
No Longer Wanting to Die - hudibras
http://opinionator.blogs.nytimes.com//2015/05/16/no-longer-wanting-to-die/
======
stegosaurus
Treatment for depression is badly handled almost universally... It seems as if
people still don't generally understand that it's more than 'feeling a bit
sad'.

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

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

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

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

~~~
a3voices
> even getting to the stage of seeing a doctor can fail, because suddenly
> everything is 'pointless' (bad wording. sorry.)

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

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

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

~~~
a3voices
I modified my original comment, so I guess I'll rewrite it. And I totally
agree.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

and:

[2] Insufficient motivation/goals/joy.

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

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

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

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

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

~~~
throwaway3301
Re: [2]

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

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

~~~
twobits
IMHO, having, and still confronting the darkness:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

~~~
kvcc01
Your story is very sad, I'm truly sorry.

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

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

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

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

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

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

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

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

Please share if possible! Sounds great.

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

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

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

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

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

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

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

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

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

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

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

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

[1] [http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-
Wo...](http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-
Workbook/dp/1572245131)

[2] [http://www.amazon.co.uk/Mindfulness-Eight-Week-Finding-
Peace...](http://www.amazon.co.uk/Mindfulness-Eight-Week-Finding-Peace-
Frantic-ebook/dp/B005NJ2T1G)

[3] [http://www.amazon.com/Taming-Your-Outer-Child-Self-
Sabotage-...](http://www.amazon.com/Taming-Your-Outer-Child-Self-Sabotage-
ebook/dp/B00KC6FDLS)

[4] [http://www.audible.com/pd/Self-Development/Home-Coming-
Audio...](http://www.audible.com/pd/Self-Development/Home-Coming-
Audiobook/B002VAET86)

[5]
[https://www.ted.com/talks/brene_brown_on_vulnerability?langu...](https://www.ted.com/talks/brene_brown_on_vulnerability?language=en)

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

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

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

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

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

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

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

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

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

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

~~~
alexashka
The previous paragraph makes a note on that:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email is in profile.

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

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

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

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

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

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

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

~~~
kvcc01
Yes. Unlike the parent, I welcome reading such stories. It keeps me cognizant
of the risks of ignoring mental well-being. I think our professions
(programming in particular) has more mischief potential because it makes it
easy to drift into solitude while remaining productive. I can easily do my
work locked up in a room with my computer sustained by Instacart without much
human interaction, but therein lies sorrow. You couldn't work like that if you
were a dentist or a plumber. I sometimes envy the forced social interactions
of other professions.

~~~
a3n
I wonder if a life of programming, in particular, could mislead us to see big
messy life as merely a stream of input, logical processing, and output.

