I think it's acceptable to strip Constitutional rights from millions of Americans because they once had in-patient treatment as a child for their anxiety."

The latter is a matter of policy (regardless of how well it's actually enforced) simply due to the fact we don't understand the human mind or psychology enough to actually draw an objective distinction between those two types of people. Laws and systems work poorly with things which require subjective determination. "I'll know it when I see it" might be an acceptable type of thing to adjudicate, but it's a terrible type of thing to build bureaucratic processes around that are faceless, soulless, with no recourse.

This is just one of many examples where having any history of seeking treatment for mental health can be a disqualifier, or worse strip you of your rights. It's an effective disqualifier for many types of jobs as well in the US, especially government jobs which require a clearance or working at any company which accepts government contracts which would require a clearance.

AnIdiotOnTheNet2• 6 years ago

However, in the real world many people are resistant to the idea of therapy and/or medication as it feels like admitting defeat. Or perhaps they've read cherry-picked horror stories of bad therapists or medication side effects on the internet.

Or, you know, it's a lot of time and money being spent on something that the medical industry has very little success in dealing with.

spyder• 6 years ago

Yes, it's like the illness affects the ability to ask for help to treat the illness. Something like expecting people who fall down a cliff to walk to the doctor with broken legs. If there is nobody there to help them it's very hard to do it themselves, and even if there is someone it's harder to help a "broken" brain than a broken leg.

spaetzleesser• 6 years ago

When I had serious depression a while ago trying to find treatment was a seriously depressing experience. I went through several therapists which I didn’t click with and made me just feel worse. When you are already down it‘s very hard to do these attempts because they require a lot of effort and building of trust Every disappointment takes you down even further then . I know people who have had great success with treatment but I also know quite a few people who got more depressed trying to find therapy unsuccessfully.

0xcde4c3db2• 6 years ago

I've had a similar experience. I think one of the biggest problems with the current approach to mental illness is that practitioners (irrespective of modality) act like unsuccessful treatments are harmless. They're not; they can very credibly reinforce a patient's belief that treatment can't help them. It's easy to say "you just haven't found the right treatment yet, keep trying", but that argument rings pretty hollow after the fifth failure or so.

bjt2n3904• 6 years ago

In promoting a biogenetic causal theory, anti-stigma campaigners – as well as psychiatrists, the popular media, and others – hoped to convince people that mental illnesses are ‘just like’ other chronic physical ailments, such as ‘heart disease or diabetes’, to quote the APA, and could be medically addressed.

We're very caught up in naturalistic thinking. Speaking of a soul or the mind is frivolous at best, and superstitious at worst. But look where this way of thinking has brought us.

The brain and the heart are two different organs. But while we can use science to gain an understanding of the brain, the mind is understood by philosophy and religion.

Case in point, I once asked a friend of mine if he could prove that he loved his wife. He said if he were able to freeze time, and gain knowledge of every synapse, every chemical reaction, every electrical potential -- he could definitively prove that he loved his wife, and she loved him.

"When you get home," I responded, "remember to duck when you tell your wife you want to go have her brain scanned to prove she loves you."

ixtli4• 6 years ago

Not to reduce a complex topic to an aphorism but: if the world is configured in a way thats antagonistic towards you, a negative response is understandable. A lot of this stuff fits neatly into a tradition of blaming people for their conditions that, by and large, they have little control over.

Oh, another aphorism that's always stuck with me is "the difference between 'crazy' and 'eccentric' is a million dollars."

opportune3• 6 years ago

I feel this is particularly apt as depression has grown considerably over the past few decades. Could be the result of destigmatization, or could be the result of society worsening in some way. If you have a poor social life and feel like an underachiever (which describes increasingly more people, IME) it’s no surprise to me that you would experience depression

ixtli4• 6 years ago

To start, I hope that if you're talking about yourself you are doing ok.

But yes I think its possible all of the things you're talking about put together. The long term effects of the extreme wealth gap are so broad they're difficult to even take a survey of. But at the same time, we're becoming more open about mental health issues and acknowledging them as legitimate problems so reporting in accepting, progressive communities is going to make it seem like there are more.

closeparen4• 6 years ago

If you look at outcomes instead of responsibility, you get the opposite conclusion. If your suffering is a defect, then maybe we can fix it. If your suffering is a correct response to your circumstances, then it's right and proper for you to experience that suffering fully and indefinitely.

ixtli4• 6 years ago

I think you might be missing my point: often the conditions are not correctable by the individual. They can only be resolved by collective action, and we can’t really start on that until we stop holding people responsible for things they don’t have meaningful control over.

ChrisMarshallNY• 6 years ago

I've had lots of experience with people struggling with various forms of mental illness.

Their stories are not mine to tell. I've managed to squeak by with just a scoche of "on the spectrum," myself, so I am quite grateful, but I have watched (often in horror), as people have spiraled down.

People suffering from mental illness can often be impossible to help; regardless of how much we want to assist. They need to initiate and maintain their treatment.

There's so much societal "baggage," here. Mentally ill folks can often be profoundly unattractive, and it can be difficult to have empathy for them, or get support for them.

I remember once, walking down the street in the Union Square district of SF, on a business trip. As folks know, SF has a big homeless population, that is growing. We stepped around an obviously mentally ill man, and one of my employees shouted "Get a job!".

Would it were that simple, but his attitude is quite common.

But when treatment works, it can be absolutely miraculous, and worth every second of the pain.

rriepe• 6 years ago

Instead, let's end prescription advertising for medication. That's where people get all these stupid ideas in the first place.

We can write and read articles like this all day. But if Rx advertisers can create new, stupid ideas in commercials faster than we can dispel them, then there's no use.

henriquez• 6 years ago

Counter-example: if you’ve ever struggled with OCD or compulsive thoughts then you know the extreme emotional anguish that comes with trying to resist the impulses, that feeling of powerlessness as you feel forced to do something that you know rationally makes zero sense. In this case, recognizing the condition as a “chemical imbalance” may be comforting and a sole source of hope that things can get better.

And this is why I don’t like elitists telling me what I should or shouldn’t say.

0xcde4c3db2• 6 years ago

I'm not sure what to make of this piece. First:

Psychiatric research doesn’t support the notion of simple cause and effect in mental health, instead uncovering a far more complex and indeterminate picture of vulnerabilities. There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’.

I wholeheartedly agree with this, and believe that it's a huge problem with the mental health discourse. However, the author then goes on to say:

Mental health treatment needs to re-engage with the language of persons. This means suspending the detached, third-person stance toward patients, and attending to their actual experience and circumstances. And it means encouraging patients themselves to avoid this stance and draw on the normal ways that people make sense of their emotions and actions.

A problem I've experienced is that "the normal ways that people make sense of their emotions and actions" do not seem to work for me. I haven't found a good description of it, but something in my sensory and cognitive feedback loop seems to be broken such that I don't get any useful sense of things in the moment and need to reverse-engineer my emotional state after the fact when it seems important to do so (NB: I don't just mean that this disconnect occurs when there's some kind of intense moment; it's pretty much constant). So I don't see how it's possible to both hold that up as the standard and also respect my "actual experience and circumstances". In other words, this sure seems like exactly the sort of one-dimensional theory of mental illness that the author decried earlier.

opportune3• 6 years ago

I completely agree with the fact that the “chemical imbalance” idea is a gross simplification, but it also makes a lot of sense why psychiatrists would be prone to this type of mindset. When all you have is medication with relatively well defined effects on neurotransmitters(mostly GABA, serotonin, norepinephrine, dopamine) everything looks like a problem of getting those in the right ratio.

Personally having experienced depression myself and knowing many others who have experienced it, I’m of the opinion that a lot of mental issues are either symptoms of some other condition (like diarrhea or coughing) or the result of learned behavior / maladaptive coping mechanisms. Or simply us treating emotional states or personalities that aren’t socially acceptable as illnesses (of course this doesn’t include things like psychosis, nor is it meant to diminish how serious depression and anxiety can be). That’s a bit uncomfortable for the existing mental health complex though

dukha• 6 years ago

I've always been depressive and pessimistic person as far as I can remember.

I've been looking at other people only to see how happy they are and how content they with their life. They feel motivated, want something from life and in generally think that being alive is alright, which I just couldn't internalize no matter how hard I tried.

Essentially, I've come to the conclusion that there _must_ be something wrong with my neurotransmitters that I just can't be happy as fellow friends around me.

Many doctor appointments, many different prescriptions.

Antidepressants did their job and I started to care less about what's going on, but they didn't make me any happier. They just made me less miserable. On the other side, I've started to see the world through some kind of fog, which blocked most of my previous perception. My long-term memory started to degradate.

Now, after many years of taking various SSRIs I'm beginning to realize, that there's nothing wrong with my brain.

That's perhaps who I am, maybe either percepting more than many people around or just more sensetive and therefore reacting stronger even on slightest stimulus in a much stronger ways. I have opinions and thougts on a topics that many do not even care about.

So instead of supressing thoughts and emotions I must accept them as they are.

kilroy_jones• 6 years ago

Your view on this and your username are linked I assume?

oldsklgdfth2• 6 years ago

Aside from medication and therapy, what other avenues have you explored?

bserge5• 6 years ago

Have you tried other drugs?

I am depressive and pessimistic by nature, too. I have accepted that. But I have to fix the extremes because otherwise I simply can't function.

Different drugs can literally make you feel and think like a different person.

The only problem is side effects and tolerance, you can't go on on drugs for very long. They can be invaluable for building different habits, though.

nastyfilthy• 6 years ago

What other drugs are you referring to? Other types of antidepressants or acid.

mint2• 6 years ago

It’s also like the Facebook effect. For the most part, people post only the best photos, so we only see their best 10%. Yet it’s easy to forget that and compare that to all our photos/experiences even though it’s not apples to apples.

And out of 100 friends, if 5-10 post something cool it’s easy to overlook that the other 90-95 didn’t.

fB is but an example. These effects happen more or less with everything.

bradlys• 6 years ago

The culture in America shames those who post upsetting things or express those feelings. It’s a whole thing where you have to always be happy and “positive”.

I’ve rebelled against this for a long time. I post happy things here and there but since my life isn’t particularly happy, I post the more upsetting things more frequently and express those feelings in real life. I like to think I’m adding balance but I know I’m just being ignored because the culture doesn’t like to hear about suffering.

XCSme2• 6 years ago

I agree. My opinion now is actually that the more a person posts "happy" photos on Facebook/Instagram, the sadder/unfulfilled they actually are IRL.

epx• 6 years ago

Not sure if this is always the solution, but yes, so many people take antidepressants and let the fundamental problems of their lives go unfixed.

And being a pessimist is not a problem that should be medicated. The world needs us!!

rednerrus• 6 years ago

What is your purpose?

twojacobtwo3• 6 years ago

Have you looked into the possibility that you have ADD/ADHD?

I ask because your description sounds spot on for how I have felt throughout life. The 'fog', lack of motivation, and sensitivity to even the slightest stimulus especially ring true. When I first took medication for ADD, I felt like I had been driving through a downpour my whole life and finally discovered the window-wipers - the storm didn't stop, but I could finally look forward and see my goals and desires clearly. Every few weeks I try to do a reset and test how I feel without medication and I definitely still feel that 'fog' that you mention. I would say my fog is more like being in a lightning storm, because I feel the constant 'patter' of thoughts hitting my subconscious (for lack of a better word), but the occasional lightning strike will pull my attention completely away from everything else momentarily.

If you want to learn more, I highly recommend looking through the ADHD subreddit[0] - especially the sidebar material.

[0] https://old.reddit.com/r/ADHD/

viburnum2• 6 years ago

There’s a view that ADHD is badly named, because many ADHD people have incredible focus (at times), and many are not hyperactive in the least. It’s more of an issue about emotional dysregulation, which can be exceptionally painful for those who suffer.

ditonal2• 6 years ago

It's very common for people on HN to tout the benefits of their ADHD diagnosis and I feel compelled to point out that getting on ADHD meds was one of the worst mistakes of my life. They triggered a manic episode. The psychiatrist solutions to all my problems was always more meds, different meds, etc. I've mentioned this a few times and I'm always accused of abusing them but the truth is I took a small dose as prescribed. Of course I was "pre-disposed" to mania but how was I supposed to learn that without finding out the hard way? I believe that if I just avoided all the psychiatric pill I never would have gone full manic (hypomanic, but not manic).

The article is right that "chemical imbalance" is a myth as there's no sort of blood tests or normative chemical ranges for any of these mental conditions that people get diagnosed because they are outside of. A quick Google search would show there's no scientific support for chemical imbalance theory, just some pills that affect brain chemicals that people report depression improvement on self-reported survey so a huge, unscientific leap is made that depression is some chemical shortage in the brain. All the psychiatrist diagnoses are basically glorified personality tests, and the criteria are based on the DSM-5 which was made closed door and with heavy influence from pharmaceutical company lobbying.

Mental health is probably one of the most complex aspects of health, things like placebo have a huge impact, it's hard to study, and there's huge bias introduced by a for-profit pharmaceutical industry that pushes treatments to pills.

The field of psychiatry is not that scientific, it's not so long ago it was forcing people into lobotomies and I see the unscientific rush to diagnose everyone into these boxes of depression and ADHD as a similar gaffe that will be looked back on poorly.

I am diagnosed with GAD, ADHD, and bipolar type 1 and I'm doing MUCH better since I went against-medical-advice and quit all meds. For bipolar disorder/anxiety, meditation, yoga, exercise, sobriety, journaling are my key treatments. Mindfulness is key, but not the Hacker News McMindfulness variety where you try to emulate a celebrity monk from Tibet so you can reach Zen all so you can write more code for your startup.

For ADHD, meditation, techniques like pomodoro, and most importantly, just accepting that maybe it's better to achieve less peak productivity than take prescription amphetamines.

I just wanted to provide some counter-perspective as someone who's followed advice like yours much to my detriment.

viburnum2• 6 years ago

This has been my experience as well. It’s taken a long time to understand how I am different than most other people.

Have you read about sensory processing sensitivity/highly sensitive people?

FailMore• 6 years ago

Hey, I'm a therapist in training and also a developer. I built a side project called Taaalk. It's a platform for people to have public conversations, and I have done a few on mental health:

https://taaalk.co/t/discussing-eating-disorders

https://taaalk.co/t/exploring-obsessive-compulsive-disorder

Would you like to do one to see if anything comes up? Kind of a public anonymous therapy session...

https://taaalk.co/t/invite/what-s-going-on-with-dukha, invite code: 314798825

(If anyone else is interested my email is in my profile)

mistermann2• 6 years ago

A psychedelic experience can often offer a profoundly different perspective on things like one's beliefs, perceptions, experiential phenomena, etc - have you ever investigated/considered that avenue? The effects are typically mostly temporary, but one is often left with some convincing fragment of knowledge that what we think/perceive reality to be is wildly off the mark, which can be a useful new base to build upon going forward.

staplers• 6 years ago

"There is no normal life that is free of pain. It’s the very wrestling with our problems that can be the impetus for our growth."

-Fred Rogers

all_blue_chucks2• 6 years ago

Your comment, "there's nothing wrong with my brain," doesn't clearly define what you mean by "wrong." From a biological standpoint, there is nothing wrong with misery. You can be miserable from birth to death, but as long as you pass on your genes your miserable self is "fit" from an evolutionary perspective.

Personally I would absolutely consider persistent misery, or experiencing extreme sadness over minor things, to be a clear proof that there is something wrong with my brain. Whether I treat that with therapy or medication, I think that is very much worth treating, and definitely not worth simply accepting.

s1artibartfast2• 6 years ago

Personally I would absolutely consider persistent misery, or experiencing extreme sadness over minor things, to be a clear proof that there is something wrong with my brain. Whether I treat that with therapy or medication, I think that is very much worth treating, and definitely not worth simply accepting.

I think you are making the assumption that it is treatable, or that the treatment advantages outweigh the disadvantages, which is not always the case.

I think there is a general over-subscription to the idea that everything can be treated or optimized. Some diseases are incurable and sometimes a personal optimal is still poor compared to average.

sandgiant2• 6 years ago

I think you're on to something really important here.

Some people (normal people if you will) just don't think too much about things. Even when they sometimes go on to make terrible choices for themselves, and others, they might regret it, they might have negative thoughts about it, but they don't become depressed. They are not inclined to ruminating hours on end about their mistakes, so the negative thoughts dissipate over time, they effectively move on.

But if your personality, or brain, or whatever, is made in such a way that you like to think a lot about what could have been, or could be, or how to behave, or what others think of you, any kind of negative thought you might have will stay around, eventually leading to (symptoms of) depression.

So I think you're right when you say that depression is not what's wrong with you. You might just be one of those people that are good at thinking. Perhaps sometimes a little too good at thinking, a little too sensitive. Being sensitive and good at thinking is not be a bad thing at all, but spending too much time having negative thoughts may be what leads to depression.

If this is the case, realizing that you have a choice, in what to think about, is an important step on improving the quality of life, perhaps even learning to life with, or overcome some of the symptoms of anxiety and depression. Accept the negative thoughts, they are just natural thoughts after all, but choose not to dwell on them, let them pass and move on to the next thought, it might be a positive one.

You may also find some inspiration in metacognitive therapy (https://en.wikipedia.org/wiki/Metacognitive_therapy).

zeta0134• 6 years ago

A realization that came to me much later in life was that, although I am in apparently full control of which thoughts I allow to persist in my mind, I do not appear to be in full control of when memories surface. Rather, very similar to my dreaming state, it seems as though there is some process which is constantly comparing my waking events to things that occurred in my past, and trying to form a connection between them.

For the most part this is good, but of course, not all memories are created equal. Sometimes this process of forming connections reminds me of a painful event, something I'd rather not think about.

At first it was frustrating when these memories surfaced repeatedly. I'd dwell on some embarassing thing I'd done, or some painful thing a friend had said to me, which they maybe didn't realize I'd taken so hard. It was tempting to analyze these events to death, and have silent conversations with these figments, as though I could go back and phrase it differently, or change my actions, and perhaps it would have gone better.

Eventually, however, I realized that these mental tasks were not productive. The event, the "danger" had already passed. So now, whenever I realize my mind is about to go down that path, when suddenly I am reminded of a painful event, we pause, my brain and I. "Do we really need to go down this road again? We know where it leads. Let's not."

And so we don't. We reach once again into the stream of thought, allow ourselves to dwell on some happier moment, and in time, that old memory fades and we're off on a different adventure.

derangedHorse3• 6 years ago

This comment assumes people can choose what they think about when most of the time there doesn't seem to be an off-switch to a certain topic or emotion. I've found that it's easier to re-apply one's thought process on something mentally demanding and important (so the mind will find it urgent enough to drop whatever it is currently thinking about) than to direct one's mind to stop thinking about a particular topic. With that being said, I know that I'm also trivializing the difficulty finding a replacement topic that sufficiently demanding and important.

ip262• 6 years ago

I felt like that for a long time. I can't say that today I am an over-exuberant bundle of joy, but somewhere along the road of fixing my quality of sleep (caffeine, nasal obstruction), eating more fruits & vegetables, and getting regular exercise, the world has become a far more cheery place.

I know it's not an illusion because I very rapidly become dour & flat when I let my diet or exercise slip.

welearnednothng• 6 years ago

I can relate to much of what you're saying. This seems to be the common trapping of modern society - everyone must be happy and care about the same things. I'm not professionally qualified on the subject, but my vote is embrace it - but also try to understand it.

For instance, find a therapist to talk with. Don't feel like you need to settle for the first one you find, find one that feels right to you. It could be that there are deep rooted thoughts or emotions that actually are unhealthy that you may want to get to the bottom of. The goal here isn't change, it's understanding... and through understanding, determine if there's anything you'd like to change or even embrace. For example, I tend to focus on the negatives and everything wrong with the world. I realized I picked these behaviors up from my mother which not only allows me to be more aware of my behavior, but also helps me gently guide conversations with her away from being so negative and help her find positive things in her life.

Psychedelics often come up in these conversations, as well. I know many people whom see their experiences with psychedelics as turning points for them. There's plenty out research out there on the subject that I won't rehash here. If you choose to go down this route, I'd suggest doing your own research and if it seems like something you'd like to try do so in a safe place with one or more persons you feel safe around. Preferably, have an experienced "guide" there with you.

Lastly, I've been digging into the subject of gratitude for awhile now - both giving and receiving. There's a lot of research indicating it can be quite powerful. I tend to focus on the negative and everything that's wrong with the world (or my job, or my partner). Sometimes, just setting aside time to stop and think about something or someone you're grateful for (and especially communicating that) can do wonders. This isn't about not having or getting rid of pessimistic thoughts - it's about finding conscious space for appreciation, which can help balance things out or just help find some sparks of joy that might otherwise get drowned out by the negativity.

We're all on our own journey. Embrace who you are and try to take in the sights along the way.

Aperocky• 6 years ago

I have always been a happy and optimistic person.

But I do very often wonder if and what is the objective purpose of life, and having thought of it for a long time, I came to the conclusion that there are no such objective purpose.

The goal of life is entirely subjective, while the achievement/advancement of the goal is grounded in logic and hard work, the goal itself is not.

XCSme2• 6 years ago

I also came to the conclusion that no one has any idea what the purpose of life is. No one. I like listening to various opinions on "how you should live your life", mostly just out of curiosity, but never really take any of them as the answer. There are people (David Goggins) saying that you should work 24/7 and be the best of version of yourself you can be while working your ass off and suffering a lot. There are others who say you shouldn't give a fuck and just enjoy the life in every way you can. Life has no purpose, just enjoy it and do whatever makes you happy and fulfilled (which could mean either slacking or achieving greatness, depending on what you want).

austincheney• 6 years ago

Now, after many years of taking various SSRIs I'm beginning to realize

So a failure to transmit or receive sufficient chemical stimulus in the brain describes a failure of hardware that may or may not be correctable with drugs. Because we live in a culture of convenience it is common to misrepresent a difference of personality as a defect correctable with a drug, which may explain the drive to consume and abuse stimulants.

Some people, myself, literally enjoy working 80+ hours a weeks with less sleep and without preconditions, like increased compensation. Many people see that as bizarre and wonder where the increased energy and focus come from. It’s not a product of increased energy or focus, but really just a minor difference of personal interest and emotional concerns. Stimulants won’t buy you a necessary change of personal goals or the necessary continuous interest of where you value your time, and certainly won’t buy you enjoyment of working 80+ hours a week. Instead people tend to be most productive where they naturally find increased output due to personal interests whether that’s just from spending time with other people or reading literature.

That’s the difference personal interests (personality) make which is not any indication of defect. There is a famous quote: “Know thyself”. The reflection to that is know what you are not or rather don’t lie to yourself.

alex504• 6 years ago

I found ssris to be a prison. A profound spiritual stasis. They cut me off from myself. They muted my emotions so instead of learning to deal with them I stayed passive and simply ignored them. When I got off of them I spent quite awhile learning who I was and how to live with myself. I have come a long way as a person and I wonder if that change wouldn't have taken place sooner had I not taken them.

It seems that lots of very smart people take these drugs and I wonder how many are emotionally and spiritually stunted by them.

kerkeslager• 6 years ago

Due to a video by Dave MacLeod[1], I made some dietary changes that have had a surprising and profound effect on my mental health. The full list of sources for that video are on his blog[2], but the paper I found most helpful was the first on the list[3].

It's hard to come to any conclusions here, but it does seem like for me, the issue was at least partly chemical.

However, I'll say that a lot of why I got to a point where I could even make the dietary changes, was that I had done a lot of emotional and psychological work. The reason I was interested when I saw the vlog, and read the paper, and made the dietary changes, was that I had done a lot of work to learn to even care about myself.

For me, there has been a feedback loop--learning to care about myself has allowed me to discover tools to improve my brain chemistry, which in turn is now allowing me to care about myself better and do more for myself (and others). I don't think that just giving people the right food or medicines to fix their brain chemistry would work if they don't see themselves as worth making the life changes for.

[1] https://www.youtube.com/watch?v=UPi41bSrFdI

[2] https://www.davemacleod.com/blog/vlog15

[3] https://pubmed.ncbi.nlm.nih.gov/30254980/

JSavageOne• 6 years ago

It's hard not to be depressed when you realize how sad society is, and how most of how we're supposed to spend our days (working for an employer, staring at a computer screen all day) has no actual meaning to the world. Yet we're not allowed to talk about it at or you'll get fired, or people will think you're depressing.

For me I've found that my happiness is mostly a function of the community of people I'm surrounded with. This means having a solid group of friends and/or significant other. It's very tough to find this, especially in the U.S. when you're already an "adult" and didn't make many friends in your childhood/university years, but it is possible.

But that's just me, others don't need much social contact. Everyone is different. But for any software engineers like me who find that staring at a computer all day does little for their happiness, you are definitely not alone.

verylittlemeat2• 6 years ago

Is there any way to get off the euphemism treadmill?

First we had to create new terms because the old ones carried baggage. Now we have to righteously and victoriously claim the old ones because we should be proud of our baggage.

Call it chemical imbalance or call it people in distress; is any of this language vacillating actually enabling better treatment or is it just a way for people to get honors and headlines without actually having to actually produce science.

curiousllama• 6 years ago

In this more than most things, perception is reality. If people used to be less hesitant to accept the label of "chemically imbalanced" than "distressed," and now preferences are reversed then we should go back precisely to enable better treatment.

mikkergp• 6 years ago

The problem is the assumption that any one idea is "Right". I in general disagree with the disease model of psychology but most of people don't and they are genuinely helped by that. Trying to teach them to adopt a more existential model of psychology probably won't help them, it's not one-size fits all. I agree with the author but I also acknowledge this approach doesn't work for everyone.

Psychology is based on the idea of "conceptualizations" or in CS lingo, abstractions. No Psych conceptualization actually carves at the joints of nature, they're all imperfect but each works for different situations or people.

(Humanistic Psychology)[https://en.wikipedia.org/wiki/Humanistic_psychology] is great unless you're dealing with a psychopath. (Cognitive Behavioral Therapy)[https://www.mayoclinic.org/tests-procedures/cognitive-behavi...] is great unless you actually have issues from your childhood to process which surprise surprise most of us do. [Psychoanalysis](https://en.wikipedia.org/wiki/Psychoanalysis) is great unless you're you know, not rich and don't have four days a week to do it.

We can't get away from "euphamisms" as you call them, but it shouldn't be a treadmill, most should exist side-by-side.

P_I_Staker• 6 years ago

The problem is we're not likely to stop stigmatising people with mental health any time soon. You can't make people believe something they desperately choose not to.

We think people are 100% responsible for their behavior, so if they do something wrong or inconvenience us, it's their fault, and they're bad people for it. They should just not complain or feel bad, because you're not entitled to sympathy for your mistakes or failings.

You have to have a convincing case for your misery, why you deserve sympathy, and how it's not your fault, and even then, don't you dare complain to much.

Obviously, I'm exaggerating a bit and don't feel that way myself. I really think most people believe some watered down version of this though.

verylittlemeat2• 6 years ago

There was an interesting article [0] from a decade ago about a NY agency called "Office of Mental Retardation and Developmental Disabilities." When the agency was established in the 70s the social workers fought hard for the clinical word "retard" over prior terms like "moron."

Cut to 2010 and there was public outcry to have the offensive agency name changed but the people working there refused to give it up because they still held on to the more neutral meaning of "retard."

[0] https://www.nytimes.com/2010/06/08/nyregion/08name.html

jlokier• 6 years ago

Pragmatically, the terminology used affects how people end up treated.

Both therepeutically, and how they are interacted with socially.

If we say it's a chemical imbalance, chemicals will be sought to correct the imbalance, and effective suggestions that require other people to change will be met with resistance.

If we say it's people in distress, other people will start to reflect and accept they play a role in causing the distress and be a bit more open to changing their behaviour.

The best "treatment" is, of course, a combination of things tailored to individual and circumstance. But widespread language greatly affects what is available in practice.

MSbPSurvivor2• 6 years ago

Language matters. It has far reaching consequences. Right now in mainstream culture mental health is used as a weapon to drag people down, or as virtual signaling and advertising conditions/medications/lifestyles with mental illnesses. It's being glamorized.

No it's not okay to use misleading language to describe, discuss, debate or eve refer to an extremely complex problem. That's how you get even more unintended problems: by not looking at the hard truths and operating off of them.

It matters because people think that most mental illnesses make the person less than, or they become insecure or fearful of people with basic mental issues and then become afraid to talk about their own.

Psychiatrists have been taking advantage of people with normal, run of the mill problems for decades. Their own industry insiders have been calling them out for years on over diagnosis. There is a very real incentive for psychiatrists to make poeple sick, or convince someone who is perfectly healthy otherwise to go on medications that will completely change their body chemistry and life.

Your attitude and approach to this problem is ignorant at best. You should speak to people before coming to such baseless conclusions and spewing them forth.

This isn't a euphemism treadmill. This is science and it makes perfect sense. Tons of people are experiencing chemical imbalances because of habits, and because of the way they are treated or disconnected with others throughout our culture. If you abuse someone emotionally and mentally enough, it will show physically, and it doesn't take much pal. I don't know what universe you're living in but maybe get out of the macho "i'm so badass" comic books metality for two seconds and realize medical abuse and corruption within our medical industries is FUBAR.

77pt772• 6 years ago

I have no problem with chemical imbalances, but if you use that as a reason but you don't measure it you are not doing science.

It's like diagnosing someone as a diabetic without measuring glucose levels directly or indirectly.

xivzgrev2• 6 years ago

A lot of people carry a fixed mindset, where we focus on what others think of us. The first girl had this image she had crafted for herself, and when reality split from that she came up with rationalizations that disconnected her from others and herself (and likely prevented her from getting treatment sooner, and may create resistance to “non-pill” treatments). I think it’s really normal to have this mindset because we live in relation with others, and we fear rejection. Others may reject us if we DONT maintain this image.

But the truth is we don’t have control over others so it’s a fool’s game to maintain an image. things can happen to “pop” it, and then you are crushed. Like the Michelin chef who committed suicide when he was in debt, felt washed up as culinary trends changed, and recently had a slight downgrade in his reviews (https://en.m.wikipedia.org/wiki/Bernard_Loiseau)

A better way I am learning (and far yet from fully realizing) is to anchor your self identify to things you can control. So rather than thinking of yourself as confident, normal woman, you might think of yourself as a woman who feels deeply and takes action. In this case, feeling depressed is not a threat to that identity - it becomes a challenge to rise up and meet, and focuses on what YOU can do, not what others think.

This all comes from the book “mindset” if you want more info.

im3w1l• 6 years ago

I don't think it's good to consciously define yourself like that. We should see ourselves as we are. And realize that things aren't black or white rather than see which stereotype fits best. You may take action most of the time, and struggle to take action regarding something. You may feel deeply generally but sometimes go numb.

voisin• 6 years ago

On this topic, I just finished reading “Lost Connections[0]” and would highly recommend it. Best book I’ve read on the causes of depression and how the “chemical imbalance” narrative was created by drug companies whose drugs are proven to have only a small, transitory impact. It describes how to resolve the “lost connections” that lead to depression.

[0] https://www.goodreads.com/book/show/34921573

seesawtron6• 6 years ago

It reminds me of what Aldous Huxley wrote (about people in distress):

“The real hopeless victims of mental illness are to be found among those who appear to be most normal. "Many of them are normal because they are so well adjusted to our mode of existence, because their human voice has been silenced so early in their lives, that they do not even struggle or suffer or develop symptoms as the neurotic does." They are normal not in what may be called the absolute sense of the word; they are normal only in relation to a profoundly abnormal society. Their perfect adjustment to that abnormal society is a measure of their mental sickness. These millions of abnormally normal people, living without fuss in a society to which, if they were fully human beings, they ought not to be adjusted.”

agumonkey2• 6 years ago

I tried going back to normal life but 6 weeks were enough to erode my mind way too deep.

seesawtron6• 6 years ago

I think the challenging part is definition of "normal life". The burden of fitting in with the "norms" of the society by suppressing your own internal beliefs for the short-term gratification of feeling normal comes back to bite you in the long-term.

Over the centuries the society has mostly been unaccommodating to those who fall on the tails of this normal distribution, ostracizing them, punishing them, so on and so forth. But I still have faith in humanity to become more accepting and understanding those who are different instead of pressuring them to be the same.

So the first step is to believe that your life is not abnormal but just different from most people. I hope you find your solace in this ever-evolving world.

danans9• 6 years ago

if they were fully human beings, they ought not to be adjusted

The myth/ideal of being "fully human" is an example of essentialism, and is one the techniques that authors like Huxley and many from his era employed. It preys upon the inner authoritarian desire to normalize the world for oneself above all else, even though ironically Huxley opposed authoritarianism himself.

A different take is that people's mental health as individuals is in a constant tug of war with their own circumstances, which are then in their own tug of war with the collective stresses of society. There is no normal/abnormal spectrum as Huxley would have us think. Just a complicated web of complicated agents, sometimes in harmony with their society and other times not. When the net entropy to the agent is relatively low, that's "normal". It's not a value judgement or a mark of inauthenticity the way Huxley might have you think.

Johnjonjoan9• 6 years ago

I disagree. Human beings as you say are products of their circumstances and one circumstance that seems very pervasive is technology.

We are no longer fully human beings.

Technology had changed what it is to be human even in Huxley's time; nowadays I wonder has AI already taken over? The prevalence of computer run algorithms in human beings decision making seems to imply it has started at least.

stanfordkid2• 6 years ago

I think his ideas and cultural critiques are a little more complicated than that — his book Island in particular is worth reading — it is the ideal mirror to the dystopia he describes in brave new world.

Essentialism is a moral critique. If you stick a tiger in a small cage it doesn’t breed — that is an objective observation rather than a moral critique. Huxleys argument is of the same nature — that society is becoming a cage to natural impulse and instinct.

coldtea2• 6 years ago

one the techniques that authors like Huxley and many from his era employed

No, it's one of the beliefs they held. The weasel phrasing "technique (...) that they employed" means they didn't believe in those, but used them cunningly to dupe people.

Second, merely saying "is an example of essentialism" doesn't solve anything, as if the case for essentialism or not is a solved one and we should now dump it. It's just a different school of thought. And can be far more nuanced than its given credit for, it's not just some caricature.

There is no normal/abnormal spectrum as Huxley would have us think. Just a complicated web of complicated agents, sometimes in harmony with their society and other times not. When the net entropy to the agent is relatively low, that's "normal".

Well, normal could just as well be people adjusted (e.g. by the passage of time, cultural norm, brainwashing, etc) to horrendous conditions. There would have been many "normal" people by your definition in USSR, for example. Slavery was also normal once -- and not just free citizens consider it as such, and based on accounts many later generation slaves internalised this as "just the way things are" (the "Uncle Tomas" variety).

Without a degree of essentialism, that is, an idea of what is normal and what a person/society should strive for, you can accept anything.

voldacar• 6 years ago

Your comments in this thread make you sound really angry and kind of spiteful about Huxley and his "essentialism."

This seems kind of weird and unhealthy to me - did some "essentialist" person hurt you in some way or something?

Johnjonjoan9• 6 years ago

I've studied this quote a lot and I do think it's very hard to realise who Aldous is talking about, but I don't think he's talking about those in distress. Rather those that gave in to this world and can live with willful ignorance at it's pitfalls rather than distress.

seesawtron6• 6 years ago

Yes of course. He is talking about the people who have been "normlised" to be what the society or those in power need them to be: the masses who never oppose their governments, the people who give up their individuality to pursue a career to buy things they might not need, and so on. It is a reflection on those people who are NOT in distress but they ought to be rather than be ignorant.

DavidVoid• 6 years ago

Reminds me of what Martin Luther King, Jr., had to say about the word "maladjusted" [1].

“You who are in the field of psychology have given us a great word. It is the word maladjusted. This word is probably used more than any other word in psychology. It is a good word; certainly it is good that in dealing with what the word implies you are declaring that destructive maladjustment should be destroyed. You are saying that all must seek the well-adjusted life in order to avoid neurotic and schizophrenic personalities.

But on the other hand, I am sure that we will recognize that there are some things in our society, some things in our world, to which we should never be adjusted. There are some things concerning which we must always be maladjusted if we are to be people of good will. We must never adjust ourselves to racial discrimination and racial segregation. We must never adjust ourselves to religious bigotry. We must never adjust ourselves to economic conditions that take necessities from the many to give luxuries to the few. We must never adjust ourselves to the madness of militarism, and the self-defeating effects of physical violence.”

[1] https://www.apa.org/monitor/features/king-challenge

bobbiechen• 6 years ago

And from George Bernard Shaw:

“The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.”

mistermann2• 6 years ago

A lot of philosophers have had similar (but different) takes on this phenomenon over time.

Plato:

https://en.wikipedia.org/wiki/Theory_of_forms

https://plato.stanford.edu/entries/plato-metaphysics/

Jiddu Krishnamurti:

https://charleseisenstein.org/video/it-is-no-measure-of-heal...

https://www.wildmind.org/blogs/quote-of-the-month/krishnamur...

Terence McKenna:

https://www.goodreads.com/quotes/7391624-we-have-gone-sick-b...

https://www.goodreads.com/quotes/5998836-the-reason-we-feel-...

https://www.goodreads.com/author/quotes/9243.Terence_McKenna

Interestingly, this sort of phenomenon is rarely if ever discussed in the mainstream - rather, when any such ideas are discussed, they are typically mocked, trivialized, discredited, misrepresented, framed, "debunked", etc. It makes one wonder why things are this way - is this consensus perspective accidental, or might something else be going on? Can we point to any other historic examples of people being deliberately (mis)led, by coordinated and powerful actors, to believe certain things to be true, that are not actually true?

seesawtron6• 6 years ago

Quoting Ernest Becker from his "The Denial of Death" which is again derived in a way from Plato's Ideas/Forms: "In man a working level of narcissism is inseparable from self-esteem, from a basic sense of self-worth. His sense of self-worth is constituted symbolically, his cherished narcissism feeds on symbols, on an abstract idea of his own worth, an idea composed of words, sounds and images, in the air, in the mind, on paper."

Can we point to any other historic examples of people being deliberately (mis)led, by coordinated and powerful actors, to believe certain things to be true, that are not actually true?

I think the whole Public Relations (aka propaganda) movement would be an example of this delibrately misleading people to believe in certain things and force them act accordingly. The modern pioneer of this would be Edward Bernays [0] how he profited the industry by convincing people that they need to buy material things (for example, new fashionable clothes) to express their individuality or helping the Tobacco industry to get rid of the taboo of smoking among women.

But I would argue that this idea of misleading masses goes back in history. I would go out on a limb here but isn't the whole idea of Church based on fear of hell in order to make people act according to "Christian" values to seek eternal heaven and save their soul? Seems like delibrating misleading people in a coordinated manner to believe in ideas that are not actually proven to be true.

[0] https://www.youtube.com/watch?v=DnPmg0R1M04

dpweb• 6 years ago

Also, what is the appropriate threshold where we call it mental illness. The article, Jenna's boyfriend cheated. She's seriously depressed. That ain't illness, it's normal. That doctor is a quack.

I feel part of the problem is the expectation that humans are supposed to be happy. Happy is just a state of mind, not necessarily our default state. Depression and mental pain have their uses. They alert us, something is wrong - make a change! Working through pain, not self-medicating, strengthens you. Even if you 'don't know what's wrong', the unconscious WILL act out on, repressed childhood trauma, for instance.

We're destined to suffer, if for no other reason the horrific reality that we will all be annihilated one day. Everything beautiful in the world will be taken from us. Our existence will end. So happiness is not our default state, or even where we SHOULD get to. Why would it be?

There are certainly people who need intervention before they suicide, and people with real chemical imbalances (for people prescribed meds - -is this EVER proven scientifically? EEG? blood test?), but we conflate those people with others who are just very rightfully sad about the circumstances in their lives. Often these people (alcohol, food, drugs, phone) instead of making the difficult changes.

grugagag• 6 years ago

I somewhat agree that depression could be a good thing under certain circumstances, circumstances that can be fixed and are not outside the control of the subject.

Also I feel that I need to add that there are different personalities, and disorders of personality. In a lot of cases the narcissistic usually comes on top exploiting and causing depression and insecurities in others. I don’t find that this type of depression is useful. And generally society is becoming more narcissistic which rises the level of distress in others and that can’t be easily fixed.

closeparen4• 6 years ago

Symptoms of depression are bad news for difficult self-improvement projects. Sometimes you need your emotional system to stop punching you in the face before you can climb out of the hole. Negative emotions can easily slip from encouraging action into preventing it. And without the capability to feel pleasure, even success will seem pretty empty.

Sometimes your life is actually great and the failure is in your perception. See the unreasonable effectiveness of applying basic rationality to your thinking, i.e. CBT.

Relief from depression is not happiness, it’s neutrality, the space to work, and the ability to feel the fruits of your work.

mschuster91• 6 years ago

Also, what is the appropriate threshold where we call it mental illness. The article, Jenna's boyfriend cheated. She's seriously depressed. That ain't illness, it's normal. That doctor is a quack.

You'd be surprised how many drug and gambling abuse spirals start with people being left by their s/o's. Back when I worked in bars, everyone with a serious drinking and/or gambling issue either had a relationship falling apart or already way beyond repair.

The difference between previous times and now is that people are actually taking care about their wellbeing (partially due to feminism actively taking down the toxic masculinity "ideal" of men that don't even go to doctors when they've broken a bone, much less for mental health), and that common "self therapy" strategies ranging from alcoholism over hard drug abuse to domestic violence are not as accepted in culture as they have been before.

jac2413• 6 years ago

That's textbook major depressive disorder. How long would you let Jenna suffer out of principle? One month was too short a time for you, so what a year, two? She's not attending classes, crying all the time, sleeping more than usual. Why would you let depression ruin her future when we have effective treatment with a favorable side effect profile (CBT + SSRIs)? It's not an either/or situation. Doctors definitely counsel to increase exercise and get outside when starting treatment for depression. I don't think your strategy is very compassionate at all.

jodrellblank• 6 years ago

"We're destined to suffer, if for no other reason the horrific reality that we will all be annihilated one day. Everything beautiful in the world will be taken from us. Our existence will end. So happiness is not our default state, or even where we SHOULD get to. Why would it be?"

Why should those things make you suffer? Desire causes suffering, if you don't desire to live forever, then not living forever doesn't cause suffering. Reactions to events cause suffering, if you don't see yourself as the center of the world, if you don't see the world as a separate and spiteful active agency, then you don't see things being "taken from you". If you don't value only the beautiful things, then you don't suffer from your imbalanced views.

Why WOULDN'T happiness be your default state? There's nothing you can do which carries you beyond the grave, there's nothing you can build which changes anything, you can't remove bad things from the world, you can't change other people, there's no obligation to do anything, and no reason to be sad about unchangable facts.

It's the learned state that you are in a competition to maximise property and money, that fame matters, that being thin or rich or pretty defines your worth, that you are important and deserve everlasting healthy youthful life, that the world isn't good enough, that are not the default state and bring suffering.

"That ain't illness, it's normal"

When everyone has cancer, cancer will stop being an illness?

"but we conflate those people with others who are just very rightfully sad about the circumstances in their lives. Often these people (alcohol, food, drugs, phone) instead of making the difficult changes."

And? What's wrong with helping people who aren't ill? What's wrong with helping people make difficult changes? What's wrong with supporting people who will benefit from support, helping everyone climb as high as they can with teamwork, instead of behaving like insurance companies and looking for every loophole to get out of doing that?

[Edit: downvoter, you didn't even have time to read this between me clicking submit, then edit, before downvoting :rolleyes:]

razakel• 6 years ago

Some more food for thought - occasionally doctors will privately admit that many of their patients aren't really depressed, they're in fact suffering from "shit life syndrome" - in other words, their mood is the normal and natural response to the circumstances they are in.

Here's an FT article about Blackpool, a deprived seaside town in the north of England. It has the highest unemployment rate, some of the lowest life expectancy, highest rate of prescription of antidepressants, and highest rate of hard drug abuse (heroin and spice) in the country:

https://www.ft.com/blackpool

yomly• 6 years ago

Anecdotally a doctor friend confirmed this same observation to me after doing a psychiatry rotation - they suggested that most people with depression were just sad but wanted a magic pill to cure the unpleasant emotion.

jkhdigital• 6 years ago

This is a gross oversimplification, but crude measures of self-reported well being can be correlated to three factors: genetics 50%, controllable life circumstances (e.g. habits, hobbies, voluntary social engagement) 40%, uncontrollable life circumstances 10% [source: The How of Happiness by Sonja Lyubomirsky]. In other words... a “shit life” for someone who hit the genetic lottery for happiness could look quite similar to a “golden life” for someone with terrible happiness genetics. The same objective life situation can result in profoundly different levels of self-reported well-being.

ogurechny• 6 years ago

Your article is better than the one on the top, which is a bit undecided about questioning the status quo. It advocates for some changes, but tries to remain inside the same world view.

From outside US, it is quiiite noticeable that a lot of age-old philosophical and societal problems have been converted into personal problems that are supposedly solved by “pills” or “therapy” (that is as uniform and easily applicable as taking pills). Despite the pace of scientific and technological progress, people don't change so fast and evolve so quickly to have those “solved”. It is also doubtful that the rates of popular “mental health issues” have grown in recent decades the way the headlines routinely tell us. If some observer told you he had been seeing more and more people with four hands and two heads, you'd suppose that he had actually been getting more and more drunk. It is possible that the system that categorizes those issues is not up to the task.

Partially, it's because everything is a nail if you have a hammer. Drugs exist, patients know that and want them, doctors know that and prescribe them, the wheels are rolling, and it's sure hard to swim up the current. Whether they do work is not that important, people have always had talismans, and strong feelings about them (just look at the global mask wearing hassle).

Partially, it's because modern education is still based on positivism, scientism, and mechanicism of XIX century, but it is very rarely stated clearly. Even “critical” disciplines take a lot of things for granted. On this very page, people write about DNA this and DNA that, neurotransmitters this and neurotransmitters that, and it's implied that they'd tend to explain the world that way. Despite the origins of these terms, it is easy to see that they are used in the same way celestial signs were used to describe the initial state of a person, and imbalance of humors was used to reason about the immediate state of a person. The physical effects of, say, a bullet flying into someone's body can be studied and understood, and surgeons do treat these wounds, but it would be stupid to only describe the problem at that level without asking how and why bullets are actually shot.

Partially, it's because the image of the world presented to a person — not just by media, but also by familiar, decent, like-minded people — is skewed, and many have to over-correct into the opposite direction to balance it. Some ever-important matters are suppressed and rarely discussed in societies that consider themselves free and well organized, and the assumed path to “success” in life won't admit everyone even in theory. Not so long ago, only nobles had an option to care about having the biggest rubies in their jewelry, but now, thanks to progress, everyone can be a small noble and worry about countless new trifles. The generated noise hinders the uncovering of what lies beneath.

All in all, the “depression” might not be the term that needs a more precise or extensive definition. It might be a swept heap of everything that is not defined.

starpilot• 6 years ago

The social critic and mathematician Ted Kaczynski said, "The concept of 'mental health' in our society is defined largely by the extent to which an individual behaves in accord with the needs of the system and does so without showing signs of stress ... Instead of removing the conditions that make people depressed, modern society gives them antidepressant drugs. In effect, antidepressants are a means of modifying an individual’s internal state in such a way as to enable him to tolerate social conditions that he would otherwise find intolerable ... Without the entertainment industry the system probably would not have been able to get away with putting as much stress-producing pressure on us as it does."

The entire concept of "boredom" to him is a state of unease brought on by the modern working lifestyle. "Depression" is really a healthy, normal response to horrible conditions that we've adjusted to, like a fish that doesn't realize he's surrounded by water.

sjtindell• 6 years ago

I agree strongly with this view. People often refer to the lessons we learned putting rats in cages. Cages that contain the things rats really need make them happy. Cages that don’t, make them unhappy. It’s not the rats mentality that needs to change, the cage needs to change or they need a new cage entirely.

seesawtron6• 6 years ago

I like that you reference him solely as social critic and mathematician. I would recommend one should read his manifesto [0] to form their own opinion. Additionally you might also enjoy the Adam Curtis's documentary series [1].

[0] https://www.semanticscholar.org/paper/The-Unabomber-Manifest...

[1] https://www.youtube.com/watch?v=DnPmg0R1M04

sixstringtheory• 6 years ago

Reminded me of the more succinct:

It is no measure of health to be well adjusted to a profoundly sick society.

Jiddu Krishnamurti

DoreenMichele3• 6 years ago

To whatever degree a mental health issue is treatable with drugs, it genuinely is a medical issue.

But that's not the only element of actual insanity. Real insanity almost always involves a sick social fabric as well that lies to you about critical information, often blaming you for problems over which you have no real control.

They know that schizophrenics often get better with in patient treatment, then go home to their screwed up families and get worse again.

My sister took graduate courses in psychology for a time. She once said to me "We clearly don't have the genes for schizophrenia in the family or someone would have it because the family would have driven them crazy by now." Dad fought in two wars. Mom grew up in a war zone. These were haunted people who could be rather difficult to deal with.

I can understand people wanting to make this distinction "that I just need a pill, it's not like I'm crazy." People who are seriously crazy aren't typically fixable with just a pill. It's more complicated than that and our current system isn't really all that effective at bringing people back once they've gone nuts.

This is part of why I object to the "homeless people are all junkies and crazies" meme: it actively helps make vulnerable people crazy. It actively blames them for things they don't control and denies the existence of systemic issues to the faces of the victims who have such a low social status and are so openly disrespected that they aren't in a good position to argue with it. They are expected to kowtow and agree with everyone hanging their crap on them.

So it actively helps drive homeless people insane and makes it a self fulfilling prophecy. It deepens the problem and is actively abusive of our most vulnerable citizens.

wolfram74• 6 years ago

Many good points, but to clarify, you're arguing that being treatable is merely an obvious indication that it's a medical issue, but not the only indication? Lots of things in non-mental health fields are acknowledge to be medical problems but also remain untreatable.

DoreenMichele3• 6 years ago

I'm really tired and I'm not sure I understand what you are saying. I did leave a reply earlier, then removed it. I have no idea if you saw that.

I think mental health issues are complex. To whatever degree a pill actually helps, it's legitimate to view it as medical.

I have a lot of medical issues and I deal a lot with somatopsychic side effects. It's a somewhat obscure word meaning you get genuine mental health effects as a side effect of actual medical issues.

I don't use drugs to treat my issues. I mostly treat them nutritionally and there is research into how diet impacts brain chemistry and so forth. I have seen research indicating that nutritional supplements have a better track of treating certain issues than the prescription medication typically used.

I know a lot about the topic and related topics. I spent a few years in therapy for abuse endured as a child. I've done a lot reading and I've thought carefully about how to handle certain things in my life for which there aren't supposed to be any good solutions.

Social fabric and the mental models that it reinforces is another huge element of mental health. My medical issues don't turn into psychiatric issues in part because my two adult sons still live with me and they are abundantly familiar with the somatopsychic issues I am prone to and how to address them. So they do a lot of things that mitigate the issue when I am angsty or depressed or suicidal or whatever. They don't make those things worse by how they respond to them.

So I know from firsthand experience that how people around you response to mental health incidents can magnify or minimize them and it is my observation that most people magnify such problems. They take a lurid interest in the issue. They feel a desire to act like your "savior," thereby actively painting you as more screwed up than you are. Etc. ad nauseum.

So I'm not really sure how to engage your comment because I don't think I really understand it and I didn't like the reply I left earlier and I may end up not liking this one either, but I also wasn't comfortable just leaving no response. :/

heavyset_go2• 6 years ago

This is part of why I object to the "homeless people are all junkies and crazies" meme: it actively helps make vulnerable people crazy. It actively blames them for things they don't control and denies the existence of systemic issues to the faces of the victims who have such a low social status and are so openly disrespected that they aren't in a good position to argue with it. They are expected to kowtow and agree with everyone hanging their crap on them.

Agree with your insights. To further this point, people who would be deemed to be suffering from schizophrenia in our culture often have worse outcomes than people with similar symptoms in cultures that accept and integrate their different experiences.

There's research done on this topic, and this article touches upon some of it[1]:

Stanford anthropologist Tanya Luhrmann found that voice-hearing experiences of people with serious psychotic disorders are shaped by local culture – in the United States, the voices are harsh and threatening; in Africa and India, they are more benign and playful. This may have clinical implications for how to treat people with schizophrenia, she suggests.

[1] https://news.stanford.edu/2014/07/16/voices-culture-luhrmann...

Dahoon• 6 years ago

My sister took graduate courses in psychology for a time. She once said to me "We clearly don't have the genes for schizophrenia in the family or someone would have it because the family would have driven them crazy by now."

Hogwash! You cannot "drive someone schizophrenic" no matter if they have it in their genes or not. I can't even begin to try and correct this. It's like saying "dad is such a jerk that he drove me to become blonde instead of brunette!"

_ywdj3• 6 years ago

I've written several comments about this topic on HN before, but here goes again.

I've had a lot of mild/moderate anxiety and depression since early in life, and whilst it's never been severe enough for me to be at risk of doing harm to myself or others, it has been a major complication in achieving good outcomes (i.e., always showed some promise and early success at intellectual, sporting and social pursuits, but could never hold it together enough emotionally to get sustained results.)

At times of particular seriousness, medication provided some relief; mostly SSRIs (sertraline/Zoloft), which I've taken in low doses for a total of about 3 years, and occasional valium for acute anxiety. But whilst these medicines made life more bearable, they never made life feel "normal" or felt like any kind of complete solution.

Part of the issue I guess was that I had a really strong feeling that what I was experiencing wasn't a biological malfunction or predetermined trait. I guess I knew that from the fact that I'd been able to do quite well at things, and feel quite happy, at least some of the time, throughout my life. It didn't make sense that I'd be biologically programmed to be well-functioning some of the time, but not at others.

After a long search I discovered deep subconscious emotional healing techniques, that enabled me to connect with the programmed reactions and beliefs that I'd picked up from some unpleasant early life experiences, that had snowballed as I progressed through life.

I've been undertaking various forms of these kinds of practices for about 8 years now, and bit by bit the anxiety and depression has dissipated, and my life outcomes (career/finances, friendships/relationships and physiological health) have steadily improved and are now doing so at an accelerating rate (though of course there are still ups and downs, with or without macro events like pandemics).

As I look around at all the unrest and widespread mental "illness" in the world, I can easily see links to the distress that so many people feel for all kinds of different specific reasons, but that often boil down to similar patterns: difficulties in childhood (feeling unsafe/unloved/undernourished at home), leading to difficulties getting good social and/or academic outcomes in school, leading to difficulties as people progress into adulthood and try to establish careers, social networks and romantic relationships in a world that can be very hostile to people who don't tick certain boxes.

I'm now quite convinced that the mainstream psychopharmacology industry is a failing effort to paper over the gaping hole in modern society's ability to provide people with the nurturing, confidence and agency needed to build satisfying lives.

From my own experience I'm sure things can be much better, but it will take a major rethink about much of the way we go about supporting people on their life journeys.

ifend• 6 years ago

I discovered deep subconscious emotional healing techniques

Can you elaborate on this? Can you recommend any resources?

_ywdj3• 6 years ago

I usually get asked this and my standard reply is that I don't prefer not to get into discussions about specifics here, but I'm happy to share info via email, and I also host a Discord group where people interested can discus and share their own experiences with different techniques.

So, please feel free to email me (address is in my profile).

Edit: the reason I’m reticent about getting into details here is that I’ve learned from years of experience that discussions on HN about unconventional health approaches can (a) easily devolve into futile arguments with motivated skeptics, and (b) be unconducive to sharing the material with sufficient detail and caution, given that some people seeking this kind of info are at risk.

And whilst there are some materials around to point to, they’re not very specific about techniques, whereas I’ve done extensive experimentation with different techniques and documentation of my learnings, including tracking of physiological indicators, and can present/explain it in a way that is more palatable to HN-types who are genuinely interested.

But if anyone wants to read published authors on the topic, try Gabor Mate, Bruce Lipton, John Sarno and Bessel Van Der Kolk as starting points.

alex_young• 6 years ago

I really liked the writing in this article, it's compelling and fun to read. I do however think the author misses a broader point somehow.

The idea that 'mental illness' is a boogyman label which one will avoid at all costs is a good one. Who would want to self apply this label? You'll throw your lot in with the person talking to themselves on the street corner.

Instead of this, we are now supposed to start trying to encourage people to humanize mental distress (no need to say disorder now), indeed to extend this even to those suffering from more severe problems.

All of this is well and good, but the problem isn't really the term 'mental illness' is it? It's that we have decided as a society to reject all mentally ill people as hopeless cases, broken beyond repair.

It doesn't have to be this way. Many mental disorders are recoverable, and there is a huge amount of unknown about the rest. We have literally made a poor cost benefit analysis years ago and stuck with it for far too long without much thought.

What we should do is recognize that mental illness impacts most of us at some point in our lives, and that it severely impacts members of our own families (if you don't think it does, they are probably not telling you because of the stigma).

What would we have to do to resolve this? We would have to decide to dedicate large financial resources to helping the mentally ill recover if possible, or to find an existence which is mutually beneficial if not. Many countries have done exactly this, and with the considerable resources we have in this society, there is little doubt that we could find more answers to helping find real recovery.

Once people observe that mental illness is not a badge of shame, but an actual illness like many others, I believe that many more will be encouraged to seek assistance, and that we will all be much better off for it. As a nice side effect, you will no longer have to feel like shit knowing that the bipolar person on the street is likely to get roughed up frequently and meet an early end because we decided that's the way it is.

mountainboot• 6 years ago

I have tried virtually every ssri. They all make me extremely tired, too tired to function. But still would encourage people with anxiety to try them as there are very few other good options.

oldsklgdfth2• 6 years ago

"The concept of “mental health” in our society is defined largely by the extent to which an individual behaves in accord with the needs of the system and does so without showing signs of stress."

I think that contemporary society puts a lot of pressure and expectations on people at a young age. I suspect this is not a very healthy way to find your way in the world. Some people conform, some people follow the rules of the game, some people rebel to the rules, some are not even aware of the game. A little compassion and empathy would go along way, rather than treating each other as automata.

that mental illnesses are ‘just like’ other chronic physical ailments, such as ‘heart disease or diabetes’

I would argue that in most cases chronic ailments (including mental illness) are not a consequence of "the way a person is made", but their lifestyle. Many people with chronic ailments accept the medication as a solution and don't make the necessary changes in their lives. I think making mental illness comparable to chronic illness made people think of it as something that can be addresses with just a pill.

bsev• 6 years ago

It is an oversimplification, but there is a lot of evidence behind it. I suspect it's very unlikely for someone to fall into clinical depression from a quick breakup as in the article without something also being mechanically wrong. Fix that issue and they are likely to bounce back to a normal state like everyone else, with or without counseling. Depression is very nuanced and has many possible causes, but has high heritability and is very strongly associated with things like inflammation, nutritional deficiencies, and side effects of medication.

quotemstr2• 6 years ago

What if it's both a chemical imbalance and people in distress? I'm a materialist. I don't draw a distinction between the machinery of the brain and the substance of consciousness. When you're happy, that's what one electro-chemical configuration feels like. When you're unhappy, that's what another, different configuration feels like.

bobthechef• 6 years ago

The categorical pathologizing of ALL human suffering is, of course, stupid. Suffering as such is the result of harm. We may speak of the appropriate amount of suffering, the excess and the deficiency of suffering given the severity and gravity of the harm, but as such, as sensory and affective response to harm, its purpose is no mystery and certainly no pathology.

Mental illness that is constitutional, what used to be called psychosis, may be patholigized, but it is hardly as common as some shrinks seem to think.

There is also another source of mental illness, probably the most common one. In an age that receives the words "sin", "vice", and "immoral" with amusement, discomfort, indifference, or even outright hostility, we seem to have lost the ability to confront this cause of mental illness, namely, sin, vice, and immorality.

There is no crisp line between physical, mental, and moral maladies, so to speak. And in this respect, vice can produce what used to be called neurosis. Sins and vices harm the sinner, and when left unacknowledged and undealt with, the guilt can manifest in a variety of bizarre ways that twist our emotions, appetites, motives, perceptions, and reasoning. It can reinforce cycles of vice. Pathologizing can be one way to find temporary, illusory relief by scapegoating one's guilt by invoking "chemical imabalance". Sure, there may be a chemical change in the brain, but that change in this scenario is the effect and not the cause.

paul7986• 6 years ago

Personally and from my own experience Prozac, Paxil and Zoloft were only placebos and never helped me. Again my own experience... what helped me in my mid 20s was talking openly to my friends and others my age about my anxieties, unusual thought processes and other silly things you deal with at that age. Upon opening up I learned a more then a few of those I compared myself to were just as crazy as I thought I was and they too were dealing with similar issues or had. Then boom a lot of the zaniness was gone minus one odd OCD that stuck around for a bit longer(still there at 40 but very minorly and all other those silly worries/anxieties in my 20s and very early 30s are a thing of the past). If u have a social anxiety..think your not like others your close to & or compare yourself too..open up to them or some of them..u most likely find they are as crazy as you and in turn your normal like they are.

logicchop2• 6 years ago

The author's point is well-taken; but I don't think the problem is simply that psychological problems have become "de-personalized," and I think the move to "chemical" explanations is largely because the "chemical" treatments have been wildly successful (especially in comparison to, what? psychotherapy? talking about it?).

I think the actual crisis is a lack of good judgment in the scientific arena. There are obvious cases we can imagine where a "chemical" explanation is simply bone-headed. Joe's dog dies, his house burns down, he is laid off from his work. His resultant emotional distress surely involves chemistry; he's a person, after all. But it is depersonalizing, naive, and a bit creepy, to suggest that his distress is "just chemical" and should be treated with a drug. That's just gross, and I take it the author's point.

But consider another example. Terry has great friends, rewarding job, engaging hobbies, etc., but spontaneous and overwhelming anxiety over the possibility of being hit by a meteorite. This is now entering the territory of an irrational psychological reason, and it isn't "de-personalizing" or naive for a doctor to suggest that there might be a purely chemical explanation. We seek the chemical explanation when there just isn't any other sufficiently motivating factor.

There's a time for both approaches.

rusabd• 6 years ago

Some people cannot break a million years of evolution baggage and have a job or friends - it is unnatural. What we think is normal these days hardly even resembles conditions we evolved to thrive in.

diehunde• 6 years ago

I think the move to "chemical" explanations is largely because the "chemical" treatments have been wildly successful

This. The fact that "the mechanism of action remains a mystery" doesn't mean we shouldn't do anything about it. Those drugs work, and AFAIK they are pretty safe. The same can be said about many other disorders that we don't know the mechanisms of action, but we still use drugs that seem to be successful (schizophrenia, OCD, Tourette, etc.). Depression and anxiety seem to be much more stigmatized when drugs are involved. I agree the diagnostics are all over the place, though. You can be sad and not be depressed, and you can be stressed without having an anxiety disorder. Doctors should be more rigorous and not default to antidepressants for every patient they see.

boucher• 6 years ago

I think you're overstating the success of chemical treatment. I'm not extremely well versed in the subject, but I've read a number of books and articles that seriously call into question that idea.

It would seem that "talking about it" is actually more effective than medication in many circumstances (e.g. the research on cognitive behavioral therapy versus medication).

The consensus at this point seems to be that we do not have any real causal theory for most mental illnesses, including depression.

logicchop2• 6 years ago

You might have an Aristotelian sense of "success" in mind here (meaning that it covers something like the long-term overarching benefit of the person), but I don't. I just mean success as in, anxiety medication actually improves anxiety; depression medication actually improves depression; attention deficit medication actually improves attention. Whether there are better ways for us to achieve long-term outcomes is a different issue.

closeparen4• 6 years ago

Antidepressants are not much more effective than placebo, which is a problem if you're a drug researcher, but as a patient it doesn't really matter that your relief actually comes from placebo effect.

cryptica• 6 years ago

I think it's normal to become 'depressed' after being deceived by someone you trusted. Medicating the victim seems like the wrong approach. It's like telling the victim that this kind of deception is OK and they're the ones who need to be fixed for not being able to cope with it better. There are a lot of psychopaths out there, it doesn't make it OK. Also, the realization of this should be painful and depressing. It is depressing. We live in a depressing time. Most people today are completely messed up in the head. Most people.

We should try to fix this problem not patch it up with medication. In terms of evolution, our social system selects for mental illness. Rewards the psychopaths and medicates the altruists so that they learn to tolerate it.

orasis• 6 years ago

Why are they in distress though? Is the root cause external or is it something under one’s control, such as diet, sleep, and exercise?

aSplash0fDerp• 6 years ago

The human condition is unique to individuals the world over.

If lifestyle and/or environmental conditions were not enough to derail a healthy mind, the information streams run with psychopath+ variables are sure to catch many who didn`t fall through the cracks (given enough time).

If the imbalance is artificial or synthetic in nature, the corner to turn is now.

The quality of an individuals information diet holds the key for many (IMHO). This also leaves room for medical conditions and other reasonable observations that may cause an imbalance of this type.

MR4D3• 6 years ago

I disagree, and do so on my personal experience with Keto (yes, you read that correctly).

Just to give one case - last month I tried to get back into keto, as the lockdown had worn away my resistance to junk food and bad eating habits began.

In the process, I bounced in and out of ketosis, and my emotional state was all over the map. Crying, ecstatic, and everything in between. It was like being bipolar (I have a family member who is clinically bipolar, so I know firsthand what that does to someone).

But then, two weeks ago, I finally was able to get into my Keto diet fully. And for two weeks, my personality has been back to normal, and much more calm, less emotional, more focused, etc. [0]

Also, while I was going through the transition phase in/out of keto last month, I had several days of really vivid bad dreams and poor sleep. Several days of bad dreams was weird. Being tired on top of it made it worse.

So that's why I disagree. My firsthand experience with changing my food made a huge difference. (The first time I got into keto - about 2 years ago - I did so with a doctor who specializes in eating habits. This time was with that knowledge, but without my doctor as a guide. Thankfully my wife was a month ahead of me in the process, which made it tolerable.)

[0] - note to anyone trying Keto - go in fully, not halfway, and you'll only have a day or two of being grumpy (usually day 3 or 4). Have a guide to support you, as being on the cusp, but not truly in keto really sucks!

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Quick Edit - there ARE people in distress, and I'm not trying to take away from that, rather I'm talking about the everyday person who has some things out of whack sometimes.

By all means, if you are depressed, PLEASE talk to someone - it will probably save your life.

newacct5832• 6 years ago

The article isn't denying a biochemical basis on emotional regulation. It's saying that building the language of treatment around that framework is harmful, because it stigmatizes sufferers (even by simply making them fear the stigma), increases anxiety, and tends to act against recovery. It's an article about the best way to practice psychiatry.

MR4D3• 6 years ago

I get that, and I disagree. I think the discussion about food should happen first.

The food you eat affects your chemical balance, and therefore your ability to process information when you are making a decision or analyzing a situation by overloading your circuits.

You can actually try this by eating a bunch of sugar and carbs for a few days, and then going without carbs or sugar for a few days. I guarantee your ability to process information will change, and your personality probably will change as well. If you have a spouse or roommate, ask them if they notice - I'll bet they will.

My point is about causality. We are basically (no pun intended) a big bag of chemicals, and those chemicals are used by our brain to do its work. Simply having the wrong level of salt in your body (not just NaCl, but any salts) can significantly affect your brain.

I just looked up the word because I couldn't remember it, but Hyponatremia is caused by not enough salt in the body and can make your brain physically swell. Think about that for a moment - just one chemical can make your brain change in size - imagine what the effects are from all foods you take in.

So to me, psychiatry has it wrong. It's like a mechanic trying to diagnose why your engine doesn't work when you put molasses in the gas tank, or why a heart surgeon talking to a 500 pound obese person and without discussing their eating habits. Why should the brain be any different?

--------

EDIT - Check out this page at the Mayo Clinic [0]. They list some of the symptoms of hyponatremia, which include, * "Confusion, Loss of energy, drowsiness and fatigue, Restlessness and irritability "*

[0] https://www.mayoclinic.org/diseases-conditions/hyponatremia/...

waheoo• 6 years ago

Its a metaphor that helps people understand the way something complicated works.

If you take offense to this, im sorry, but you have a chemical imbalance.

Depression can feel like your whole world is upside down, an imbalance in the way your head works is a perfectly apt metaphor for how your brain works in this state.

These ideas arent mutually exclusive either. Context matters, I wouldnt point at jane and say, this is the one i was telling you about, the one with the imbalanced brain.

I would say, this is jane, the one going through some depression as of late.

If someone says well whats depression? Then maybe it would make sense to explain how depression works, maybe then it would come up.

winrid• 6 years ago

Growing up I've watched quite a few family members fall apart mentally including mother and step father (they're ok right now), even ending up homeless in a couple scenarios. Usually they would be diagnosed with bipolar disorder, or schizophrenia.

It was always linked to some stressful event. Loosing a job, not being able to keep the lights on, loosing a partner, or an abusive partner....

aristophenes• 6 years ago

I think the problem is misidentified in the article. I agree that giving people the idea that they need a pill to function normally is not great. But the 'chemical imbalance' explanation itself is very helpful, and doesn't require discounting a person's experience, a dependency on medication, or a fear of being labeled as crazy.

I had severe depression as a young man, and I remember being confused about it, as when I objectively examined my life there was no reason for it. But I was drowning in despair. When depression was explained to me, with the idea of a chemical imbalance, it all clicked. It enabled me to fight back appropriately and win back my mind. Without medication. It took a few years to get back to normal but I am a much, much stronger person for it, and have never had a hint of a relapse despite actually going through difficult times since then.

Humans are, as much as we hate to admit it, fundamentally emotional thinkers. And when we have emotions we immediately conjure up logical reasons for those emotions to exist, whether they are truly justified or not. And then we tell ourselves the reasons came first, and caused the emotions. Depression can be a bad feedback loop of chemicals that color the way we see the world, and then we justify how bad we feel, making us feel worse.

This might not be the solution for everyone, but for me the trick was not to try to understand my emotional suffering, but to ignore it. I would think, "that's the depression talking, its meaningless, you will feel bad today but it doesn't matter, get on with life". It was very hard, but as I stopped feeding the beast it slowly died away. Of course there are those that truly have reasons to be depressed, but I still think, after processing what happened, the best approach is to move on.

everly• 6 years ago

This, along with some of the comments here, reminded me of a short passage from a profile on Tupac Shakur, in which the author wrote:

"He feels his mania is what we all have and deny, that insanity is a rational adjustment to an insane world." [0]

[0] https://www.spin.com/2017/06/tupac-birthday-danyel-smith/

solinent• 6 years ago

The concept of "chemical imbalance" is a great tool to sell some chemicals to get ya balanced, however. Maybe the chemicals in good food are what we really need.

marcus_holmes• 6 years ago

I had a clinical depression. I took anti-depressants for it, but they were never intended to be a cure. I got into therapy, and got through it.

I was aware, though,of the yawning abyss between my mood disorder and "real" mental health issues. I have a very good friend who is very affected by bipolar disorder, and while they maintain that depression and bipolar are as debilitating as each other, I see the shit they go through and shudder. But then, I've seen the shit they went through and shudder. Correlation is not causation, but everyone I've met who is working their way through mental health problems has a proportionate amount of trauma to go with it.

milesvp• 6 years ago

I can sympathize with the author. I think they are probably correct in the general, that this tendency to try to treat normal psychological responses as something fixable with pharmaceuticals is a problem.

That said I have some very real anecdotes related to emotional responses to things. These are things I've noticed that very much link short term emotional effects to physiological effects in the brain.

The first, is a tool I learned from someone living with a type1 diabetic. He noticed that occasionally they'd end up in weirdly emotional antagonistic discussions with his partner, and eventually linked it to when his partner had low blood sugar. So, they established, that whenever conversations turn irrational, they pause and do a blood sugar check. Usually addressing this underlying problem made their conversation much more productive (and certainly just taking a break helped too). Similarly with my wife, we've established rules that allow one of us to pause the conversation to make sure the other is dealing with some underlying physical issue, usually one or both of us are tired or hungry when we start fighting. Tired and hungry both have profound effects on brain chemistry, so addressing them can have very real psychological effects.

My other anecdote is related to a correlation I've found with mental health and taking a vitamin D supplement. It's not entirely clear to me whether taking vitamin D prevents my tendency towards mild depression, or if I'm tending towards depression so I stop taking vitamin D. But I know that if I keep taking it on a daily basis, my mood tends to be more stable. If I were to replace it with a sugar pill it may have similar effects, but given I live in Seattle where many tend to be deficient, I'd probably start to notice in a couple weeks.

sandgiant2• 6 years ago

This is a fantastic article, thanks for sharing! This part really resonated:

Psychiatric research doesn’t support the notion of simple cause and effect in mental health, instead uncovering a far more complex and indeterminate picture of vulnerabilities. There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’. Nor does the beneficial use of psychiatric medicines require it. In fact, their precise mechanism of action and relation to troublesome experience remains a mystery. It would be more truthful for mental health professionals and public health campaigns to acknowledge this.

MSbPSurvivor2• 6 years ago

As an adult survivor of MSbP (both of my worst abusers were psychiatrists) I have to say this is amazing to hear.

It has always disturbed me greatly that pharmaceutical companies can go around claiming disorders in the DSM based on tons of research, but where is the pathway testing done? Why don't we see that happening with regular patients? There is a very strong disconnect between how these diseases are agreed upon AND treated VS the Hippocratic oath, objectivity, scientific, methodological reasoning.

What's even more disturbing is how completely normal mental health issues are then twisted in main stream culture, and used to control or hurt people, rather than help them. Mental health virtue signaling amongst psychiatrists is at an all time high with people bragging about how wonderful their disorder is and how proud they are. Does nobody else see something wrong with that? These doctors are convincing people they are permanently damaged (DNA/hereditary) and then pumping them full of drugs that don't quite do the trick. And this is happening in MASS. Mutagenic drugs fed to children and industry insiders have been blowing the whistle on overdiagnosis and overmedication for decades. And people wonder why our country is going crazy... wow.

Just. wow.

Mental health professionals in our society are failing us hard as a group and as individuals. I would cry myself to sleep, tears of sweet joy if I knew this was getting fixed and regulated and that psychiatrists had to undergo psychiatric evaluations themselves because I know several who are downright sociopaths and think that it's their right to tell other people they're permanently damaged and therefor wrong about <insert whatever random disagreement they have here>. It's honestly scary as hell because psychiatrists have made my life a living nightmare and nobody seems to want to listen or help, or the ones that do can't or don't know how. I even talked to Monica W. of proxy project and she is only putting money she gets into research or legal testimony. MSbP victims aren't being helped on a big scale and this is an issue serious enough that if left unchecked is going to (and already is) cause untold damage to our culture and society, shit I'd wager our ability to survive even.

I do blame fakes like Dr. Phil for making everyone afraid of MSbP victims. He sensationalized the case about the girl and her boyfriend who killed her mom. Then he just makes it seem like some horrifying rare condition. No other cases to go over, no suggestions about how we can tackle this problem. Just straight up fear mongering. he's a real big piece of . While in fact this is happening all the time everywhere in front of our noses, but we somehow went from blindly trusting in Pastors who rape boys to Psychiatrists who convince everyone they need to pay them the rest of their life and take pills that will permanently alter their body chemistry in unintended ways.

Find out more about medical abuse at proxy project.

habitue• 6 years ago

This article points out a really crucial thing: we talk about "chemical imbalances", and this language subtly implies we know what we're talking about when we really don't. It's scientific sounding language: it's precise sounding.

It lends the impression that you're saying something like: "Brains of well-adjusted humans have a dopamine to seratonin ratio of X, but my brain puts out X + epsilon. So, I take this pill, and it moves the dopamine amounts down to normal, and leaves everything else the same."

But, as everyone cringing right now at that statement knows, not only do we laymen not understand how the brain works well enough to make any such statement, but no one can make any such statement. There are multiple levels of problems involved:

1. Determine with certainty that a given psychological problem to one that is purely solved by altering brain chemicals in principle (vs. neuronal structure or environment, etc)

2. Determine that this living individual, whom you cannot crack open the brain of, is suffering from this psychological disorder because of a brain chemical imbalance.

3. Synthesize a drug that alters this chemical imbalance, leaving everything else the same. This would involve understanding both the immediate effect of the drug, and the eventual ramifications as the brain reacts and compensates for the drug's presence, such that the final steady state of the drug is the desired brain chemical balance.

The state of our science is such that we really can't do any of these with the precision the "chemical imbalance" framing implies. Compared with this unrealistic standard, we're barely better than alchemists. We know that in principle, some psychological problems are caused at least in part by brain chemical imbalances. But I agree with the article that we should stop giving the impression that this awareness implies an ability to diagnose and solve these imbalances.

pugz• 6 years ago

I agree in general that prescription antidepressants are over-prescribed. Unfortunately there are few medications that can ameliorate shit life syndrome.

That said, some people do have genuine chemical imbalances. I've had bipolar disorder all my life. My cocktail of medications has allowed the last 11 years of my life to be the most productive, stable and happiest. There are of course side effects - and I can understand why some people find them intolerable. I have tremendous difficulty ejaculating, for example. But on balance it's worth it as a) I'm alive and b) my quality of life has improved.

Likewise for my grandmother, my mother, my aunt and my cousin. Bipolar disorder ravaged our families at various points and medication has improved our lives immeasurably in various ways. I just feel for earlier generations that didn't have an explanation (let alone cure) for their woes.

svrtknst• 6 years ago

I haven't read the article - am just about to - so this may be addressed in it, but:

I'd like to add that even if you do suffer from some aspect of SLS rather than crossed wires, medication can be key in enabling other forms of improvement.

Medication can be what enables you to seek other forms of therapy, what gives you enough energy to make it to the next appointment, what enables you to sort out other factors in your life, be it self esteem, socioeconomics, or relationships.

At least a few years back there was a pretty big sentiment against "happy pills" and medication, which I believe is harmful. That said, I don't believe solely in medication either, but want to maintain that it's an important tool that can serve either as a solution, or as the enabler of a solution.

allworknoplay• 6 years ago

The author wasn't discussing overprescription, they were talking about an apparently common impression that mental illness is different from something called a "chemical imbalance".

Their point was that neither someone for whom a little bit of adderall or antidepressants, nor someone like yourself for whom a full compliment of medications has helped is understood to simply have a "chemical imbalance", and certainly not one that's 1-to-1 corrected by drugs.

Instead, it's the case that through some medications many people with mental illnesses of varying severities are helped in coping with or reducing symptoms of their illness.

The point is that people "other" themselves from people with mental illnesses, telling themselves that it's just a chemical imbalance they're correcting. This change in many peoples' understanding of how therapy or their own brains works has unfortunately not reduced the stigma of mental illness, it's just something people have been telling themselves (as the authors studies show) to substitute for an admission that mental illness is ok and can be worked on.

strogonoff• 6 years ago

I’m really happy to see valuable research like this published.

Attributing mental health issues to physiology might look like a convenient way for a distressed individual to escape the associated social stigma, but in absence of causal mechanisms pointing that way it is a dangerous assumption to make, prompting symptomatic treatments that leave the underlying cause to fester.

Unintentionally perpetuating the stigma of mental illness through e.g. mindlessly used unfortunate figures of speech is among the worst casual slips one can make.

totetsu• 6 years ago

Zoologist Matthew Cobb who studies modeling maggot neural systems, has just published a book "The Idea of the Brain" about the different conceptual models we have had for the brain through time. He talks about the limitations with he chemical based, neural transmitter model. That there is no drug that can be guaranteed to cure a mental illness, and that most of the large pharmaceutical research companies have withdrawn from developing new drugs in this area. And perhaps it was these companies that popularized the notion of "chemical imbalance" in the first place. https://www.rnz.co.nz/national/programmes/saturday/audio/201...

kutorio• 6 years ago

Given that the entire brain is arguably a collection of "chemical processes", how do you separate a condition that is "just a chemical imbalance" vs something that is... "you"?

pdfernhout2• 6 years ago

Better options are available than prescription drugs in almost all cases. Almost all psychiatric medicines are essentially placebos -- often with harmful side effects including psychosis and where treating side-effects lead to a treadmill of medications. See: "Deadly Psychiatry and Organised Denial" by Peter C. Gøtzsche https://www.goodreads.com/book/show/26214735-deadly-psychiat... "Deadly Psychiatry and Organised Denial explains in evidence-based detail why the way we currently use psychiatric drugs does far more harm than good. Professor, Doctor of Medical Science, Peter C. Gøtzsche documents that psychiatric drugs kill more than half a million people every year among those aged 65 and above in the United States and Europe. This makes psychiatric drugs the third leading cause of death, after heart disease and cancer. Gøtzsche explains that we could reduce our current usage of psychotropic drugs by 98% and at the same time improve patients' mental and physical health and survival. It can be difficult, however, to come off the drugs, as many people become dependent on them. As the withdrawal symptoms can be severe, long-lasting and even dangerous, slow tapering is usually necessary. In his book, Gøtzsche debunks the many myths that leading psychiatrists - very often on drug industry payroll - have created and nurtured over decades in order to conceal the fact that biological psychiatry has generally been a failure. Biological psychiatry sees drugs as the "solution" for virtually all problems, in marked contrast to the patients' views. Most patients don't respond to the drugs they receive but, unfortunately, the psychiatrists' frustrations over the lack of progress often lead to more diagnoses, more drugs and higher doses, harming the patients further."

For people facing psychological issues, see the resources I've collected in the "Health and Wellness" section of this reading list I have put together: https://github.com/pdfernhout/High-Performance-Organizations...

If you can only look at one resource, read or watch something by Stephen Ilardi, PhD, author of "The Depression Cure: The 6-Step Program to Beat Depression without Drugs", whose advice is built around this quote of his: "We were never designed for the sedentary, indoor, sleep-deprived, socially-isolated, fast-food-laden, frenetic pace of modern life."

Dr. Ilardi prescribes an easy-to-follow, clinically proven program that harks back to what our bodies were originally adapted for and what they continue to need with these six components:

    * Brain Food [supplement with Omega 3s; remember your brain is mostly fat]
    * Don't Think, Do [avoid excessive rumination by doing things]
    * Antidepressant Exercise [aerobic exercise is medicine]
    * Let There Be Light [get natural sunlight and supplement as needed with vitamin D3]
    * Get Connected [engage in face-to-face social activities regularly]
    * Habits of Healthy Sleep [get enough sleep by following basic guidelines]

There are many other books as like the excellent "Why We Sleep" by Matthew Walker or many on nutrition (e.g. Fuhrman, Weil, Mackey, etc.) that examine aspects of this issue -- but what makes Ilardi's book so useful is bringing so many of these ideas together in a historical context. Ilardi says his advice is general and some people with specific traumas underlying their depression may need additional specific help (such as in "The Body Keeps The Score" book on recovery from trauma mentioned below).

Other books that address specific aspects of depression and related issues of addiction, trauma, and perfectionism (and how they are at root deep cultural issues related to recent Western lifestyle changes) include:

    * "Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions" by Johann Hari. From the last chapter of the book: "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."
    * "Chasing the Scream: the First and Last Days of the War on Drugs" by Johann Hari
    * "The Globalization of Addiction: A Study in Poverty of the Spirit" by Bruce Alexander
    * "In the Realm of Hungry Ghosts: Close Encounters with Addiction" by Gabor Maté, MD
    * "The Story You Need to Tell: Writing to Heal from Trauma, Illness, or Loss" by Sandra Marinella
    * "Writing Hard Stories: Celebrated Memoirists Who Shaped Art from Trauma" by Melanie Brooks
    * "The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are" by Brené Brown
    * "Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead" by Brené Brown

For people dealing with the special case of a specific trauma for themselves or a loved one, consider reading "The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma" by Bessel A. van der Kolk. As the blurb for that says, "Trauma is a fact of life. Veterans and their families deal with the painful aftermath of combat; one in five Americans has been molested; one in four grew up with alcoholics; one in three couples have engaged in physical violence. Such experiences inevitably leave traces on minds, emotions, and even on biology. Sadly, trauma sufferers frequently pass on their stress to their partners and children. Renowned trauma expert Bessel van der Kolk has spent over three decades working with survivors. In The Body Keeps the Score, he transforms our understanding of traumatic stress, revealing how it literally rearranges the brain’s wiring -- specifically areas dedicated to pleasure, engagement, control, and trust. He shows how these areas can be reactivated through innovative treatments including neurofeedback, mindfulness techniques, play, yoga, and other therapies. Based on Dr. van der Kolk’s own research and that of other leading specialists, The Body Keeps the Score offers proven alternatives to drugs and talk therapy -- and a way to reclaim lives."

For those facing specific issues related to suicide for themselves or a loved one, a key book is: "Out of the Nightmare: Recovery from Depression and Suicidal Pain" by David Conroy. By reconceptualizing suicide as an involuntary action that occurs when total pain exceeds resources for coping with pain, David Conroy provides a morally neutral way for organizations and society to think about suicide prevention in a productive way. Rather than focus mainly on intervening in a crisis, organizations and societies can rethink their operations to reduce participant pain and to increase coping resources. This helps everyone -- not just those who have reached a threshold where pain is very close to coping resources. Aggregate pain includes physical pain, emotional pain, and social pain. Reducing pain in any area by even a small amount may bring a person below a threshold for suicide. Similarly there are many types of coping resources from interacting with a friend, to going to a funny movie, to receiving adequate health care, to interacting with a pet. There are also some short-term coping strategies like denial or drinking which may have long-term negative consequences that become new sources of pain when done to excess.

As David Conroy says: "Suicide is not chosen; it happens when pain exceeds resources for coping with pain. That's all it's about. You are not a bad person, or crazy, or weak, or flawed, because you feel suicidal. It doesn't even mean that you really want to die - it only means that you have more pain than you can cope with right now. If I start piling weights on your shoulders, you will eventually collapse if I add enough weights... no matter how much you want to remain standing. Willpower has nothing to do with it. Of course you would cheer yourself up, if you could. Don't accept it if someone tells you, "That's not enough to be suicidal about." There are many kinds of pain that may lead to suicide. Whether or not the pain is bearable may differ from person to person. What might be bearable to someone else, may not be bearable to you. The point at which the pain becomes unbearable depends on what kinds of coping resources you have. Individuals vary greatly in their capacity to withstand pain. When pain exceeds pain-coping resources, suicidal feelings are the result. Suicide is neither wrong nor right; it is not a defect of character; it is morally neutral. It is simply an imbalance of pain versus coping resources. You can survive suicidal feelings if you do either of two things: (1) find a way to reduce your pain, or (2) find a way to increase your coping resources. Both are possible."

(I write this in memory of my friend from Princeton, Robin Rochlin Cooperman, M.D. Psychiatry, 1963-2010. I can wish that she was still alive to talk with about all this newly emerging information about increasing wellness in a wide variety of ways beyond prescription pharmaceuticals. And also I write this in memory of other friends I have lost along the way...)

core-questions2• 6 years ago

Thanks for this post. I used to be a textbook example of "sedentary, indoor, sleep-deprived, socially-isolated, fast-food-laden" and somehow bumbled into improvement on all those fronts the hard way, one by one. Better eating, a more action-oriented outlook, exercise, and socializing with people changed my life massively and I am now very stable, and even optimistic despite the state of the world.

Sleep has taken a back seat since having kids, but not for lack of trying, and I have every confidence that a few years from now it will be in fine form again.

My difficulty now is to try to get my wife to go on a similar journey of improvement. She eats well, but ruminates, doesn't exercise, works in a windowless office or leaves the curtains closed when working from home, avoids people, and sleeps terribly. She'll even lament these things, knowing they're a problem, but my encouragement (or nagging, let's be realistic) to try to improve these things falls on deaf ears. There's always some excuse, always some reason why it can't be now, why it can't be scheduled for soon, why it's not going to happen. Books I've bought her on the topic sit unread, gift cards for yoga classes go unused.

If you know of any resources for someone to try to help someone else improve without falling into the pitfalls I keep falling into, time and again, I'd appreciate it.

pdfernhout2• 6 years ago

You're welcome. That's a tough situation (but a common one). The main things I can thing of right now are:

   * continue to be a good example
   * try to reduce stress in her life (without increasing yours significantly)
   * be a good listener
   * consider a physical hobby together like swing dancing -- or maybe walking or swimming or yoga or kayaking in the sunshine (ideally things your kids can be safely involved in too)
   * consider humor (healthy humor; maybe read up on that like stuff by Joel Goodman such as "Laffirmations" or things by others)
  * consider a temporary change of scenery (like an active vacation in the sun?)

Kudos on your own success though. That has to be helping your wife even if indirectly in being able to be a better parent and better spouse.

One idea is like on airlines: "Put on your own oxygen mask first before assisting others". You've already done that, but keep it in mind. As Zig Ziglar said, "People often say that motivation doesn't last. Well, neither does bathing - that's why we recommend it daily." Also, a lot of this for everyone is a spiral -- or ups and downs with backsliding. It takes practice (and mistakes) to get better at things. You might find of general interest two somewhat funny movies by Joe Cross called "Fat Sick and Nearly Dead I and II". They talk about progress and backsliding and progress again in nutrition and exercise. They might be useful in knowing you are not alone in that sense.

You can try to structure your shared environment (also to your own benefit) to make doing the healthier thing easy to do. Like maybe figuring out a better way to open and close curtains -- maybe even something automated? Maybe consider a treadmill workstation (although it requires reasonably good eyesight so works better at younger ages with more flexible accommodating eye lenses). The pandemic makes socializing harder of course, but maybe think about how you can help your wife more easily stay connected to any friends or family she already has (even one phone call a week).

Also, a gift card for yoga in a way just adds to your wife's workload (including travel to and from lessons). So how about getting a yoga mat and doing yoga together at home? Again, setting a good example yourself could help. As is the idea of making doing the healthier things easier.

Since the issue (including nagging) may affect your relationship eventually, consider pre-emptively reading a John Gottman book like "What Makes Love Last". Maybe also check out this HN discussion and story on "Beware of Being "Right"" to avoid crossing over from being supportive to being controlling: https://news.ycombinator.com/item?id=23802241

Also, rather than nag given it is not working (but still may make you feel good that you are trying and so be reinforcing to you), consider saying nothing about what you think should happen but instead providing some sort of positive reinforcement for your wife when she actually does a healthy thing -- even a small step. Look at writings or videos by dolphin trainers or positive-reinforcement-only dog trainers, like perhaps Karen Pryor. People are always doing a variety of things, so look for the positive tiniest incremental improvements and help them grow. That will also help you yourself focus more on looking for the positive things your wife is doing than the negative.

Or, at a higher cognitive level, since you are interested in influencing decisions, you could also look into books on selling, like Dan Pink's "To Sell is Human". From the blurb: "To Sell Is Human offers a fresh look at the art and science of selling. As he did in Drive and A Whole New Mind, Daniel H. Pink draws on a rich trove of social science for his counterintuitive insights. He reveals the new ABCs of moving others (it’s no longer “Always Be Closing”), explains why extraverts don’t make the best salespeople, and shows how giving people an “off-ramp” for their actions can matter more than actually changing their minds. Along the way, Pink describes the six successors to the elevator pitch, the three rules for understanding another’s perspective, the five frames that can make your message clearer and more persuasive, and much more. The result is a perceptive and practical book–one that will change how you see the world and transform what you do at work, at school, and at home."

Yoga nidra or positive visioning might also help if your wife does want to change something?

If you can address one aspect, which should it be? I'd suggest sleep. That can be a huge challenge with young kids. Try reading "Why We Sleep" by Matthew Walker. Or maybe listen to it as an audio book? What I got from that book was a sense that our brains are adapted to run overclocked (as it were) during daylight hours, building up waste products and also accumulating unstored memories. When we sleep well, channels in the brain literally widen and fluid flows to wash away the toxic buildup (which otherwise can contribute to Alzheimer's), our brain moves memories of the day into long-term storage, or brain via dreams also processes traumatic events of the day to remove the distressing emotional overtones and learn from them. But that only happens with good sleep. So, ask yourself, how can you help your wife get better sleep? You can also ask yourself if maybe she is a night owl trying to keep a schedule better for a morning lark or vice versa?

Anyway, some ideas to get you started. Now that you are thinking more about this, all sorts of ideas might come into your attention. Still, in the end, no one is perfect (if such a thing is even definable given conflicting -priorities). So take time to enjoy your imperfect relationship with your imperfect wife and imperfect kids -- and try to be thankful every day for how lucky you are given you are imperfect too (as is everyone in some way). That might help reduce some of the stress of the situation for everyone -- which might have its own beneficial effects.

Good luck!

hemantv2• 6 years ago

I feel like a big part most of us avoid unpleasant emotions we try to replace them or get rid of them very quickly.

Just experiencing these emotions and meditating on their cause will relieve a lot more people.

vertbhrtn• 6 years ago

"Depression" is often just inability to adjust to depressing environment. In the most extreme case, prisoners in Nazi camps should feel depressed and I'd argue that so should most of the people below the poverty line that's forced to be cogs in the depressing machine of capitalism. If my only choice was to be a cog on one of Amazon's warehouses, I'd rather choose to be a hermit, try shrooms and generally decline to waste life on doing silly things to enrich someone.

If we discard true clinical depression where a young dude in perfect health feels suicidal in his own bentley, my approach to treat depression would be reading books that stimulate imagination, from Harry Potter to more exciting literature like Transcendental Magic by Eliphas Levi.

jackcosgrove• 6 years ago

The chemical imbalance explanation is... wanting. My response typically is, "Which chemical is out of balance? Phlegm, blood, yellow bile, or black bile?" The chemical imbalance explanation has been used for centuries as a crutch when we don't know what's going on.

Perenti• 6 years ago

I don't like this idea at all. By not saying "chemical imbalance" there's the possibility of implying that mental illness is about attitude or choice, which is a destructive comment that people who struggle with depression have to deal with a lot.

Let’s avoid talk of ‘chemical imbalance’: it’s people in distress

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