
Depression Confessional Culture Obscures the True Nature of Mental Illness - empressplay
http://www.crikey.com.au/2015/04/02/rundle-depression-confessional-culture-obscures-the-true-nature-of-mental-illness/
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spenrose
An excellent book on depression, arguing it is an evolved capacity of the
mind:

    
    
      http://psychcentral.com/lib/the-depths-the-evolutionary-origins-of-the-depression-epidemic/00018693
    

"Overall, this is a surprisingly accessible book and one that would serve any
layperson well as an introduction to the science of depression. Rottenberg’s
practical style and talent for using real-world examples by real-world people
to illustrate states of low and high mood is refreshing. While not an in-depth
tome by any means on depression, treatment, or evolutionary origin, the book
is a wonderful first step for those who wish to better understand the illness
from a scientific viewpoint. And it gives the reader hope by suggesting that
depression is a common, albeit painful, human experience: that a low mood does
not mean we have failed."

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formulaT
I'm glad that someone is challenging what the author calls the 'medical
"physical" theory of depression/anxiety', although it's unfortunate that the
only way to do this is to use another progressive narrative (alienation caused
by capitalism).

To me, the biggest gap in the mainstream theory is that it claims that
depression is qualitatively different from sadness, and yet I have never seen
any scientific article that provides evidence of this. The usual argument that
is given for this distinction is that, unlike merely being sad, depression
produces extreme feelings of helplessness, pessimism and inability to act. And
yet what if these were actually just extreme versions of things that already
go along with what we call sadness? That is, what if mild sadness and mild
depression were the same thing, and severe depression was categorically
different from mild sadness only because it was more extreme?

~~~
speechduh
As you yourself said, the claim is "qualitatively" different, not
"quantitatively" different. If you think about what qualitatively means, I
really have no idea what you're trying to say. "Just" being "more extreme" is
sufficient for something to be qualitatively different. Different symptoms
start manifesting, especially as compensatory systems start to fail. As far as
I can tell your point is vacuous; please clarify, otherwise.

If you're instead trying to say that they're biologically / mechanically
similar phenomena, well, that's a different discussion we could have.

Have you ever experienced severe depression (i.e., the type that prevents you
from getting out of bed for months or causes you to be hospitalized)? Because
it's absolutely fucking awful. I'd love some clarification of where you're
going with this hypothetical, because right now it sounds like you're denying
the experience of a whole lot of people in a whole lot of pain, without having
much of a point.

~~~
formulaT
The main point is that there are a number of different axes along which
"severe", "major" or "clinical" depression is said to differ from ordinary
sadness, and that the qualitative distinction is used to justify all of these.

The main ones are

1) Depression (unlike sadness) is not caused by circumstances that cause a
person to be unhappy.

2) Depression (unlike sadness) can only be cured by addressing to root
(medical) cause of unbalanced brain chemistry.

3) Depression (unlike sadness) either is not curable, only the symptoms can be
cured, or people who recover are prone to relapse.

 _> Have you ever experienced severe depression (i.e., the type that prevents
you from getting out of bed for months or causes you to be hospitalized)?
Because it's absolutely fucking awful._

No, but maybe I've experienced things just as bad? I don't really know, but I
also don't know how you claim to be able to compare your experience to mine.

 _I 'd love some clarification of where you're going with this hypothetical,
because right now it sounds like you're denying the experience of a whole lot
of people in a whole lot of pain, without having much of a point._

It's a logical fallacy to think that people do/should only make arguments with
some end goal. My goal is to express my opinion on the nature of mental
illness. Another fallacy is that arguing that "X is true" can be immoral,
because of X were true, then some immoral consequence would follow. If I am
right, we should still be just as compassionate towards other people's
problems.

You can be compassionate and understanding towards someone's problems without
categorizing those problems as a medical illness. Similarly, you can use this
categorization as an excuse not to be compassionate, e.g. treating a person as
irrational or untrustworthy because they have had a mental illness in the
past.

~~~
DanBC
> and that the qualitative distinction is used to justify all of these.

Yes - does it pose a risk of harm to yourself or other people; does it
interfere with your day to day life? These quality statements are used as part
of the process of assessing whether someone needs or wants a treatment, and
they should be common across all forms of mental illness. (EG people with
auditory hallucinations often go unmedicated because they can live with their
voices.)

> You can be compassionate and understanding towards someone's problems
> without categorizing those problems as a medical illness.

Compassion does not treat depression, although it's important part of
preventing depression. Talking therapies like CBT are pretty structured, and
the evidence says they seem to work. We know the counseling generally doesn't,
and can be harmful. And also, if a person needs treatment then they might need
money to pay for that treatment and protected time off work to get treatment.
Calling dysfunctional forms of sadness "depression" is partly a bureaucratic
measure we take to fund treatment and protect people from losing a job.

Strongly agree with your last sentence. A few people on HN equate mental
illness with violence but mental illness does not predict violent behaviour
(drug addiction; or previous violence are much better predictors, and if you
have a combination of either / both of those and a mental illness that's a
better predictor, but merely mental illness itself isn't predictive).

------
ta-026d16b2
While it raises a few valid points, this essay is pretty bad overall. Apart
from distorting the history of SSRIs (one can't meaningfully tell the story of
the rise of SSRIs without talking about the prior successes and drawbacks of
tricyclic antidepressants and MAO inhibitors), it pushes a false narrative
characteristic of politically-motivated drug-bashers: there is a single
"physical theory" of depression, centered on two or three molecules, that was
advanced through commercially-motivated distortion of science and later
debunked. The basic monoamine hypothesis has been known to be faulty for
decades, nearly as long as monoamine reuptake inhibitors have been in
widespread use; the psychiatric research community has long since been
studying other possibilities.

Studies do show that, on average, antidepressants barely outperform placebo.
However, this is because the effects of antidepressants are correlated to
symptom severity, so averaging the entire population together shows virtually
no difference. This certainly supports less widespread use of antidepressants
than has been common in recent decades, but not that antidepressants are
useless. It's not like the evidence generally shows that psychotherapy is much
better, either. It's prescribed so much less not out of some ideological
antipathy for introspection and hard work, but because it's not generally any
more effective, costs far more, has much worse compliance, and is less readily
available (especially in smaller cities and rural areas) than generic drugs.
The dirty little secret of psychiatry isn't that SSRIs don't work; it's that
everything sort of works, but any single thing doesn't work very well for most
patients, and there's no validated model that predicts which treatment is
likely to work for which patient.

In my opinion, the biggest problem with studying depression is that the
diagnosis of depressive disorders is tremendously unreliable. Virtually all of
their symptoms overlap with "sickness behavior", which is triggered by dozens
(if not hundreds) of different physiological diseases. Implicit in the
diagnosis of a mood disorder (actually explicit in the DSM, but people are
rarely told this) is that those diseases have been ruled out as the underlying
cause. In practice, this rarely happens. Doctors will do some perfunctory
screening for things like hypothyroid and hypogonadal disorders, but those
screening tests have very poor sensitivity and only cover a handful of common
causes of depressive symptoms. If you're lucky, you might get an actual formal
screening for neurological disorders. Initial screening for sleep disorders is
mostly done with crappy questionnaire scales that disproportionately focus on
superficial aspects of stereotypical presentation ("Do you snore?"). In a
nutshell, being diagnosed with a depressive disorder has little inherent
meaning beyond your GP/PCP running out of ideas or patience. In turn, any
given study population of "people with depressive disorders" is unlikely to
actually be homogeneous in the origins of its depressive symptoms.

~~~
marincounty
"The dirty little secret of psychiatry isn't that SSRIs don't work; it's that
everything sort of works, but any single thing doesn't work very well for most
patients, and there's no validated model that predicts which treatment is
likely to work for which patient."

I sometimes wonder if all long term improvement in all treatment modalities
can be attributed to The Placebo Effect, poorly designed/collated
drug/treatment studies, and the brain repairing itself with time? My view on
Psychiatry is if you don't have the money to see one; you just might be better
off on the long run?(That is assuming you are not suicidial, or psychotic?)

I wish the profession well, but you have not come a long way baby! I do think
any patient that has been on a psychotropic drug(especially the addictive
ones) a long time, should be able to get that particular drug without seeing a
Psychiatrist. I know that will never happen on the U.S.

After hearing that Robin Williams committed suicide and the last tabs open on
his IPad were the side effects of the various drugs he was taking, I wonder if
he would still be alive if he didn't have access to the best Psychiatrists?

~~~
ta-026d16b2
> I sometimes wonder if all long term improvement in all treatment modalities
> can be attributed to The Placebo Effect, poorly designed/collated
> drug/treatment studies, and the brain repairing itself with time?

Some cases probably can, but it's not very plausible that such things explain
all treatment effects, which are occasionally quite dramatic. Also, many
studies include a "waiting list" group to control for the effect of simple
passage of time. There are of course many, many, many poorly-designed studies
out there; this is not by any means unique to psychiatric drugs, or even
medicine in general.

> I do think any patient that has been on a psychotropic drug(especially the
> addictive ones) a long time, should be able to get that particular drug
> without seeing a Psychiatrist. I know that will never happen on the U.S.

As far as I know, any licensed MD/DO can prescribe psychotropic drugs in the
US. Some choose not to prescribe some classes of drugs (e.g. antipsychotics,
MAOIs) because they tend to have more risks associated with them. However, the
same can be said for psychiatrists. There are a few psychiatrists who
explicitly refuse to prescribe drugs at all, except in the process of
discontinuing a pre-existing treatment. Many doctors will also refuse to
prescribe the more addictive drugs out of fear of enabling addiction (this is
a huge problem for people with chronic pain, as is the FDA's requirement of
"abuse-resistant" pills for oxycodone that just happened to be announced on
the same day as the original OxyContin patent expired...)

> After hearing that Robin Williams committed suicide and the last tabs open
> on his IPad were the side effects of the various drugs he was taking, I
> wonder if he would still be alive if he didn't have access to the best
> Psychiatrists?

There's a risk of iatrogenesis for treatment of virtually any condition. But I
think it's far more likely that the drugs in question simply didn't work for
him, or stopped working suddenly (this can happen after long periods of
treatment with psychotropic drugs, and as far as I know most patients aren't
warned about it; I certainly never was).

~~~
DanBC
> Many doctors will also refuse to prescribe the more addictive drugs out of
> fear of enabling addiction (this is a huge problem for people with chronic
> pain,

Most long term pain should not be treated with medication. That medication
should be used short term to allow the sufferer to take part in
rehabilitation.

Addiction to painkillers that do not work is a big problem for people with
chronic pain, and now they not only have the chronic pain but also an
addiction.

There's a segment on this radio programme where they visit a pain clinic in
Bristol (UK) to talk to people who are taking huge amounts of opiod pain
killers and not getting any relief from their pain.

[http://www.bbc.co.uk/programmes/b04wv052](http://www.bbc.co.uk/programmes/b04wv052)

