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No Longer Wanting to Die (opinionator.blogs.nytimes.com)
181 points by hudibras on May 17, 2015 | hide | past | favorite | 100 comments



Treatment for depression is badly handled almost universally... It seems as if people still don't generally understand that it's more than 'feeling a bit sad'.

If you break your knee, you will (99.9% chance) go and see a doctor. If the first doctor doesn't fix it, you'll see another. Your knee is broken, unusable, painful and you have a drive to fix it.

A more serious injury will generally result in a friend/family member/passer by getting you to a doctor.

If you suddenly enter a depression... even getting to the stage of seeing a doctor can fail, because suddenly everything is 'pointless' (bad wording. sorry.). And if you see them and they give bad advice, you maybe can't be bothered to see the next one. Or you miss the appointment because getting out of bed was too hard. Etc.

It's more severe than most physical injuries because it affects your ability to seek help.


Not to mention the social stigma that still(!) haunts depression (and virtually all psychological injuries). Few physical injuries have any sort of stigma - and the ones that do are usually associated with depression. Certainly it would be better if that stopped entirely (and, as with homosexuality in general, and gay marriage, it seems to be happening).

That said, I actually have sympathy for the stigmatizers. From their perspective a perfectly healthy person with no overt negative stimuli is profoundly unhappy for no reason. That's got to be frustrating because it's completely and totally opaque, untouchable, alien, and unaddressable. The condition stymies the compassionate person, making a mockery of their good intentions. That is frustrating, even angering, and is probably the cause of the ambient hostility that lingers around depression. Depressives behavior appears stubbornly self-destructive, which essentially and irreducibly thwarts the will of those that care for them.


It doesn't matter much if a person is sad for no reason, no one wants to be around someone who is sad.


This didn't deserve a downvote, it's a good observation of the problem. If you're depressed, it's very hard for people to be around you, and that makes the depression worse.


Yep. In fact, I think that (apart from clinical practitioners who might find it fascinating) the people best positioned to help the depressed are those who've experienced it themselves, and overcome it.


I'm depressed. It comes and goes, but generally in the middle of an episode I don't want to be around other people either, which I think compounds the issue.


I think one of the issues is that often when it comes to depression treatment precedes diagnosis, and treatments affecting the symptoms can make the diagnosis even more difficult.

People going to their GP with a 'I feel depressed' that get told 'well, here's a prescription for some pills, let me know if you feel better with them if not I can give you something else to try' would be the same as if somebody reports a thorny concurrency bug with your embedded multithreaded application and your first response is 'well, let's try to overclock/underclock the CPU to see if it improves things, if not maybe we can try to change the RAM next time'.

It is a lot cheaper for medical services as a whole to have GPs easily prescribe antidepressants and psychoactive drugs in general rather than have psychologists available immediately for anybody who might need them, but it does not make it right.

Others might not share my misgivings but I would only be willing being prescribed a psychoactive drug by a specialist (psychologist/psychiatrist) after a thorough evaluation and non-pharmacological therapy first, and even then very conservatively and after an explanation more objective than "you have a chemical imbalance in your brain" (which chemicals? what imbalance? what should be the normal values?).

There should be much easier and cheaper access to non-pharmacological treatment for mental issues, but maybe to have that one would need it to be destigmatized, which of course is a very slow process and might or might not be possible due to the identification we have with our minds: if our knee hurts we think "my knee hurts, it needs fixing" if our mind hurts we think "I feel bad, I am a worthless person" which is a lot harder to deal with unfortunately.


This is further compounded by the stigma & blame that surrounds mental illness, which can be quite severe in certain cultures/countries e.g. China


Add India to the list


Plus you can get banned from entering the US

http://www.cbc.ca/news/canada/toronto/canadian-woman-refused...


wow is this forreal?


I feel like laughing not out of happiness but out of despair(think: The Killing Joke) because I exactly understand what you mean by 'pointless'.


> even getting to the stage of seeing a doctor can fail, because suddenly everything is 'pointless' (bad wording. sorry.)

Everything actually is pointless, since all matter and energy will dissipate from entropy on a long enough time span. Also everyone you know will be dead in 100 years, most likely.

Also most of these people would go see their doctor if there was a million dollars in gold waiting there for them. It's not that 'everything is pointless' is the reason preventing them, but rather that there isn't enough significance in seeing the doctor.


> Also most of these people would go see their doctor if there was a million dollars in gold waiting there for them.

I'll caution you against this thinking, in general. If you have a depression so severe it keeps you from seeking help, you're probably well aware that it's a matter of life and death. Even if you're not acutely suicidal, you live day to day just "running out the clock", hoping it doesn't get any worse before you die. The prospect of wealth or fame in your future is not only not enticing; it may well make you feel worse, as self-awareness of your inability to care reinforces your depression.

The idea that people who are not motivated by death will be motivated by money is, while not categorically false, surely fraught.


Yes, all true, but you'd have to be depressed to not have the cognitive biases which prevent you from making this more than an academic observation.


I modified my original comment, so I guess I'll rewrite it. And I totally agree.


I can't agree with this. Having had a lovely time with depression a couple of times you could double that amount and it wouldn't even register. Depression isn't a lack of motivation, a lack of motivation is a symptom of the greater issue

Merely anecdotal evidence of course, but I don't think you're on the right path here


As someone who has suffered from moderate but not debilitating depression for much of my adulthood, one thing that has always stood in the way of getting treatment has been finding a damn therapist. Back when I was a broke, insurance-less musician, I went to inexpensive sessions with a student therapist who listened to me talk for a semester but offered very little in the way of help.

Shortly after getting insurance I asked my doctor for a therapist recommendation. The therapist she sent me to was a very nice old man who started suggesting prayer as an answer to my problems in the second session. That was also our last session.

I wish there were a way to do this that eliminated some of the trial and error, because listings tend to be pretty neutral, and reviews are sparse and not particularly trustworthy. You end up picking someone who's close to you and hoping it works out. It's a great way to lose a lot of time, and you know one of the things about depression is failing to find a therapist after a few tries greatly decreases motivation to keep trying.


I think this is a general problem with the health care system. Finding somebody that's worth a shit is basically impossible to do in any sensible way, even for something as straightforward as orthopedics -- my journey towards shoulder surgery has been ridiculous to the point of farce.

If it's this bad for ortho it must be unimaginably awful for anything touching mental health. What does one do? Get personal recommendations from trusted friends who've done their own searches? Are online communities any use?


I can testify to the mental health search difficulty. A close family member is searching for a therapist for emotional help dealing with an occasionally debilitating physical health issue. The first group we found through online searches ended up being a front for a multi-level-marketing group schilling essential oils. The second group, recommended by the overseeing physician at one of the most prestigious hospitals in the United States, was actually a "new age" center, whose main advise was to try homeopathic remedies. The third group, recommended glowingly on its web page, and organized by the hospital itself for sufferers of my family member's very condition, seemed to have vanished without a trace. No one had heard of it. Turns out it went defunct years ago, but no one bothered to update or remove its associated page.

That's where we stand. Infuriating. This is not quality befitting a first world nation.


I've begun to wonder if the US is really and second and a half world nation. We have so much potential, and we keep it from ourselves. Maddening.


If you can, I suggest finding a Psychotherapy institute (this is not the "institute" of "institutionalized"). They have many therapists on "staff", and you begin your treatment with an interview that's designed to match you to a therapist that works well for you. The interview asks about why you're seeking therapy and if you have any preferences for your therapist (male, female, young, old, religious, non-religious, etc.). And if you wind up not liking the therapist they recommend, you can ask for another without any fuss.

There are a number of these offices in NYC and I'm sure there are some in other cities as well. I hope you find somebody that works for you.


Oh wow. That's even worse than the therapist I tried to see after getting out of undergrad and finding myself depressed with adulthood. I said that I was depressed with the thought that life after graduation consisted exclusively of work and materialism. He said I was being immature and should grow up.

Psychotherapists and psychiatrists often seem to be utter shit at serving patients as normatively neutral medical professionals, ie: not treating their own lifestyle preferences or ideological frameworks as the One True Way to Live.


Interesting, I'm not sure it's worse than your experience. I was pretty well equipped to discount the advice of a therapist pushing prayer and weird conspiracy theories. On the other hand, your therapist was an authority on mental health who was actually confirming some of the negative thoughts that depressed people often have. That would be a lot harder to defend against.


Totally speculative, but I think this might have something to do with a high demand for good therapists. For instance, I spoke recently with a friend who was studying to practice psychoanalysis and when I asked him if he was looking for clients, he turned me down in such a way as to suggest 'you're not on the level of my clientele' or at least 'I have all the clients I need.' This was in New York where I'm sure there's a huge base of wealthy potential clients willing to pay a premium.

If therapists have no problem finding clients, word of mouth may actually be the best system for them.

Please correct me if I'm off-base here.


Or maybe he didn't want a friend as a patient. You're not supposed to bond with your therapist but if you're already a friend it's too late.

So his rejection may have been ethical and not about your worth as a patient.


I know as someone who was a caretaker[0] for a partner, it's incredibly hard to separate making responsible choices for someone who can't always make them from your regular actual friendship or relationship with them.

If you were already friends with the person, I really don't see them ever wanting to treat you formally. In the worst case they might have to make the almost impossible decision between involuntarily committing you (if they think you are a danger to yourself/others) and losing a valued friendship, or not committing you against their better instincts to preserve their friendship and risking you harming yourself/others. (Not that you are necessarily in that category ever, but if you're making a decision like "Can I ethically provide treatment for this person?" you really have to think about worst cases.)

[0] I don't have any medical/therapy training, but I wound up spending a few months taking care of someone I was dating who was having a pretty severe manic episode. Very irresponsible of her doctor, in retrospect, who later said the reason he hadn't hospitalized her was because she had me to help take care of her/watch her--and we were both college students and he had met me once, briefly.


Should have mentioned he was more of a friend-of-a-friend and he also mentioned to me that he does see acquaintances.


It's a classic NY/Jewish joke that the only doctor worth seeing is a doctor whose schedule is fully booked.


I highly recommend the book "Feeling Good" (by David Burns) as an alternative to talk therapy. I (and several of my friends) have found it instrumental in overcoming depression. More importantly, it has been clinically studied and IIRC evidence suggests that it's on par with talk therapy or medication for mild to moderate depression.


I've felt the same way. I randomly found a therapist who has been very helpful to me and who I think is quite talented, but I only found her long after I'd given up on searching (many years later). It was essentially random happenstance. Though it also required me to become more open minded about the value someone could provide despite what I consider a less than ideal scientific literacy (in this case Myers-Briggs).


Was your second session your last because the prayer suggestion made you not want to go again?


It was a little more than that - he was talking about the HAARP conspiracy theory as well. It just became clear he didn't approach the world rationally. I'm sure for some people he would be a great therapist, but not a good match for me.


So I'm a sucker for conspiracy theories, and this one's a new one on me:

http://en.wikipedia.org/wiki/High_Frequency_Active_Auroral_R...


Yeah, I hadn't heard of it either. He started talking about it and I said, "that sounds like a conspiracy theory," and then ended up looking it up in the session because he wouldn't let it go.


Wow, that's and extremely weird thing to come up from the therapist in a therapy session.


That, and the bit about prayer, sounds like the therapist was focusing on his own needs rather than the needs of the client.


Being told to pray is pretty much the antithesis of good therapy.


Not necessarily. I haven't researched it beyond what my doctor told me, but "studies have shown" that for people who have prayer as part of their life to begin with, prayer can be very helpful. Not for the GP commenter, so that suggestion wasn't helpful, but certainly for people already open to it.

And doesn't that make sense? We're not merely bodies and brains, a biological machine built to specification, arriving at a particular day exactly like each other and exactly like we were born. Besides differences in brain mechanics and chemistry from each other and from our birth, we are also each the various experiences of our history. We have as much in difference as in common with each other.

Quite apart from the question of whether prayer and what's prayed to is reality or not, people do believe in prayer and what's prayed to. If that's an effective part of their therapy, I see no reason to question it. If it lifts them out of the horror of depression and keeps them alive, I'm very happy for them, and for me if they're in my life.

-- Signed: a non-partisan, small "a" atheist.


I see (religious) prayer as simply a form of deliberate enunciation or vocalisation of hope. One would likely only pray if there was even the smallest glimmer of hope to begin with! Doesn't matter if it's a call for a miracle, there's still some dopamine activity there.

The idea of encouraging the hopeless to pray as a method of bootstrapping themselves out of depression may simply be an appeal to a more cognitive self-realisation process. This simply by the act of vocalising what the individual hopes for.


Depends why the therapist is suggesting it.

If he thinks that praying in and of itself will be valuable, eg, because the patient is religious and a calm, focussed mental state would be valuable, then it is good therapy.

If the therapist is suggesting that the patient ask God to cure him... well, that's not good therapy.


I am not religious but I can see the value of prayer.

In this case, the therapist could have understood that prayer was not a helpful suggestion - but in general, it's a valuable tool.


When used with caution, perhaps. Separation from a god-belief coincided with the start of my depression, so prayer would be super-not-helpful.


This is why prayer is better as a preventive measure, not a treatment.

Keeping faith feels healthier than trying yo regain it.


How so? Seriously praying is an involved, focused mental state. It's not flippantly wishing.


Being asked to pray is not the right way to go. But, gaining a spiritul practice of some sort and learning/practicing mindfulness can be a tremendous help to someone suffering from major depressive disorder, such as myself. It has helped me quite a bit. Though I am still depressed, as I have been my entire life. It's a good tool in my toolbox of things that I have to help myself.


I am not surprised that a treatment that is so effective to the author has remained unknown to him for so long. I have had feelings of suicide for the last 14 years. I personally hate meeting psychologists, because they can be so unpredictable. Some of the better ones prescribed me medicine, some of the worse ones, told me I had to stop crying and find solutions to my problems, that I was lazy. I was also told because I could do my job and earn a good living, I had nothing wrong. Few acknowledge that having no friends for 14 years can be disruptive. I am in a state where every moment is sad, but over the years at least I have learnt to keep a happy face on the outside and wait for something to happen. I just wished psychologists be more scientific and stop considering everything trial and error!


Here are some suggestions that worked for me, and may (or may not) help.

I find that depression -- at least for me -- has two main causes:

[1] Excessive emotional response to bad situations (similar to what the author of this article is experiencing).

and:

[2] Insufficient motivation/goals/joy.

My solution to [1] is twofold: mindfulness and resolution. Be aware that excessive negative emotional responses are bad (as they lead to depression), so it is better to just observe bad situations and try not to get overly emotional. Secondly, try to resolve the issue (either by actively managing it, or by accepting that the world is just like that and you can't change it), so that the conflict doesn't arise in future.

For [2], the solution is to have a purpose in life, with motivating, goal-oriented activities that you enjoy. I suspect this might be the issue for you. There is more to life than having a well-paid job. I gave up very well paid contract work 15 years ago, as I hated it. Since then I have worked on my own business. I earn a hell of a lot less money now, but I'm much happier.

Having friends (or at least social contact) is also important to mental health, even if that is just saying hello to people you meet on the street, or chatting to like-minded people online.

Please don't wait for something to happen. Take charge of your life and do something about it. Being depressed all the time is an unnatural state, and is your brain's way of telling you that you need to change something in your life. Sometimes you need to make major changes in your life to make things better.

Feel free to email me at cpncrunchhn@gmail.com if you want to chat.


Re: [2]

But what are you to do when you have no purpose in life? No motivating, goal-oriented activities that you enjoy? For many depressed people, including myself, everything seems pointless and therefore nothing has purpose and nothing is motivating or truly interesting.

No one really offers any good advice on this part of the solution and yet it's the most important part! Everyone seems to think that everyone must have something that interests them enough to chase a goal for the rest of their lives but I think the reality is that very few people have this. And furthermore motivation ebbs and flows, I have found that it's not very reliable and so a solution that involves it seems oversimplified to me.


There's a concept of "social prescribing" being developed. So, if you need to go to a gym a doctor will give you a prescription which gives you cheaper access to a gym.

There are a bunch of organisations to provide "vocational services" for people with mental health problems. Vocational services doesn't just mean work based activity, it involves social and sports and etc stuff too. This used to be "day services" and was provided in sub-optimal ways. Usually it'd be in a room in a hospital or other mental health building, and there would be strict segregation so no members of the general community would use the room and people with a MH problem wouldn't use rooms in the wider community. There was little concept of progression or push.

The Sainsbury Centre for Mental Health did a great report and so now day services are better - although still no where near good enough.

My local area has "People and Places". They have a large allotment in a normal allotments place. They grow fruit and veg and flowers with other gardening work.

There's also the Independence Trust which run a variety of different groups and sign post to other groups.

Both these groups work with people at most stages of illness (not while they're detained under section in hospital, but pretty much everything else) and they can tailor the work to what the people feel able to do.

http://www.independencetrust.co.uk/

http://www.peopleandplacesglos.co.uk/


I just want to say that there are two perspectives expressed in response to this comment. One is the idea that pleasure in life comes from starting out abstract (e.g. with abstract goals) and finding more specific things to enact those goals. The other is the idea that pleasure in life comes from starting out concrete (e.g. pooping, eating, quenching thirst, etc).

The first idea is wrong, the second idea is right.

But from those concrete things you build up more and more abstract. The more abstract things gain meaning (bring pleasure) from the less abstract things.

As a primitive man, you feel cold and want to be warm, so you build a fire. Then you build a house. Then you kill an animal and make a warm coat. Then you build a better bow. Then you learn how to hunt better. Then you start planning years ahead. You move to better hunting grounds, you start saving up firewood, etc. That is the primitive man's version of a career; the same applies to a modern career.

However, you can't reduce the value of the more abstract things to the less abstract things. Saving up firewood is not reducible to the sum of warm nights you get as a result. It has its own, separate meaning. But that meaning is only possible because of the less abstract things.

Relatedly, people are wrong to say that life is pointless. The point is the pleasure and pain you feel. Meaning is derived from pleasure and pain. Nature gave us a source of meaning---that had to be the case for advanced life to evolve, and it's pleasure and pain.

tl;dr 1) values are built from the ground up, not the top down 2) values are based on pleasure and that is the "point"


Well, everything is pointless by itself. Universe has no mind so it doesn't go anywhere and doesn't give a shit about anytning.

But you do have mind, and so you can choose your purpose, to decide on what you value and then go after it.

Values are arbitrary. Well, the most basic ones are built into you(survival and reproduction, valuing food/safety/sex), but the kind of values humans speak of when they think about a "purpose" are mostly made up by them(making money, raising kids, pleasing god, being a good programmer, whatever).

So if you're looking for "purpose" it's not about finding it somewhere in the world, but more about deciding what you want out of life. I suggest you start by deciding and being clear on what kind of things you value. Once you know what you want out of life on the high/abstract level - you look for the more concrete examples and activities that move you towards achieving these values.

Here's my example. What I want the most in life, in a very abstract sense, is "being clever", so I am very motivated to do everything that moves me in that general direction. More specifically, I want to be great at thinking and creating things, coming up with ideas and understanding the world. This is something I want for the sake of itself, this is what makes life fun, I value these things "just because". After thinking for a while, I figured that the best practical activities that move me in the direction of these values are Computer Science, building a startup, and writing comedy/fiction.

So at this point my abstract desire to "be clever" drives my motivation to "learn programming" or "get good at writing comedy". And from there I can come up with goals and practical projects, which I am motivated to do because they move me further towards fulfilling my values in life.

I went through a period of depression and apathy, and thought a lot about how to figure out what I want. I'm still scared/depressed(for various reasons, mostly related to logistics in life), but now I have figured out how to "find my passion" and come up with goals that make me motivated and driven. So if what I wrote makes any sense or is in any way helpful, I'm happy to talk more on the topic, if you're interested, maybe you could bounce ideas off of me, maybe that will help you out. If you want - feel free to message me to raymestalez@gmail.com


IMHO, having, and still confronting the darkness:

a) Yes, everything is indeed pointless / "pointless".

b) Think about what "pointless" means. It requires an agent to assign and remove importance. Who is this agent? Is it you, is it society, is it what you have been told since born? What's his goals / values / pov? Why exactly is something "important" or not?

c) Fck "saving the world". Fck "there is a point in this". See it, start, simpler: Do you enjoy eating some specific food? That's the meaning of life. Do you enjoy taking a dump? That's the meaning of life. Do you enjoy chewing gum? That's the meaning of life. Do you enjoy saying some arcane joke? To yourself or some random person you just met? Even if they dislike it or don't understand it? That's the meaning of life. Do you enjoy scratching your @@? That's the meaning of life.

The "purpose in life", is to eg scratch your @@, and for 2 seconds, say "I liked that, and I currently feel good".

It may sound ridiculous, but everything comes from that. If you eg say, "I was thirsty, it's hot, and I enjoyed this cold glass of water", you are on your way to be happy, and also on your way to save humanity. If you want to do that. ..Don't believe me that everything comes from that. But, pls, do enjoy the one second of today, that you felt well doing whatever.

That's the meaning of life. That's the purpose. And when you internalise that, you will find something that is nice for two seconds, and, eventually, you will find the "purpose".


Yes, I agree that you should try and find meaning in everything you do. Basically you want everything that you do in your life to be in line with your motivation and goals. It's partly a process of changing your outlook on life, and partly about making actual changes to how you live your life.

However, you should also be aware that one of the symptoms of depression is being unable to find enjoyment in activities that you normally find enjoyable. This might be the problem that throwaway3301 is experiencing.

It's not always easy to figure out what is causing depression. It's as if your brain has set off a "master caution" warning light, and you then have to figure out yourself what the problem actually is. I would recommend just asking yourself "is this what I want to do with my life" (in terms of your job, where you live, your relationships, etc.)

Also, depression can feed on itself in a vicious circle. I think this is where CBT comes in, as it teaches you to avoid negative thought patterns (although I never used it myself).


This is awesome, and reminds me of what Eckhart Tolle is describing in his book "A New Earth". Essentially, "your purpose in life is whatever you are doing right now".


Thanks cpncrunch! It feels good to have my problems acknowledged. I will remember your advice. Regarding mindfullness, I am trying to be busy all the time and take no breaks. Either do some activity that doesn't let me analyze an event or crash on the bed. The moment I feel I am getting involved in some topic, I just try to move on.


Remember that busy doesn't have to mean hectic -- taking a walk or seeing a movie with people is a way to stay busy.


Yes, agreed. Excessive stress can also cause depression. I find hiking, cycling, napping, swimming in the sea, sitting at the beach, etc. are all good for optimum mental health.


> I am in a state where every moment is sad

Please, keep trying.

As for trial and error, we're far from knowing everything. Among a list of things known to have worked for various people, it is still somewhat trial and error finding out which of those things will work for any individual.

We're big bags of meat, bone and mystery, and solving that mystery is a challenge, for ourselves and for our practitioners.


[flagged]


"How are you not dead?" And what would you have me do about it - Kill myself. Not really a solution. is it?

Most rich people will break if they are forced to live in poverty. Most people take what they have for granted. Rarely realizing, how lucky they are.


Yeah, eli_gottlieb's comment was just not accurate. As you know, you absolutely can be lonely for 14 years and be "just fine." You will be lonely, but you will go on living, go on taking pleasure in some things (even if they are minor), and go on hoping for better times ahead. Relationships are not everything. Important, but not everything.

I've gone through a long period (several years) of almost total loneliness, where my only regular contact was with my mom (and she has a brain disability from a stroke, rendering her mostly unable to respond other than "yes" and "no").

A lot of that isolation came from not feeling able to fit in, even with the friends I already had (who I drifted away from). I didn't have anybody at all to call up to hang out with, and nobody called me.

It wasn't 14 years, but I just want you to know you're not alone. I'm still pretty isolated (way more than is OK for most people---even a bit too isolated for myself), but it's not as bad as it was, it's totally bearable without causing me to be depressed. (In fact, being lonely does not cause depression. Depression causes being lonely, though.)

As somebody else said, the "forever alone"[1] type of person is probably actually WAY more common than people think. In fact, I find it a tiny bit comforting that you are out there.

[1] However, that concept is invalid. It isn't determined that a person will be forever alone unless they voluntarily choose to make it so and never make an effort to meet people or allow people to meet them.


I'd like to believe that the commenter meant to express admiration for your strength in getting through so many difficult years. But if he didn't feel that way, I sure do, and I bet most people reading this thread do. Thank you for sharing your experience with us.


What the GP might take from this comment, and possibly what the commenter might have said next, is "Wow, you have real, and serious, problems, no question about it. Problems that should not be dealt with alone. Your problems are serious enough that you should persist in getting help."

And he would be right. It's serious, don't give up, it's very likely that something will work if you give yourself a chance to find it. But you have to look.


If this is really what you want to say, maybe try to spend a bit more effort saying it.


Yeah, a little sympathy and open-mindedness here would be helpful.

I'm a grown adult, C-level professional with ZERO real-world friends. And I've tried... but the connections haven't stuck. It's quite bothersome, and makes you question everything about yourself and why this outcome could possibly be true after a lifetime of having tried to maintain and improve connections with others.

I've adopted a more tolerant and accepting self-view with respect to this, and the pain level of being completely socially isolated is in the 20-30% range, but the pain of on-going disinterest on the part of others was quite high.. like 80-90%. So it's a bit of progress. But my point is: for those who haven't found their way to an operable level of acceptance, a "WTF!" response isn't kind or helpful or insightful.

There are many of us "ForeverAlone"-ers out there, and trust me... we're 10x more confused than you might profess to be.


Thanks for the support!! I have heard a lot worse from people. The worst is always when I am suddenly cut off from their life or just ignored. Well, the only way is to move on and try again in such situations. Over analyzing or confrontation only hurts more.


[flagged]


That's all fine, but what do you expect the person you are engaged with to gain from reading your post?

It isn't readily apparent to me what that would be, but instead of assuming that you were just being a jerk, I suggested trying harder to communicate whatever it was you thought was of value there.


Please don't make people uncomfortable sharing their troubles.


"That would have broken me in mere months."

a) You are being mean, with no reason. b) He is stronger than you.


Wait wait wait. You're saying that expressing comparative weakness to show sympathy is being mean?

What?


I had a brother that committed suicide 7 years ago and his story was similar to yours.

A history of extreme emotional swings and hospitalization for attempting suicide.

I was the best man at his wedding. Once he got married and had three sons I thought that was the end of that part of his life.

In my mind, no one with three little boys could ever kill themselves.

I was wrong. As soon as his marriage started to fall apart, he did it.

If anyone reading this knows someone that suffers from depression, never underestimate the power of depression.


Your story is very sad, I'm truly sorry.

An important risk factor for career-oriented married men is total abdication of social efforts and leaving it to the spouse "to manage the social calendar." In the long run, this causes men's own friendships to atrophy. Then, if your spouse divorces you (or pre-deceases you), you find yourself without any functional support structure, which could trigger depression or worse.

I learned this from a book I read a while ago ("Lonely at the Top"), which tries to explain the causes of male suicide, especially among successful men. I vowed then, that if I get married, I'd make a very deliberate effort to maintain those friendships I had before the marriage. It's quite possible that someday, those friendships will be all that you may have left to rely on.


This is so important, and one of the subtle reasons that the modern divorce-friendly culture adds dangers to men.


While I don't really understand the differences between CBT and DBT, I've been seeing a therapist who has prescribed a lot of the treatments the author mentions. It never occurred to me that I suffered with anxiety but through a series of events I started having panic attacks and sought help.

I've since learned that anxiety is often a front for emotions that cannot be adequately expressed or processed. For me, it's all the "unhealthy" emotions - anger, sadness, shame. The tools I've been able to deploy in anxiety fits include mindfulness: simply concentrating on my breathing and realizing how my body is reacting to stimuli. Often just meditating for a few minutes helps lower my anxiety, get my breathing under control and stop my heart from pounding.

There's also journaling my emotions several times a day. I built an app that sends me an SMS asking me how I am feeling and why and logs the response for later analysis.

It's not easy building new skills. It's also not easy re-training your mind after a lifetime of negative thinking. But so far its been working, and I've been able to do it drug free.


> I built an app that sends me an SMS asking me how I am feeling and why and logs the response for later analysis.

Please share if possible! Sounds great.


In England DBT is patchily available. You'd usually have to be very ill, or persistant, to get it, and wait times can be too long.

There has been a focus on CBT. That's great because for most people CBT is effective and short, but as this article says it doesn't work for everyone.

Very recently there is a lot of work to improve access to other talking therapies. Patients now have more choice about where to get their treatment; maximum times for waiting are going to be introduced; "parity of esteem" with physical health is more important. (Although watch out: You may have to wait 18 weeks to have a hip replaced, so you may have to wait 18 weeks to start your psychological therapy.)

One of the problems is that DBT needs experienced (expensive) practitioners, and tends to be used for people who are iller and who need a bit more support. So it's harder for health trusts to implement DBT programmes. Not trying to make excuses for them - I campaign pretty hard to improve treatment for people with a diagnosis of personality disorder and access to therapy is one of the main things.

> And as imperfect as my D.B.T. practice was early on, I found that just taking anxiety down a degree or two gave me a measure of control over my decision making in the presence of intense emotion. The lesson was profound. I couldn’t eliminate anxiety from my life, but I could learn how to tolerate it, and cope without making the situation worse.

This is a really nice point. It's an iterative process. You work at it.


Having done CBT, I found the complaints in the article really puzzling. Glad the author found something that worked for him, though.


What jumps out at me is that, as far as I know, CBT training focuses on having the therapist provide cognitive tools to reduce awful automatic thoughts and emotions. The therapist empowers the client. Some therapists bring from their own prior experience the ability to manage anxiety, shame, and guilt by leading the conversation, but others approach their work like computer programmers -- for them the task is to get the code in there. If you have ever seen a talented salesperson alternate pushing and withdrawal as they manage the prospect's anxiety and vanity while bringing them to a purchase, you have seen the element that is present in some CBT, but not part of the official training. Without that management by the therapist, the client may feel worse in sessions, and might come away with the sense that CBT is belittling. An irony here is that the greater respect of empowering the client may feel like less respect.


Especially as what he describes sounds like CBT anyway.


This is an important article. Dialectical behavior therapy and other mindfulness-based treatments are rapidly becoming go-to therapeutic methods. While I wasn't depressed or suicidal, about two months ago I started DBT training through a book [1], but used another audio book for mindfulness training [2]. The results have been fairly profound.

The key is "radical acceptance". The universe is perfect in this moment, even if there are things you don't particularly like. You are a worthy and lovable person in this moment, even as there are certain aspects of yourself that you are currently trying to change. That's the dialectical part of dialectical behavior therapy. The idea of radical acceptance is something that can be applied right now, even before learning the skills.

The author talks about shame. Shame convinces us that we are broken, that we aren't good enough. It tends to get passed through generations due to the way we are raised and the way we raise our children. Treating that shame is very effective for convincing us that we are, in fact, good enough. A book called Taming Your Outer Child [3], accompanied by meditations developed by John Bradshaw meant to get one in touch with one's inner child [4], are both very powerful for healing that shame.

Finally, I can't help but add a TED talk by Brene Brown called the Power of Vulnerability [5]. In it she describes the idea of feeling worthy and "enough," and how it is key to happiness and living a fulfilled life. For me, it was helpful because it gave me a concrete idea to work towards.

[1] http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Wo...

[2] http://www.amazon.co.uk/Mindfulness-Eight-Week-Finding-Peace...

[3] http://www.amazon.com/Taming-Your-Outer-Child-Self-Sabotage-...

[4] http://www.audible.com/pd/Self-Development/Home-Coming-Audio...

[5] https://www.ted.com/talks/brene_brown_on_vulnerability?langu...


I find it curious that what strikes me as the real reason for feeling depressed - his inability to handle anxiety and reliance on medication for it, was not the first paragraph, with multiple exclamation marks around it.

THAT was the problem that got fixed as far as I can tell. There was also shame, feeling of inadequacy, etc but the real issue here seems to be that once you can handle a debilitating level of anxiety, you feel empowered to go out and live life and try things.

That's what so many of these depression or suicide articles/ideas seem to be missing - there is usually some debilitating condition that the person is keeping quiet about, that's contributing to the downward spiral and until that gets fixed, nothing is going to work out.

The debilitating problems range from individual to individual, so how can one silver bullet be found for being suicidal or being depressed? It varies.

The issue as I see it in a lot of cases, is one of not being open enough about the root of the problem with yourself and others. Sometimes they don't even really know! (Usually younger people)

I have met a number of people who have depression and it's usually the same story - being very defensive about whatever the root cause might be and if you probe them, they'll clamp up. It's almost like it hurts too much to admit that you are not ok.

That's where there's such enormous amounts of shame - if you've lived with a problem for a dozen years and haven't fixed it, that'll get most people down, no doubt about it.

So yeah, on one hand there's definitely stigma attached to depression and being suicidal but on the other, by treating it as some unicorn of a problem, we are not helping anybody. I think an assumption that there's a root problem that once tackled, will yield massive returns, would go a long way. Coupled with recognizing that most people feel almost insurmountable amounts of pressure at one point or another and find/having people who are understanding and constructively supportive beyond 'everything's gonna be ok' is paramount.


> I have met a number of people who have depression and it's usually the same story - being very defensive about whatever the root cause might be and if you probe them, they'll clamp up. It's almost like it hurts too much to admit that you are not ok.

There often isn't a root cause for depression. Asking people why they're depressed can feel like you're judging them - "What have you got to be depressed about?"


Plus, it's quite possibly the other way around much of the time: the depressed person, in a desire to understand and/or explain their depression, designates something as the 'root cause' and acts accordingly (clamming up, etc.).


The previous paragraph makes a note on that:

"The issue as I see it in a lot of cases, is one of not being open enough about the root of the problem with yourself and others. Sometimes they don't even really know! (Usually younger people)"

If you genuinely don't know, then you need to figure that out, asap. That's what happened to me pretty early on in life, I actually went to my parents one day and musingly said 'I am not happy, I don't know why'. Acknowledging that there genuinely was a problem, was an important step, because then I read all sorts of books and at least did surface level things like 'being more positive' - gleamed from that famous Dale Carnegie book.

It didn't do anything overnight but it got me to open my mind to a wide array of ideas I hadn't considered before - some of them counter-productive, others quite good.

To think that there isn't a root for depression is to basically admit defeat. I recognize that there may be great comfort in going 'well, that's just how I am, not much I can do' but that's the type of mentality that leads down the dark road of despair - if you think you are powerless to change it, then you are quite likely to end up in a place where you are pretty fkd.


One difficulty with 'root causes' is that this is very often considered to mean 'things that happened in your past,' whereas the root cause could also be biological factors, environmental factors, or 'faulty' thought patterns. Focusing on 'things in the past' too much can keep you from seeing other possibilities.

Unfortunately psychoanalysis is still quite popular, and as a result too many people remain stuck in endlessly probing their subconscious where CBT or another approach might help them instead.


> To think that there isn't a root for depression is to basically admit defeat.

No. It's to accept that depression happens for a variety of complex reasons and to simplify it to some mythical root cause is not in anyway helpful.

This root cause stuff sounds like traditional psychoanalysis which has been pretty much totally debunked as useless now.

People are much better off ignoring root cause and focussing on treatment. The article mentions two evidence based therapies - CBT and DBT - neither of which ask people to look for a root cause.


Maybe root was the wrong word to use - I didn't mean some singular event that happened to you. It takes 2 seconds to recognize that that makes no sense.

By root I mean by changing one aspect of your life - you'll see considerable results. There may be 2-3 root causes, maybe even FIVE!

Point is it's not insurmountable. If you talk to people who were depressed and aren't anymore, they won't claim it was alchemy that fixed it. More likely, they'd attribute it to feeling empowered, rather than helpless and being a victim.

As a personal example - I know a lady who was deeply depressed, food disorder, alcohol problems, a lot of stuff.

Everybody was at a loss for what the fk to do about it. Then comes my friend who happens to really like her. Guess what, they're engaged and she's doing A LOOOOOT better.

Why? Because now instead of feeling like her life is over and that she's worthless, she can see that what she wanted (family and kids and being loved) is not some unattainable dream. She got some professional help for her disorders and while it's a long road ahead, she's in a different place.

So while there's many things left to unroot, ONE root of finding somebody who she can see a future with, is giving her the motivation to get better.

These are the kinds of stories that make a lot of sense - finding something to look forward to AND feeling like you can get there, along with some help in terms of logistics goes a long way.

I went off on a tangent there but I'm all for CBT or whatever other techniques. Point is - if you don't have a conscious break-through of recognizing what the problem was and how you're fixing it and WHY it's working, you are still lost. Just that you're receiving some mythical help at the moment.


This thread describes so many flaws to the mental health care system. Does anyone want to team up and maybe solve the problem?

While I'm no domain expert, I know a ton about mental health and the process of finding a good provider that you're comfortable with.

I'm a generalist, mostly back-end guy (Ruby/Rails/Postgres) with a good eye for design. I've had a few lucky exits. I think this can be another one.

Email is in profile.


Lithium actually did it for me. One week on it and the suicidal ideations disappeared. It is basically poisoning yourself though, can be pretty rough on your body.

Also the concept of "mindfulness" is so great for those ruminations that never seem to quiet down. Yoga, meditation, running, working out, all seemed to really feed into the idea of being "present".


Honest question: Is it just me or did articles related to suicide appear more frequently than usual lately here, and in the general media? Or is it this bias where I just pay more attention lately and the frequency never really changed, plus/minus noise?


This "DBT" idea seems like it's just a specific implementation of "CBT." Not something to contrast with "CBT".


I've seen hypnosis and EFT help some people with depression. Unfortunately, they seem to be a treatment options that go overlooked.


Hacker News unfortunately seems to be more and more about depression/psychology and less and less about positive entrepreneurship and tech/programming. I want to be inspired.


You could just not read the articles that aren't interesting to you. Wishing that all/more of the articles are within your interests is essentially wishing that all/more of the people within the community are more like you. But in a community, that's unlikely.

Or, you could read some of the articles that aren't interesting to you, as they'll have ideas and problems that might be outside of your immediate experience and view. Who knows, they might directly or indirectly inspire some entrepreneurial idea that wouldn't have occurred to you otherwise.

Keep your eyes and mind open, you never know what problems you might solve.


Infact I have read lots of psychology books over the years. However I have found that I feel worse if I think too much about how I am and behave. I prefer to think about what I like to do since that feels less depressing and I have since become a much happier person. I posted my comment in a hope to find others with a similar feeling/experience about self-help vs well-being as opposites.


I suspect that it might be because the people who are driven to be entrepreneurs also have a higher likelihood of suffering from depression.


Yes. Unlike the parent, I welcome reading such stories. It keeps me cognizant of the risks of ignoring mental well-being. I think our professions (programming in particular) has more mischief potential because it makes it easy to drift into solitude while remaining productive. I can easily do my work locked up in a room with my computer sustained by Instacart without much human interaction, but therein lies sorrow. You couldn't work like that if you were a dentist or a plumber. I sometimes envy the forced social interactions of other professions.


I wonder if a life of programming, in particular, could mislead us to see big messy life as merely a stream of input, logical processing, and output.


Suicide is the biggest killer of men aged between 20-34, and 35 to 49, in the UK.

Rates are similarly high in the US - in 2013 one person died by suicide every 12 minutes.

I'm not sure that entrepreneurs have higher rates of depression or suicidality. I think that depression and suicide are just very very common.


Are you depressed?




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