
Anxiety and Depression Are Symptoms, Not Diseases - _xs0j
https://www.psychologytoday.com/blog/theory-knowledge/201603/anxiety-and-depression-are-symptoms-not-diseases
======
pc2g4d
Amen to this article. As one who myself once believed my depression "came out
of nowhere" (but which, in retrospect, was an obvious symptom of my
emotionally destructive family and school environment) and who tried for many
years to smother those feelings with antidepressants, I feel strongly that
this article presents a wiser path.

Evolutionarily speaking, it seems likely that depression/anxiety are there for
some purpose, and yet we treat them both like meaningless pain meant only to
be banished using drugs. I believe both are signals that something in our
environment is not working for us. They indicate emotional or physical needs
unmet---needs for safety, autonomy, connection, etc.

Often the individual suffering is fundamentally unaware of their own
circumstances. I didn't realize how messed up my family relationships were
growing up until much later. There are various reasons for this unawareness,
but I believe the depression/anxiety are there to force our conscious self and
the people around us to acknowledge that something is wrong.

This isn't just the old nonsense about depressed people needing to cheer up,
and that it will pass in a day. This is a completely different paradigm that
explains depression and anxiety as meaningful signals of underlying problems
rather than as inexplicable suffering to be numbed through prescription
medication. I believe it will prove the more robust and also the wiser way of
looking at these experiences.

~~~
Dylan16807
> Evolutionarily speaking, it seems likely that depression/anxiety are there
> for some purpose, and yet we treat them both like meaningless pain meant
> only to be banished using drugs. I believe both are signals that something
> in our environment is not working for us. They indicate emotional or
> physical needs unmet---needs for safety, autonomy, connection, etc.

> Often the individual suffering is fundamentally unaware of their own
> circumstances. I didn't realize how messed up my family relationships were
> growing up until much later. There are various reasons for this unawareness,
> but I believe the depression/anxiety are there to force our conscious self
> and the people around us to acknowledge that something is wrong.

If a situation is causing no problems outside of depression/anxiety, and you
took away the depression/anxiety mechanism, there would be nothing wrong with
it.

If there are other problems, then piling depression on top makes it _harder_
to fix.

A lot of medical conditions cause chronic pain. The pain helpfully signals
"something is wrong" once, and then keeps unhelpfully reminding over and over.
You want to treat the pain itself in that situation. Sometimes the pain is the
only thing you need to treat at all.

Being an indicator of other problems does not make chronic pain _useful_.
Depression is similarly crippling and unhelpful.

~~~
Taek
Depression is sometimes described a numbing experience. Everything loses
color, loses that spark. Sometimes, everything hurts, nothing feels good.
Making the same daily decisions is painful and slow, like walking through an
ocean of glass.

Depression gives you the power to make really big decisions. Everything hurts
about the same. Going to work is about as painful as staying home, meaning
it's easier to quit a horrible job. It's easier to divorce an abusive partner.
It's easier to pack up life and start over.

Having been through extreme depression multiple times, I can say with
confidence that it makes those really big, really scary decisions a lot
easier. You get thoughts like "it would all be over if I never saw that person
again". "I would enjoy life if I got a divorce and moved back to my home
town". "My job is abusive and it's slowly killing me, having no income is
better than hating 70 hours of every waking week".

If you are depressed and having those types of thoughts, you might actually be
right. Following through on those major, traumatic changes might actually be
what you need to do. And depression makes it easy to do so. Normal life
becomes so bad that change is welcome, because change feels like a way out.

~~~
johnmaguire2013
This is a really interesting perspective. Not sure if I agree with it 100%,
but really something to consider. Thank you for sharing.

------
warmfuzzykitten
The comments here are depressing. People who are actually depressed are saying
that the author is completely wrong about their depression, while others with
no experience of depression are nitpicking at them with for what passes for
logic on the internet.

The truth is, this PhD is not a psychiatrist, appears to have little clinical
experience except whatever his "practice" has thrown his way, and, tellingly,
refers to "clients" instead of "patients".

Some depression is situational, for sure, but this is not a deep observation
or original thinking. The author is perhaps qualified to treat situational,
temporary depression but cannot speak to clinical depression or depression
that arises from mood disorders. To the extent he is in denial that these
forms exist he is mistreating his "clients", and he shouldn't have the support
of a bunch of smarty-pants nerds when he does it.

~~~
spangry
Indeed. Speaking as a sufferer of a serious depressive disorder, one well
educated on the current medical science, I find these discussions incredibly
frustrating.

Everyone brings out their anecdotes about how their aunt 'just got better
through positive thinking, and you can too!' Or people just throw in whatever
pop-psychology is currently in fashion. If we were having this conversation in
the 1950s, all the smarty-pants would be talking about how depression is
simply one of the many materialisations of conflicts between the concious and
unconscious mind a la Freudian psychoanalytic theory.

Thankfully our methods of scientific inquiry (if you could categorise past
efforts as such) have advanced significantly, and continue to do so. Our
understanding of genomics suggests that mood disorders like unipolar and
bipolar depression, and even psychotic disorders like schizophrenia, represent
a spectrum of possibly thousands of different 'diseases', rather than the few
'categories' arbitrarily delineated in the DSM.

Advances in neuroscience and medical imaging allow us to directly observe how
different symptoms are associated with inefficient information processing in
different topographically localised brain regions. As we gather more data and
the verisimilitude of our observations increases (as tends to occur with
rigorous scientific study), we will be able to develop new treatments; be they
psycho pharmacological (e.g. drugs) or physical (e.g. trans-cranial magnetic
stimulation).

Yes, psychological therapy has its use, and has proven effective in certain
situations. But it is just one tool in our ever-growing toolbox. To just
blithely deem the rest of the tools to be useless and throw them out is to
condemn people like me to a (short) life filled with suffering.

~~~
alfapla
At the risk of sounding snarky or disrespectful, I can't fail to notice how
often people suffering from depression become all passionate and fiery when
discussing the cause of (their) depression.

~~~
spangry
No worries, I get what you're saying and it's something I've observed in
myself. I'm usually very calm when discussing my depression with an open-
minded person. And by open-minded I mean someone who just genuinely wants to
know, asks the question and then listens to the answer.

The thing that gets me (and others) worked up is when people make sweeping
generalisations regarding the causes and treatments of depression. No one
likes being painted with a broad-brush, but it adds insult to injury when
something that has caused me so much suffering is dismissed as trivial and
easy to solve. I've spent more than a decade trying to treat my condition.
It's not as simple or easy as most people think.

I guess it's also an issue of semantics: 'depression' is a very broad term
that gets narrowed down in our minds, based on our own personal experiences.
When I hear it, I tend to think of the more serious kind because that's what
I've lived through: not leaving my house for two weeks, not showering, eating
or sleeping for three days etc... I can understand why some others might think
of it more like 'that time my goldfish died and I was sad': this is the
fortunate extent of their experience of low moods.

Or maybe I just envy those without brain cooties...

------
funkysquid
> Or if you are outside for a long time in the cold with no jacket, upon
> feeling very cold, you don’t say that you have "a coldness disorder".

A better example for anxiety or depression would be standing inside in a warm
room, and despite everyone else in the room being comfortable, you are unable
to warm up at all. When you complain, you are told that "everyone gets cold
sometimes".

This article doesn't seem to have any new information, it's just repeating the
old ideas that depression and anxiety are the same as temporary sadness and
worry due to legitimate problems.

~~~
themgt
The problem with using a purely neurochemical explanation like this is the
rates of these disorders differ dramatically between societies and within
societies geographically, demographically and over time. It is clear that the
United States in particular is, especially in recent years, churning out
unprecedented numbers of severely psychologically ill individuals. The idea
this is solely due to previously undiagnosed individuals or otherwise not
representative of a sickening society is difficult to support.

Frankly we have spent too long acting as if mental disorders could not
possibly have anything to do with ones surroundings, upbringing and life in
general, when it's beyond obvious that they have very much to do with those
things, as well as genotype/phenotype/etc. We've used this idea that it shames
individuals to suggest that the actual problems they deal with could
contribute to mental damage in much the manner they can physical damage, which
is simply dogma masquerading as science.

In fact, using purely neurochemical explanations denies people's humanity and
lived experience, denies that we are sentient humans not some organic robots
that need an serotonin oil change and some dopamine transmission fluid.

~~~
dilemma
Medication is essentially victim blaming by society unto the individual
reacting against its conditions. And the medical health specialists are agents
of society, not the person they're ostensibly helping.

~~~
pzone
Not trying to contradict you, but it's _also_ one of the precious ways
offering a shot at helping people overcome depression.

------
jonny1090231
I have been suffering depression for long time and can tell you right now that
this article is as wrong in describing how I feel as one could get it.
Regardless of how my need are taken care of and how satisfied I should be with
the status quo depression takes it all away from you without you understanding
why and how. There are days that I feel like I am the luckiest man in the
world, technically speaking, yet I feel the 'saddest' and most depressed I
have ever been. Don't believe for a second what the author claims here -
depression is a disease and it needs to be treated as one. Very dangerous post
indeed.

~~~
rifung
I don't really understand how any part of what you said refutes the article.

> There are days that I feel like I am the luckiest man in the world,
> technically speaking

The reality is that each person's needs are different, and just because you
are the luckiest man in the world based off society's values doesn't mean your
individual needs are being met.

I sympathize with the fact that you have depression but I don't really see how
the article is dangerous. If anything I would think that it's good to try and
find/fix any underlying issues which cause the depression if possible rather
than just hoping medication will make everything go away.

We still don't have a good understanding of the brain and psychological
disorders..

~~~
TenOhms
The biggest issue I take with the article is a classic chicken and egg
problem. The article takes the stance that your depression is there because of
your life choices and some factors that aren't in your control. I'm of the
very strong opinion that the exact opposite is true.

~~~
blisse
What really is the exact opposite here? That depression has nothing to do with
your environment and only to do with your body?

~~~
ars
> That depression has nothing to do with your environment and only to do with
> your body?

Yes. Exactly. And until you experience such a thing for yourself, or interact
with someone like that you will 100% never believe it to be possible.

Yet it is.

~~~
intenex
Nope! I was chronically suicidal and depressed from 8th grade all the way
through my first semester of college at Harvard. Someone jumped off a building
halfway through that first semester, and ever after, I couldn't stop thinking
about killing myself. Knew I'd unequivocally off myself if I stuck around, so
it finally provided the impetus for me to drop out, travel around the world,
get a Thiel Fellowship, and now be surrounded by the most amazing group of
friends, family, and coworkers, and to be working on something I truly find
meaningful.

Haven't been depressed or suicidal in the _slightest_ since I came out here to
SF and started living an autonomous life on my own trajectory. Was 100%
circumstantial and situational for me, took zero drugs and professional
therapy didn't do anything. Changing my life circumstances did everything.

~~~
ars
So for you it was not like that. Did you think I meant it was only the way I
said?

I meant that for some people it has zero to do with environment, not that it
was like that for everyone.

Be glad it was so easy to fix for you, not everyone is so lucky.

------
jim-greer
While there's truth to this, it's a generalization. Twin studies show that
there's a moderate genetic factor in depression, and a strong one for manic
depression

[http://www.ncbi.nlm.nih.gov/pubmed/558030](http://www.ncbi.nlm.nih.gov/pubmed/558030)

[http://www.ncbi.nlm.nih.gov/pubmed/16390897](http://www.ncbi.nlm.nih.gov/pubmed/16390897)

~~~
jjbiotech
Maybe these individuals with genetic "risks" evolved to live in an environment
different from our modern society. Everyone has a different optimal operating
environment. These studies don't really conflict with anything the author
said.

~~~
jim-greer
How would you describe the difference between a symptom and a disease?

To me this article is akin to saying that the various forms of heart disease
are not actually diseases. Instead, they are symptoms of a poor diet and lack
of exercise.

------
rsp1984
I'm not a psychologist or have received any other professional training in
this direction but really I think there are two types of depression.

\- Clinical depression. The disease type that for many "comes out of nowhere"
and paralyzes people to the point where they can't leave bed any more. I'd
venture to say it's the minority of cases but the author may be wrong in
putting them in the same group as the...

\- Symptom depression. That's what I think the author is talking about and
what I think is the majority of cases. People who work a lot call it "burn-
out". Those affected can still function in daily live but quality of life is
still pretty poor.

It's probably a mistake to put the first kind in the same class as the second
kind. However I think it is a far bigger mistake to treat the second kind like
the first kind and that's I think what the author was trying to say (and I
would very much agree with it).

~~~
dgudkov
Clinical depression is frequently caused by extreme emotional long-term
fatigue which is self-sustained because of not identified and fixed issues
that cause the depression. So it's not a pathology, it's just very extreme
fatigue. To make an analogy -- loosing weight because of not eating is not a
pathology. Fix nutrition and you will stop losing weight. But if you don't fix
it -- you can get into a very severe condition. Again, not because of some
pathology, but because of malnutrition.

~~~
superuser2
What we hear when you say

>it's not a pathology

is that the medical establishment ought to respond to those who approach it in
immense pain by saying, "this is working as expected, go away."

To use your analogy, if a patient presents with a problematic degree of weight
loss, the appropriate response is not "yeah, that's what happens when you
don't eat, bye." It's to figure out _why_ they aren't eating, and how to get
them to eat. Loss of appetite is a symptom of all sorts of pathologies, from
an obsession with mass-media standards of beauty to all sorts of fun physical
disorders, and a doctor would investigate these avenues and resolve whatever
is responsible so that the patient starts eating again.

------
d4amnation
So I have depressive symptoms for quite some time. I've talked to my doctor
like 2 years ago about it. He told me that the only way to get a therapy is to
seek out a therapist on my own. This is fine, I can understand that. Just like
an alcoholic must accept that he has problems and seeks out for help. I am not
going to lie, it is a tough thing to do. But as an general scepticist I have
the huge problem to find someone to trust. I find it absurd that I have to
check the phone book or the internet to find some nice looking person that
maybe can help with my mental health. Eventually, a therapy is something that
both therapist and patient have to agree about. But I can't really see myself
to visit mutliple therapists just to find someone that can work with me.

So if someone lives in germany and can give me a hint to find someone, or
anyone else in any way I'd appreciate it.

~~~
pzone
Finding a therapist isn't so magical. The key things they will do is provide
empathy and view your life from a third person perspective, and has training
in the way the mind works, particularly how it goes wrong. If you can find a
therapist who does a good job understanding you and who you respect, they can
help you solve many problems.

------
belorn
Depression is commonly defined as the inability to recover from negative
emotional state. To then call that a symptom of emotional needs seems to miss
the distinction.

If we compared this to injure and clotting, it would be weird to describe a
clotting disorder as a symptom of injuries. Preventing more injuries is likely
going to help and is a good step forward, but it do nothing to address the
issue on why the recovery process is impaired.

~~~
firethief
The article is talking about ongoing the emotional effects of ongoing
circumstances. I'm not sure how the concept of recovery can be applied when
the cause of the state has not abated.

It isn't a clotting disorder if your foot keeps bleeding because you haven't
taken the tack out of your shoe.

I don't know how accurate the author's characterisation of depression is, but
I don't think a useful analysis will result from applying that definition of
the word depression so literally in this particular case.

------
slaxman
There is major difference with being depressed and having clinical depression.
I have been fighting the latter for the last few years and I can vouch for
there being no cause.

Example: I was with my extended family members in mountains of coffee
plantations enjoying a vacation. There was no internet connection and thus
nothing to disturb me. We were all (over 20 of us) having a great time. We
were playing a game of cricket, where during the game I had a depression
attack and almost collapsed on the ground. There was nothing there to upset me
at all.

This is just one example. I have faced many more in a similar manner.

There is one thing for sure. Community support helps you fight depression very
well. I am a member of a Buddhist group and their encouragement and support
has really help me fight it.

~~~
serpix
I have dropped all anxiety medication after starting a very regular and strict
meditation routine. today I was in a large meeting/workshop with mostly
unknown (to me) people. This would previously have caused major anxiety
symptoms, possibly even an full blown panic attack hours ahead of the meeting
or during.

Yet I felt happy and energized by just being with these people and being
mindful at the same time. Any racing thought quickly identified and dismissed.
Never experienced anything like this before. I now truly think anxiety can be
blown to shreds by applying what you learn in meditation in your daily life.

------
EGreg
This! So many times I see that "depression is not just something you can
address with actionable things, talking about rainbows", etc. and some sort of
implicit acknowledgment that psychotropic drugs are necessary and that
depression is totally okay and just has to be understood and empathized with.
(I wish I expressed this sentiment better, but I hope you know what I mean
since the same sentiment keeps appearing.) And then that can lead to downward
spirals, drug abuse, and even suicide.

Depression and anxiety are usually symptoms of needs not being met, or
embracing a worldview in which one is not living up to things they believe are
essential. Often the worldview makes a big difference, including and
especially religion and philosophy -- as these affect what the person values
the most. That and the interpersonal relationships with people and how they
are affected by the person's goals.

If you are close to someone who is depressed, ask them about:

Their worldview

What is important

Their values and goals

Why must they achieve those goals

How have they been achieving them

Their interpersonal relationships

What is wrong is often systemic - it is seen over and over in various people
in various ways. The underlying worldview usually is the first factor,
followed by interpersonal relationships that are colored by the worldview and
goals. Often one's early relationship with the parents sets unconcious goals
(eg must get married to someone within the faith, must get good grades etc.)
that cause people to expend a lot of effort pursuing while not fulfilling
their physical and emotional needs. They end up depressed or anxious as a
result.

------
graycat
While trying better to understand someone else in my family, the expert advice
I got was that anxiety is nearly always genetic, that is, nature and not
nurture. And the expert claimed that it is known that psychotherapy, e.g., as
suggested in the OP, doesn't work for anxiety or some of its other symptoms,
obsessive-compulsive disorder, social phobia, paranoia, hysteria,
psychopathic-passive.

For more, there is

David V. Sheehan, M.D., _The Anxiety Disease._

where he argues that, even after _controlling_ on various obvious candidate
variables, anxiety disease is four times more common in human females than
human males. He conjectures that the difference is so great that at some time
the disease must have had some reproductive advantage.

Or, some people come from just horrible backgrounds and still do not suffer
from anxiety disease, while other people come from apparently ideal
backgrounds and do suffer.

Of course, a child gets from their parents both nature and nurture, so we have
to suspect that can be difficult to separate the two.

Still, IMHO, on this quite serious subject, the OP is a bit too simplistic.

~~~
DanBC
> And the expert claimed that it is known that psychotherapy, e.g., as
> suggested in the OP, doesn't work for anxiety or some of its other symptoms,
> obsessive-compulsive disorder, social phobia, paranoia,

That's an _interesting_ bit of advice. English NICE recommends psychotherapy
for front line treatment of anxiety.
[https://www.nice.org.uk/guidance/qs53](https://www.nice.org.uk/guidance/qs53)

~~~
graycat
My info was first hand from the Chief of Psychiatry, Westchester County
Hospital, NY, USA. He seemed darned serious, bright, well informed, enormously
experienced, and competent.

~~~
Domenic_S
Perhaps you misunderstood the Chief; CBT is the gold standard for treating
anxiety-related disorders. See this meta-analysis:
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/)

~~~
TeMPOraL
The interesting thing IMO is that CBT is actually about _totally ignoring_ the
"underlying reasons" of your problem, and instead it's about literally hacking
your mind to deal with the symptoms. Drugs are a hardware solution, CBT is a
software solution, and all that searching for problems in your life is mostly
attempts at patching up datasets provided by third parties.

~~~
Domenic_S
Sort of... it's learning to recognize when your brain starts looping and
giving you the skills to be able to hit ctrl + c, while at the same time
teaching you how to not write loops in the first place.

GAD and PTSD and all that spectrum are coping mechanisms, they're just
maladaptive. CBT teaches you how to cope productively.

(personal opinion incoming), I think a person can get to the point where they
need an SSRI as a stepping stone to even have the energy/capability to benefit
from CBT, then they learn adaptive behavior, then they can dump the SSRI and
let their new skills handle day-to-day life.

The "underlying reasons" are only useful inasmuch as you know what to look for
so you can proactively start coping/remove yourself from maladaptive
situations, but IMO most people try way too hard with the "why" stuff. The
only thing that matters is "what now?"

~~~
TeMPOraL
I share your personal opinion. I'm actually in the process of that, and I can
attest from my experience that it would not be possible for me to benefit from
CBT without first getting an SSRI therapy - I was stuck so deep in anxiety
loops that even the keyboard interrupt handler was starved for resources.
SSRIs reduced my problems to something I'm struggling with - before drugs I
was unable to function as a productive member of society at all.

(Ironically, some of my present problems are indeed caused by life conditions
- exactly the conditions I inflicted upon myself during the period before I
started taking drugs.)

------
js8
There was an interesting article few days ago on HN:
[https://news.ycombinator.com/item?id=11358931](https://news.ycombinator.com/item?id=11358931)

In the article, there was a quote: Many people with severe anxiety and/or
depression are also anti-authoritarians. Often a major pain of their lives
that fuels their anxiety and/or depression is fear that their contempt for
illegitimate authorities will cause them to be financially and socially
marginalized; but they fear that compliance with such illegitimate authorities
will cause them existential death.

It seems to me, sometimes, being a member of society (having these societal
needs met) can be quite tricky.

------
acscott
Dis-ease. Semantics. There can be morphological
([http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785515/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785515/))
and biochemical indicators of depression and anxiety.

To make mice depressed they will do a forced swimming test (poor mice). So
this is another way to induce depression: physical+psychological stress.

If there were good science with good funding it's feasible to come up with a
lab test for depression--and anxiety--that's very, very accurate.

No, the article is incorrect. It does not have citations either. Explore
pubmed for plenty of information. (Keep in mind the sad reality is that even
good science is wrong lots of the time--I'm hedging, okay most of the time.)

The risks of not properly treating depression and anxiety is very, very high.
So the article is very irresponsible in my opinion.

~~~
cpncrunch
>There can be morphological
([http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785515/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785515/))
and biochemical indicators of depression and anxiety.

That doesn't really have any bearing on the accuracy of the article. PTSD is
also associated with reduced hippocampal volume, which reverses with
successful treatment. It isn't as if the hippocampus suddenly shrinks for no
apparent reason...

>So this is another way to induce depression: physical+psychological stress.

The article is talking about psychological stress, so you're really just
discussing the same underlying cause.

>No, the article is incorrect. It does not have citations either. Explore
pubmed for plenty of information.

I don't see how it is incorrect. It is just discussing the problem at a
systems level rather than a biochemical level. Both explanations can be
correct.

>The risks of not properly treating depression and anxiety is very, very high.
So the article is very irresponsible in my opinion.

On the contrary, I think it's very irresponsible to dismiss articles like this
out of hand, as _that_ will likely prevent people from seeking the correct
treatment.

------
stantona
This is pure generalization and does not apply to those who are clinically
depressed or suffer bipolar.

~~~
tim333
The guy says "Depression and anxiety are, for the large majority of cases,
emotional signals." I don't think he'd ever say it was true for all cases.

------
some-guy
There's a HUGE difference between depression/anxiety the symptom, and major
depressive disorder.

For those with an hour to kill, Robert Sapolsky has a wonderful, accessible
lecture on the topic[1].

1.)
[https://www.youtube.com/watch?v=NOAgplgTxfc](https://www.youtube.com/watch?v=NOAgplgTxfc)

~~~
Tempest1981
Good descriptive word: Anhedonia -- the inability to experience pleasure from
activities usually found enjoyable.
[https://en.m.wikipedia.org/wiki/Anhedonia](https://en.m.wikipedia.org/wiki/Anhedonia)

Also: psychomotor retardation: Physical difficulty performing activities which
normally would require little thought or effort such as walking up a flight of
stairs, getting out of bed, preparing meals and clearing dishes from the
table, household chores or returning phone calls.
[https://en.m.wikipedia.org/wiki/Psychomotor_retardation](https://en.m.wikipedia.org/wiki/Psychomotor_retardation)

------
cairo_x
Many mental illnesses, over the past decade, have been proven to be diseases.
They can be tested for. Currently there are a whole hosts of new tests and
treatments going through the phases.

Gregg and his ideas run parallel to a line of thought associated with The
Citizens Commission on Human Rights, a group hell bent on denouncing mental
illness as a disease. CCHR are/were a nonprofit organization established in
1969 by the Church of Scientology and psychiatrist Thomas Szasz.

I can't believe people are still pushing these ideas, but this thread is rife
with them. Please would ya'll make an effort to update yourselves to the state
of the art.

~~~
namlem
I think there is some merit to these ideas, but we shouldn't go overboard.
With anxiety and depression specifically, I believe we need to make a
distinction between the chronic and acute forms. If you have healthy
relationships and a generally fulfilling life, yet still have problems with
anxiety and depression, you most likely have the chronic form and need
medication. If, on the other hand, your symptoms can be explained by other
factors, like those described in the article, non-medical interventions should
be used. It seems that there is also a risk of the acute forms of these
disorders evolving into the chronic forms, which are harder to treat.

------
LandoCalrissian
This is a terrible article that completely treats depression as the fault of
the individual. Pretty irresponsible frankly.

~~~
darkclarity
The way I got out of those sorts of issues was by noticing that the medical
system is inadequate. It is geared towards hiding symptoms with drugs - to get
people back into work, even if those people are a mess inside.

It's all down to personal responsibility. You have to find the drive inside to
constantly push. To forget the victim mentality that society encourages. To
fix one problem at a time. To fight the hellish mode that your mind has
enabled.

~~~
LandoCalrissian
Honestly that is lot of BS. I get what your saying to a point, but I have
never used my depression as an excuse to dismiss any of my normal duties, and
I think it's pretty bad that you would assume many would.

By all accounts I have a great life, I have friends that have been with me for
over 20 years, have a wife who by all my accounts is the greatest person in
the world, have an amazing job that I completely love going to every day. I'm
truly blessed with what I have, and could never argue otherwise.

I am a diagnosed manic depressive and I treat it like alcoholism. You're not
going to see an alcoholic stand up in an AA meeting 20 years later and say
"I'm not an alcoholic anymore". I treat depression the same way, you have to
confront it head on each day and admit what is happening to you mentally. 10
years from now, 20 years from now, whenever. The great irony of that is that
alcoholism is recognized as a disease where this article is arguing that
depression isn't the same.

You can have the best life, the best people in it and still want to top
yourself. To "fight the hellish mode" is such a radical oversimplification
it's comical. I seriously have some of the best and most longstanding
relationships with my friends that makes it most people jealous. Most people
don't understand how a group of people could still be with each other after
20+ years. Yet I'm still depressed every day. It's never going away, it will
always be there no matter what I do. To characterize that as victimization or
lack of effort is exactly what leads people to kill themselves, because whats
the point after honestly? You are literally saying their inability to foster
positive relationships is what is the problem. Having nothing but positive
relationships in my life I can tell you that's bullshit.

It's not interaction that fosters the problem, it's fucking depression, the
disease. Get off you high horse or were going to have more Aaron Swartz's on
our hands. The stigma is a 100% real, and garbage like this just makes people
with depression feel more alienated.

~~~
Swannie
I know someone that would describe themselves in a similar situation as
yourself.

I don't know that this article is complete garbage. My friend certainly felt
that therapy (recommended by their psychiatrist) was an extremely valuable
tool, in addition to medication, to help them manage their day-to-day
symptoms, and to understand the things that would trigger the worse periods.
They also felt that therapy allowed them to improve their relationships, which
improved their support structure, which was slowly reducing the frequency and
duration of the bouts of depression.

But yeah, saying that depression can be fixed by therapy is harmful, and after
a careful re-read, I'd consider this article as 80% junk.

------
linhchi
Maybe it's the lack of emotional education from my childhood or i was born
with it, but i'm diagnosed that i don't feel for myself, and (worse) mirror
all the feeling of others on me. Which explains why people tire me out so
fast. And when i'm overwhelmed by people emotions in a room, i get iritated
and aggressive (a lot).

Now I realise that anger is a self defense mechanism because when my system is
overloaded with people's emotions, it's a desperate but sane manuever of my
subconscious in order to cut off the situation completely.

Of course it's just a temporary solution and it has many consequences but if
you're loading too much of others on you, your body has to issue an
irrevokable state of mind.

I think it's similar to other "negative" symptoms. So when i started to
meditation (in order to create an interface to talk with the hidden drive in
my subsconscious), i regarded them as little wicked monsters, but not anymore,
now i regard them as the only company i have in my breakdown episode. Because
when you're depressed, you don't believe in whatever your loved ones say
anymore. there's only you and the battle.

------
intenex
Agreed 100% here. I was chronically suicidal and depressed from 8th grade all
the way through my first semester of college at Harvard. Someone jumped off a
building halfway through that first semester, and ever after, I couldn't stop
thinking about killing myself. Knew I'd unequivocally off myself if I stuck
around, so it finally provided the impetus for me to drop out, travel around
the world, get a Thiel Fellowship, and now be surrounded by the most amazing
group of friends, family, and coworkers, and to be working on something I
truly find meaningful.

Haven't been depressed or suicidal in the _slightest_ since I came out here to
SF and started living an autonomous life on my own trajectory half a decade
ago. Was 100% circumstantial and situational for me, took zero drugs and
professional therapy didn't do anything. Changing my life circumstances did
everything.

------
haberman
This is one reason that the famous Hyperbole and a Half entries describing
depression were always so surprising to me. The first entry starts like this:

> Some people have a legitimate reason to feel depressed, but not me. I just
> woke up one day feeling sad and helpless for absolutely no reason.

[http://hyperboleandahalf.blogspot.com/2011/10/adventures-
in-...](http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-
depression.html)

[http://hyperboleandahalf.blogspot.com/2013/05/depression-
par...](http://hyperboleandahalf.blogspot.com/2013/05/depression-part-
two.html)

If this article is true, the Allie just hadn't figured out what the underlying
issue was yet. Or what she went through was something else entirely.

------
_98fj
The author fails to differentiate quite a few things here.

Long-term depression is a way of thinking and feeling that some people fall
into easier than others and that is also cultivated over time.

If you had a rough childhood and coped with it by getting sad and finally
dissociating from your emotions in an early age, and you proceed to do that
for a long time, then you are likely to get what's called a major depression.

I don't know if I would call that a symptom or a disorder and I frankly think
that most of the time it doesn't matter for the treatment.

------
sgift
This follow up article by the same author (linked at the bottom) seems
important to understand his position in my opinion - it answers many of the
points raised here in various comments:
[https://www.psychologytoday.com/blog/theory-
knowledge/201603...](https://www.psychologytoday.com/blog/theory-
knowledge/201603/clarifying-the-nature-anxiety-and-depression)

------
m0llusk
Perhaps, but it is clearly more complicated than that. PTSD appears to be
related to changes in the amygdala that make anxiety reactions more bursty and
intense than they would otherwise be. What exactly triggers the reaction is
not the problem as much as what happens next within the brain and thus the
mind.

------
strathmeyer
Lol I'm depressed because I can't find a job. I can't find a job because I
don't have a job. Which is sort of depressing. Which doesn't make looking for
jobs fun. Depression makes you not want to do things that aren't fun. So I
keep looking for jobs with the hope it can bring me out of my depression. But
when I ask for people for job help they are a jerk to me. When I mention I am
a little sad they say I need to act happy to get a job. They get upset that
I'm not happy. But.... that's what I was upset about!

------
amelius
Has anybody here had any success with applying Alexander Technique for
treating depression and/or anxiety? I'm asking this because I suspect that
many technology workers are using wrong posture while sitting behind the
computer (and most start this bad practice at a young age, including myself).
I have recently started forcing myself into a better posture and I must say
that I'm feeling much better. Of course, perhaps this is just a coincidence,
so I'm wondering about any other experiences.

------
foobarqux
The article seems to essentially be advocating psychodynamic psychotherapy,
which isn't new but seems to be out of favor compared to thoughts-cause-
emotions models common in CBT.

~~~
tim333
I don't think he's advocating that at all. More sorting your life out if
that's what's causing the depression.

------
baron816
My startup, Krewe ([https://www.gokrewe.com](https://www.gokrewe.com)), aims
to help people make a new group of close, meaningful friends in their
neighborhood and become connected with their local community. I really hope
it'll go a long way towards alleviating depression for many people.

------
ivanceras
Google cache view
[http://webcache.googleusercontent.com/search?q=cache:https:/...](http://webcache.googleusercontent.com/search?q=cache:https://www.psychologytoday.com/blog/theory-
knowledge/201603/anxiety-and-depression-are-symptoms-not-diseases)

------
xivzgrev
If you break your arm and then go into the emergency room, you don’t say, “I
have pain-in-my-arm disorder”.

Haha! How true.

~~~
jimothyhalpert7
While I'd agree with this phrase, when it's taken out of context, the analogy
the author is making is a horrible one. Skipping past the fact that it
completely diminishes the near infinite complexity of the human brain, the
clear problem is the ease of root cause determination for both situations.

A analogy which would make more sense, albeit still horrible would be: you
feel pain in your arm, and decide to wait, until it gets so unbearable, that
you see the doctor. The doctor asks you to try and think what could be the
cause, and after some time and much thinking, you finally remember that you
broke your arm that one time in the 3rd grade, but didn't go to the doctor,
because it healed up itself.

Hence, you have a improperly resolved (cured) childhood trauma, that
manifested itself after many years, without my immediate recollection of the
root cause. In this case, I would only go to the doctor with the symptom. And,
while there is one primary root cause, I'd need some pain relief to at least
start thinking straight.

------
_Codemonkeyism
Some people think depression is also linked to inflammation.

e.g.
[http://www.nature.com/nri/journal/v16/n1/full/nri.2015.5.htm...](http://www.nature.com/nri/journal/v16/n1/full/nri.2015.5.html)

~~~
DrScump
"linked" can mean causation in _either_ direction.

------
agumonkey
The issue with the metaphor is that it's very subtle. We understand matter and
mechanics. A broken bone is obvious. When you feel depressed you don't really
know what's broken.

------
cairo_x
Depression is not a symptom. It is the inability of neurons to recover from
stress -- ever. I know, I know, it's a novel thought -- to actually pay
attention to the state of the art in depression research, but, what'evs.
Gregg's a psychologist, so he doesn't have to care about that neuroscience
sciencey weirdness.

------
dschiptsov
I have said this a few years ago on this very site. Should I publish an
article instead?)

So is Asperger's by the way. Mild forms of autism, it seems, is an adaptation
of a brain to cope with overwhelming cognitive overload of certain types,
usually related to other people and unfamiliar places, which could be compared
to too loud noise or an attacks of height-sickness.

And there is no single cause, of course. The symptoms are results of some
genetic predisposition (slight differences in brain structure, perhaps, or
higher levels of some neurotransmitters) and environmental and social factors,
which conditioned the resulting habits and behavioral patterns.

One of the simplest and less wrong theories about mild forms of autism is that
of so-called mind blindness. The children who have difficulty with maintaining
eye contact and are looking to a mouth area instead of eyes area, could not
learn to properly read accompanying emotions form faces of other people, so
they constantly confused about interpreting the intentions and behavior of
others and easily fooled by fake "Pan Am" smiles, so they learn to avoid
confusing society and develop what we call introvert or nerdy mentality, with
typical social awkwardness and eventually lack of interest in all these
clowns, which clowns label sociopaths.)

------
zxcvvcxz
This is a fantastic article.

> Depression is a way the emotional system signals that things are not working
> and that one is not getting one’s relational needs met. If you are low on
> relational value in the key domains of family, friends, lovers, group and
> self, feeling depressed in this context is EXACTLY like feeling pain from a
> broken arm, feeling cold being outside in the cold, and feeling hungry after
> going 24 hours without food.

Exactly, it's a signal, not a disease. A signal a lot more people I know are
having as they grow into their desk jobs with bleak outlooks for advancement
and fulfillment. Anecdotally, when I talk to depressed men I know, lack of
romantic prospects is by far the biggest factor. We've never had more single
men: [http://cnsnews.com/news/article/barbara-
hollingsworth/bachel...](http://cnsnews.com/news/article/barbara-
hollingsworth/bachelor-nation-70-men-aged-20-34-are-not-married) I'm sure
women are much happier either with these circumstances. Somehow modern society
has us further apart in this regard.

I've written before about being prescribed SSRIs after a 45 minute meeting
with a college psychiatrist. Absolute rubish. The real solution was to cut out
a failing romantic relationship, stop living with this person, and start
cultivating new, healthier relationships. I've never been depressed since, but
I got a great experience dealing with SSRI withdrawal symptoms in a foreign
country.

If anyone reading this is depressed, I strongly recommend thinking about it as
a _signal_ that something is off in your life. For most people (though
certainly not all), the meds will only help you cope with whatever the
underlying problems are. Get some exercise:
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/)
and also start being more social. Practical tip for hitting two birds with one
stone: join a running club.

------
okonomiyaki3000
Nooooo Shiiiiiitttt!!!!!

------
known
Understanding
[https://en.wikipedia.org/wiki/List_of_cognitive_biases](https://en.wikipedia.org/wiki/List_of_cognitive_biases)
will alleviate your anxiety/depression

------
bischofs
What does this have to do with software or tech? are developers all depressed
or something? Is this site just turning into another reddit? Someone please
help me to understand why hacker news should be a safe place for depressed
people to talk about their feelings, there has to be a better venue for that.

~~~
jamble
It may not be directly related to the tech industry, but I certainly
appreciate seeing more openness on the topic - especially because our mental
state of mind impacts everything from motivation to try new things; to read
and digest new information; to apply for a new job; and to hold a job. And so
much more.

Obviously, this is not exclusive to the tech industry, but I don't think
that's any reason to shy away from like-minded people having discussions on
the topic (by using HN).

On the topic of mental health, I have recently had more pleasant and/or
constructive conversations on HN than I have in years on other social media
sites (reddit, facebook, twitter, tumblr). I also enjoy reading the comments
and discussion on the subject quite a bit from the HN community.

FWIW, I did also discover devpressed.com recently thanks to another mental
health related thread and I'm grateful for that as well. Wouldn't have found
that resource without HN.

\- SysEng with mental illness.

