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Anxiety and Depression Are Symptoms, Not Diseases (psychologytoday.com)
551 points by jakegarelick on Mar 28, 2016 | hide | past | web | favorite | 266 comments



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.


> 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.


Oh, this is a fantastic and beautiful deconstruction of this argument, I LOVE this. The comparison to chronic pain is fantastic, because indeed, chronic pain is a side effect of many conditions, and if we were able to relieve the chronic pain somehow, we certainly would, but being currently unable, we seek means to treat the chronic pain.

I've often held that the most insidious part about clinical depression is its self-reinforcing nature. Deep clinical depression is throwing a person into a deep hole with thorns sticking out of the sides- every attempt to climb out of said hole results in swollen cuts and pain to the arms and body, rendering eventual escape more difficult with each struggle.

Eventually, it becomes like trying to climb out of said hole with no arms at all. It's one of my life goals to discover biochemical methods to help such people regain the use of their arms, or even essentially grow new ones.

I find articles like this one useful ONLY* insofar as they assist those who have gained use of their arms and cut away the brambles on the walls of the pit- for most others, it merely ends up encouraging more struggling, self-recriminations, and effectually a deepening of the hole. :(


I have this wacky idea that maybe, just maybe we should reconsider the point at which opiates would be appropriate for treating depression. I mean maybe make them a 2nd or 3rd line treatment... right now I'm pretty sure they'd only give you opiates once that whole "induce a controlled seizure" thing fails.

Sure, they're addictive, but the "opium cure" was used up until the 1950's[1] and it's not like society was overrun by addicts. (I admit it's possible that the circumstances have changed, but I'd need to hear an argument for that.) Plus the fact that both Buprenorphine and Heroin-Assisted Treatment have been successful... opiates can be given as controlled medicine, and I feel like many people could benefit from them.

Over 40,000 Americans die by their own hand every year.[2] I would much rather have 40,000 opioid-dependent living people if it helped them bear the weight.

[1] https://www.ncbi.nlm.nih.gov/pubmed/18956529

[2] http://afsp.org/about-suicide/suicide-statistics/


each year 19,000 americans die from prescription opioid overdoses and another 10,000 die from heroin overdoses which often start with prescription opioid use.

In my experience (as an anaesthesiologist), people who use opioids as a response to non-pain problems are some of the most miserable people there are. It might work for a couple of weeks, but soon you're tolerant, addicted, intermittently withdrawing and your life becomes a wreck. "The prevalence of suicide attempts among opioid addicts is reported to lie between 8% and 17%, with some studies reporting an even higher rate among special groups of addicts. " http://www.ncbi.nlm.nih.gov/pubmed/9018906

Using MDMA might be useful as it is non-addictive, but again habitual use leads to decreasing benefits and increasing problems.


I appreciate your input as a medical professional.

Are you familiar with studies using NMDA receptor antagonists to reduce opiate tolerance?

For example, here's a study they did on mice: http://www.ncbi.nlm.nih.gov/pubmed/10763858

Also, don't you think your sample is biased as a doctor? As in: the people you're likely to encounter in your line of work are those that are in need of medical care?


Saying that prescription opioid use is a cause of heroin overdoses ignores the fact that the reason people move to heroin is because of the paranoia about addiction which causes their prescriptions to be cut off in the first place.

In the same vein (no pun intended) I've been looking for stats but not being able to find anything about what percentage of prescription opioid overdoses occur while the patient is being actively prescribed, versus those which occur when the patient is obtaining the drugs illegally once their prescription has been cut off because doctors are afraid they'll become addicted.


There's a piece missing from this argument: opioids were inappropriately prescribed to start with in many cases.

Think of all those folks with back pain. Back pain is complex and difficult to treat, but huge components come from 1) the stupid chairs we sit in 2) at our stupid jobs that encourage hours of sitting 3) in our cities that discourage biking or walking to work, all in the context of 4) a food system that gives us crap to eat that makes us mildly addicted to sugar and salt and makes us unhealthy.

So the real cure for back pain for a lot of people is to go back 20 years in time, make a commitment to taking care of their physical selves, aligning their eating, transportation, work, and recreation with health. The second-best cure is physical therapy. Physical therapy right now! But that costs money and time and no one believes it works (it does!!!) so the pain med is seen as the proximate best answer.

Brings us back to the original original post, actually.


> that the reason people move to heroin is because of the paranoia about addiction which causes their prescriptions to be cut off in the first place

Well it seems they are right, if people will move to an illegal substance right after they get cut from it


Pretty sure if coffee was outlawed tomorrow you'd see a lot of people moving to illegal substances. Doesn't mean people can't handle the substance, just means people who are cut off from substances they depend on will go out of their way to satisfy that dependency.


This is a tautology. You're not "right" to fear illegal drug use if your reaction to said fear (cutting off access to quality-controlled, measured doses) causes it.


contrary to popular opinion these days, I think pain is undertreated and routinely so. quality of life should take priority over dependence concerns especially in the elderly.


Opioids are not a suitable treatment for long term pain, especially in the elderly.

People need rapid access to pain management clinics, with weight loss and strength building exercise, and access to meds (which in long term pain are often not opioids).

Giving those people opioids increases their risk of accidental death, and suicide. It gives them an addiction. But worse it does not treat their pain - they will still have the pain.


This is ignorant at best and naive at worst. God help anyone you treat, and if you aren't a medical professional its probably for the best. Your comment makes me physically ill.


Which bit is wrong?

You seem to think pain control is opioids or nothing, and that's not true. There are a range of meds that should be used before opioids are tried. You also seem to think that pain control is only medication, and that's not true either. Exercise is a powerful intervention that can cure some long term pain (especially long term lower back pain). This strength building exercise is really important for older people too.

Opioids really don't work for long term pain. People develop a tolerance, which means they need to take more to get the same effect, but that means they end up taking dangerous quantities, and not getting pain relief.

Here's a Pubic Health England project to support prescribing of opioids: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...

> 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain.

> 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation)

> 3. The risk of harm increases substantially at doses above an oral morphine equivalent of 120mg/day, but there is not increased benefit.

> 4. If a patient is using opioids but is still in pain, the opioids are not effective and should be discontinued, even if no other treatment is available.

Here's a BBC Radio programme about health. They visit a pain management clinic. People who visit that clinic usually have to detox from their opioid addiction before they can start the pain management work. This is because opioids really are not suitable for long term pain, and other meds / interventions should be used. http://www.bbc.co.uk/programmes/b04wv052

Here's a physician on HN talking about why opiates are not suitable for long term pain: https://news.ycombinator.com/item?id=10285321


You sound like a drug abuse apologist.


But what is the root cause of pain? I used to be depressed and in a lot of pain. I could have got anti depressants and anti pain rXs. Turns out I was just fat and my body was mad at me. Switched to an active lifestyle and everything got better.

Does that mean it would work for everyone? No. But no doctor told me to go run. they either gave me medicine A or B or C, and changed doses to try and minimize side effects. It's terrible but I understand. I can't go to an overweight depressed friend and tell him he needs to fix his life not take drugs for his bad back.


> afraid they'll become addicted.

Someone who isn't addicted to highly addictive substances doesn't engage in risky behavior, disregarding consequences and their well-being, by seeking out undosed, more potent and potentially adulterated highly addictive street drugs.

Maybe their doctor has a valid concern. Opioids are rarely an effective treatment for non-cancer and chronic pain if taken regularly for a variety of reasons.

Ideally, if a doctor is going to stop refilling a prescription of an opioid addicted patient, they should be referred to appropriate services. Detoxification, pain management and mental health specialists should be all be involved for the patient's well-being. The patient should never be cut off cold-turkey like that.


You sure about that? I'd imagine given enough pain for a long enough duration, I'd find a solution that either cures or kills me.


I think mushrooms might be a better drug to give people than opiates. Send people to the redwood forest for a week to stay in a small cabin and eat mushrooms/smoke weed/eat good food and see how depressed they are afterwards!


Rofl! These are interesting points, and honestly, cause for deep thought. If these premises are sound, one might argue that a large part of the rise of clinical depression as the problem is presently constituted coincided with the phasing out of the so-called 'opium cure.' XD

(I'm so not willing to commit to that position, but I mean, just looking at only those facts you've popped in right there, it sure looks like a possibility, no real harm in admitting the possibility of any given conclusion! :) )

I'd rather have opioid dependent folk than suicides, as well, mostly because I strongly trend towards any outcome where there continues to be choice and opportunity for betterment. Certainly worth exploring, at least in thought! :)


If you're interested in studying the closest thing to it, look at the rise in popularity of Kratom, a Southeast Asian plant containing opioid alkaloids. It's commonly used by opiate addicts as a replacement therapy, and also by others as self-medication for anxiety, depression, and pain.

I'm not recommending anyone try it... nobody's entirely sure if it's safe, or if it could function as a gateway drug to harder opiates. But it's worth considering the good it may be doing for some people.


> Kratom.. self-medication for anxiety, depression, and pain. > But it's worth considering the good it may be doing for some people.

The only the good it's doing these people is turing them into opioid addicts with a new problem that has a good chance of eclipsing the original and a certainty of exacerbating it severely in the long-run.


About three years ago I tried kratom and a few hours into it I decided to start an exercise habit and I haven't stopped. I should try kratom again some day.


I don't think prescribing opiates to the right patient is a bad idea, or just make them legal--which will never happen.

That said, you, or anyone else are not going to get opiates from any doctor in the United States. The federal government is comming down hard on doctors who prescribe opiates.

The FDA just sent out prescribing recommendations to all doctors. It is stern. It's basically telling doctors just don't prescribe them--period! Or, only to cancer, and for palliative care.

It will go down like this; patent will go to that rediculious office visit to discuss their pain(a lot of that pain is real. Opoids make you feel better, so the pain is bearable. There are people who stay on their original doses.)

Doctor will just say--no.

Patient will detox, and might die, if old, or has underlying health problems. Just like the way Jerry Garcia died out in Woodacre, CA.

Or, patient will go to herion? If they live in the right area, and they are willing to break the law?

Whatever--getting any opiates will be very difficult. The average patient will be in pain. I really don't like the way the government is telling doctors how to prescribe.

(Bupenorpine shouldn't be thrown in the opiate mix. I have never seen anyone abuse it--period. I know it's opoid like, but so different. I don't even think it possible to OD on this drug.)


There's some research happening recently arpund the use of ketamine as a short term measure to stop suicidal thinking or to get people out of deep treatment resistant depression.

So there's some possibility.


The way I've heard it put is that opiates are an extremely effective treatment for anxiety and depression, with the common and serious side effect of ruining your life. But I hear they're working on eliminating the side effects:

http://mentalhealthdaily.com/2014/12/20/ly-2456302-for-depre...


That does seem to be the conventional wisdom. But it's a bit contradictory, don't you think? I mean, crippling depression already ruins your life, and suicide... well, that's the ultimate life-ruiner.

Opioid replacement therapy seems to work, so I'm just not convinced that all opiates inevitably lead to doom... it feels more like FUD rather than anything backed by scientific evidence.


Agreed, that's an interesting take. Do you know if medical professionals differentiate chronic depression from acute depression? Is "clinical" depression related to one or both of those?


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.


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


I've seen one person really depressed, what I would call a major depression, not what most of us mean when we say we feel depressed. She was totally numb, like her brain was removed, all will gone. There was no reasoning, nothing going on. It was horrible to see, and very educational for me. It's good to see something like this, to understand it. I don't think she was ready to make any decision, but I may be wrong.


This is exactly how I get out of depressive or anxious periods. Somehow the clarity of lying in bed being as painful as getting up hits home and whoop you're on your way out of the slump.

This does not work on all people though, I know of one person who's been resistant to medication, meditation, therapy.. none of it seems to truly change thought patterns. It just keeps coming back time after time.


Absolutely. See also Winston Churchill, who cultivated his ailments into strengths: http://theconversation.com/winston-churchill-and-his-black-d...


> Having been through extreme depression multiple times,

Have you been diagnosed with depression by a mental health professional?


Just thinking out loud here: What about allergies?

In that model, what you need to fix is not to remove the trigger (e.g. the pollen may be safe) nor to inhibit the ability to respond (sometimes you need a big immune reaction) but instead to focus on whatever's gone awry with the fiddly logic in the middle that normally regulates frequency/severity/duration.

If that were the case, then the "depression reaction" might be a useful adaptation... but for some people it's occuring disproportionately.


>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.

The article's premise is that having one's core psychological needs go unmet is like having a broken bone.

If you take away the pain from a broken bone, you still have a broken bone. As you say, there is nothing wrong with taking the pain away. But the bone is still broken, and limits you in ways that a healthy bone would not.

Taking away the symptoms of an unwell psyche still leaves you disabled, even if it isn't as outwardly evident as a broken bone.


Yes but giving someone antidepressants for 30 years is like giving someone advil 30 years for a broken bone. Set the bone, then do advil for a week while it sets. But this isn't how drugs are used in the US. You get on them as a lifelong journey.


If you have a broken bone, it causes you serious problems outside of the pain. The pain is mildly important to alert you, and not very important after that.

Setting the bone is important, but if the pain makes it harder to fix the bone, drug it away asap.

And sometimes non-broken bones ache. No need to suffer it.


A large proportion of chronic pain is iatrogenic, or the product of maladaptive coping strategies. The canonical example is back pain; Standard medical advice was once a long period of bedrest, but this further weakened the supportive musculature of the back, creating a vicious cycle of pain and inactivity. The standard advice is now the exact opposite; Exercise is essential in spite of the pain, for both physical and psychological reasons.

There are often complex psychosocial factors involved, with access to disability benefits playing a substantial role in a large proportion of cases. Long-term use of opiates can cause hyperalgesia and rebound pain due to tolerance and withdrawal. Chronic pain is not simply a spontaneous biological phenomenon.

In the relational frame theory that underpins acceptance and commitment therapy, similar mechanisms are seen as integral to chronic anxiety and depression. Experiential avoidance is a common response to unpleasant emotions, but avoiding stimuli that trigger painful emotions tends to cause a paradoxical increase in the intensity and frequency of those painful emotions. Managed exposure to these stimuli is an essential component of a wide range of behavioural therapies.


> 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.

My experience with SSRI's has been that taking away that mechanism is taking away creativity, emotional range, and introspective ability. Reality distortion is reality distortion. I reject procrustean medicine that fits humans to the mold of what is best for society, which is the primary environment in which anxiety/depression originate.


> My experience with SSRI's has been that taking away that mechanism is taking away creativity, emotional range, and introspective ability.

I'm not talking about SSRI's, I mean a theoretical way of removing only depression and the similar kinds of chronic anxiety. You can be very creative and introspective without being actively depressed.

> Reality distortion is reality distortion.

It's depression that distorts reality, even to the point of making you feel negative emotions that you know aren't true but can't stop.

> I reject procrustean medicine that fits humans to the mold of what is best for society, which is the primary environment in which anxiety/depression originate.

That's great. Me too. But that's really a different issue. You could fix that entirely, and you'd still have people hurt by depression.


What i'm suggesting is that its perhaps not even a coherent idea that one can remove depression without harming a person's mind in negative ways in the general case. There are some people who make fantastic recoveries with modern pharmaceutical treatments for mental disorders, but there are many who pay a steeper cost.

I'm well aware of how distorting depression is. I've been nearly bed-ridden for days at the worst of times. I am equally well aware of how distorting the pharmaceutical treatments for depression can be. It is like trying to correct a distorted mirror by putting a distorted lens in front of it for many people.

Some people have mental disorders that respond perfectly to purely pharmaceutical treatment. I don't know how many, but i doubt it's a majority or even a significant minority.


That can fall amongst their side-effects, but it doesn't have to be. If you are experiencing them you should absolutely discuss that with your doctor, and whether the side-effects are tolerable at the level they are at. They also don't distort reality, they raise the level of serotonin in your brain. Now on the opposite side we do not have a fundamental understanding of how any of that works. For instance, the serotonin levels in the brain of a healthy person might be lower than those of someone suffering from depression. We simply don't have the knowledge know why things are happening specifically.

Speaking from personal experience, which is all I can really do given that I am not a medical professional, they brought be back to a basic level of functionality. In direct regards to what you had mentioned they didn't take away creativity, emotional range, or introspective ability, quite the opposite in fact. Before I began treatment I was rapidly falling towards not ever leaving my room and hiding from people all the time. I am not saying they are for everyone. I just want to point out that we all need to be careful assigning our experiences to others on this.


Bad metaphors for chronic pain don't really help here.

There probably aren't any scenarios where, if you just removed the depression/anxiety "everything else" would be just fine.

What has happened is this: mainstream culture claims that these scenarios are fine when they are not, and so people seek to remove the depression and/or anxiety from them without even questioning whether the scenarios themselves are very healthy.

You're unable (unwilling) to accept that these circumstances are bad. You don't want to change them, you want reality to be something other than it is so that your culture can continue as it has without changing and growing. You would prefer that people numb themselves to it rather than address these defects.

The article's example is full of these.

* People pushed into college who do not want to be there * Parents of young children divorcing * Parents of young children remarrying * Shallow friendships * Hookups

These are not problems that will be easier to fix if he's doped up on prozac, they aren't problems you probably even want to acknowledge as such.


I appreciate this challenge to the article's viewpoint. My response would be that regardless of our unawareness of the causes, both emotional and physical pain are signals of things we need to pay attention to. Maybe chronic pain is the perfect analogue to depression/anxiety exactly because it seems to have unknown or untreatable causes. Maybe there is a need for painkillers in difficult chronic cases, but the vast majority of experiences of pain are functional and helpful.

Additionally, chronic pain conditions generally strike late in life whereas depression/anxiety come earlier. The emotional pain seems more likely to be adaptive whereas the seemingly meaningless physical pain later in life seems more like people's bodies breaking down.

Thanks for the critique.


> 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.

The problem is that the connection between depression/anxiety and interpersonal relationships has been programmed into our systems by evolution. So the question remains if it is wise to alter our biochemistry to suppress mental illness.


>Depression is similarly crippling and unhelpful.

Though it must have some function or evolution would have got rid of it. My theory is keeping your head down may be helpful if you are screwing up socially. These days if the people who know you don't like you you can just move but in the hunter gatherer days that may have been fatal.


Sometimes you can infer from evolution that a trait is useful. But only if the trait:

1. Is in a stable part of the genetic code, giving opportunity for bad traits to be weeded out.

2. Is not correlated with a different useful trait that overshadows its goodness/badness.

3. Shows up early enough to affect reproduction.

Human intelligence is quite recent, so prerequisite #1 is not met. We have no idea if prerequisite #2 is met, and prerequisite #3 is met.

So natural selection can't tell us if depression is/was useful. The kinks of human intelligence are not yet worked out.


#1 Dogs can get depressed so it doesn't need human intelligence. (https://en.wikipedia.org/wiki/Learned_helplessness)

#2 Depression has a major effect, I doubt it's overshadowed

#3 You get depressed teenagers

So I'd think 1,2 and 3 are met.


Re #1: There's absolutely no way to know if dogs experience "depression" in the same way humans do -- even assuming the outwardly symptoms are similar.

Re #2: Your doubt does not constitute evidence in any reasonable sense.


Evolution tends to keep things that increase survival chances, but it can also keep useless features. Also, when the environment changes, a previously useful feature may become useless. Evolution doesn't ensure that feature will disappear, unless it provides a major disadvantage.


By that logic, why can I get sick at all? Why must depression only have social roots?


Therese are degrees of chronic pain. In its acute form painkillers are helpful. In its mild form there is always danger of suppressing a useful signal. The signal gives clues how small changes affect it allowing one eventually to find a remedy that works.

Similar with depression. Unless it is severe, it gives a hint to try to change something. Those changes can be really small, like getting enough sleep, or going to sea once in a while, or talking to an old buddy, or joining some volunteer activity. The key is to try and recognize the feedback that is impossible under antidepressants.


I really enjoy this analogy as well, thanks!


Thanks for the perspective, and ditto. It sounds condescending, and obviously physical brain damage (e.g. CTE) can cause depression completely separately from life circumstances, but I would venture that for a majority of people who say "My life is just fine but I am depressed anyway", their life is not actually fine.

It's not even that they are lying, but we humans are very good at hiding truths, even from ourselves. It can be very hard to truly admit that one is unhappy about one's life, and frankly many people have never really experienced a true sense of fulfillment, peace, belonging, purpose and happiness, and don't know what it would feel like or understand how lacking the feeling is in their lives.

"My life is fine" generally means "I've checked the right boxes: 'success', 'friends', a relationship, but I still feel empty." Don't use drugs to numb that feeling. Listen to it.


Inaccurate.

These symptoms can be caused by trauma that happened in the long ago past. Your current life situation could actually be fine but you have symptoms of past trama.

Seen too many people running around making drastic changes in their lives in an attempt to feel happy but each change just brings more depression because it doesn't work.

"Just make a change in your life" is some feel good bullshit. It's not that simple.


But drugs are awesome :D

Seriously though, compared to being depressed when you can't fix it because you don't have any idea that something is wrong, drugs are fucking amazing. The shitty part is people end up trapped now as the drugs can fuel the negativity which lead to the depression in the first place.


I actually agree drugs are useful for treating mental issues, I just disagree that people need a daily drip-drip-drip of e.g. serotonin or dopamine to function. Drugs can be extremely helpful in treating acute mental issues and helping people "break through" or inoculate themselves against episodes of illness, see e.g. psilocybin, MDMA, ketamine for treatments of e.g. anxiety/depression/PTSD/psychological health in the terminally ill, cluster headaches, etc.

The common thread though is that a single dose of the drug offers long-lasting protection, weeks or months or years. It's not about chemically changing the brain day after day, it's about using neurochemicals to jolt the brain out of a rut. It's about occasionally kickstarting the brain back into normal self-regulation, not using externally supplied chemicals to permanently supplement dysregulation.


For more information on trials being conducted using the drugs described above, see MAPS (Multidisciplinary Association of Psychedelic Studies): http://www.maps.org/.


But drugs are awesome :D

Completely depends on the drug, person and context.

The painkillers when I dislocated my shoulder and they had to reset it? Wonderful.

The antidepressants that after several weeks (so once they'd started "working properly"), made me feel "not unhappy" but like a robot and then also gave me vivid, real nightmares in which I died horribly over and over again? Not so great...

I'd never touch antidepressants ever again. For some people they do work, but for others they don't. Yet we still push them on everyone.


Yet your experience doesn't necessarily match the experience of everyone. It's just a anecdotal to say that your issues with anti-depressants (all of which work differently on different people; even drugs within the same "family") are the same for everyone as it is to invalidate someone else's depression with some BS "I was depressed once, but I pulled myself up by the bootstraps and got better, so that's what everyone needs to do" story.


I think what they're saying is: "side effects are real"


Definitely agree with this. The exchange the doctor describes to begin the article is also common online. I've spent a lot of time in anxiety and depression support forums and chat rooms for my own problems with anxiety. The most common view is that anxiety and depression are diseases that you need to take medicine to treat.

No doubt medicine has its uses in treating anxiety and depression, a momentary reprieve can grant you the clarity to see what you do need to change to feel better. However, I see many people online who cling so strongly to the idea that anxiety and depression are chemical imbalances that you are unlucky enough to be predisposed to developing and that balance can only be restored through medication, that when you suggest that anxiety and depression are not diseases and so can be treated to the point that they are not a problem anymore, people will react violently, as if you just assaulted their identity.

This line of thinking makes it extremely difficult for them to get relief. It is also beneficial to pharmaceutical companies who can make a customer for life by convincing customers that if they don't have a certain medication they will always feel miserable.


Unless we can more reliably distinguish between the cases where it is a neurochemical imbalance that needs medicinal intervention and not, then it can be just as damaging to fight against that viewpoint as it is to fight for it.

What we need is to foster open discussion of both viewpoints because both are fully valid explanations of anxiety and depression. For those who truly do need[1] such medicine it is demeaning and disheartening to hear views like yours touted as the only valid point of view because it implies they are invalid, or that they're cheating because they're not managing without drugs.

I similarly take issue with the article's claim that "anxiety and depression are symptoms of psychosocial needs and threats" because it completely rejects neurological causes of anxiety and depression. There's nothing that says predisposition to neurochemical imbalances will never be more severe than what can be managed without medication. And the same can be said for environmental factors (e.g. ingested and inhaled compounds from the area around where you live, just by happening to live there).

Has anyone done a scientific study on the common root causes of anxiety and depression? Do we even know enough about the brain to be able to confidently identify the root cause?

[1] If you know there are no such people, I'd like to learn about how you know that.


There are also some forums where people discuss abusing a depression/anxiety diagnosis to claim disability welfare. This is much more widespread than most people realise since the rates are higher and the requirements much lower than regular welfare.

It's a surprisingly cushy lifestyle, and some would do anything to keep it. And that entire structure is dependent on depression/anxiety being seen as a medical problem with no solution, only medication.

They are very vocal in it's protection.


> the rates are higher

could you explain this? I've never heard about it.


The simplest example would be welfare per month from (disability + unemployed) > unemployed only.


Hm, I didn't think you could claim both.


..or that for some individuals, those who suffer bipolar (such as myself) or clinical depression, there's a biological factor that has little relation to past circumstances.


I'm not sure why you are calling this a new paradigm. Don't most, if not all, therapists deal with depression as a symptom for necessary changes in life circumstance? Yes, every particular case is different, but in general, therapy is meant to motivate you to make a change---either in perspective, or practice or upon external sources of angst.


You're right, this is not new to psychology itself. It's more of a direct challenge to the culturally powerful psychiatric/biomedical approach to depression and anxiety.


My experience is no, most therapists don't deal with depression as a symptom for necessary changes in life circumstances. They'll expect you to talk about your feelings and so on. I've never heard of one saying your life sucks, change your job and make some friends. Which would often actually be helpful.


I often notice people assume evolution to be "wise" and "nice" when searching for evolutionary explanations, which it is neither.

Evolutionarily speaking, just because something has evolved does not mean it happened for a purpose, or is useful at all.

Pathological anxiety and depression may actually be purely disadvantageous mutations which nevertheless still passed evolution filters because they are not disadvantageous enough to wipe out 100% of their carriers.

Or they may have a much uglier purpose than you have assumed, for example, to force weak individuals (in)voluntarily withdraw from consuming resources useful to others, or even to kill themselves completely, which might be "wise" during foraging times but is nothing but useless breakage in civilized age.


But most human variations are recent! We've changed more in the last 50,000 years than the previous 1M years. I'd say, instead of a real purpose, any 'breakages' are likely coincidental to some other, more advantageous adaptation. Getting smaller and more calorie-efficient (to suit the village/town/city/urban environment) may mean biochemical changes that change our mental state. Not because we 'need' that mental state, but because its better for the clan if more of us fit closer together.

So many adaptations are sledgehammers for a smaller problem. Evolution doesn't plan; it just diddles around until something (sort of) works. And our bodies are the unfortunate result!


While I agree with you on some points, one has to be careful with anything that tries to explain away a complex phenomenon.

After all, there are quacks out there trying to explain away cancer as a symptom, not a disease (see: http://www.goodreads.com/book/show/163184.Cancer_Is_Not_a_Di...).


How are suicidal ideation/attempts and 'successful' suicides explained by this hypothesis?


As I read this, its not a hypothesis, nor is it a theory. Its just a long value statement about how to think about what's going on.

You can accept or ignore this, and it won't change the science at all.


As I read it

"Depression and anxiety are, for the large majority of cases, emotional signals that one’s psychological health is not ideal and that one’s psychosocial/relational needs are not being met."

looks like a theory and and experimentally testable and falsifiable one at that. Take a bunch of depressed people, try to fix their relationship needs along the lines mentioned in the article, survey the people who now have friends, get on with their family and so on and see if they are still depressed and compare to a control group. Simples.


Depression and anxiety are by definition not ideal physcological health.

And almost no ones social needs are ever truly completely met. we also know already that social support helps anxiety and depression regardless of whether it is a root cause. So your test wouldn't falsify if it returned a negative value, nor support with a positive correlation.


Fantastic comment. Medical history is replete with quack-theories and charlatans offering various cures. Blood-letting to balance the body's "humours" for example.

The wonderful thing about scientific progress is that it shrinks the space quacks and charlatans have to peddle their pet theories and cures.


First let me preface this by saying that I have no training in psychology or related fields, so this comment may be complete bunk.

I think that suicide could have some evolutionary advantage in a group. Say there is a member of a group who has become sick, injured, or otherwise incapacitated and is unable to contribute to the group. The group must spend more work to take care of the member than they receive back from the individuals paltry, or nonexistent contributions to the group. If the member's ailment is temporary, then it would be advantageous for the group to bear the burden of taking care of the member, as they would benefit more in the long run.

However, if the member's condition is more permanent, then they represent a net loss to the group's well-being. It would then benefit the group as a whole if that member were to commit suicide, eliminating their burden from the group.

I think this is something that many individuals with suicidal ideation feel on some level. They think that they cannot contribute to their group (family, friends, job, community, country, etc), and that their lack of contribution will be indefinite. For example, a person with anxiety so bad that they are unable to leave the house or get a job might feel like a burden to their family, and unable to contribute. Or, a person with depression might have such a low opinion of themselves that they are unable to see the contributions they are making, or think that their contributions are meaningless and so feel like they are not contributing anything at all worthwhile.

Even though suicide could have had evolutionary advantages in the earlier days of human existence, in modern times I don't think this is the case any longer. With modern medicines and technologies, medical conditions are not as crippling as in the past, and there are more ways to contribute to a group than ever, even without being able to walk or leave the home. The difficulty would then seem to be either helping the suicidal individual to find a group and method of worthwhile contribution, or helping the individual to understand the ways they are already contributing to a group and why that contribution is worthwhile.

Of course, this is just a baseless theory of mine, and I would be very curious to see if there is any actual evidence to back this up.


> I think that suicide could have some evolutionary advantage in a group.

Sounds like archives of Sarah Perry’s The View from Hell[0] may be something you’d interested in checking out. She touches upon a range of suicide-related topics and provides references for further reading.

[0] http://theviewfromhell.blogspot.com/


From a purely mathematical perspective, how would evolution ever select for a trait that causes someone to destroy themselves for the benefit of others?

It seems like any characteristic that prevents the individual from reproducing is by definition not selected for. But I could be misunderstanding something.

Maybe it could work in the case of people who are already parents. Favoring the group could increase the likeliness of their children surviving perhaps?


The individual would still have other relatives who would pass on the genes, like sisters, brothers, other family members. If the individual's sacrifice helps the group survive, their genes would be passed on in those relatives. Also note that the gene would only be activated under a certain set of circumstances, so individuals could have the "self-sacrifice" gene and pass it to their children, even if they never encountered the set of circumstances that would induce suicidal ideation themselves.

I believe there is similar thinking for genetic passing of traits like homosexuality.


That explanation doesn't make sense to me. Your brothers/sisters etc. have similar genes, but they don't have your genes. The theory of evolution is that the most fit genes propagate. So if your brothers/sisters propagate but you don't, then your brothers/sisters genes (along with whatever mutations they might have) are being selected over yours, just as if you had some mutation that made you overall less fit.


It's called kin selection and I think it's generally accepted within scientific community to be a real phenomenon.

https://en.wikipedia.org/wiki/Kin_selection


That addresses my question exactly, thanks!


The most fit genes propagate, not the most fit individuals. Your siblings have many of the same genes that you have. Say there is a gene A that will result in some individuals not reproducing, but will result in more members of their group reproducing. Now say there is 1 group where the members of the group have gene A, and another group where the members don't have gene A. Over time the group with gene A will reproduce more than the group without A, resulting in more copies of A in the general population.

Even if some individuals in the group do not reproduce, their relatives in the group do reproduce. So say 1 person self-sacrifices and does not reproduce, and as a result of their sacrifice 10 others in the group survive and reproduce that would not have been able to if the first individual had not self sacrificed. The family all has gene A, so this results in a net gain of 9 individuals with gene A. So the amount of people with gene A increases, even though some individuals with gene A potentially do not survive and reproduce.

If you want to learn more about this kind of thing, look into "Selfish Gene Theory".


I guess this works if you separate the idea of "fit for a particular situation/environment" for "fit in general."

Suppose we did not separate these things. In that case, for an entire group to have A, that implies that some ancestor of that entire group had A. But this contradicts the premise that the gene makes people less likely to reproduce.

It works if you accept the idea that genes which are fit in some situations are less fit in others. In that case you could have a person who developed this mutation of feeling suicidal when they feel useless, but it doesn't "activate" because they aren't in a situation where they feel useless. But once a whole group has this gene, then your theory of propagation through siblings/cousins is more plausible.


Not every trait that exists has to be selected for. It just has to not be selected against enough for it to be completely wiped out. Some people procreate before they commit suicide, even those that don't would have relatives who might have been spared by different circumstances, or a slightly different mix of genes.


Sometimes traits are related, or negative traits are only manifest in a recessive manner. In such a way positive traits can be selected for, which have a consequence of a negative trait being present in a population.

The example frequently citied in this area is sickle cell anaemia, which can be inadvertently selected for in areas where Malaria is common. Having one 'bad' gene protects the person from Malaria, having two means that one has sickle cell anaemia.

This means that people with a single gene are more likely to survive, and hence pass on their gene, but this sometimes manifests as someone with sickle cell anaemia. See https://en.wikipedia.org/wiki/Sickle-cell_disease#Epidemiolo...


It's easy to make evolutionary just-so stories and they're usually worthless anyway, but here's my attempt at one: as an animal, if you reach a certain age and are not already a parent, it means you're deficient. It's better for the gene pool if you die without reproducing. If you're a parent and you did all that was needed for the offspring to survive the early development period, you're no longer needed and probably better off dying instead of consuming resources your children need.


Yes I generally hate evolutionary just-so stories.

> if you reach a certain age and are not already a parent, it means you're deficient. It's better for the gene pool if you die without reproducing.

This explanation makes no sense to me. Evolution doesn't select for the overall gene pool AIUI, it selects for fit individuals. I can't see how, even in theory, this explanation would be plausible.

> If you're a parent and you did all that was needed for the offspring to survive the early development period, you're no longer needed and probably better off dying instead of consuming resources your children need.

This explanation sounds at least mathematically plausible to me.


How does this explain the higher rate of suicidal ideation/actions in depressed adolescents who are at their biological prime for reproduction?


I don't know. Except maybe that biologically they're supposed to have children instead of sitting in school and waiting for marriage, home and a job.


No idea what this means if you're a male. Males are fertile forever basically, so there isn't some "optimal" age to have offspring.

By your logic, males should be continuously fathering offspring throughout their lives, as soon as they reach puberty.



The agony is so horrible that the depressed deludes himself into thinking that death is the only way out.


If agony is the motivating factor, why are the rates of suicide for people experiencing chronic pain (5%) not as high as the depressed (15%)?

If the answer is that they come to the conclusion of suicide because they are deluded by depression, it comes back to the question in the OP: how does the grandparent's hypothesis explain the symptom of suicidal ideation/acts in depression?


Maybe depression hurts worse than pain?


I completely agree, thanks for the insight. A little disappointed to see people dismissing this article right off the bat.


My favorite pet theory is that depression is the equivalent of autoimmune reaction for the brain. The same way we need some exposure to dirt to calibrate our immune system to not go berserk with some food allergies or lupus, probably we need something in our life to calibrate our brains' loopback feeds.


So, people who've led relatively normal, successful lives with good relationships and have depression might be experiencing it so deeply because they haven't had much exposure to sadness? Sounds like a reasonable theory to me.

That would also explain how people are able to get out of unexplainable depression after a period of time, and why people sometimes seem to seek out more sadness when they're already sad. They're looking for perspective.

Awareness is the goal of some forms of meditation. I'd like to see more studies on the effects of meditation on those who have various forms of depression.


The author addresses social structures and we seem to live in an age of increasing isolatedness amongst people. I thought it would have been a hard read (I suffer from depression) but it's also liberating to see it in a different light.


>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.

Yes, that's all true IMO, but the problem is that many times, it simply isn't feasible to change your environment. So antidepressants are a good way to deal with the problem.

For instance, suppose you live in the ghetto and are constantly struggling to make ends meet. How do you change your environment here? Well, here in American, you don't. You just suffer. If it were that easy to get out of poverty, most people in that trap would do it. Indeed, many things in society seem to be actively designed to keep people trapped in poverty.

What if you're lonely because you're single and have never had any success dating, and the reason is that you're cursed with being extremely unattractive? There again, there's only so much you can do to change that. (Or worse, you have a serious physical disability, which really limits how many people are willing to date you.)

>but I believe the depression/anxiety are there to force our conscious self and the people around us to acknowledge that something is wrong.

Sounds like an interesting theory, but in reality, at least in this society, it seems to have the opposite effect: it makes you an outcast. No one wants to be around depressed people, so they're stuck being lonely, which feeds the depression, it's a vicious cycle. Antidepressants can really help a lot here, by giving you a short-term boost to jump-start your social life and just to help you cope with life in general.

>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.

I think the problem with this idea is that this seems to require some gigantic changes in our very culture and how we deal with people who are depressed.


At the same time some people are just more neurotic(and genetics has a big role), it's not so simple


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.


His bio states: "Gregg Henriques, Ph.D., author of A New Unified Theory of Psychology, directs the Combined Clinical and School Psychology Doctoral Program at James Madison University. He is a licensed clinical psychologist..."

You're right that he isn't a psychiatrist, but he is a clinical psychologist. My educated layman's understanding is that this informs the more behaviorally/environmentally-driven view in his article, but because psychiatrists are trained from a traditional medicine/biology-focus, they are just as likely to be shifted towards the (also valid) biochemical explanations of depression (and the pharmaceutical treatments).


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.


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.


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...


From my own experience, I do trust anyone doing actual psychotherapy more (hence 'client') than a psychiatrist who see their patients for 10 minutes max. My therapist knows me so much better than any of the doctors. I've been enjoying going to my therapist, even though they force me to go there. Not so much the doctors they force me to go there (see http://jglauche.de/posts/misc/2016-01-30-discrimination-by-l... )


> 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.

There are a number of comments in here from people who say they were depressed for years and found some solution. People share their personal stories on the internet. It's an anonymous outlet. It is what we do. Readers can make up their own minds who to listen to. I don't hold any power over you with the words I write and nor do you over me.

"For clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, nearly every day" [1]

[1] http://www.mayoclinic.org/diseases-conditions/depression/exp...


Couldn't agree with you more; out of the half dozen bouts of serious depression I've had in my life (I'm 32) only 1 of them had a series of direct triggers. The rest had no basis, and this is what makes them all the more discomforting; you know in your bones that there is simply nothing you can rectify in your life to make them go away.


I have a close family member that suffers from treatment-resistant rapid cycling depression. Basically, throughout the year, she cycles from hypomania to normal to depression. And there's no real/consistent trigger for these episodes. There's a history of bipolar disorder in the family, so clearly it's genetic.


Depression isn't the disease, it's a symptom.

Perhaps he should have clarified that the cause of the symptom might be situational, or it might be the result of another medical problem, e.g. brain malfunction/chemicals, genetics, nervous system disorder, cortisol issues, thyroid, hormone disorders etc., all shown to correlate with high levels of depression.

Most people who I've talked to who say it's a disease seem to believe so because they haven't identified the cause, and that brings them comfort.

But the meds, while necessary in some cases, should be avoided when possible, or weaned off quickly. They're bad news pushed by an industry that's making so much money from them, and the side effects are worse than what's being disclosed.


You are wrong. 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 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 review your position, and make an effort to update yourself to the state of the art.


A syndrome is a collection of symptoms. A disease is a when a symptom or collection of symptoms can be traced back to a root cause.


Right on. Most people with actual depression are rarely able to visit a doctor, let alone survive the hoop jumping required to see a psychiatrist, yet alone get a referral for a psychologist, yet alone participate in a study. Frankly, I doubt there has ever been a study ever done on depression where the majority of participants actually had it. It is simply not realistic. You'd have more luck getting a paraplegic into the Olympics than a depressed person into anything more an appointment with a GP.

But every man and his dog has claimed they've had depression. It's like listening to a student who had to survive on ramen noodles for a few years, claim they know what starvation and poverty is like. Unbelievable.


Perhaps there are some who exaggerate. But I wonder how many people who never experienced life-altering depression would be interested in this thread, and how many people who did would follow it. My intuition says the second number is bigger and that generally speaking, most people here have had experience with either meds, therapy, or untreated life-altering depression.


Everyone likes to think they've had depression. It's the human struggle -- only it's not. It is the inability for neurons to recover from stress. Most people are able to recover. People with depression are not. Everyone who is a human being, who has gone through grief, may entertain the idea they've had depression, and may follow this thread, but very few both to pay attention to the state of the art. Instead people fall back to high school level psychology. Amazing how psychologists, too, are somehow exempt from paying attention to the state of neuroscience. Psychology is to neuroscience what philosophy is to physics. Only psychology has done a lot more damage. Nice to see that meta study after meta study is slow debunking all those years of phony studies. Meanwhile they wine and rage and refuse to go back to university, and instead take to the blogs and snake oil. It makes me sick.


> Everyone who is a human being, who has gone through grief, may entertain the idea they've had depression, and may follow this thread, but very few both to pay attention to the state of the art. Instead people fall back to high school level psychology. Amazing how psychologists, too, are somehow exempt from paying attention to the state of neuroscience.

I realize there are different levels of grief and depression.

I'm saying, there are people in this thread who were clinically diagnosed, dealt with depression for years, and have stories about that. Some had bad experiences with meds. We should not discard the experiences of these people simply because there are some people out there who mistakenly think they've experienced depression. The fact is, many of the people in this thread have. Patients don't need to understand all of neuroscience. They can still share their experiences.

> Meanwhile they wine and rage and refuse to go back to university, and instead take to the blogs and snake oil. It makes me sick.

There is recent research that suggests some meds can cause harmful manic behavior. This is not to be ignored either.

Other people have a right to share their opinion. You have the right to feel sick about it. One of these is under your control, perhaps with the help of a friend or therapist. The other is definitely out of your control.


Everyone has the right to share opinions.

Unfortunately the diagnosis of depression has been down to opinion also. Not an opinion informed by understanding, but by criteria of a disease no one yet fully understands, concocted by a bunch of cocaine snorting pompous bullshit artists (too far?).

Being diagnosed means a doctor listened to you describing a bunch of feelings and looked up a checklist, and matched some of those words you said to the checklist, and presto! Depression! Have a pill, be on your way.

And if you speak out against psychology then it's all explained by anti authoritarianism, and they put you in with the jews, and the gays, and the anarchists. Yes, homosexuality, and anti-authoritarianism were once recently on the checklist. You can't win. Complete gaslight tactics.

Please understand, I'm not having an argument here, I'm venting some rage, big time. Nothing personal. Some of us have been through the ringer by bastards like the writer of that article. Well meaning bastards. True nurse ratchett evil bastard ..... has aneurysm


> Please understand, I'm not having an argument here, I'm venting some rage, big time. Nothing personal.

Got it, no sweat.

> Some of us have been through the ringer by bastards like the writer of that article. Well meaning bastards. True nurse ratchett evil bastard ..... has aneurysm

I can understand if you've been mistreated by people who work in health. I don't see how the author is to blame or how you have come to feel he would treat you the same way. That's a mistake people commonly make, putting labels on people. All of our brains try to find patterns, so it's normal, but individual people are incredibly unique, and much more so than snowflakes. We may not all be good but we are all equally deserving of each other's respect.

That said, vent on! And feel free to lob any complaints my way about anything I've said. I'm not easily offended.


Gregg is in the business of classifying and tinkering with the way seriously mentally ill people are treated and pigeonholed. Advice being given by people who don't know the answers, especially when it comes to the suicidal, is incredibly irresponsible.

You know that feeling you get when something is broken and you see someone trying to fix it, and you know you can do better, and you want to push them out of the way and give your own advice, because you're sure yours is the best way? You just know it? That has been the MO of psychology. A long line of men and woman pricking up their fingers and saying, I've an idea, try this. On live, human subjects. Think I'm being overly dramatic? Look at his frikken tree of knowledge model. It's like this giant pantomime admission of this failure, but then goes on to say that his model -- unification of all the nonsense -- is the light in the darkness. His model is like the epitome of what all pseudo sciences attempt -- to first suspend disbelief and criticism with a cheeky wink towards an indirect admission of nonsense, then to about turn and pile themselves upon genuine physical sciences and claim, not only to be a part, but to be a vital piece of the puzzle. It's like some L. Ron Hubbard type shit. It's incredible really. The realm of psychology is full of people like him. It is theoretical anthropology at best. At worst it is malpractice.


> Look at his frikken tree of knowledge model

I know you're venting but you're a little off topic and hard to follow. It sounds like you have a bone to pick with this author. This sub-thread began with "warmfuzzykitten" lamenting the HN comments and now you're discussing other work by the author.

Venting is totally fine and useful. There are some other techniques for releasing frustration that are more effective. Meditation, for example, can teach you to cast aside thoughts on which you do not wish to dwell. The book Mindfulness in Plain English is a good introduction. I'm not telling you what to do, because it would be a waste of my energy. You'll make up your own mind regardless. I'm just sharing a strategy that's worked for me, alongside other things. That's what people do. We share stories, whether about good times or bad.


I know you're acting out your therapist fantasy, but you're being a little passive aggressive.

Meditation has been debunked. CBT has been debunked, Mindfulness has been debunked. Not only that, but meditation has been shown to be counterproductive and even dangerous. CBT is no better. It has become an industry of exploitation and snake oil. Recently two meta studies came out debunking the original CBT studies. Surprise surprise.

Yet psychologists keep going on and on about how it helps some people. Listen. If you are going through a rough patch and you try a bunch of things, the last fad you tried is always going to seem like it might have helped. If a million people are giving anal breathing a go, and half of them come out of their "episode" while practicing, they're all going to proclaim a cure. It's like this never ending loop, over and over of bullshit.

This is basic stuff. I can see you're feeding off my distress, so this is the last I'll say on the matter. Some people really are sick.

cue passive aggressive "I know you're"... "totally fine, and useful" creeping Jesus response


> This is basic stuff. I can see you're feeding off my distress, so this is the last I'll say on the matter. Some people really are sick.

> cue passive aggressive "I know you're"... "totally fine, and useful" creeping Jesus response

Here are the facts. You choose to only believe certain research, and you won't take the effort to spend 30 minutes sincerely trying something which is not dangerous or risky for you.

I never said neuroscience was unfounded. My point is, neuroscientists are not the only scientists capable of doing research and running through the scientific method. We should be praising whatever work follows that technique, not just neuroscience because it appears to be cutting edge. The scientific method has guided and helped judge aspects of all sciences for hundreds of years.


I try everything. No matter how stupid it seems, or what I think of it, because I'm desperate.

Lots of people out there feed of it and I have no choice but to try it because I'm a stuffed unit (presently I've been reduced to Ketamine. It is the only thing that has remotely come close to giving me temporary relief, and I must be reduced to criminality to use it -- because of some quacks who started selling shots (exploitation, again, sigh) genuine doctors can no longer use it off label, in my country). I would never recommend this to anyone because I'M NOT A FRIKKEN DOCTOR, YEAH? And neither are you, so stop with the irresponsible suggestions, because again, I will try anything.

Over the many years I've learned a few things about the people that feed off people like me, and people who feed off the dabblers and the grief stricken, the ashamed, all lumping us in together. All the above move on and the rest of us who can never recover get blamed for not having our lives in order. I've been very lucky with my life. If I didn't have certain privileges/luck I'd be dead like the rest of them, you don't have to contend with.

Neuroscience comes from a grounding in the physical sciences. Psychology abstracts from the top down. Psychology uses the scientific technique, but without the basic understanding required by all the other sciences. It is a culture of delusion and megalomania, a circle jerk of dunces, with the occasional valid observation, but never understanding. The hard sciences are taking those brave steps for one simple reason. They are grounded on small, proven facts. Psychology is grounded upon a quagmire of bullshit.

As psychology slowly loses its parasitic grip upon depression, I'm sure we'll see more of these death-knell articles, written by people for whom a career change is no longer practical. Soon, like Jung, all they'll have is their dreams and coloring books to remember them by. Sad relics of a backward era. Get out of it while you still can.


> Get out of it while you still can.

I'm not a psychologist, I'm a programmer. You can see it in my profile. I'm not making any prescriptions that require an MD. You're not paying me and I'm not claiming to dispense professional advice. I'm just sharing part of what worked for me. You're not required to read this or try meditation but it would only take you 30 minutes to try to sit in a quiet space and think about nothing, focusing on breathing. I do it every day now and it works great along with the understanding that we are all equally valuable. Nobody is more important than anyone else. What I write isn't more important than what you write. You're just as valuable as anyone else.


Reiteration:

Meditation can be catastrophic for people with depression.

There is a reason any meditation retreat will reject you if you answer 'yes' to currently going through depression.

Empty your mind, empty your feelings? Ummm.... Well, a depressed person has most of their feelings wiped to begin with, except for a heavy, sick, sinking, feeling.

A depressed person cannot think. You catch yourself just standing and sitting, hunched in one place and the whole day has passed.

Meditation is redundant for a depressed person. On top of that, there's so much stress hormones in the system just crossing the legs, and focusing on your breathing get become a source of distress.

People really have no idea what they're dealing with in depression because everyone assumes they've been through it, because that's what psychologists have always assumed. Then a real depressed person comes their way and they have to come up with a different name for it. Add a chronic, or a clinical, or some such bullshit -- it's the difference between alternative medicine and medicine. One is real, the other fake. One requires an MD, the other does not.

I have been going back to meditation my entire life to see if it will help, and it never does. It's good if you're feeling stable to begin with, but can really loop you out if you're depressed.

You don't get how serious it is. SUICIDE is a constant demon. You get that? Kill yourself kill yourself, evolution's kill switch, for the good of mankind, constantly going through your head is not some to be dismissed. If you say, meh, I can tell a depressed person what I want about what they should try and what might work, you are playing with nuclear fire.


> If you say, meh, I can tell a depressed person what I want about what they should try and what might work, you are playing with nuclear fire.

I'm not dispensing professional medical advice, I'm relating an experience I had. You're free to make up your own mind. I thought I already made that clear.

Anyway, I'm not talking about a meditation retreat. I've never done that and hear it is rather intense. I wouldn't recommend it to someone diagnosed with depression in any form. What I'm talking about can be done in the comfort of your own home. If you've tried that yourself and it hasn't worked then you need only say so and I'd see no reason for me to comment further. From your last comment, it sounds like you have tried that and it didn't help. For me, it did. It wasn't the full solution for me but it was a piece.

I'll just add that you don't need to sit cross legged to meditate. You can sit comfortably upright in a chair or lying down on a bed. This is all discussed in the book I recommended. It sounds like your experience with meditation was more strict than what I've experienced. There is more than one form of meditation. Discarding the whole practice as unworkable for anyone who has depression after only knowing directly about your own reaction to one form of meditation is as unscientific as anything I can imagine.

Best of luck to you. I hope you keep finding things that work for you.


> 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.


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.


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.


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


> It is clear that the United States in particular is, especially in recent years, churning out unprecedented numbers of severely psychologically ill individuals.

Is it clear? Or have we gotten better at diagnosing conditions that people have been experiencing all along? (Not to mention reducing stigma and making people more likely to admit to having these conditions.) In any case, citation needed.


When I got diagnosed with manic depression, I did some research on my family medical history going back several generations. Many of them through two lineages (my father's mother's family, and my mother's father's family) in my family exhibited symptoms of manic depression, but have no corresponding diagnoses.

Not anything scientific, but it does point toward the fact that destigmatizing mental illnesses and our better understanding of them is leading to more diagnoses, not anything else. Everyone's quick to forget how horrifying psychiatric care in the US was up until quite recently.


> organic robots

Where does diabetes fall I to this argument? I'll concede that depression is frequently misdiagnosed, especially as a misdiagnosis for other conditions (e.g. MTHFR) and even more frequently as a self-misdiagnosis. However, this does not change the struggle of people who genuinely suffer from it.


I disagree, this is pretty different from depression-is-just-sadness.

The article is not shortcutting to a non-solution, it's pointing out that there can be overlooked root causes beyond the symptom, and this can be a very valuable thing to point out to people, leading to actionable solutions to their problem.

I was diagnosed depressed for many years, and it turned out I simply had the expected affect given I was not socializing enough, exercising enough, or sleeping well enough given an undiagnosed case of sleep apnea and a bit of a spiral from obsessing about trying to stay employed despite that affect.

Talking myself in circles, messing around with serotonin, none of this got me anywhere because it wasn't solving the actual problems. I didn't need any of that, I needed a machine that pushes air into my face at night and another one that pulls a belt below my feet in the morning, but the professionals I visited failed to prescribe these.

People have no basis of comparison when it comes to their direct subjective experience with long-lived habits so someone who exercises regularly can say "if I couch-potato too hard, I'll start to feel gross", but someone who doesn't can't as easily observe "I feel gross all the time because I never exercise enough". Likewise with hygiene, regular social exposure, sleeping properly, eating properly. It's important to think of mood as a complex function with many inputs and a good amount of feedback and delay.

Certainly it can be the case that depression is its own root cause, and one should not reject talk therapy or prescriptions to help with it, but I definitely recommend people search for something they may have overlooked.

Maybe there are good psychiatrists and therapists which will find these kinds of things, but I haven't met any. Patients should be aware they need to consider them.


> I didn't need any of that, I needed a machine that pushes air into my face at night and another one that pulls a belt below my feet in the morning, but the professionals I visited failed to prescribe these.

What sort of therapy is that?


Air in face is APAP for sleep apnea.

Belt under the feet is a treadmill for exercise.


The belt one was funny.


Let me just take a moment to register monumentally huge agreement with your modification of the the metaphor at hand. The problem here is that huge numbers of other people are living in almost exactly the same circumstances - or ones that are objectively worse - and they register no depression.

And here, by objectively worse, we're talking, risk their lives daily on a shoestring lifestyle that barely keeps them from not having a roof over their heads and rice or beans enough not to starve to death. Do those who risk their lives have something the comparatively wealthy depression cases lack? Are the kinds of pressure the relatively wealthy depression cases experience particularly likely to create this kind of response? What's the difference? What's the root cause?!

If we had actual, good root causes, then we'd be golden, but the problem, the HUGE PROBLEM that the paradigm espoused in the article faces, is that we DON'T have a kind of 'smoking gun' need that is not being fulfilled for people with depression. MANY, MANY people with deep depression really do have fantastic lives compared to those who suffer no depression- and moreover, admonishing people with depression to 'figure out what need is being unfulfilled in your life, and fill it' is highly toxic advice, at least in its way- based on my experience with depressed individuals, if you effectually tell depressed people to figure out what's wrong in their life and fix it- well, it's one way to obliquely encourage suicide.


Different people have different needs. There is no standard for what an awesome life is. Having an awesome life in some ways can still be miserable in other ways, and only for particular people. An "fantastic life" where one is depressed is not fantastic.

Psychological diversity is a precious resource, and a society that is too inflexible to accommodate those who are particularly sensitive or have exceptionally different needs is a bad society. Depression and anxiety, and a host of other mental disorders for that matter, are an epidemic in too many countries, too many countries that are supposed to have high quality of life.

> if you effectually tell depressed people to figure out what's wrong in their life and fix it- well, it's one way to obliquely encourage suicide.

Kind of a straw man don't you think?


No, I don't think it's a straw man at all, I think it's absolutely correct in the sense that severe depression at a clinical level virtually precludes people just "figuring out what they're missing" or excising the things that suck from it - it will feel literally the same as when people assert that those suffering depression need to "buck up and face life." I'm saying that your assertion that it might be a strawman is indicative of a deep, insidious skew to your worldview on the matter - seriously.

I think this is all excellent advice for healthy people who have NOT fallen into clinical-level depression, but once depression has asserted itself, this immediately becomes horrible advice that, similar to "just get over it," encourages those who are depressed to take the most direct route to relief of their symptoms (suicide).


That's not what i meant by straw man. I don't think anyone sympathetic to the idea that depression is strongly related to environmental and lifestyle factors intends the treatment of depression to be to tell the person who is depressed to magically deduce and solve the problems in their life.

While your reasoning from your premises are correct i don't think the position you've described is the one proposed in this submission. That's what i mean by straw man.


That seems reasonable, but I'm left wondering what else I can reasonably draw from the article- if we present depression as a reasonable response of our inherent psychology that's attempting to induce us to change, what block can I place in the logic chain that prevents me from therefore automatically asserting that those suffering from depression should therefore "find out what's causing their depression and relieve it?"

I mean, I'm all for exploring the issue from many perspectives, and I don't intend the 'oblique suicide' remark as a condemnation of this line of discussion, I intend it as a condemnation of the natural conclusion of this line of thinking - that is to say, unless we add at least some minor caveat (I didn't see it, did I do a reading comprehension fail, perhaps?) that "this is discussion NOT for people suffering from depression but for their doctors and psychologists, we're just exploring possibilities, here, people!"

Or is this position not asserting that the 'cure' for depression is to find out what's wrong in your life and fix it? I mean, that's absolutely what I took from it, was I wrong in that? If that's the position in the article, is there some piece I'm missing that will prevent me from 'strawmanning' the author?

I guess, for now, I just have to assert that leveling a devastating criticism at a position - "this is tantamount to obliquely encouraging suicide" - that's not always strawmanning, sometimes it's just spot- on criticism. I suppose I ought to be another read-through to be certain, but I'll probably try to move on, for now- I just have to assert that I think my understanding of the author's position and my reasoning from these premises- I do think they lead to exactly the place I've described.

I still don't think that makes anyone evil in this discussion, but I do assert that it may well make them wrong at a deep, potentially axiomatic, level. I appreciate the opportunity for discussion, even if I disagree very strongly with the positions presented. :)


I think the solution to your dilemma is that we have a shared responsibility for each others' mental health. Indeed, isolation and alienation are part of the cycle of depression and breaking it necessarily means relying on others for mutual support and aid. Emotional labor is an often underlooked and undervalued aspect of human relationships. Performing it for each other is one way in which humans support each others' well-being. Depression and anxiety, as problems of environment aren't of the Human and Nature variety, but the Human and Human variety. A person that is depressed has lost the ability, or never had it to begin with, to regulate their social environment. To be quite honest, most of us don't have that much control over our own social environments. It is too costly, too risky to live a life too far off the beaten path. The structure of our society determines what social environments are easy to achieve and maintain and which ones are difficult, and for whom it is easy and difficult.

This can explain why the rich suffer from depression too within the environmental framework. Material wealth usually implies being embedded in a particular part of society, and there's no reason why that environment which is good for making money is any good for one's personal health. It is for some people, not for others. One example in recent memory is Notch, the creator of Minecraft who became a billionaire for it, but a few years ago lamented how socially isolated it made him.

Human beings are fundamentally social creatures. It is often the case excepting physiological disorders that mental disorders are social disorders. No particular feature of our societies' structures is completely fixed. Our relationships are radically different today compared to 50, 100, 1000, 10000, 100000 years ago, and yet our brains have the ability to adapt to such changing circumstances. It's clear however, that what is tolerable for some is intolerable for others. Social problems manifest first as individual problems amongst the most vulnerable. The rising tide of mental disorder is a rising tide of social disorder.


I propose the following: Why not slightly change the >'figure out what need is being unfulfilled in your life, and fill it'

...and amend it to read: >'figure out (through a well-defined, detailed, objective process with the help of your psych(olog/ichiatr)ist [I'm not a medical human]) if there is a need that's being unfulfilled in your life, and make a plan to incrementally, sustainably fill it'

That changes the nature of the argument significantly. I propose that this may be a valuable line of inquiry to take before/during pharmacological treatment.


The author makes his point clearer in his follow-up article:

https://www.psychologytoday.com/blog/theory-knowledge/201603...

His position is that investigating the practical causes of depression and anxiety should be the first approach to diagnosis, not that it should be the only approach. It's not that cases of depression without another cause don't exist; he's just saying those cases are less common.

To compare it with physical pain, saying that most cases are symptoms of something else doesn't mean that the pain shouldn't be treated, nor that cases of unknown or genetic origin would be any less legitimate.


That's better than the unsubstantiated theory that depression is a serotonin disorder.


Reminder that for panic disorder, OCD and severe major depression, SSRIs are effective.

I am not suggesting that depression is a 'serotonin disorder', just that this class of medication does work for some with this disorder and others.

The other side of this is that exercise, MAOIs, CBT, ERP etc are effective as well.


How do you mean unsubstantiated? If you mean it's less than certain than sure, but SSRIs and SNRIs and NaSSAs and such improve depression greatly for many patients. That at least says something about serotonin levels in patients with depression.


Depression is different for different people. It's an umbrella term that captures many different types of illness.

Anti depressants do work very well for some people; not so well for others; and not at all for others. Some people may have to try different meds. We know there's a genetic factor with effectiveness too.

But it's useful to have other approaches to treatment, and that's where the good psychologists come in.

There is always a bit of a kerfuffle between psychologists ("It's all psycho-social!") and psychiatrists ("It's all chemistry!") (the analogies with computer language flame wars are obvious) and the truth probably lies somewhere in between.


Indeed. It blows my mind sometimes how much people, including people who really ought to know better, grasp at the ideal of having the One True Explanation and One True Treatment for depression. It's not even just the division between biological and psychosocial approaches; I've seen some very troubling, almost childish bickering among adherents of various psychotherapeutic schools (some of the more esoteric and old-school types denounce CBT in much the same terms that they denounce drugs), and have learned the hard way that if I ever hear my psychiatrist tell me that something is "a really good drug", I need a new psychiatrist.


"Opiates improve pain-in-arm symptoms greatly for many patients. That at least says something about opiate levels in patients with pain-in-arm."


And by studying how they work we learn about how pain works. Compare to alternative, "keep smiling and find better friends". Fuck that. Even if it was relevant (it probably isn't), I can't smile or talk to people, because I'm constantly in agony because of my arm. I'll stick to opiates because they let me live.


The point in the analogy though is, the pain is a symptom. Understanding how pain is transmitted through nerves and how to block it is certainly useful in the treatment of broken bones, but far more important is understanding that the pain is caused by the broken bone. The pain itself is not the problem, even if makes sense to ameliorate; focusing on the pain instead of the break can lead you to masking and failing to treat the underlying problem, allowing it to worsen.


Yeah, I get the point of the analogy, but I think in reality, the "social" approaches to solving depression are closer to curing broken bones by telling patients to change friends / sleep more / find God. And I say this as a person who had depression and anxiety issues for a long time. Yes, some parts of it are affected by my life conditions, but sadly I can't wish my way out of sudden, random anxiety attacks.


Indeed. And if you take an SSRI for pain-in-arm and realize it doesn't do shit, then perhaps pain-in-arm isn't related to serotonin levels?


>it's just repeating the old ideas that depression and anxiety are the same as temporary sadness

His main argument seems to be that depression is a symptom of mucked up relationships. Googling "depression symptom relationships" his is the only article arguing that in the first 40 results. So it seems at least somewhat original.


Real depression comes out of nowhere, hits you like a ton of bricks, and makes you wish you weren't alive.


I agree with this, but I also think a lot of "non-real depression" is too easily diagnosed as the real thing. A lot of depressed people could be "cured" by just changing circumstances in their life (not that it is always easy, but saying there is stuff in your life you can't change and it is making you depressed, doesn't make it a mental illness).

But you have worn out doctors facing a tough choice: do the near impossible and try and help someone change their life, or take 40 second to prescribe a pill from a billion dollar drug company that is paying for him to go on a conference in the Bahamas next month.


I disagree about the way this choice is painted. It's never "just changing circumstances" - people who have problems that directly caused by something in their lives will stumble upon the solution by sheer luck.

We should actually be grateful that there are pills that for many people can insta-cure or significantly reduce the symptoms of depression. It means they get a shot at much better life in exchange of having to take some medication everyday. Contrast that not with "just changing circumstances" - contrast that with no other solution at all.

I'm happy every time we can find a pill for solving a problem - because the pill actually works. Social approaches to solving problems is often a tool for politicians to invent new ineffective methods at non-solving things, and for a lot of people to make money out of it. See e.g. various strategies for solving drug addiction.

Also note an interesting post on the topic: http://slatestarcodex.com/2014/09/10/society-is-fixed-biolog....


> I'm happy every time we can find a pill for solving a problem - because the pill actually works

If a woman is depressed because she is stuck in an unhappy marriage with a man she doesn't love...and she then pops a pill and becomes "happy"...I am not sure that meets my definition of "works".


We have a solution for that already - it's called "divorce". But this is a very bad example overall, because there's insane amount of complexity hiding under the phrase "doesn't love". Love is a very complicated amalgamate of emotions that routinely escapes comprehension of otherwise healthy people. What do you mean she "doesn't love" her husband - did the relationship between them dried out? Did she get bored? Did they marry on emotional high with no stronger bond being formed between them? Maybe the husband is abusive?

To solve that seemingly simple example case one needs to inspect the exact reasons for the problem. And hell, for some of the particular issues there may even be a pill and I'd be totally happy about it.


> We have a solution for that already - it's called "divorce".

And we can't extrapolate that to "just change the things in your life that are making you unhappy", because?

I understand there are some life circumstances that are difficult to change or rectify. And that sometimes medication might help people cope with difficulties in their life. But let's not pretend that is about mental illness - these people are healthy, their symptoms of depression are a healthy response to negative circumstances - and medication in this case is a palliative aid, not a cure to a disease or malfunction.


> And we can't extrapolate that to "just change the things in your life that are making you unhappy", because?

Oh we can and we do. If you go to the doctor and say, "I'm unhappy because I am doing X", he'll say you should stop doing X. But those clear-cut issues are the type people tend to solve themselves. You don't go to psychiatrist to ask if maybe you need a divorce. You just get a divorce.

Going back to depression - sometimes it's very hard to tell whether something is a healthy response to negative circumstances. The mental pain tends to interfere with your ability to perceive its cause. So it may be a healthy response, or an amplified response, or it may be a good response to wrong signals, or your brain may just be broken. There are special treatments for the last case, but for the former cases getting an entry-level antidepressant is often enough to help you figure out what's going on (with or without guidance of psychologists).

And even in the cases where you have a healthy response to negative circumstances, people who end up taking pills don't take them because they're too lazy to change the circumstances, but because changing circumstances is an impractical option. If it weren't, they'd have already changed them.


What is suicide if not the ultimate malfunction of a person as a system? Under what twisted definition of health can something which causes death be considered healthy when there is just a sliver less of it?

We might consider emotional pain "working as intended" when it alerts its victim to a problem and motivates them to fix it.

When they cannot identify the problem, or it is beyond their (suppressed by pain) power to fix, then the pain is no longer working as intended but is going to have some other effect, such as long-term suffering and death. At that point the alert system is itself a problem.

If Nagios wakes you up in the middle of the night to tell you a server's disk is nearly full, great, fix that server. If Nagios sends a few hundred billion alerts a second about this fact causing DoS on your entire network, yes you still need to fix that disk usage, but shut Nagios up first.


> A lot of depressed people could be "cured" by just changing circumstances in their life (not that it is always easy, but saying there is stuff in your life you can't change and it is making you depressed, doesn't make it a mental illness).

I believe what you're largely referring to is Adjustment Disorder. You're stuck in a situation, and but if the situation changes to something more favorable, the depressive mood (with time) goes away. In my experience, a lot of people in the military with a depression diagnosis tends to be Adjustment Disorder. The PT almost always ceases to display depression symptoms once their contract has expired. This is why (I believe) people tend to say, "Just cheer up, man. It's not that bad!" Others will see that changing something (smiling, going to a movie, visiting friends) can cure a case of the blues.

Note that I am not minimizing the effects that the depressive mood can have on person with Adjustment Disorder. I am just highlighting the difference between Major Depressive Disorder (change the situation, relatively same symptoms) and Adjustment Disoder (change the situation, no symptoms).


>but saying there is stuff in your life you can't change and it is making you depressed, doesn't make it a mental illness

The only practical consequence of whether something is a mental illness or not is whether the person experiencing it will receive help in feeling better. I would characterize your position as cruelty, bordering on straight-up evil.


Incidentally a lot of antidepressants (like the one I'm taking) have generics available that make this kind of thing less likely. I gotta say though, life with antidepressants for me is a life I haven't experienced in a very, very long time, in fact I can't remember when the last time I felt this way was.


I think there are many types of "real" depression - and I feel like oversimplifying such a complex condition doesn't contribute very much to the discussion.

Related: https://en.wikipedia.org/wiki/No_true_Scotsman


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.


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..


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.


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


> 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.


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.


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.


Yeah, you're incorrect on this one. You as a human aren't somehow totally disconnected from your environment. The environment you live in, is a part of yourself, the two can't be separated.

You have more foreign bacteria living in your body than human cells. "life flows on within you and without you".


> Yeah, you're incorrect on this one

No I am not.

And like I said, till it happens to you, or you are with someone like that, you will never believe it.

I certainly never did. For some people it's environmental - for other? They are depressed for no reason whatsoever.

The rest of what you wrote is just empty phrases and has zero to do with this subject.


> And like I said, till it happens to you, or you are with someone like that, you will never believe it.

Just because you have experienced it before does not mean that you understand the causes of depression any more than anyone else. After all, you don't assume that people who have cancer have a better understanding of what causes cancer (all else being equal).

As a society we still don't really understand much about depression. You could be right or wrong, but how would you even know? Your case could be environmental without you knowing or understanding it. On the other hand you could also be correct that it's something else entirely.

Without more studies, we just don't know. I would believe that depression is not necessarily a disease and instead a group of symptoms. That's not to say that you don't have a disorder, but that I think our idea that all cases of depression are the same is incorrect. This would explain why some cases of depression are environmental whereas others may not be; they could actually be different diseases that both cause these symptoms.

As someone who is bipolar, depressive episodes are extremely similar to depression. In fact, about 1/5 cases of bipolar are initially misdiagnosed as depression, reportedly. As far as I know though, we aren't actually sure if they were misdiagnosed or depression developed into bipolar.

Indeed some studies have shown there is a link between bipolar, schizophrenia, and depression. See here: http://www.nimh.nih.gov/news/science-news/2013/new-data-reve...

I don't think it's fair for others to say you are incorrect but it's also premature to say you are correct too. I hope that we will uncover the truth sometime in our lifetimes but it seems we are still pretty far away from understanding psychological disorders.


Depression could be a symptom of a bigger physiological problem.

Sudden pain isn't itself a disease, but a symptom of some other underlying issue. Why can't depression be the same way? No one here is discounting the discomfort of the depressive experience.


how satisfied I should be with the status quo depression

I'd be pretty damn depressed if I were thinking in terms of how satisfied I should be with the status quo. A person needs more than having his/her needs taken care of -- what is it? That search is part of the whole life, and you won't find any answers at all for yourself unless you're harnessing the power of depression. Labelling it as a disease will not get you anywhere but just leaves you as a bystander who unfairly got sick.


Isn't this precisely what the article is saying though? That upon reflection the sufferer can't see anything environmentally wrong?


I don't think depression is just one thing, certainly not the way they are prescribing SSRIs these days.


i'm with you on your description of 'those days'. i feel like (and technically true) all my needs are met and i'm much, much luckier than most people. but those are the worst days. i just hope this feeling would end, and for you too.


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/16390897


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.


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.


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).


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.


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.


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.


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.



> But I can't really see myself to visit mutliple therapists just to find someone that can work with me.

You want help, right? If so, then pick up the phone, and keep searching until you find a fit.


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.


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.


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.


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.


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.


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.


> 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


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.


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/


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.


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?"


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.)


Naw, I understood the Chief.

I followed your link to that paper -- sure, CBT, once unwind the acronym, sounds fine. That's what I thought would work on the patient in my family (by marriage, not by birth). But CBT didn't work. Not even a little, not a chance. And the patient was just awash in cognitive ability -- brilliant, actually. Or, maybe the brilliance caused seeing more threats and, thus, more anxiety.

The usual suspects, say, SSRIs, etc. didn't work, either. The result was, right, the worst possible, and of course there are hints that SSRIs can contribute to that result.

Much of the problem was social phobia, e.g., as in the link. Well, it was strongly in common to the mother and all three daughters. So, nature or nurture? If just nurture, maybe CBT, etc. should have worked. But, gotta tell you, at least on the social phobia part, nothing made a dent. All three of the daughters had at least talk therapy, and, no help at all. None.

If CBT can work, as in the link, fine, no, terrific. But, for anyone facing the problems mentioned in the link, need to keep in mind that for a specific case the averages don't have to matter and have to entertain that maybe CBT won't work.

Just why the Chief was so down on talk therapy, or CBT if that is close enough, I don't know. But, we're talking 20+ years ago.

It can be serious stuff, and darned tough to deal with.

Or, the Chief's summary remark went: "Get the patient all calmed down, stable, happy, and then suddenly there will some little event, say, a new file folder of work, and the patient will be all stressed out again."

Or, in my intuition, provide something like a padded cell life for the patient, and things could look fine. But, try to have the patient address the real world, and just some random, new event, say, where there might be some risk that they would have to think through and handle, and they could get all "stressed out" again -- sleepless nights, GI problems, tears, depression, clinical depression, etc.

I'm no expert, but, again, overall IMHO the OP is a bit simplistic.


I'm sorry to hear that story. I hope this doesn't come off cruel because it isn't meant to be, but there are always outliers -- people for whom the gold standard, or any standard, just doesn't work. It's not a good idea to dismiss a well-studied treatment universally shown to be effective because we don't know if it'll work in a specific case. It's important not to anchor a patient -- already living on the edge -- with thoughts that 'maybe this isn't going to work for me'. On average, most people are average.

What we do know is that CBT is exceptionally good at handling most cases. No single treatment (for any disorder) works equally well/at all for all patients, but of course medicine is concerned with helping the largest population efficiently.

I hope one day we understand the brain better, to the point that people like your relative don't have to suffer anymore.


> I'm sorry to hear that story. I hope this doesn't come off cruel because it isn't meant to be, but there are always outliers -- people for whom the gold standard, or any standard, just doesn't work.

I urge caution. The Chief 20+ years ago was darned well informed. Talk therapy and anxiety disease had been going for most of the 20th century. I don't know when cognitive approaches started, but, since they are an obvious approach, gotta guess that they have been understood for a long time.

> It's not a good idea to dismiss a well-studied treatment universally shown to be effective because we don't know if it'll work in a specific case.

Right, "dismiss" would be wrong. Trying it as a first step, if only since it's relatively easy and just a mild intervention, sure.

If you and the NLM, etc. link are correct, then it's news in the last 20 or so years.

From the Sheehan data, the Chief, and some more evidence, I have to guess that often, not just for an outlier, genetics can be an important cause. Sure, even then, maybe something cognitive can help one compensate.

My main point here is simple -- IMHO, the OP looks too simplistic.


It isn't, necessarily, the best solution for everyone anyway.

CBT is based on challenging negative thoughts, assuming that those thoughts are manufactured or, at least, grossly exaggerated. That kinda puts you in a corner if those thoughts are factual.

ACT (Acceptance and Commitment Therapy) has more recent science behind it and gives you strategies on how to minimize the effect of unhelpful thoughts, factual or not.

https://en.wikipedia.org/wiki/Acceptance_and_commitment_ther...


Psychotherapy comes in 2 broad forms.

Short term CBT style (which is recommended first line treatment) and long form therapies such as psychdynamic counselling. These long form talking therapies tend not to be useful for anxiety.


There was an interesting article few days ago on HN: 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.


Dis-ease. Semantics. There can be morphological (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.


>There can be morphological (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.


>Keep in mind the sad reality is that even good science is wrong lots of the time

Similarly, keep in mind the uplifting reality that it's usually a little bit less wrong than what came before it.


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


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.


I think it's generalization to say that it doesn't apply to those who are clinically depressed. I know many (previously) clinically depressed people who it definitely does apply to.

The article wasn't talking about bipolar.


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


Good descriptive word: Anhedonia -- the inability to experience pleasure from activities usually found enjoyable. 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


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.


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.


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


In what way does the article treat depression as the fault of the individual?

Seems more like a failing of our society to recognize the importance of relationships. I'd argue this is especially true in the US where we obsess over careers and monetary wealth much more than we emphasize the importance of friendships, family, and romance.

Considering how little we understand about the brain and psychological disorders, it seems premature to dismiss the article so easily, especially when the author is a practicing psychologist and presumably has had some level of success with his methods.


> Seems more like a failing of our society to recognize the importance of relationships. I'd argue this is especially true in the US where we obsess over careers and monetary wealth much more than we emphasize the importance of friendships, family, and romance.

{{ citation needed }}


I apologize; I thought this was just generally accepted as fact so I appreciate you pointing out my own bias.

This article mentions how the US is more materialistic than other countries, although it's not the main point of the article. Still, I do find the other points equally interesting. http://www.apa.org/monitor/2009/01/consumerism.aspx


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.


> 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.

This is what doesn't work. This approach is wrong - we already know you can't rely on peoples' willpower in normal tasks, what makes people think it will work with issues that by definition kill whatever willpower reserves you have? Talking about personal responsibility didn't cure obeseity, didn't cure alcoholism, didn't cure drug abuse - so it sure as hell isn't going to cure depression.

Now I'm not saying this is equal to putting all hope in drugs. Maybe there are other "social" approaches, but it won't help to tell people that depression is their choice.


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.


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.


I get how authoritarian pill pushers turn people into libertarian bootstrap people, but just because your depression isn't chemical doesn't mean it's your fault, or that there's anything that you can ultimately do about it by yourself. My problem with the pills is that they don't work, because they're targeted at a made-up disease. That the disease that current practice has lumped people into is made up doesn't mean that people are not suffering, they are, and doesn't mean that they don't need help; we do.

Talking to people, making sure that they're healthy, connected, secure, and that they feel like they can express themselves is more expensive than drugging them and/or warehousing them, so I don't think that avoiding the depression diagnosis should reduce public spending or concern with the same sufferers, but raise it. I also assume that when the people who are now lumped together in depression diagnoses are dealt with with more precise approaches, there will always be places among those approaches where drugging and warehousing will be the best option.

Treating sadness with drugs is like how we try to cure poverty with teachers.


It's never talking to people _or_ drugging them though. Since when do psychiatrists send you off with a prescription for Prozac and then never see you again?

Answer: they don't. Major depression is treated with drugs and therapy. And it's the combination of both that helps. Rarely if ever are patients given drugs so the psychiatrist can avoid giving them therapy.


> And it's the combination of both that helps.

I think that's overstating it. The chances of recovery are better on average with the combination, but I don't think anyone has really teased out the extent to which this is additive or synergistic on an individual level versus simply having better odds by betting on two lines instead of one.


Yes they absolutely do. Your average Psychiatrist books in 10-15 minute blocks on demand only, and focuses entirely on what drug you need while you're in the office. It's the patient's responsibility (and if they are lucky, a good psychologist in tandem) to follow up on their med treatment.


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.


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.


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/2013/05/depression-par...

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.


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.


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...


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.


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... 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/ and also start being more social. Practical tip for hitting two birds with one stone: join a running club.


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!


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.


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.


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


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