Robert Sapolsky on Depression (2009)

https://www.robertsapolskyrocks.com/depression.html

by Tomte • 5 years ago

212 123 5 years ago

cung• 5 years ago

The chemicalization, medicalization and commercialization of depression is a dead end. While the chemical imbalances might be real, the symptoms are due to actual situations in your life. Treating the symptoms with drugs is a pretend solution that only works because it is often the first step people take to actually better their life.

Broken_Hippo• 5 years ago

" it is often the first step people take to actually better their life."

What makes you think this - and what makes you think that so many folks have so much agency in their life? A lot of folks don't, and if you have depression, you generally have even less of it because you wind up with an inability to see options you do have... if any.

It isn't like everyone can escape poverty or a bad spouse (it takes money to divorce someone or even leave if you need to get your own place). It isn't like anyone can magically make a disease diagnosis go away nor does changing jobs always fix things, especially if the reason you stay is because you desperately need the health insurance or because no where else pays as much in your area (and moving costs money).

We don't make sure folks have tools to improve their life.

Additionally, this really just blames the victim and I really hope you don't say this to folks actually suffering.

pjerem3• 5 years ago

I 100% agree with your post but i’d like to add something about this :

It isn't like everyone can escape poverty or a bad spouse

You are right and medicalization is useful to overcome this. But there is a real risk, as a society, that we find it normal to treat the depression induced by those issues, rather than the issues themselves. We should treat poverty and work towards making divorce less painful rather than thinking medication allows a status-quo.

But that’s another topic on its own and absolutely not a counter argument of your answer.

bayesian_horse2• 5 years ago

That is a wrong and damaging statement. You are ignoring the reality of depression as a disease. It has been shown that depression, in the medical definition, is often not caused by situations in the patient's life.

Thus it is equally foolish to believe, the patients could "better their life" and thereby alleviate depression. Somehow assuming the symptoms of depression actually allow any of that. Hard to improve your life if you can barely get out of bed.

Your comment is the exact kind of stigmatizing, patient-blaming and "just stop being depressed" bullshit that hasn't worked for centuries and contributes to the problem.

OJFord2• 5 years ago

I don't necessarily agree with GP, but I think your comment is the worst-possible reading of it, as in taking it in the worst light.

stigmatizing, patient-blaming and "just stop being depressed"

is coming from

the symptoms are due to actual situations in your life

? Isn't that the opposite, GP is saying yes it is real, but arguing that the drugs are like spraying air freshener in a room that still contains the source of the stink?

Again, not saying I agree, I just didn't read it as stigmatising or 'just stop' at all.

Honga• 5 years ago

Would you have any sources to back this up? Seems like a big claim to go against standard practice.

I suffer from chronic episodic depression. But my life is objectively great and fulfilling. Are you saying that I should not be at peace with my lifestyle? Or that my depression is a nurture rather than nature type issue?

I'm both triggered and curious to hear your thoughts.

pjerem3• 5 years ago

I don’t agree with you about the « dead end » of medicalization.

Medicalization really help you to break the circle. It temporarily treats the symptoms and allows you a timeframe where you can work towards the origin of your issues. And if for some reason, you can’t, it at least helps you live a more supportable life.

Here we are in a mental disease but you can easily make an analogy with any disease. If you need re-education after an accident that broke something, the first step is generally to treat the symptoms that could block you to achieve re-education.

As an example, my dad completely lost its equilibrium after a brain stroke. Re-education was long and hard, eventually succeeded, but would have been totally impossible without medication against nausea, which you constantly get when your equilibrium system is failing.

And I would add that, AFAIK, some forms of depressions are purely chemical issues. And it isn’t surprising. There exists tons of diseases that are chemical issues.

himinlomax• 5 years ago

This is complete nonsense as well as damaging for people who suffer from depression and who would believe your nonsense instead of seeking science-based help.

frereubu• 5 years ago

You can split definitions of depression in a number of ways, but one that's been around for a long time is exogenous (external causes) and endogenous (internal causes). The idea that symptoms are only due to life situations is simplistic and wrong.

This feels a bit like the straw man arguments about economics only treating people as rational actors, whereas economists have been aware of the issues with that for decades.

gatestone2• 5 years ago

The conflict between the external world and your inner self (psychology, neurology,nurture) is a situational problem, not so much medical.

You don’t have to seek blame, not from outside or inside in your self. But you can look for a solution in changing either or both.

haxiomic• 5 years ago

Depression is a symptom that can be the result of a multitude of physiological causes and not always psychological. One could induce the effects of serious depression in a person through gene therapy, specific nutritional deficiency, certain drugs, for example.

It can be hard to understand the cause for each person, and I do believe strongly we currently under-treat and under-investigate depression and it’s sources in people

The arguments put forward in the article and video are good and do a better job than I could at explaining what we know about depression

OJFord2• 5 years ago

Is it not contradictory to say it's a 'dead end', and also (only) 'works because it is often the first step people take to actually better their life'? (emphasis mine)

I don't have strong feelings either way (and basically will just do what a doctor tells me to do as long as I somewhat understand it seems to make sense) but I've vouched (not voted) for the parent comment because I think there's already the beginning of interesting discussion here; people can (have) disagree(d), but there's not really a reason to flag it IMO.

belorn4• 5 years ago

The environment impact the chemical balance of the human body. The chemical balance impact how the environment impacts the chemical balance.

Depression is the inability to recover from loss. With some of the more extreme depressions the mind can even invent losses which does not exist in the form of delusions. There are also seasonal depression where individuals lose temporarily the ability to handle loss. The actual situations in your life is not major factors in those, through the environment could provide protective benefits.

kayodelycaon• 5 years ago

Eh… that really depends on what the source of the depression is. I’m bipolar and I’ll never be free of depression, hypomania, anxiety, and the various parts of my brain that are broken.

While medication and therapy can reduce symptoms, there is no cure. When I get depressed, I just have to ride it out. All I can do is accept that.

There are forms of depression that are biological in nature, just like bipolar is, and there is no cure, only mitigation.

dec0dedab0de2• 5 years ago

I don't think everyone should be piling on, you're mostly correct. Except that your first and last points are contradictory. A dead end and a first step are different things. Though I thought it was common knowledge that these drugs are supposed to be a first step, that too many people use as a crutch, while thinking they are a cure.

s5300• 5 years ago

The entire article is pretty spot on, experience wise at least (can't comment on the chemistry of it)

However

Inside the body is going through a massive stress response that is similar to what your body would be doing if you were fleeing an armed assailant. All the time.

This right here... is important, and something I don't think most are aware of. It's also something I don't think one can fully understand without having experienced it.

I have been mugged at gunpoint/knifepoint and also had bullets fired in my direction in an attempted carjacking (thank you downtown St. Louis) at an earlier time in my life. The fight or flight reflex was definitely about as strong as you might imagine it would/should be in that situation, perhaps slighty dampened by a hobby that required a lot of situational awareness/vigilance.

Cue coming down with a pretty severe chronic physical illness a couple years later and no financial means nor support to fully deal with it (fuck Vascular Ehlers Danlos and Thoracic Outlet Syndrome) - obviously, some severe depression comes with the hopelessness of things like this. The fight or flight reflex... just, came on as symptoms became severe. It was quite noticable and fluctuated in severity the first month or so, but soon became an all encompassing baseline normal... now going on for years.

Simply put, figuratively, I could walk straight up to somebody shooting at me and touch them on the face without any fear/monkey brain instinct to save my life. Literally, I would likely be quickly dead because bullets do that to you and it's not hard to hit somebody walking straight up to you. I really do not mean this in a suicidal sense whatsoever, just the fact that there is absolutely no further stress response from any situation I may find myself in, no matter how dangerous (well, I haven't been plastered in easily visible US military gear in the middle of Afghanistan with people shooting at me, so perhaps I may be slightly too full of myself).

But, the stress response one would normally get that invokes the fear and adrenaline to run away from imminent dangers, it essentially no longer suddenly happens, as it's just been a part of daily life for so long. I can't walk down a busy street without the instant mental registration of where every sound I'm able to hear is coming from. Basically, extreme hypervigilance. It is outright extremely exhausting, and once in a blue moon slightly convenient (like when not having realized the bar you're coming out of at 2am is less than a block from Skid Row and you've got quite a walk to get where you're headed).

I wish more people were aware of this aspect of this mental illness, and I very much hope that there's not a point of no return from it. Something makes me think that there has to be though - whether that's years, or decades of the non-stop fight or flight stressor, and perhaps dependent on what portion of your development you experience it in.

CretinDesAlpes• 5 years ago

This 2018 talk from Dr Yapko, "Keys to unlock depression: Why skills work better than pills" - https://www.youtube.com/watch?v=TVgQ_tgWMyU - suggests a multidimensional viewpoint rather than purely biological. He says the causes are:

1. Biological. He says "Yes, biology matters, but surprisingly not as much as you would think, that when we look at what’s termed genetic variance, how much do genes play a role in depression? Is there a depression gene? No. Are there genes that make people vulnerable to depression? Definitely. So if we look at biochemistry, yes it’s a factor. If we look at disease processes, there are many diseases where depression is a predictable consequence. If we look at drugs, there are many drugs that have depression as a predictable side effect. Biology matters, but when we look at genetic variance, that figure is between .3 and .4. That represents a mild, moderate at best, genetic influence."

2. Psychological. In particular what is known as "Attributional/Explanatory style" (https://en.wikipedia.org/wiki/Explanatory_style), i.e. the person's habitual or reflexive way of attaching meaning to life events. He says "It isn't what happens to people that increases their risk for depression so much as how they interpret and respond to what happens to them."

3. Social

At the end, he says "the goal is not to cure depression, the goal is to learn how to manage your mood. You don't exercise once and now you're done with the exercise thing."

codetrotter• 5 years ago

In particular what is known as "Attributional/Explanatory style" (https://en.wikipedia.org/wiki/Explanatory_style)

Thanks for the link! I’ve been thinking quite often about these things for the past couple of years, having observed similar differences between people I’ve interacted with, but never knew that there was a name for it. Nice to know.

My own pet theory is that the experiences and our surroundings affect us a lot more than we may think.

And it is also a useful reminder for myself, as for years now I have tended to be rather harsh against myself at times, and to look negatively on the future and on what is possible, based on really a small set of bad experiences, some of them recent and some of them earlier in my life.

It’s difficult a lot of the time, to stay positive. And for the past couple of months I’ve been going through what I am pretty sure qualifies as burnout. And during this time I’ve also increasingly thought negatively about myself.

And I think the end of your comment, where you bring up a quote "the goal is not to cure depression, the goal is to learn how to manage your mood. You don't exercise once and now you're done with the exercise thing." is also probably key.

johndubchak• 5 years ago

Self-compassion is key in combatting a lot of that negative self talk. Always ask yourself, “Would I talk this way to another person?”

If the answer is “no” then maybe it’s time you stop treating yourself this way and react with more internal kindness.

belorn4• 5 years ago

Depression in Robert Sapolsky talk is defined as a sliding scale of the inability to recover from the feeling of loss. Some types of inability should be targeted with the intention to cure, while others is more about building defenses and addressing how people react to life events. Both talks seems to agree that a multidimensional viewpoint should be applied depending on the patient situation.

The goal should be to cure depression in cases where we can cure it, in the similar way that we should cure the inability to walk in individuals when we have the technology to do so. A big point brought up in the video is that the medical understanding of the ability to recover from loss is still very much in the infancy when it comes to depressions. Our understanding of a physical leg and what makes a person unable to walk is pretty decent in comparison, and so there isn't as large debate between when to use medicine and when to use exercise and life adjustments.

mcguire2• 5 years ago

Out of curiosity, have you ever spent any significant period of time where you wake up every morning and the first thought that goes through your mind is, "I wish I were dead"?

deskglass5• 5 years ago

After enjoying Sapolsky's lectures on YouTube (including this one) I began reading his book Behave. I was surprised to see that it refers to theories that fail to replicate (eg priming) as if they were solid theories. Stuart Richie (a psychologist who wrote a book on the replication crisis) enumerates other examples in his review https://www.spectator.co.uk/article/rules-of-behaviour/

Please be wary of this failure to drop unreplicated findings when reading Sapolsky's works.

aritmo• 5 years ago

I wouldn't give too much importance to Stuart Ritchie. He is right-wing and conservative, and conservatives hate Sapolsky. Ritchie's political views are evident in his book.

deskglass5• 5 years ago

I read Science Fictions and don't recall politics coming up much. Ironically, his most political point was his defense of the Mertonian norm of universalism from both leftist and rightist critiques. That norm is relevant in this discussion :P. That said, I haven't read his other book.

Politics aside, those theories did fail replication. Forget I mentioned Ritchie at all and the problem remains.

inglor_cz• 5 years ago

The replication crisis would be with us even if every right-wing pundit suddenly disappeared. Much like heliocentrism exists independent of Copernicus or the Church.

Replication crisis isn't political at its core, it is scientific.

ChemSpider• 5 years ago

I agree on both (great books, great lectures, but not everything stands the test of time).

But the good thing is that the book is very well referenced. So whenever I wondered "Is that really true?" or simply "Why?" I was able to find the original paper(s)/source(s) and then take it from there. For me, that is the gold standard of writing a science book.

belorn4• 5 years ago

One of those citations brought me to "How to Think, Say, or Do Precisely the Worst Thing for Any Occasion", a study that show how the worst thing has a higher probability of occurring than random chance would make it. With a title like that I could just not read it.

deskglass5• 5 years ago

True, but Behave was published in 2017! That's ~7 years after people noticed these theories fail to replicate. So it's not that some parts of the book don't stand the test of time, it's that it doesn't accurately represent the state of the science for when it was published.

gerbilly2• 5 years ago

I've sat this out for long time, but I've got to say that it's hilarious watching the HN community—mostly made up of engineers—constantly harp about the replication crisis in Psychology.

In some cases effect may be real even though the studies aren't replicating today. There are several factors.

Replication in psychology isn't as easy as in the physical sciences.

Let me use an example from another field to give you an idea. If I asked you to translate the sentence: "He took the train for London at eight am." into French, would you translate "London" as "London" or as "Paris?"

In other words the social context—social norms, expectations, attitudes—from when many of these studies which don't replicate today has shifted, such that re-running the study verbatim might fail to...replicate.

However say you do try to adapt the study to adjust for the shift in context, then you could also say that the replication isn't valid because you didn't re-run the study exactly as specified.

People aren't robots, so we can just re-run the unit tests on them and expect the exact same results. People aren't even self contained robots, we are social beings, and are very strongly affected by our peers. We aren't swimming in the same water that we were swimming in when these studies were done.

We need new studies for each of these effects that are designed with today's reality in mind. But. No matter how one tries to 'replicate' an old psychology result, it will leave room for skepticism. It just won't be able to account for the 'translation' required without leaving room for doubt.

I guess the most important thing we could learn from this is that it's important to replicate any current studies right now, and not wait forty years to do so.

pas3• 5 years ago

No, the problem is a lot deeper than just "capturing the protocol in the methods section is hard". (There are very interesting articles about how word frequency shifting might be a confounding factor, which can cause old - from the 70s and 80s - papers to fail replication. But then there's no follow up with a new corpus and new replication.)

It's not just bad (vacuous) science, at its core it's people who act in a bad (selfish, non-scientific) ways: https://statmodeling.stat.columbia.edu/2016/09/21/what-has-h...

I guess the most important thing we could learn from this is that it's important to replicate any current studies right now, and not wait forty years to do so.

Yes, that too, but what's even more important is to shift into a mindset that starts with good models, good data generation processes (ie. experiments), then we can check and compare their predictive power. Otherwise we get these statistically flawless abominations that prove ESP:

https://statmodeling.stat.columbia.edu/2011/01/11/one_more_t...

And, sure, yeah, it's hard to do this. But otherwise we'll have nothing more than just-so stories supported by random data that happened to break through some significance threshold.

deskglass5• 5 years ago

The replication crisis isn't merely in psychology, old studies, or studies that didn't carefully record their methodology. Eg the review I linked mentions a study from 2006 that didnt replicate in a larger trial. The one about stories involving immorality priming people to use more antiseptic wipes. It's weird to me that someone would write a book and reference that study without mentioning this replication failure. Especially in the context of the many other such failures to replicate for priming.

Theories ought to be backed by experiments that replicate. Maybe describing methodology precisely is hard, but replication is how we know a phenomenon is actually real and not p-hacked or otherwise mistaken (eg by experimenters mis-measuring).

slingnow• 5 years ago

So what you're saying is all study designs are acceptable. All study results should be trusted. We should trust studies that can't be replicated, because "something about translating London into Paris".

What you're describing isn't science. If you want psychology to be held to a different standard, then that's fine. But then you can't call it science.

fulafel• 5 years ago

Priming is not a theory that generally failed to replicate afaict. There was bad research but priming as a phenomenon is far from "busted".

deskglass5• 5 years ago

Note that I didn't just read the word "priming" in the book and seize upon it generically. As noted in Ritchie's review, Sapolsky references specific studies which larger trials have failed to replicate (eg the Macbeth Effect where reading stories about unethical behavior made people more likely to grab antiseptic wipes).

SlySherZ• 5 years ago

If you like this, do yourself a favor and go watch the entire Human Behavioral Biology course from Standford, it's also taught by Sapolsky: https://www.youtube.com/watch?v=NNnIGh9g6fA

What I think makes the course so good is that it gives you a brief but solid introduction to many different fields:

    - Behavioral Evolution
    - Molecular Genetics
    - Behavioral Genetics
    - Ethology
    - Neuroscience
    - Neurology and Endocrinology

And then combines all of those to try to make sense of human behavior, by looking at animal and human behavior from all these different lenses.

junon• 5 years ago

Seconded. I've only watched the first five or so, but they are absolutely worth it. They changed a lot about how I think through certain situations and have proven their worth many times.

The man is also just an incredible lecturer, too.

arketyp• 5 years ago

Great lectures. He even manages to cover chaos theory. Philosophy students should look into this series for some biology orientation, in my humble opinion.

xorfish3• 5 years ago

Especially if they want to discuss Free Will.

seg_lol• 5 years ago

The lectures are good, the LECTURER is galaxy class. Everyone regardless of discipline should watch the lectures for their metacognitive qualities alone.

Sapolsky could literally give a lecture on shit and I'd be at the bus stop, someone would mention just a sliver of a lead and I'd intergect with, "I just saw this amazing lecture on shit by Sapolsky ..." to a complete stranger.

His lectures are that good. He is science jesus.

belorn4• 5 years ago

I often bring up his lecture series as an shining example of how to explain scientific theories with a critical qualifier that almost always is otherwise missing.

He first explains a concept with logically and narrative consistency in order to explain why something occur. Then at the end he goes and demonstrate all the wholes in the theory and through that shine a light at where the narrative fails. It is only after going through multiple different competing theories that the edges start to get defined.

ReDeiPirati2• 5 years ago

Cannot recommend this more! Seriously. It has been an eye opener to me. For people who loves books over video, he wrote those books where he covers the same topics:

- Behave: The Biology of Humans at Our Best and Worst

- Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping

mikevm• 5 years ago

Have you read the books as well? I was wondering whether it's worth listening to the lectures or reading the book.

aasasd• 5 years ago

Perhaps we should stop badgering the site to death.

WBM has a mirror: https://web.archive.org/web/20210901085438/https://www.rober...

I don't see images in the mirrored page, but I also have no idea if there were any in the article itself.

cushychicken2• 5 years ago

If you haven't read Sapolsky's A Primate's Memoir, do not walk, run to your nearest bookstore or Kindle and grab a copy.

It is without a doubt one of the best books I have ever read. Highly recommended for fans of Finnegan's Barbarian Days.

misiti3780• 5 years ago

purchased!, although cant seem to see how Barbarian Days is related (it's about surfing, no?)

cushychicken2• 5 years ago

Topically, it's completely unrelated. They are both memoirs, and they strike me as cut from the same cloth in tone and substance. They are both reminiscences to an earlier, much beloved time in someone's life.

I really liked both of them, and many of the folks who have read one have liked the other when I've recommended it to them.

ncmncm• 5 years ago

Why Zebras Don't Get Ulcers was the most profound book experience I have had in 50 years' reading.

In the final chapter, it took me a half hour to read each page, because it was tying together threads from the whole rest of the book. Each sentence called out themes from widely separated chapters.

I had always wondered how systems as elaborate as the human body could work at all. This book made it clear that, for any vital process, you have at least three and often more separate systems for each function, and they all suppress one another, so that if one is interrupted, it stops suppressing the others and they step up. But, each system is also doing more than one thing, so you never get just one effect. It's a massive Rube-Goldberg / Heath-Robinson contraption tuned over million of years for a sort of statistical robustness, at the extreme expense to simplicity.

To be an endocrinologist, you need to be several times smarter and more careful and diligent than any other medical specialty.

Another endocrinologist worthy of close attention is Robert Lustig. He has excellent lectures on youtube that, if you pay the close attention he deserves, will lead you to make radical changes in your daily habits.

xorfish3• 5 years ago

I read his newer book, "Behave: The Biology of Humans at Our Best and Worst".

The book changed my view of the world quite a bit. Especially about wealth, poverty, crime and justice.

guerrilla• 5 years ago

The book changed my view of the world quite a bit. Especially about wealth, poverty, crime and justice.

How so?

amin• 5 years ago

Adverse childhood experiences (ACE's) have been shown to have a strong correlation with depression rates later in life.

In other words; someone who grows up in a warm and loving family, with both biological parents, is much more likely to end up happy than someone who grew up with an alcoholic father, emotionally absent mother, a handicapped sibling, and an uncle in prison.

Source: https://pubmed.ncbi.nlm.nih.gov/23595840/

sjg007• 5 years ago

I don't think ACEs is sufficient in scope, there's a lower end of adverse experiences that they miss on the verbal abuse scale.

iainctduncan• 5 years ago

If you love Sapolksy (and I do!) you will also love Frans De Waal. His books are fantastic too!

zerop2• 5 years ago

A simple solution that works for depression mostly is meditation. Consistency is key.

eimrine• 5 years ago

What is your understanding of meditation, any differences in comparing to just doing nothing?

zerop2• 5 years ago

In short: focus, observe thoughts but don't react to thoughts...

Goal is to eventually become observer than reacter. When done consistently, the subsconcious mind will learn it. You overall stop reacting in-general.

motohagiography• 5 years ago

Depression is aggression turned inward .

This was a very powerful reframing of the idea, especially after setting up the biological sources of aggression. Inventing new, accessible, and even useful outlets or ways to exernalize aggression instead of suppressing it could help a lot of people. The very idea that aggression could be a real need that benefits from relief could be a huge breakthrough in helping people manage their general mental health under extreme conditions like long term isolation. It also implies that suppressing aggression may cause depression, which any situation where you've been made to feel powerless is in effect, defined by.

It sort of makes sense that our societies have created social taboos around aggression needs that started as necessary but metastasized over time, the same way we have managed to dement other needs like sexuality, food, and companionship with primative categorical tools that produce versions and understandings of them that are abominations. Analogously, in that framework, depression may also be such an artifact of a similar cognitive abomination.

The idea of "men not talking about their feelings," makes more sense as men suppressing aggression because our societies use disgust taboos as a tool to manage them, in a very similar way that disgust is used to control womens' sexuality. When you view aggression as a physiological need, and then analogize it to how we obviously pervert other needs by managing them with disgust, some conceptual dominoes start to fall.

Admittedly I'm sounding this out for the first time myself, but if aggression is a physiological response to being threatened, creative activities can relieve our aggression needs because they are a reassertion and expression of self that has been threatened. Powerlessness causes aggression, and creativity is often a response to it. The reason physicality "works," on depression because it directs all the faculties that would be an aggression response outward. Lifting weights, running, martial arts, even more advanced yoga, or any exercise is going to provide some relief of that need. It's different from peace, rest, sympathy, or entertainment and it could also apply to things like gambling and substance abuse, where the masochism (def: craving of intensity) is a release for inverted agressive needs.

My close male friends are all type-A giant personalities, and the things we have in common are these intense activities that in effect, manage aggression. We do hyper intense things together like riding motorcycles and horses, snowboarding, lift weights, make heavy music, perform, code, and write (among other things), which are all high intensity activities that are assertions of self, and in effect, relieving a need for aggression.

Viewed as something essential or a need, engineering people (socially or otherwise) to be immoderately less aggressive would be like doing the same for appetite, sexuality, or sociability, and literally make them the expression of the disgust that motivated altering them.

Unbelievable what the reframing of a concept can unlock.

neuroma• 5 years ago

Great Post thank you,

I need to express my unending frustrating with the manner in which educators are bringing up the roles of neurotransmitters in psychiatry.

Quoting neurochemical imbalances as originators, or targets to fix, is mostly false. That narrative is also harmful to people's self knowledge, and to progress in the field.

Engineers: how would you feel if someone described a technical problem, a UX issue, a data handling nuance or a security flaw... all as 'down to electricity'. Whilst pedantically correct it serves little use and may harm us by arresting the first tendrils of thought that were reaching out, hoping to understand this mystery.

The narrative that psychiatric illness relates to 'neurochemical imbalances' is largely a hangover from pharma marketing. Of course, neurochemicals are involved, and there will be patterns to be found. But let's collectively reject those oversimplifications that helped sell semi efficacious drugs for decades whilst doing little for societal progress in coping with psychiatric illness.

These mental health problems are bio psycho social. And the bio component is enormously more complex than "low mood, low serotonin".

Its okay to just say, "It's bio psycho social, and it's complicated".

xibalba• 5 years ago

oversimplifications that helped sell semi efficacious drugs

YES. Anyone who has rotated through the kaleidoscope of antidepressants seeking help knows this in their bones. Current pharma options barely work and come with many unpleasant side effects.

pas3• 5 years ago

At the same time many people got their life back thanks to those lame drugs. It's not a panacea.

getpost• 5 years ago

"Chemical imbalance" is not only a marketing phrase. Lots of people are willing to receive treatment for a "chemical imbalance," but aren't willing to engage in therapy, or admit they're depressed. This was very common in the last couple decades prior to the turn of the century, when mental illness was much more stigmatized than it is now.

ericsoderstrom• 5 years ago

Isn't that marketing?

bserge4• 5 years ago

Well, that sure works the other way, too: stop calling it a mental issue that can be resolved with willpower or attitude when it's clear that for many people, medication works and it works well.

To make it worse, doctors just get on the SSRI bandwagon and consider it a cure-all with zero consideration for anything else, making a sizeable minority of people suffer even more and longer.

Yeah, biopsychosocial. Good luck finding a doctor who will actually help you find the root cause when you're on standard insurance and can't afford the best private ones (or worse, it's actually illegal to bypass the system).

alecst• 5 years ago

stop calling it a mental issue that can be resolved with willpower or attitude when it's clear that for many people, medication works and it works well.

He didn't say that though. In fact OP would agree with you that calling it a matter of willpower is an oversimplification. That was the whole point of his biopsychosocial thing.

Anyway the drugs sometimes work and sometimes don't. Hitting a CRT TV sometimes makes the picture come back. That doesn't mean a TV has a hitting deficiency. It's not clear why it works. SSRIs sometimes work and sometimes don't. But depressives don't have a serotonin deficiency. It's not clear why they work.

qwerty4561275• 5 years ago

What I ' not sure I understand is why does Dr. Sapolsky insist humans have exactly zero free will. Privileged to have (hmm, I'm not sure if this sounds humble or supercilious in this case) a rather healthy brain with sufficiently developed prefrontal cortex and other areas, no matter how depressed or aroused I am (I have probably never been either in a serious degree but nevertheless) I usually can "wake up", pause, overcome my urges and make a conscious decision to behave this or that way out of some logic, mindfully aware of the fact what I feel and think is subjective and mostly illusory. I agree the degree of freedom of the will in rather humble in the majority of people (me included) but why zero?

steveads• 5 years ago

https://www.youtube.com/watch?v=3O61I0pNPg8&t=356

jessermeyer2• 5 years ago

He mentions this in passing on the Mindscape podcast (with Sean Carroll). Essentially, he's read too many studies that have participants perform so called 'rational' tests whose outcomes are largely a function of the environment and not the 'given test' -- ie, the presence of a foul smell caused a statistical difference in the outcome of the test. Our capacity to reflect and internalize is, to him, another output of a vast and continual, unconscious, shaping all life undergoes.

qwerty4561275• 5 years ago

the presence of a foul smell caused a statistical difference in the outcome of the test

But the fact there is a statistical difference does not mean it affects everyone and in the same degree. E.g. they probably didn't test many experienced Zen monks trained to impartially and vigilantly observe what they perceive and feel and a couple of weird guys who do this naturally also didn't affect the statistics. Statistics is both a great tool and also a problem of modern science. I bet some medications dismissed for failing to show statistical significance in DBPC trials could actually work (by means of some real phenomenon rather than the placebo effect) in some rare cases.

Our capacity to reflect and internalize is, to him, another output of a vast and continual, unconscious, shaping all life undergoes.

It probably is. No action can exist without a sequence of past interactions which led to it. Even if I stop, think and make a conscious decision, even if I try to come up with a non-standard one, this means my previous experience led me to the idea I even should. But this doesn't mean "humans have no free will", it means "free will" is a meaningless concept outside the realm of logic and neither saying it exists nor saying it doesn't makes any sense and being sad about this doesn't make any sense either.

katmannthree2• 5 years ago

Can you give a rigorous definition of what you think of as free will?

qwerty4561275• 5 years ago

I can give 2:

1. A totally undefined concept making no sense to say it exists as well as to say it doesn't.

2. The ability of a person to consciously observe, question and disobey what they feel. The degree in which a person is capable of this varies between different people and different circumstances.

manmal2• 5 years ago

Pardon for introducing philosophy here, but Schopenhauer‘s „A man can do what he [wants], but not [want] what he [wants]“ might be a good attempt at an answer. Past and current environment, genetic setup etc would completely predetermine the processes in your brain.

https://philosophy.stackexchange.com/a/32734

qwerty4561275• 5 years ago

Choosing what to want may be non-trivial in many contexts but I actually do this often. I often choose to want to do what I have to do and, given some effort, this switches me from feeling angry to feeling happy.

layer8• 5 years ago

I usually can […] overcome my urges and make a conscious decision to behave this or that way out of some logic

But what made you make that decision instead of a different one (or none)? You generally have no choice but to make the exact deliberate choice that you make in the given moment.

nefitty• 5 years ago

The world is material. In this material world, everything that occurs has a physical consequence. We cannot introduce the concept of free will without introducing a non-material cause, eg souls or magic.

hart_russell• 5 years ago

I very much identify with the psychomotor retardation and sleep changes.

I grind my teeth all night and wake up feeling exhausted.

I’ve tried a SSRI and an SNRI and neither did anything for me.

throwaway11121312• 5 years ago

Sorry for the thread hijacking but I'd like to ask the HN crowd about my problems:

For the past three years I have various health related problems like brain fog, tiredeness, breathing trouble, pain all over my body and a general bad mood. These things come and go (some times are worse some better) but for these years I remember myself always having some difficulty.

I am very sad and can't enjoy anything anymore. I can't enjoy my family and I feel I am a problem to them for being always moody and sad. I don't want to go out with friends, only stay at home and do chores or play games. I am constantly afraid that I have a major health problem and try to think all the time what may I have or how I can get better. Actually I can't really think of anything else beyond my health problems.

However after visiting a number of doctors and done lots of exams they couldn't find anything.

Notice that I have never visited a psychiatrist or psychologist and I don't think that I had ever had any psychological problems. I may have some form of minor autism but that didn't stop me of being happy the years before.

Do you think that I have some psychological problems? Maybe depression or some major anxiety? Should I visit a psychiatrist? I can't think of what to say to the psychiatrist... Should I keep visiting other doctors to do more tests? Any help would be much appreciated.

fddhjjj• 5 years ago

If I felt said for a period of months without specific cause, yes, I would see a psychiatrist or psychologist.

What did the doctors who you did see say when you told them about your symptoms? It strikes me as odd that they did not recommend a mental health specialist.

throwaway11121312• 5 years ago

I feel sad because I feel that I have some major health problem. If somehow I knew that I didn't have anything and all my problems stopped then I believe I'd feel better.

I don't talk to other doctors about being sad or not enjoying life or thinking about my health problems all the time. I am too shy to talk about that.

taylus• 5 years ago

I would try to get a referral from your doctor to speak with a therapist.

fighterpilot3• 5 years ago

I am not an expert or a doctor, but did your doctor rule out fibromyalgia? You mention widespread physical pain.

throwaway11121312• 5 years ago

I am not familiar with that condition. The physical pain is not constant nor very bad. I can function normally when I feel that pain. Also because it travels in my body doctor's don't really care about it.

bserge4• 5 years ago

Good luck. I've been struggling for over a decade and it's just getting worse, so much worse. If you can, go to as many docs as possible.

I found stuff that works for me and then started struggling to get doctors to prescribe it.

The healthcare industry is a massive joke.

Funny enough, this week I witnessed an ambulance driving up to a guy on the ground (not homeless looking by any means), waking him up and... leaving.

I assume he was just drunk af, but come on, at least give him some water, he's literally forced to pay for your "care" :D

Would they even fix a broken arm, I often wonder.

throwaway11121312• 5 years ago

What do you mean stuff that works for you? Is it a medicine for a psychological condition or for something else? I am living in EU and the health care here is better I believe. Also I have money to spent and can visit doctors at will.

twostorytower2• 5 years ago

You should probably talk to a psychologist regardless, as the psychological impact this is having is very apparent and mental health is just as important as your physical health.

This might be obvious and you may have already done a study for this but have you looked into sleep apnea? I had the first two symptoms you described for about a year and it ended up being mild sleep apnea and acid reflux related. Obviously your case could be completely different, but good to rule out. Now I wear a Somnomed mouth piece at night and take acid reflux medication day and night.

No more brain fog.

throwaway11121312• 5 years ago

Thank you for the tip. Yes I guess I need to go to a psychologist or psychiatrist but it's very difficult for me to go and speak to him.

For the sleep apnea thing, doesn't sleep apnea mean that I will be loudly snoring? My wife hasn't complained about snoring ever.

abecode• 5 years ago

Lithium supplements maybe? There are over-the-counter supplements available. Prescription lithium has proven uses for some mental treatments. I read some positive things about areas with naturally occurring lithium in drinking water. As far as elements go, it is the first solid element at terrestrial conditions, so one might expect it to be a trace nutrient for organisms living in terrestrial conditions.

throwaway11121312• 5 years ago

I'll research this a bit and give it a try. Thank you

winrid2• 5 years ago

From experience, and as silly as it sounds, check for things like vitamin B12 deficiency.

throwaway11121312• 5 years ago

I have checked it, it's fine...

mcguire2• 5 years ago

Your description sounds similar to my case, although I never had any anxiety about my health. And I did have short, sharp flashes of extreme anger. But the ultimate question is up to you: Do you think you have a problem? Is it affecting your life?

I first tried psychological counseling. I also have no idea what to say to them, but that's why they are there. Tell them what you wrote here and they can ask questions to go deeper.

In my case, the counseling helped briefly; I was better for a few days after each session. But at that point I was more comfortable going to my primary doctor and asking about medication, which has helped greatly.

To my knowledge, there aren't any kind of blood tests for psychological issues.

Oh, and be very, very cautious of recommended treatments from randos on the internet. The medical folks don't really understand the machine they're working on, and they're frequently wrong, but they do know a hell of a lot more than someone who just googled 'ivermectin'.

throwaway11121312• 5 years ago

Thank you for the insight! Yes I think I have a problem and it definitely affects my life and my relations with my family :|

caddywompus• 5 years ago

The inability to find joy in things you normally do, feeling tired all the time, even when there is no reason for it, over an extended period of time, are all red flags for depression requiring intervention.

As far as I've seen, there is no physical (i.e. blood/fluids) test that can detect depression, it is diagnosed based on behaviors and history. A common feeling is that you want to make sense of these feelings by attributing it to a more understandable health issue.

Depending on what your mind ruminates on, it can be impossible to talk to others about what your thinking (as they may be dismissive, or alarmed). That's where you need someone who's qualified to talk to, like a doctor or counselor.

I'm surprised by the amount of criticism of medication in this thread. Although it is by no means a cure, it is an extremely powerful tool that can allow your brain to break out of feedback loops, and give you some control over your emotional regulation.

Reach out to your doctor, and be frank. Tell them exactly how low your feeling, and don't sugar coat it. They'll have questions to ask you. Also note that you can get doctors who are not a right fit. If you feel like your doctor is not helping, or you feel worse off from seeing them, then find a new one.

Depending on the severity, know that you can always push the issue, regardless of what friends/parents/teachers/colleagues tell you. If you are in crisis, call a cab, an emergency line, whatever, to get yourself to a clinic or hospital.

This kind of thing takes time and effort to solve, and you're the only one who knows how, you, personally feel. It's not like a broken bone, or infection, you have to do your best to describe to doctors how you're feeling.

throwaway11121312• 5 years ago

Thank you for this great advice. I will definitely try to talk to a doctor!

dec0dedab0de2• 5 years ago

Sorry to be cliche, but have you tried changing your diet and exercising more? Letting them slip always ends up with me feeling like that. To be fair, the one time it ended up being cancer, but even then the cancer felt better when I was moving around and eating more vegetables. My checklist when I start feeling down: Water, Magnesium, vitamin D3, Fiber, squats, full nights sleep, no alchohol, wake up early every day, have sex, pet a dog, go into the woods.

It doesn't always work, but it's still good place to start. I hope you figure it out.

throwaway11121312• 5 years ago

I was exercising regularly and eating fine (I think). It's difficult keeping it up though when you feel very bad...

realitygrill• 5 years ago

You might also want to look into ME/CFS. I'm very sorry to hear about this, because I had an analogous experience for years and know how hopeless it feels to try to figure out what the issue is (while your cognitive abilities / stamina are limited by brain fog), fail over and over, and in the meanwhile others cannot understand and don't believe you.

Feel free to email me if you want to chat.

winrid2• 5 years ago

Depression is amazingly difficult to reason about when you are on the outside looking in, especially when you throw in sickness.

Especially when you're a sick family member with depression and want your family to just let you die, but nobody wants that for you.

Going through that right now with a relative.

Robert Sapolsky on Depression (2009)

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