
Let’s avoid talk of ‘chemical imbalance’: it’s people in distress - rbanffy
https://psyche.co/ideas/lets-avoid-talk-of-chemical-imbalance-its-people-in-distress
======
seesawtron
It reminds me of what Aldous Huxley wrote (about people in distress):

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

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

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

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

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

~~~
jac241
That's textbook major depressive disorder. How long would you let Jenna suffer
out of principle? One month was too short a time for you, so what a year, two?
She's not attending classes, crying all the time, sleeping more than usual.
Why would you let depression ruin her future when we have effective treatment
with a favorable side effect profile (CBT + SSRIs)? It's not an either/or
situation. Doctors definitely counsel to increase exercise and get outside
when starting treatment for depression. I don't think your strategy is very
compassionate at all.

~~~
kmmlng
I think there is an argument to be made here that prescribing medication might
be treating the symptoms but not the root causes, which will lead the patient
to ignore the root causes, leading to worse outcomes in the long run while an
improvement can be observed in the short term.

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

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

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

Many doctor appointments, many different prescriptions.

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

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

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

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

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

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

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

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

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

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

~~~
zeta0134
A realization that came to me much later in life was that, although I am in
apparently full control of which thoughts I allow to persist in my mind, I do
not appear to be in full control of when memories surface. Rather, very
similar to my dreaming state, it seems as though there is some process which
is constantly comparing my waking events to things that occurred in my past,
and trying to form a connection between them.

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

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

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

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

------
sillysaurusx
_they struggled against the dehumanising notion that their thoughts, feelings
or behaviour were mechanistically caused._

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

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

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

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

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

Support networks only got me so far.

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

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

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

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

~~~
Delk
I don't think it is.

I've had times in my life when I certainly didn't constantly distract myself,
and being of a contemplative type, sometimes also delved into existential
thoughts. But I didn't automatically (or generally) feel angst about it.

I'm not religious and haven't been since I was 15 or so. (I don't deny
possibly having something of a mildly spiritual side, but I consider that
different as it doesn't require belief in anything other than various kinds of
feelings and experiences being part of the human experience. It also doesn't
provide an externally assigned meaning.)

In times when my mental health and wellbeing have generally been worse,
existential questions have also become much more distressing.

So yeah, maybe for some or even many people, existential questions may amount
to angst, but in my experience it has depended a lot more on my other
emotional and psychological state.

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

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

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

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

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

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

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

~~~
wolfram74
Many good points, but to clarify, you're arguing that being treatable is
merely an obvious indication that it's a medical issue, but not the only
indication? Lots of things in non-mental health fields are acknowledge to be
medical problems but also remain untreatable.

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

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

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

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

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

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

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

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

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

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

~~~
partyboat1586
Brains are not machines like your phone is a machine or your car is a machine.
They are complex systems and the result of an emergent process rather than
designed systems with discrete components.

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

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

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

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

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

~~~
nathan_compton
In my view its a simple category error, though of a subtle kind. Machines are
similar to biological systems in only the most superficial ways: they are non-
static systems which exceed a certain complexity and they both follow the laws
of physics (see footnote).

There are a lot of ways to think about the differences between machines and
people. One very simple one is that machines typically function in only a very
limited subset of the space of their available degrees of freedom and small
deviations are usually catastrophic. Biological systems don't usually have
this property.

Another way to think about it is that machines show evidence of design, which
you might characterize as a certain economy of ideas. Two clocks in a computer
a much more likely to be identical or to share major conceptual underpinnings
than two clocks in a biological system, for example.

I used to have your view of things and then I read Deacon's "Incomplete
Nature," a book whose thesis fails to land but is never the less a
comprehensive analysis of the properties of living organisms in a unified if
rickety system which encompasses the basic laws of physics. It really
convinced me that the analogy between brain and machine is poor.

The question of what a mind is and how it relates to the brain is not settled
science or philosophy, at any rate. It doesn't do anyone any good to pretend
it is.

(footnote): This is a reasonable assumption to make but its hardly widely
believed by the general public nor settled scientific fact. Luminaries like
Penrose still assert a fundamental disjunction between what brains do and what
machines do and he isn't alone among physicists, to say nothing of the broader
philosophical community or the lumpen mass of human opinion.

~~~
nathan_compton
Another thing: to assert that biological systems are just machines is to
subscribe to the same error which allows creationists or intelligent design
people to put forward the argument that we ought to take the complexity of
life as evidence of a designer. It conflates two totally different phenomena
by observing a superficial similarity between the two and ignoring all of
their manifold and salient differences.

~~~
realharo
It's just a metaphor. Because the way it works can be viewed as

inputs (sensors, environment, external chemicals) + current state ---> outputs
(behavior) + new state

kinda like computers or robots, in a deterministic manner (except it is
practically impossible to recreate the exact same inputs, or the exact same
state). You don't have to take it too literally, people who read it generally
understand what it means.

~~~
jimbokun
> inputs (sensors, environment, external chemicals) + current state --->
> outputs (behavior) + new state

It's just not a very helpful metaphor, because we are nowhere close to having
a way to simulate or compute that function.

So treating people as agents with goals, desires, personalities, experiences
and histories and traumas, and drawing on our hard wired abilities for
empathy, can be a far more useful model for actually helping and healing
people than just giving them a pill.

~~~
luckylion
> So treating people as agents with goals, desires, personalities, experiences
> and histories and traumas, and drawing on our hard wired abilities for
> empathy, can be a far more useful model for actually helping and healing
> people than just giving them a pill.

But that's not a dichotomy. Nobody is saying to either disregard biochemistry
and believe that God gave us free will by some magical act _or_ just throw
random pills at people.

You can see people as all that and still not reject the idea that chemical
imbalances can negatively influence their goals, desires and personalities,
and that chemicals can also positively influence them,

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

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

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

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

------
aantix
Magnesium is used by the body to cope with stress.

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

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

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

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

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

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

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

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

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

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

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

------
verylittlemeat
Is there any way to get off the euphemism treadmill?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

~~~
ifend
> I discovered deep subconscious emotional healing techniques

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

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

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

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

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

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

~~~
EE84M3i
To be blunt: why? Your reply reads to me like you're recruiting for a cult
and/or selling something.

~~~
tomhoward
Fair enough, I expanded my comment with more explanation and detail.

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

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

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

[0]:
[https://www.frontiersin.org/articles/10.3389/fpsyt.2019.0040...](https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00407/full)

~~~
Barrin92
'Chemical imbalance' as a causal explanation seems to me almost useless
because every severe change in behaviour pretty much by definition corresponds
to change in the brain. How else is it supposed to be manifest? Is there
supposed to be drastic change in psychology without change in the brain?

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

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

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

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

~~~
fzeroracer
I don't think it is though. For example, one of the things we know is that IBS
can cause depression/anxiety (or perhaps more accurately, people with IBS are
more likely to have depression/anxiety).

In this case chemical imbalance would be objectively wrong. Their brain is
being affected by another part of the body entirely, but you would have
doctors selectively treating the symptoms (the 'chemical imbalance') rather
than the cause.

~~~
Supermancho
> In this case chemical imbalance would be objectively wrong.

I disagree. Chemical imbalance is not necessarily a solitary cause, it's
describing a condition regardless. _shrug_

> you would have doctors selectively treating the symptoms (the 'chemical
> imbalance') rather than the cause

Typically they treat both or in most cases, the easier problem with less
severe treatment consequences (classic House MD - live in constant pain from
muscle death vs lose a limb).

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

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

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

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

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

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

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

------
ChrisMarshallNY
I've had _lots_ of experience with people struggling with various forms of
mental illness.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

There's a time for both approaches.

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

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

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

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

~~~
sfink
Except sadly that's not true. Anxiety medication usually does not improve
anxiety. Same with the rest. But sometimes they do, and when it works it's
enormously valuable to people.

Medication and talk therapies (including CBT) are more or less tied, from what
I've heard.

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

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

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

~~~
thex10
From TFA:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

------
nsl73
I find the chemical imbalance metaphor for mental illness the opposite of
empowering and an easy well to sell pharmaceuticals.

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

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

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

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

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

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

~~~
asveikau
Fair points.

Just want to add I have heard people say they avoid antipsychotics due to what
you describe as "dysphoria" and "sedating" qualities but one must also
recognize that for many, a symptom of their illness is that they do not think
they are ill or that anything is wrong.

------
totetsu
Zoologist Matthew Cobb who studies modeling maggot neural systems, has just
published a book "The Idea of the Brain" about the different conceptual models
we have had for the brain through time. He talks about the limitations with he
chemical based, neural transmitter model. That there is no drug that can be
guaranteed to cure a mental illness, and that most of the large pharmaceutical
research companies have withdrawn from developing new drugs in this area. And
perhaps it was these companies that popularized the notion of "chemical
imbalance" in the first place.
[https://www.rnz.co.nz/national/programmes/saturday/audio/201...](https://www.rnz.co.nz/national/programmes/saturday/audio/2018753534/the-
history-and-mystery-of-the-brain-matthew-cobb)

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

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

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

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

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

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

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

I had severe depression as a young man, and I remember being confused about
it, as when I objectively examined my life there was no reason for it. But I
was drowning in despair. When depression was explained to me, with the idea of
a chemical imbalance, it all clicked. It enabled me to fight back
appropriately and win back my mind. _Without_ medication. It took a few years
to get back to normal but I am a much, much stronger person for it, and have
never had a hint of a relapse despite actually going through difficult times
since then.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

~~~
im3w1l
I don't think it's good to consciously define yourself like that. We should
see ourselves as we are. And realize that things aren't black or white rather
than see which stereotype fits best. You may take action most of the time, and
struggle to take action regarding something. You may feel deeply generally but
sometimes go numb.

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

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

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

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

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

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

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

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

------
0xcde4c3db
I'm not sure what to make of this piece. First:

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

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

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

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

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

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

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

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

------
bjt2n3904
> In promoting a biogenetic causal theory, anti-stigma campaigners – as well
> as psychiatrists, the popular media, and others – hoped to convince people
> that mental illnesses are ‘just like’ other chronic physical ailments, such
> as ‘heart disease or diabetes’, to quote the APA, and could be medically
> addressed.

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

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

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

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

------
MR4D
I disagree, and do so on my personal experience with Keto (yes, you read that
correctly).

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

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

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

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

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

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

\------

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

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

~~~
newacct583
The article isn't denying a biochemical basis on emotional regulation. It's
saying that building the language of treatment _around_ that framework is
harmful, because it stigmatizes sufferers (even by simply making them fear the
stigma), increases anxiety, and tends to act against recovery. It's an article
about the best way to practice psychiatry.

~~~
MR4D
I get that, and I disagree. I think the discussion about food should happen
first.

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

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

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

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

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

\--------

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

[0] - [https://www.mayoclinic.org/diseases-
conditions/hyponatremia/...](https://www.mayoclinic.org/diseases-
conditions/hyponatremia/symptoms-causes/syc-20373711)

~~~
newacct583
So... the science of diet isn't nearly as well understood as you're
presenting. It's like "back pain" \-- everyone tends to suffer in some way
from it, so everyone relates to statements like yours and wants to believe in
a simple resolution. But in practice, everyone suffers in different ways, and
everyone responds differently to the same treatments. It's not really "a
thing" in a medical sense.

Like... that hyponatremia link is almost the definition of this kind of
thinking: it's a real syndrome, it's documented, it's worth understanding and
studying. But come on: _EVERYONE_ has "Confusion, Loss of energy, drowsiness
and fatigue, Restlessness and irritability" at some level, and of those how
many are actually sodium deficient? That's a non-diagnosis.

~~~
MR4D
You make some good points, and I don't argue with any of them (although, per
your last point, I've found that eating something salty helps me from time to
time :) ).

I guess my main issue is if we _ignore_ diet as a cause, then we quickly get
to medications, which can make the situation worse (not necessarily make the
problem worse, but other problems can arise as a result).

I think that if psychiatrists were as well trained in food chemistry as they
are in drug chemistry that the world would be a better place.

Finally, one personal anecdote - my business partner is really attuned to my
moods. When I come into the office in a grouchy mood (of which I'm often not
aware), he'll call it out. The first year or so it was off-putting, and
somewhat annoying, but after I got into Keto, I noticed that my mood was
changing as a result of the food I ate the day(s) before. Over time, our whole
team has started to become attuned to it as well (yeah, it's kinda weird, and
no, we are not all on keto - we tend to have fairly varied diets among us).
The great result is that we call it out like, - "you're in a grouchy mood,
what did you eat yesterday?", or "I'm not focused today" and the other person
asks what they ate recently. This has been really effective for us, because
most of the time it's the food affecting us, as opposed to us just being a
jerk. Obviously other things weigh too, such as other stressors in life. but
many little things we can trace back to food, and it has made our team much
better at working together because we are freer at calling these sorts of
things out.

------
paul7986
Personally and from my own experience Prozac, Paxil and Zoloft were only
placebos and never helped me. Again my own experience... what helped me in my
mid 20s was talking openly to my friends and others my age about my anxieties,
unusual thought processes and other silly things you deal with at that age.
Upon opening up I learned a more then a few of those I compared myself to were
just as crazy as I thought I was and they too were dealing with similar issues
or had. Then boom a lot of the zaniness was gone minus one odd OCD that stuck
around for a bit longer(still there at 40 but very minorly and all other those
silly worries/anxieties in my 20s and very early 30s are a thing of the past).
If u have a social anxiety..think your not like others your close to & or
compare yourself too..open up to them or some of them..u most likely find they
are as crazy as you and in turn your normal like they are.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

------
aSplash0fDerp
The human condition is unique to individuals the world over.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

------
77pt77
I have no problem with chemical imbalances, but if you use that as a reason
but you don't measure it you are not doing science.

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

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

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

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

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

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

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

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

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

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

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

~~~
mtgp1000
Came here to make a similar comment. Scientists are not supposed to be
activists - focusing on eliminating words that carry stigma from popular (or
scientific) use makes me question not just objectivity but qualifications as a
scientist.

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

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

~~~
mtgp1000
There's a difference between ideology and an ideologue. One may believe in
something while at least attempting to compartmentalize it's influence over
ones work. I feel like that sort of self-restriction is increasingly absent in
much of the professional and academic world.

Yeah, sure, everything is political, but that doesn't mean you are obligated
to inject your politics into everything.

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

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

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

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

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

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

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

    
    
        * "Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions" by Johann Hari. From the last chapter of the book: "You aren’t a machine with broken parts. You are an animal whose needs are not being met. You need to have a community. You need to have meaningful values, not the junk values you’ve been pumped full of all your life, telling you happiness comes through money and buying objects. You need to have meaningful work. You need the natural world. You need to feel you are respected. You need a secure future. You need connections to all these things. You need to release any shame you might feel for having been mistreated."
        * "Chasing the Scream: the First and Last Days of the War on Drugs" by Johann Hari
        * "The Globalization of Addiction: A Study in Poverty of the Spirit" by Bruce Alexander
        * "In the Realm of Hungry Ghosts: Close Encounters with Addiction" by Gabor Maté, MD
        * "The Story You Need to Tell: Writing to Heal from Trauma, Illness, or Loss" by Sandra Marinella
        * "Writing Hard Stories: Celebrated Memoirists Who Shaped Art from Trauma" by Melanie Brooks
        * "The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are" by Brené Brown
        * "Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead" by Brené Brown
    

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Good luck!

~~~
core-questions
Thank you for this, I will look into your suggestions. Much appreciated.

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

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

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

Just. wow.

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

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

Find out more about medical abuse at proxy project.

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

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

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

------
Ericson2314
Rampant inequality ruins everyone's mental health, but not equally and now
it's a weird status symbol.

\- homeless <=> crazy, bad

\- Some anxiety <=> type A hustler, good

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

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

