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Anxiety, depression, and PTSD may be adaptive responses to adversity: study (psychologytoday.com)
327 points by firstbase 88 days ago | hide | past | favorite | 259 comments

At first I viewed the depression I started fighting in my teens as a scourge, a defect, something broken to be fixed.

I have since come to see it as an important signal. When I am managing my life and mental states well, it often fades into the background. When it starts to flare up, like with some kind of physical pain, that's telling me I need to pay attention and change things up a bit.

Furthermore - and perhaps most importantly - it is a preferred failure mode to freaking out or engaging in suicidal ideation. When I'm overwhelmed by that gloom, I remind myself that I could have a stroke, aneurysm or heart attack at any moment, and I think about what the consequences would be if I did. As long as I'm in a safe situation, I can simply take my first opportunity to Just. Stop. Taking time to shut down, and to cease forcing yourself to engage with a world that would go on without you if you suddenly died, is a good idea now & then.

Yeah, at times I feel some twinges of guilt for doing this. It seems selfish on the surface. But when you compare it to the alternatives, well-- it's better than being dead, isn't it? I feel like my ability to manage my life (and depression) has improved considerably with this insight. If you need to stop, stop. Rest. Let whatever is pushing you to the brink simmer in a corner for a while, provided it is physically safe to do so. You will be better equipped to deal with it when you've had a chance to breathe, and to remind yourself that a temporary shutdown is indeed better than being dead.

This may make sense for you in particular, but it a lot of people the signal provided by depression is distinct in its persistent alarm about something that isn't really in the present. Listening to the signal and stopping to take stock of it and make changes is often what makes depression so paralyzing, since it is characteristic of it that this doesnt help. Depression for most people is that "stop, stop, rest" happening indefinitely. This is not to say that what works for you doesn't work for you. But, in general, treating depression like an important signal of something really wrong in one's life that one needs to stop and address before moving forward is pretty much depression itself.

> about something that isn't really in the present

Or is it? Therapy, especially gestalt or existential, often makes people realise that something really is off with their outlook on life, relationships with other people or other things like this — something that they had paid no attention to and perceived as "normal", that really wasn't. And in the end, what started as their fight against depression ended up as work to fix the core reason for which that depression was only a symptom.

I know this to be the case with myself and some close friends of mine. I'm not a health professional, and this is anecdotal evidence, but from talking to other people and therapists, I hear about this quite often.

PTSD among combat vets, for example, can have a person chronically frightful while they live in a safe environment actively preventing them from properly apprehending their current environment. Most people who want to rid themselves of their mental illnesses aren't experiencing it as a signal that their outlook is wrong, their mental illness is actively hampering their ability to properly engage and function in their life.

And for illnesses with a stressor: sometimes a person is not empowered to resolve it.

You shouldn't have too much faith in your own biology, it is far from perfect.

Can you give an example, personal or otherwise?

Not the OP, but I'm in therapy personally, and just as a personal example, didn't realize that some current reactions and feelings were colored by past experiences. In particular, this has to do with patterns I hadn't noticed across different relationships and work. Like my pathological independence and general lack of trust in humanity.

This is not an anonymous nickname, so I wouldn't be able to give you an honest and full answer.

fair enough

Often the "answers" to why one is depressed can be hidden under many layers. It can be from a psychological source, a physiological/neurological source (an injury, etc), or a physiological source BROUGHT ON BY a psychological source, that may or may not continue to exist.

The last part is in my experience the thing people are missing that creates a lot of arguments, especially around medication. I have gone through lots of trauma growing up, and I only recently learned of the role of the interplay between the physical and the mental. I had always eschewed medication - and I still think it to be /mostly/ a first-aid treatment. There's nothing to say that someone has a long-term physiological imbalance, or one that we don't know how to treat. Therefore its valid if someone needs to be on a medication for the long term. The saying goes amongst people I know - "If you can't make your own neurochemicals, store bought is fine.".

For me, medication allowed the relative calm in order to directly tackle and address childhood trauma and patterns of thinking that ultimately result in acute depression and anxiety. Unawareness of those triggers or ways to deal with them leads that acute depression/anxiety to become chronic over time, where no trigger is necessary.

CBT (cognative behavioral therapy) is a very good way to identify patterns of thoughts or thinking that doesn't make sense, or create a reaction that is far outside of the range that a person would expect. You end up having this moments of unclear thoughts when digging into past events, or things that upset you, or thoughts about yourself. I have learned to relish those - that means I'm learning something or making a connection that I didn't have before.

Finally, approaching entirely from the psychological side does not always give results. Having gone through lots and lots of cognative behavioral therapy, I'm fully aware when I'm being irrational or have a stronger than expected emotional reaction to things. I even apologize while I'm doing it! But it wasn't until I dug into a different type of therapy, EMDR, that started to approach from the physical side of things. I started to learn to notice things that were making my hands ball up in anger, even though I didn't notice them before. I learned that I dissociate sometimes and don't form memories of when I'm upset, which severely hampers my ability to address the things. All of this to say, its complex. It all has underlying rational reasons behind it, and seeking out information and building your own mental model of, well, your mental model, is a very helpful way to go about it, though it takes a long time.

So try medication, try therapy, try different types of therapy. Its extremely difficult. Its sort of like performing surgery on yourself. But there is always another path and more things to learn about yourself.

For some people, these diseases (depression, anxiety, ADHD, bipolar, schizophrenia, OCD, intermittent explosive disorder, etc.) are lifelong maladies present from birth; where even if the disease only “showed up” later on, it is known from the person’s genetics/neuroanatomy/etc. that it was inevitable for this person to get them, eventually, regardless of environment or lifestyle.

Such cases are no more adaptive than Cystic Fibrosis is adaptive. They’re malfunctions.

I would hesitate before calling these conditions "lifelong maladies present from birth". It's much more accurate to call them predispositions that may or may not manifest. And even so, the degree of manifestation may depend on the degree of trauma, addiction, or other challenges the person happens to face in life. This variation is what makes me doubt any clean division into adaptive/maladaptive cases. Not everyone so predisposed is triggered into these mental reactions through their life experiences, and not everyone who is so diagnosed is a lost cause, and furthermore, those who can manage their conditions may take offence at being called "malfunctioning" when they did in fact "adapt".

> those who can manage their conditions may take offence at being called "malfunctioning" when they did in fact "adapt".

People don't malfunction; bodies do. People are (cybernetic) systems, composed of a mind and a body; but people's bodies specifically, when taken on their own—including their brains, when taken on their own as organs!—are just complex machines, that can have organic diseases. (In the case of the brain, we call these https://en.wikipedia.org/wiki/Organic_brain_syndrome s.)

If your computer spontaneously powers off whenever you open hit your keyboard's "A" key, that's a malfunction. Computers, as machines, aren't supposed to do that. If you avoid ever hitting the "A" key, you might have worked around the problem, but the problem itself is still present—the computer, considered as a standalone machine rather than a cybernetic operator-machine system, is still malfunctioning.

If you have an SNP in the gene DDC, causing https://en.wikipedia.org/wiki/Aromatic_L-amino_acid_decarbox..., that is a malfunction (or manufacturing defect) in your brain-as-machine. You — the mind-body system — might learn to adapt to/work around this malfunction; but that doesn't mean the brain-as-machine isn't continuing to malfunction. A working system can be constructed from unreliable components.

> who is so diagnosed is a lost cause

Who said anything about being a lost cause? For something to be maladaptive, it simply has to reduce inclusive genetic fitness, such that people with the condition reproduce less than people without the condition. That says nothing about whether you can live your life with the condition.

Whatever part of the human brain thinks getting a vasectomy is a good idea, is extremely maladaptive! But that's not to say that we don't prefer things that way. :)

Interesting counterpoint, but if you don't make changes then, aren't you just trying harder at the same thing every day, expecting different results? I guess I sympathize with OP as "try harder tomorrow" just hasn't seemed to work for me. What is it you're suggesting if stop and rest is actually the wrong thing to do?

I think it's different for everyone, but therapy and/or drugs are often effective when your own efforts aren't enough. "Stop and rest" is not the wrong thing to do though, it just might not help.

Very good book, “the Depths” about depression. It argues it’s partially an evolutionary response.

Also “quiet” by Susan Cain is even more excellent and insightful about introverts.

Is it really better than death? to me, death means salvation, I'll no longer have to deal with troubles.

“It is not worth the bother of killing yourself, since you always kill yourself too late.”

-- E. Cioran

The trouble with "death means salvation", and believe me I know that yearning, is that you don't get to experience this salvation. Suicide is literally not the answer, because you will never get to experience the relief on the other end. This is the essence of Cioran's quote here. It would have been better to not exist, but it's too late for that now and ceasing to exist will not, in fact, afford you any sense of relief. The only relief you feel is in the fantasizing about death itself.

Eventually you will die and after that point it won't matter how long or how painfully you've lived. From the perspective of death life doesn't matter at all, but you won't be alive to experience that perspective.

Believe me, I know what it is to suffer. But even though I lean against suicide strongly since I've lived the whole "if you're going through hell keep going" thing, and the relief when the (years long) suffering is over is immense. However, I struggle with things like a suicide pill given to air force pilots.

Would it be better to be tortured for years? To have your family knowing that your fingernails got ripped out? That you lost your genitals to electrocution?

I'm not sure. Plenty of heroes committed suicide.

> However, I struggle with things like a suicide pill given to air force pilots.

it does raise an interesting, if morbid question. personally, I think it is fine for someone to kill themselves (or receive assistance in doing so) if they are facing a near certainty of terrible suffering for the rest of their life. the tricky part is the "certainty" bit. many people experience varying degrees of suffering at some point in their lives, but it is uncommon for it to persist throughout their entire lives.

if you are interested in a way to sidestep this specific question, I would point out that the pills are not only for the benefit of the pilots. the measure is also to protect others who might be harmed by information divulged under interrogation.

Yeah, that is a valid point that I've thought about as well. Though there is also the argument that pilots would be told less critical information if the people commanding them didn't expect them to commit suicide before capture.

FWIW, the US claims that they no longer give these pills to any military personnel. [0]

as for why the pilots in particular, my (fairly uneducated) guess is that pilots inherently have knowledge of more sensitive information than a typical infantry person. while the soldier probably only has knowledge of local troop movements that will be stale in a few days (most US infantry standard procedures and equipment details are public knowledge), the pilot may know classified information about the aircraft they are flying.

[0] https://www.usnews.com/news/articles/2015/02/19/suicide-pill...

If GP meant what I think he meant and he did manage to swim out of troubled waters.. I think yeah. And in general I remember that I was born to survive not to die. That every tuesday I get a happy moment.. so things are not fully broken. But I need to remove the noxious part of my life so more happy moments come than sad ones.

Again it's not a universal solution but very often when you change context, you find yourself having it easier. You're not even trying to be happy, it just grows around.

Do you realize these two sentences say the same exact thing? You have a pain, which is a signal of a disorder, and you need to change something to fix it.

"At first I viewed the depression I started fighting in my teens as a scourge, a defect, something broken to be fixed."

"I have since come to see it as an important signal. When I am managing my life and mental states well, it often fades into the background. When it starts to flare up, like with some kind of physical pain, that's telling me I need to pay attention and change things up a bit."

No. One sees the depression as something to be fixed, the other sees the underlying problem causing the depression as something to be fixed.

Yeah, I agree. But the signal is still the disorder that needs to be fixed.

Any psychiatrist will tell you that psychiatric medications only treat the symptoms of mood disorders and that they do not know the cause of most of them. It is hogwash that they think mood disorders are "only chemical imbalances in the brain". They know these disorders are polygenic and environmental. But for some people, a short dose of SSRI's or antipsychotics can keep them alive long enough to find out what it is that is giving them so much pain, i mean singnals.

Are you familiar with what it’s like to have depression? It’s not something you can really ever get rid of, even if you can mitigate it with medication and lifestyle changes. It’s there, though not dominant, even when things are going well and even when you’re in a positive mood.

I struggle with similar feelings, and the idea that depression becomes something that is there but can be put to positive use absolutely tracks with my own experience.

Please read my other posts. I have a 35 year history of hospitalizations for both manic and depressive episodes and I have attempted suicide twice. I have lived with 9 month long depressions where all I could do was watch cartoons and not enough energy to even brush my teeth.

If one cannot get rid of depression then one cannot get rid of heart disease or cancer.

Have you been tested for lyme's disease regarding the lack of energy?

I think depression can spiral into a positive feedback loop that forms a depressive disorder. Mood affects life which affects mood which affects life...

Many people who haven't been stuck in that positive feedback loop have still been blue. Their capacity to feel happiness is muted just like ours, but they are successfully able to get out of that with a behavioral change. That's not always the case with a depressive disorder, and it can take a multi-faceted approach of medications, lifestyle change, sleep hygiene improvement, sometimes electroshock therapy for those people to get out of it.

I had it a large chunk of my life. It went, eventually. It can go but that's because it's not in my nature/mind/brain/chemistry/whatever. In this I'm very fortunate, but please don't completely rule out defeating it, though the odds are poor.

> Are you familiar with what it’s like to have depression?

Pretty sure there are many distinct conditions that we now call "depression".

Your description is very true for some of them, and not at all for others.

This probably varies by the person.

Some people might get a single episode, then get through it one way or another, and never have another one.

Others might have a lifelong tendency or vulnerability to it, and in that sense it might always be there in the background. I'm fairly certain I was more or less depressed (although not diagnosed) in my teenage years and early 20's. In my later 20's things were brighter, although I probably had a tendency for some amount of depression, especially during the darker winter months of the year (I live in the north). However, there were definitely times when I wouldn't have considered myself depressed. I'm not sure I'd even say it was "there" at those times, in the sense of being actively present in any way, even in a non-dominant way.

Later on, I got another deeper episode of depression that I'm still battling.

Yet other people might have it always there in some way, as you say.

Amphetamines have shown some promising results in actually curing depression. There is a vicious cycle of depression where the anhedonia and lack of motivation cause the sufferer to allow the underlying causes to get even worse leading to deeper depression. Amphetamines can help break that cycle and ideally even start a virtuous cycle where their use can be tapered and eventually discontinued. It's vitally important though that the drug treatment is combined with behavioral modification so that the artificial stimulation of reward circuits can be operant conditioned on behavior patterns that mitigate the underlying cause of depression. Anyhow I might be off on the jargon since college psychology was a long time ago, but the basic concept strikes me as highly plausible and consistent with what we know about the human mind. And anecdotally I have friends who benefited from amphetamines for depression.

However used improperly it can end in amphetamine addiction or even psychosis. It's not surprising most mainstream psychiatrists don't like to use them for depression, but it is a powerful tool in the box.

That seems perfectly reasonable to me as a line of reasoning, and I'm not casting doubt on whether it could work.

With that said, I also wonder how many of those people had undiagnosed ADHD/if such studies involved screening for ADHD.

Unmanaged ADHD leading to consistent failures in life and other difficulties -> depression/depressive symptoms from the consequences, lack of achievement, etc over the long term, is a pretty common story.

And obviously, the responsiveness of those with ADHD to stimulants is pretty well-known.

> However used improperly it can end in amphetamine addiction or even psychosis.

Someone I know managed to do that, despite being on intramuscular antipsychotics. Unfortunately no middle ground, the meds keep him anhedonic and abulic, but without them it's mania. I would be careful with stimulants.

>It is hogwash that they think mood disorders are "only chemical imbalances in the brain".

Who are you quoting here? What psychiatrists think this? AFAIK, this hasn't been the meta for a long time.

I can't speak to exactly who uses this terminology, and I have not heard it from a medical professional, but I feel like it lingers on, like in medication pamphlets.

Because fundamentally, I think, it is necessary to try to get people to comply with medication that seems to help sometimes, while avoiding the reality that the way it works is not known.

No, I agree with you. I do not find psychiatrists believe that mood disorders are only chemical imbalances in the brain.

I have come across people have been led to believe it’s a chemical imbalance by psychiatrists, even in the last few years.

It may not be the modern psychiatric view, but it’s also true that psychiatrists are just doctors, and many of them are very slow to change from what they were taught in medical school.

it's a default API for brains, but ideas will trigger neurochemistry too .. well I'm sure you got that already

I think these two sentences are different: it's analogous to treating a symptom vs treating an underlying condition.

Yeah, I agree with that distinction. This is am important semantic discussion.

But he just changed the name of the thing he wants to get rid of from "pain" to "signal". The signal is still a disorder. The signal is the thing that bothers us.

I think they is saying that if you put your hand on a hot thing, you get a signal. You can also call it pain. But the problem is not an internal problem with your body, but a consequence of your environment. So change your environment or what you are doing and the pain will disappear. Don't try to keep your environment the same and try to change within.

(I don't entirely agree with them, but that's my best summary of their argument).

Out of necessity (after existing conventional treatments offered little help) I've been conducting a 10+ year self-experiment related to this topic.

Like others have described, when I started experiencing symptoms of conditions resembling anxiety, depression, ADHD, mild bipolar, paranoia and CFS/ME, I initially sought mainstream medical psychiatric treatment and undertook talk therapy and was prescribed anti-anxiety (benzos) and antidepressant (SSRI) medications. There was some relief but there were also unpleasant side-effects, and I just had a strong feeling these treatments were not really addressing the core problems, and indeed I even felt like the symptoms were fairly normal reactions to the life experiences I'd endured.

Later I tried to heal myself with nutritional and exercise-based approaches, and relatively conventional emotional approaches like meditation. Again, some mild/temporary improvements were noticeable, but they were inadequate, and it still felt like there was something deeper I needed to connect with.

About 8 years ago, I found an approach that involves identifying and releasing traumas, attitudes, behavioural patterns, self-perceptions and defense mechanisms that are held in the subconscious mind, particularly ones that have been attained in early life and have snowballed through repetition compulsion [1] (a concept that Freud first articulated).

I've been undertaking these approaches continually since I discovered them, and bit by bit all the symptoms have resolved.

My experience has confirmed, at least to me, that these conditions are "adaptive responses to adversity" (or something else related to that concept), and that in order to heal the symptoms, I needed to understand their basis at a very deep level; as Jung said, "making the unconscious conscious" [2].

Once that had been done, adopting new, healthy attitudes and behaviours and living free of those symptoms has been fairly easy; i.e., healthier behaviours just emerged naturally once the causes of the unhealthy behaviours were identified and understood.

If any researchers or laypeople are interested to know more about the techniques I've used and the results I've experienced, I'm happy to be contacted (email address in profile). None of the approaches I've used or their underlying hypotheses are novel; it's been written/spoken about extensively by veteran experts on mind+body health including Maté and Bruce Lipton. But there doesn't seem to be much in the way formal studies into these concepts, so I'd be happy to connect with anyone working in the field or anyone else interested to explore further.

[1] https://en.wikipedia.org/wiki/Repetition_compulsion

[2] https://www.goodreads.com/quotes/44379-until-you-make-the-un...

I completely agree. In my experience, most therapists have been given very powerful tools but are not really equipped to handle them. It has led me to understanding these concepts much like you. As for this:

as Jung said, "making the unconscious conscious"

I may be misquoting but "until you make the unconcious concious, it will control you life and you will call it fate." Or something close to that. I agree, we often do things for reasons we dont fully understand. We can offer an explanation that sounds plausible, but there may well be more to it that even we haven't really explored.

This has been my experience as well, but I found it through talk therapy, medication and some philosophy.

Almost all of my negative emotions on a day to day basis are generated by defenses I developed as a child to make being a kid with undiagnosed ADHD workable. It worked while I was a kid, but became untenable as I got older.

Once I discovered the ADHD as a basis for this thinking, everything started falling into place and as I started exposing these thought patterns to myself, they started going away.

The Trauma of the Gifted Child by Alice Miller is probably a good read to throw in here if this is the direction you're looking to explore - especially if you can get an early edition that hasn't been watered down. Some of her perspectives into experiences as a child that are commonly accepted as "normal" but are often experienced by the child as trauma and grow into dysfunction as adults were interesting.

Is it "Trauma" or "Drama"? The version I'm seeing on Amazon is "The Drama of the Gifted Child".

ETA: I found this interesting, too - the author's own child wrote a book about his negative childhood experiences: https://www.haaretz.com/life/books/.premium-mother-dearest-1...

It's "Drama"

Thanks :)

I attest to this. This book should be required reading in school. There's so much suffering in the world being done to children in the privacy of homes. That suffering goes without punishment and the victims grow up to be perpetrators or victims again (in abusive relationships). And most don't even know how that happened.

>an approach that involves identifying and releasing traumas, attitudes, behavioural patterns, self-perceptions and defense mechanisms that are held in the subconscious mind

Could you elaborate on this part? What does "identifying and releasing" look like, in practice?

This is where discussions about this stuff can go off the rails, as the main modality I've used has links to the chiropractic profession (even though I think that profession is highly dysfunctional and many or even most of its practitioners are quacks at best and frauds at worst).

Anyway, the modality I've most used is a technique called NET (neuro-emotional technique), which (I believe) is similar to a practice called Psych-K (I've never done this one but I'm told they're similar). Both of them use muscle-testing to identify incongruences between different aspects of the mind and body (e.g., conflicting/incompatible desires, beliefs or values).

I've also done plenty of Holotropic Breathwork and Ericksonian Hypnosis, some EMDR, some EFT/Tapping, and some use of basic affirmations. Someone else I know well has done a lot of a practice called Family Constellations, as well as another practice that focuses on healing the trauma of birth - though I've not done either of those practices.

These sound like awesome techniques to have in your toolkit. Any idea if they've been studied in double blinded evidence based trials on patients for efficacy? We need more tools like this at our disposal for cracking the code on the last frontier that is mental health, in addition to the current shotgun approach of flooding our synapses with neurochemicals via SSRIs.

Also wish I could try psychoactives like Psilocybin which many have had life changing positive responses to.

Of NET, some small trials by fringe researchers have been conducted [1] (or just planned [2]), but none has had much impact.

This 2017 study [3] seemed to find promising results:

Changes in cerebellar functional connectivity and autonomic regulation in cancer patients treated with the Neuro Emotional Technique for traumatic stress symptoms


Results: The results demonstrated significant changes in the NET group, as compared to the control group, in the functional connectivity between the cerebellum (including the vermis) and the amygdala, parahippocampus, and brain stem. Likewise, participants receiving the NET intervention had significant reductions in autonomic reactivity based on heart rate response to the traumatic stimulus compared to the control group.

That result seems to warrant further research, but I can't see it happening at any significant scale.

I've thought/read at length about the state of research into these kinds of modalities, and have concluded that it doesn't and won't happen at scale, due to a combination of these reasons:

- The cost/effort to run a large, controlled trial, including longitudinal research (you'd really need to monitor people over at least 5, but ideally 10+ years to get the best results) would be huge.

- No body with the resources to conduct such a trial is sufficiently motivated to do so, as there's no drug discovery or other outcome that can yield billions of dollars in revenues.

- The chiropractic profession exists at the fringes of medical practice (for generally valid reasons) and is too "hot" for any government or major research institution to want to touch.

The same goes for the work of the researchers I mentioned in other comments; Gabor Maté, Stan/Christina Grof, Peter Levine, Bruce Lipton and others. They've done plenty of qualitative research through their careers, and have written many papers and built solid careers as writers and seminar speakers for sizeable-but-still-niche audiences (of mostly very privileged people with plenty of spare time and money to devote to this kind of healing work). But parlaying that into large-scale studies just never seems feasible, no matter how compelling their findings.

But I think it's profoundly important work, as I'm sure it has the potential to transform the existing psychology/psychiatry fields, so, who knows, maybe something will click one day to make something happen.

[1] https://www.google.com/search?q=site:nih.gov+neuro-emotional...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646715/

[3] https://pubmed.ncbi.nlm.nih.gov/29052102/

Thank you for the thoughtful and thorough response

Hey if worked for you, it worked for you. Thanks for laying it out there regardless of what I think of some of these techniques.

This is known as psychodynamic therapy for others who want a name for it. There are therapists that specialize in it. I must warn you its a very long type of therapy with a lot of sessions, so it will cost you $$$. Also some people use it as a weekly whining session for years and never get anywhere with it, so please go into it trying to get results.

> Also some people use it as a weekly whining session for years and never get anywhere with it, so please go into it trying to get results.

A bit harshly formulated, but I agree. I've seen people being quite aimless in their therapy. I'd recommend becoming an expert on your own condition.

Can you give us an example of one of the techniques you used?

While I'm very happy that this worked out for you, and I'm also sure that your scenario will apply to others, maybe even many people, even then I have to add a word of caution: generalizing from the experiences of one person to all psychological conditions would be a scientifically unsound position to take (I know that this not what you are saying, but it is possible to walk away with that conclusion).

For example, many of the issues that you mentioned (anxiety, depression, etc) are symptoms that can have wildly varying causes. It's similar to, say, a fever: if you have a fever it can be completely different reason than what causes it for someone else: one can develop a fever from an infection, or from stress alone - so a psychosomatic cause. It's even possible to have chronic fever due to brain damage! It has to be evaluated on a case-by-case basis

Sure, thanks, but remember we're adults here, and pretty well educated ones at that, so, the need for caution and discernment can be presumed to be understood by readers on this site :)

For what it's worth, plenty of books have been written about these concepts over several decades; some authors include Gabor Maté, Bruce Lipton, Stanislav and Christina Grof, Peter Levine and Iain McGilchrist, all of whom have advanced academic credentials in psychiatry or biomedical science.

So, yeah, there's no "generalizing from the experiences of one person to all psychological conditions"; there's sharing one anecdote as an example of what many experts have known for years (even if those experts' research findings aren't used much in formulating the DSM or applied by your average neighborhood psychiatrist, for reasons that are a whole other discussion!).

I'm most surprised to learn that this _isn't_ the current prevailing view in the medical profession. I am not a doctor, but it's always seemed more natural to me to view depression and anxiety as adaptive behaviours - albeit perhaps ones that can end up being triggered too far.

I read an article once (wish I could find it) that one advantage of mild depression was as sort a "call for help and support" from other embers of a close-knit social group, although I'm not sure how well-founded the claim was.

Largely because articles like this generally focus on what I think of as “layman’s depression”, or “layman’s anxiety.” That is, a mild form of the condition that straddles the gray area between “personality” and “mild personality disorder,” that diminishes quality of life in a perceptible but not devastating way.

Then you go work on a psych floor and meet people whose depression is so severe it induces catatonia; people who look and feel like zombies and who would end their lives if given the chance; people whose depression comes with a healthy side-order of delusions. Extreme things that render someone incapable of even mild functioning.

Or severe anxiety - patients whose worry comes from no external stimulant, renders them incapable of anything but physically sickening levels of worry, and if you manage to somehow help them reason through the thing they are currently worried about ... find a new thing to attach their emotions to. Look at something like OCD, wherein one - for instance - May obsessively wash hands to stymie an overpowering anxiety that ones house may burn down (OCD sometimes has logical triggers between ritual and anxiety; often not.)

Interpreting that as “an adaptive response” is ridiculous.

An adaptive response “taken too far”, on the other hand, is the very definition of wide swaths of disease - autoimmune, cancer, etc.

I find the “gosh it’s just cultural mismatch” theory to be a modern stigma against mental disease. You can break any bone or system in the body - except for neuro/behavioral, that’s just another type of person that needs some cultural adaptation. /That’s/ never really broken.

Interpreting that as “an adaptive response” is ridiculous.

An adaptive response “taken too far”, on the other hand, is the very definition of wide swaths of disease - autoimmune, cancer, etc.

These two statements don't add up for me. If you do accept that various autoimmune disorders and cancers are essentially adaptive responses taken too far, then why can't depression similarly be considered the same? Or is your point that depression is simply an adaptive response, and it's not "taken too far" until people are at the catatonic state?

Sorry, your question is fair -- let me elaborate:

I feel the OP puts forward two statements, categorizing depression as "adaptive", or "adaptive response taken too far." I wish to address each of these separately.

Having seen what these maladies do, I believe that categorizing them as "adaptive" is a position that can only be borne from "have never seen these diseases in their full spectrum, largely responding to mild, layman's-presented versions of them."

Separately, addressing the concept of them being "adaptive responses being taken too far," I find essentially tautological. Give me a little leeway to oversimplify when I say that there are two broad categories of disease: exogenous (trauma, infection - things done to us by the external environment) and endogenous (things that occur from dysregulation of human physiology).

((Aside: the above is, like all models, wrong. There are interactions and predispositions between biology, exposure, etc. I aim to use the above to illustrate a point about "adaptive response gone too far", not to overlook the full biopsychosocial model of disease.))

Calling a non-exogenous disease "an adaptive response taken too far" is a tautology. All human physiology arises from homeostasis - it's all "adaptive" in purpose, if not in effect. So all endogenous disease can be described as "adaptive response that is acting maladaptively."

You don't have depression if you really hate your job / university degree / sad your mom died, you just hate your job / sad your mom died.

> I find the “gosh it’s just cultural mismatch” theory to be a modern stigma against mental disease. You can break any bone or system in the body - except for neuro/behavioral, that’s just another type of person that needs some cultural adaptation.

Also ties into minimization of mental illness, which is a form of stigma!

> That is, a mild form of the condition that straddles the gray area between “personality” and “mild personality disorder,” that diminishes quality of life in a perceptible but not devastating way.

I otherwise agree with your comment, but depression and anxiety aren't personality disorders or personality related at all. Depression is an affective disorder. Anxiety is its own class of disorder.

You’re quite right. That was a typo/brain fart, and by the time I noticed it my comment was past editing.

How common is that extreme form of depression? Sounds like we need two different names for two very different diseases (or perhaps only one is actually a disease)

There are no diseases, only symptoms. We can name diseases forever but that gets us nowhere. They just have more depression, or are more depressed.

By the way, why don't people get SSRI's when they are depressed with a flu? I mean that is caused my lower serotonin as well. So for some reason we accept that depression because we have a reason for it?


You see, depression is fundamentally and immune disorder. We react negatively to something in the environment, like a bad job or marriage.

> You see, depression is fundamentally and immune disorder.

That's a lot of certainty for something that is still very much uncertain.

> By the way, why don't people get SSRI's when they are depressed with a flu?

Because that's a short term, acute condition that will get better on its own? That's the same as saying "People in the hospital who can't breath are given oxygen, so why aren't runners who are breathing hard?" Because long term major depressive disorder is totally different than having a down couple of days.

More certain than ever actually:


Regarding oxygen use during running, it is already something: https://trainright.com/hyperoxic-training-little-know-traini...

As best I can tell there's not implication of causation there - it could be that depression causes the immune disorder, just as it causes any other number of conditions. I don't know the value in assuming we can categorize it like that.

I assume with the oxygen thing you're intentionally missing my point which is that a regular momentary disruption isn't considered a disorder.

I agree with you, depression alters the immune system and the immune system can cause depression. But it is through the immune system that we feel the effect.

"momentary disruption isn't considered a disorder"

By definition it is. Duration is irrelevant. My panic attacks can last for only 2 minutes.

> By the way, why don't people get SSRI's when they are depressed with a flu?

One reason is SSRIs typically require a a few weeks to reach effective levels in your system; about how long it takes to recover from the flu.

> depression is fundamentally and immune disorder

You appear to be playing a free association game with words, not describing reality.

The idea that it take weeks for antidepressants to reach 'effective levels" is a misunderstanding of the science. It is is true for MOST people that, for example, fluoxetine and its metabolite, norfluoxetine will be at a certain level in the serum before they have resolution of symptoms, but this is not the case for all people.

It takes a very small dose to inhibit serotonin reuptake and this will happen with the first dose.

https://www.nature.com/articles/1395757 "The single dose caused only a slight increase in drug plasma concentrations but relatively clear changes in sleep structure."

And I was hoping you would all chime in and say it is useless for the flu. Because it might be very helpful


> You see, depression is fundamentally and immune disorder. We react negatively to something in the environment, like a bad job or marriage.

This is an atrociously overly simplistic statement. There are plenty of people who suffer from depression despite having everything going for them. A person can have not a single thing in the world to complain about and still have depression.

I'd still argue that a person with "everything going for them" can still have a "reason" to be depressed. Maybe they do a really good duck impression -- calm on the surface, kicking frantically below. That is, maybe there is something wrong with their life or their past that isn't visible to others, or even to themselves. Or maybe they have been pursuing the checklists of society and found that they aren't personally fulfilled by them, and must seek fulfillment elsewhere. Maybe they have a desire to be living one kind of life but can only excel in a different kind of life that only looks good from the outside.

“A person can not have a single thing in the world to complain about”

What person?

Gautama Buddha! =)

What about all the other things that might affect their immune system? Have they ruled them all out? Latent viral or bacterial infection? Allergies? Diet? Look at diet and Omega 6 consumption, that alone will screw with the immune system and throw the catecholamines off kilter.


The examples you have given seem to be outliers where the system "human" broke out of its basic parameters, causing multiple other subsystems to fire out of control.

There is a movement within psychiatry that wants to take a view similar to yours, although it is very much in a minority. I would point to figures such as the British psychiatrists Sami Timimi [1] and Joanna Moncrieff [2], associated with the groups "Council for Evidence-Based Psychiatry" [3] and "Critical Psychiatry Network" [4].

The emphasise the ideas that psychotropic medications are overprescribed (they are not totally opposed to their use in all cases, but do think that the evidence for their benefit is often overstated, and the evidence of harmful side effects is often unfairly minimised), that the DSM-5 and ICD-10/11 diagnostic manuals have very weak science behind them and encourage blaming the patient's brain for the patient's problems (in a very general way – advocates of the biological model can rarely point to anything specifically wrong with a given individual patient's brain, just the faith that some biological explanation is waiting to one day be discovered) even while ignoring the factors in the patient's social situation which may be a better explanation (but maybe a less socially convenient one – blaming the brain rather than the society eases society's conscience).

[1] https://en.wikipedia.org/wiki/Sami_Timimi

[2] https://joannamoncrieff.com

[3] http://cepuk.org

[4] https://web.archive.org/web/20200225204400/http://criticalps...

One thing that I learned during my psychology degrees that always stuck with me was that mildly depressed people are measurably better at judging probabilities of things happening. (Unfortunately I can't remember off the top of my head the structure of the study, or how much better they were). I wonder if that might fit into this, in that if you're mildly depressed presumably bad things are happening to you, so perhaps it's adaptive to be more realistic about your situation. Pretty hand-wavy stuff, but interesting to think about.

I don't know who conducted the original study, but I remember that Martin Seligman opened his book Learned Optimism with a discussion of an experiment exactly along these lines.

Two groups of people -- a group of clinically depressed people, and a control group -- were asked to operate some apparatus that was programmed to fail a certain percent of the time. They were then asked to estimate how much actual control they had over the apparatus.

The control group consistently overestimated, while the depressed people were spot on.

A try it yourself experiment: simply start giving accurate time estimates to project managers, and see how long it takes them to call you a pessimist :)

Those who are successful in life have walked a path of failure, yet they keep getting up and trying again, learning from their mistakes and growing. This at its heart is a healthy kind of optimism.

Those who call themselves a realist, who believe it will fail, shoot themselves in the foot, because they do not get to learn the valuable lesson that comes from that failure. Without trying and failing growth is stunted. Trying is a win-win. You either get what you aimed for, or you learn and grow.

One scenario is if one grows up in a dangerous situation, you're shut down from risk taking, because taking a risk in a situation like that could seriously harm you. Meanwhile those who grew up in a safe environment could safely explore and open themselves up to positive hypotheticals worth attempting.

Another scenario is that when one fails instead of learning how to do better next time they create an assumption that any remotely close scenario in the future will end in failure. When one believes a negative dangerous outcome will happen, and they're thrown into that situation, it creates anxiety. This is why anxiety and depression often go hand in hand.

I remember reading an article like that. Also, it's a bit of a meme that if depression was 100% harmful then it would already be eliminated by evolution. I mean why shouldn't people prone to depression die off?

Don't make a mistake, I'm still working on improving my life and uncovering the root causes. It is a silent thief of life.

Evolution does not and cannot give a shit about you is why really. Elimination by evolution requires it to be both utterly nonviable and not tied to anything else. Look at sickle cell anemia - one copy protects against malaria via mild blood cell deformation. Two makes them concave.

There are plenty of non-optimal things kept around because there isn't sufficient pressure to ensure it dies out.

Or sinuses!

An Annoying Quirk Of Our Evolution


But what I meant is that according to the theory of evolution, individuals with disadvantageous traits reproduce less often. If they reproduce less often, they pass their genes less often. I think they say the trait is regressive.

> Elimination by evolution requires it to be both utterly nonviable and not tied to anything else.

Neither of those things are required. Any disadvantage to reproduction frequency of an allele can lead to its extinction. Even a 'good' allele can lose to a 'better' one.

(The scare quotes are to acknowledge that these terms are just frequency re-stated)

> I mean why shouldn't people prone to depression die off?

"Having a child will make me happy". And hell, maybe it will - it's the perfect ruse by our genes - keep us depressed until we reproduce.

Or maybe we leading a path in life with no meaning causes us to be depressed and seek a solution. Having a child puts one in the present moment and does give some meaning back though is not a cure for depression. I highly doubt the genetics make us depressed to have children.

The appendix is 100% harmful but not eliminated. As is nearsightedness.

Evolution is only affected by genotypes that prevent reproduction.

Uhm, no.


"the strongest signals of recent human adaptation in Europe did not coincide with the Neolithic transition but with more recent changes in environment, diet, or efficiency of selection due to increases in effective population size."

> The appendix is 100% harmful

It is not.

Much better examples would be cancer and auto-immune diseases. Evolution is not magical, it can't produce 100% fault-free organisms. Or maybe it will, given a few more billion years. But in a limited time span, there is no reason to expect it to correct any potential flaw in an organism (and experience obviously shows that it hasn't).

That's a rather antiquated view. Nowadays, the appendix is considered an active organ again, essentially a spawning zone for the gut flora. I recall reading that people that still have their appendix have a more diverse gut microbiome, and more importantly, their gut flora recover more quickly after antibiotic treatments.

I struggle with mild depression, especially in the long winter months in the Northeast U.S. Anecdata, I know, but I'm much better at estimating times (arrival times, how long it will take to pack for a trip, when we will actually leave to get to an appointment) than my wife who is eternally optimistic.

This comes in handy on estimating project times as well though only for me internally as most people don't want to hear realistic project times.

I think there is also data that intelligent people are more susceptible to depression, so that might influence that result. Cannot find the source of it though.

There's a general bucketing in the modern world of all unhappiness being depression that should be treated, which I don't think really fits what's going on. There are absolutely cases where anxiety and depression are a medical issue which warrant treatment with medication, but there are also completely legitimate reasons for those conditions. If your lifestyle is one of never leaving the house, zero social contact, with the bank imminently foreclosing on your house then depression and anxiety are entirely appropriate - so long as those feelings then cause you to do something about the problem.

Naming these two medical conditions "Depression" and "Anxiety" is pretty unfortunate. They are completely different from"feeling depressed" and "feeling anxious". Having depression or anxiety in the medical sense will not cause you to do anything about any problem, because they are debilitating. They reflect long-term changes to your brain chemistry that may or may not respond to medication - transiently feeling anxious or depressed is not that.

Seems like depression is like tissue regeneration. It tries to fix things then it bails out. Depression is often called a pit, when you're in it, you haven't the slightest idea nor capability to do whatever. The only evolutionnary value I see in this is making you so sluggish you'll be left out by whoever or whatever is harming you because time goes on and they'll move.

I am a bit confused by your comment. When you write 'legitimate reasons', do you mean from a _moral_ stand point? I can't otherwise make sense of 'legitimacy' in this context.

edit: Do you mean 'legitimate' in the context of it increasing evolutionary fitness in some way?

I'm not a doctor, but I was also very surprised that this is "news" to the medical world. I has just always assumed that this was a well known thing, because it just seems completely logical to me.

Just asking "what could the evolutionary purpose of depression be?" should already lead to the conclusion that it's most likely a mental defense mechanism, or byproduct of one, that can most likely be triggered by experiences rather than just be part of a persons genetics.

But apparently it wasn't all that obvious after all.

There are lots of obvious and completely logical things about the world, like the sun and planets go around the earth, animals cannot feel pain, and insects form spontaneously from rotten matter. But some of them are not correct despite being obvious and logical to everyone, and thus we have science.

There is no a priori reason to think depression has an "evolutionary purpose" any more than to think a broken bone does.

Indeed. Although many practitioners are open about it that they cannot really influence those factors, so the try to offer the best individualized solutions to for respective patients.

But to claim there are no environmental factors that might benefit depression is very likely just plain wrong. But in practice these factors are declared out of scope because neither patient nor psychologist can change those.

Of course numbing yourself down with meds has other repercussions and maybe hinders that environmental factors are considered and changed.

Because this actually IS the prevailing view, but it is not really actionable.

What is the alternative to drugs?

A real advantage of depression is you won't challenge authority so you'll be more likely to appease the Alpha members of the group.

So what?

How would this help a doctor treat a mental health patient?

> What is the alternative to drugs?

A social safety net. A society that thinks providing the communication resources and facilities for people with common interests to socialize about those interests is as important as providing highways.

> How would this help a doctor treat a mental health patient?

You don't have to be a doctor to dispense pills. You can always anesthetize people who are panicking, but I'm not sure that should be called "treatment."

Talking therapy probably works because it's the opportunity to talk to someone with no ulterior motives at length about your problems. We could provide that.

> A social safety net.

I believe this would be great. But perhaps not, perhaps this was only in the what Ovid calls the Golden Age -- perhaps small communities of hunter-gatherers, perhaps never in the way we imagined.

But I don't see this happening unless we revert to much smaller communities.

I think we could realistically cut world military spending by 90% before we could offer everybody that social safety net.

So we DO need pills, because we cannot realistically offer 1 in X the support they need, the best we can do is offer pills that work long enough that they help themselves or some psychotherapy.

Psychotherapy can be greatly helped in a lot of cases by pills.

I have seen the light when I started experimenting with drugs(illegal and legal) -- it is such an incredible release to know you have the power to change your mental state, even if chemically.

Having a Xanax in my walled, completely stopped my panic attacks, I haven't had one in years.

> facilities for people with common interests to socialize about those interests

We have that. It's even called a highway! The information superhighway.

It hasn't cured depression and anxiety, and may have worsened it.

> What is the alternative to drugs? Another one is lifestyle intervention. Gut problems for example may lead to depression, as gut is an important factor in neurotransmitter production. Metabolic problems will lead to lowered levels of energy. The chronic disease epidemic is real.

Depression may come for many different reasons, and the underlying factor should be looked for

A combination of targeted therapy and short courses of drugs designed to ease the therapy process and control symptoms in the short term?

In my experience most psychiatrists recommend some form of talk therapy in addition to medication and my impression is that the consensus view is medications + therapy are more effective than either by themselves (also recommended are exercising , sleeping well, and other general health stuff most doctors lecture their patients about)

That is also common knowledge and practice.

My point when I said it is not actionable -- was that removing adversity is actually impossible most of the time, the therapist/psychiatrist has to give the client/patient the tools so he can help himself out, to better cope with adversity.

The therapist knows you're anxious because you had shitty parents, because you have a shitty boss and so on and so on, but that knowledge in itself is not actionable.

It would be great if we all stopped being pricks to one another, make a big circle and hug eachother, but since that's not going to happen anytime soon, we have to learn how to cope with adversity.

What you you suggest doctors do when short term treatment regimens become decades long?

If only the symptoms are treated it is illogical to expect the condition to go away. In fact, it's likely to get worse.

> A real advantage of depression is you won't challenge authority

Not true. It can give a fatalistic outlook and raise aggression. I know a (depressed) guy that almost got himself killed in traffic, because he would rather die than yielding to a pushy road user.

I would look at other fields of medicine, e.g. research around how certain diets and fasting protocols can reverse metabolic syndrome and type-ii diabetes along with a variety of other positive health benefits.

So what is a major focus of research? Finding ways to isolate/synthesize specific compounds to make a patentable drug that can be given in lieu of patients making lifestyle changes, because a) you can't patent a lifestyle change and put it in a pill and make billions of dollars off it and b) because patients are generally assumed to be unwilling/unable to make the lifestyle changes.

So, "how would this help a doctor treat a mental health patient?" is perhaps the wrong question, because it won't because the doctor isn't interested or trained nor has the time to guide a person through a lifestyle change. It nonetheless may be very relevant to you in deciding whether you'd rather be on insulin for the rest of your life vs. finding a way to lose weight. Just as it may be helpful for you to consider whether makes changes to lower/resolve sources of stress and anxiety in your life is a better option for managing mental distress than being on an SSRI/benzo indefinitely.

I wouldn't hold my breath waiting for the AstraZeneca "how to be happy without psychopharmaceuticals" guide to living.

> I'm most surprised to learn that this _isn't_ the current prevailing view in the medical profession.

In the UK I speak to very many mental health care professionals, and I've only ever met one who pushed the biological model above the bio-psycho-social model. Everyone else is keenly aware of the wider determinants of mental health.

There's some attempt to build this into the system, but it's pretty difficult because of the way the NHS and Public Health are set up at the moment. There's a lot of regional variation.

> I read an article once (wish I could find it) that one advantage of mild depression was as sort a "call for help and support" from other embers of a close-knit social group, although I'm not sure how well-founded the claim was.

In the same vein I also read something about how depression helps in momentarily retiring from the group to be perceived as a non-threat and the rumination is the symptom of a brain dedicating resources to finding solutions to a problem. Pop psychology most likely I suppose.

I went to therapy because of this. When I chose the therapist I focussed on choosing one that has a proper website and appears to use modern methods. Actually it was also the therapist's opinion that certain behaviours made sense at some point. In fact the therapy method didn't even require making a formal diagnosis because all these diagnoses are just summaries of statistics and not necessarily match the black box inside our head. Instead after the 3rd or 4th session I got a questionnaire in which I had to fill in what should be improved and what the goals should be.

Also of course there was some kind of homework after each session. Usually the therapist then asked me how I could accomplish that goal. Then I came up with something and the therapist also told me "you are an expert for yourself, you know this best". That was both really surprising and encouraging. The therapy actually really improved my quality of life tenfold. I'm still wondering whether it was the method (Systemic therapy) or just the overall setup that made it so successful.

I agree, especially since the ACE Study was released decades ago:


Could the article have been by Robert Sapolsky? He discusses something like that in one of his later books, the one with a chimp on the cover where he talks about how male chimps leave their childhood tribes and head out to seek mates... and the adjustment of moving from a close-knit social group to a new alien group is covered.

He's an endocrinologist/anthropologist by profession I think, but his books are sort of more about anthropology and psychology.

I've read a similar article although with a different angle, stating that the advantage of depression is that members of a tribe which are a burden to the rest will eventually withdraw completely and/or kill themselves and therefore cease being a burden to the tribe. That said, I don't know how well-founded the claim was either.

It's hard to determine what our ancestors actually did. I'm sure you could argue any number of solutions they might have used. I'm wondering though what the prevalence is of these afflictions were back then or now in modern hunter-gatherer societies. The latter is not proof of anything, but it would be an indication of what a possibility might be like.

Going with a very medicalized framework could very well be an adaptive behavior on part of the professionals too.

The common sense approach makes it much harder to build a rich field of scientific looking knowledge and products.

This is horrible. If a therapist thinks depression is purely neurological then they will not try to cure the person and instead resort to talking to help comfort them.

This view needs to change.

But this doesn't make economic sense. Billions could be lost from prescription revenues worldwide if this became the prevailing view. Hence, we will all continue to be "sick" and treatable with medication, rather than adaptively responding to adversity.

> If ADHD is not a disorder, but a mismatch with a human environment, then suddenly it’s not a medical issue. It’s an issue for educational reform. And that is a compelling thought, given the evidence that kids’ focus and cognition are improved by physical activity. Still, we need to take this study with a grain of salt. There is a large body of research showing other biological factors when it comes to ADHD. For instance, there is evidence that premature birth increases rates of ADHD later.

So speaking as someone with adult ADHD who is getting by without medication with the right lifestyle choices, this sounds a bit like arguing that cardiovascular diseases are not medical issues, they're lifestyle problems.

I mean, yeah, in both cases the problems very much are largely caused by our lifestyles. But these lifestyles still affects me differently than how it affects most other people. Don't get me wrong, I'd be very happy if we get rid of the disorder label, not to mention societal stigmas surrounding mental illnesses and/or being neuro-atypical in general, but I don't see why we'd have to choose between (in this example) educational reform and psychiatric therapy when both seem valid options that complement each other.

EDIT: also, if you really want a good example of dystopian victim blaming in psychology, I'd suggest checking out "opppositional defiant disorder" and imagining how that label can be abused


>So speaking as someone with adult ADHD who is getting by without medication with the right lifestyle choices

How do you do it exactly? Without ADHD medication I can't function on a basic level, and even then it's pretty hard. (Yes that's just ADHD, I tried every antidepressant and mood stabilizer under the sun for years before getting diagnosed with ADHD)

And this is what I hate about these article, they leave people out in the cold who are suffering.

Start with getting your genetics, your full genome if you can afford it. This is something that saved my life.

Could be something as simple as nutrients, like B6 (P5P): https://www.researchgate.net/profile/Marnina_Stimmel/publica...

Well, I have the inattentive subtype, without hyperactivity or much of the associated impulsivity. So I guess I'm already in a starting point that is easier to compensate for.

I pay a lot of attention to my sleep - I'm a chronic insomniac. And keep in mind that it's not just about sleep time, it's also about sleep quality. So sleep hygiene is really crucial. No caffeine after lunch, and no alcohol in general (unless you know you can afford to be less well-rested the next day) because that might make you drowsy but it prevents entering the deep sleep cycle. Low-dosage melatonin seems to help me, not so much with falling asleep as it does with ensuring that once I do manage to sleep, I hit that "deep sleep" cycle that is absolutely necessary to recover.

I'm very sensitive to disturbances at night, noises can drive me nuts. So I spent a lot of time finding comfortable ear-plugs. They are essential for uninterrupted sleep for me, which again is crucial for hitting the deep sleep cycle.

Then there is the question of falling asleep. If I have trouble with that (which is almost every night), I get out of bed and go read in the living room, so that my brain keeps associating the bedroom with rest. Sometimes I start having ideas just before falling asleep, I then try to write those down on paper, and maybe work them out a bit - I realized that part of why late night thinking keeps me awake is that I'm afraid to forget all the ideas, so writing it down gives me peace, and doing so by hand also calms forces me to slow down. Meditation is also good for slowing down racing thoughts, but it really depends on what the thoughts in question are.

Then there's diet. I don't know if I can generalize what works for me specifically, but lots of leafy greens in general. There is evidence that berries and other sources of polyphenols help a lot with children with ADHD, and in general those are supposedly really healthy, so I figure they won't hurt me either. Avoid things that give sugar rushes/crashes. Finally I take supplements for common deficiencies that apparently disproportionately affect people with ADHD (B, zinc, magnesium).

Exercise helps because the cerebellum is involved with regulating attention. So I try to start the day with some mild exercise (like a short run) to really activate it. I've noticed that this helps with my attention regulation throughout the day. Sitting all day programming reduces activity again, so sometimes I take short "activation breaks" where I just do ten squats or burpees or whatever, not to exercise but to wake up the cerebellum.

Therapy is important. The overlap between ADHD symptoms and co-morbid/complex PTSD symptoms is large, leading me to believe that maybe people with ADHD are just more likely to end up in traumatizing situations (in my case: other kids loved to provoke temper tantrums in me) and part of their symptoms are really just a consequence of the resulting PTSD. As difficult as it was to process my past, therapy helped me a lot. It seems to have reduced some of my ADHD symptoms a bit, but even if it didn't: someone with ADHD is likely to have a lot of pain to process as a result of their condition. Doing so means having one burden less to carry, making it easier to cope with the remaining issues.

One very important thing I learned: ADHD means that inevitably I will slip up at some point and forget an important appointment or something. The screw-up itself is punishment enough, so if I hate myself for always screwing up too I'm just punishing myself twice. So learn to be kind to yourself and forgive yourself when that happens, that makes it easier to pick yourself up, fix the problem, and move on when this happens.

Therapy also helped me with being better at being brutally honest about my limitations. No, I cannot plan five things in a day when I know that I can't complete more than two. If I know I'll likely forget something at home when I go somewhere, even with checklists, leave early so I can go back to pick it up when I inevitably remember I forgot it five minutes after leaving the house. Try to develop good habits. More importantly, only try to develop one habit at a time, and give it enough time to really become a habit. And so on.

And finally: use that ADHD hyperfocus to your advantage, and do deep dives into learning as much as you can about how to ADHD works and what you can do about it.

Thanks a lot, this is very good resources. I read the whole thing several times despite having a pretty bad brainfog day.

Thank you, yes, I said the same thing in another reply.

I am Bipolar getting by without meds. I do not have a disorder, I have a difference. So I need to live and eat differently.

Sorry but that attitude is extremely dangerous. Maybe you have a less severe case that's manageable without treatment but that's not the case for everyone. Mania states are actively brain damaging and can blow into full-on psychosis. There is no lifestyle change, diet or essential oil that's going to stop that from happening for folks with a severe bipolar disorder, which is absolutely a disease since it destroys your brain if left unchecked.

Spreading such misinformation can lead to people not seeking treatment and getting hurt. Your case is absolutely not the canonic case for people with bipolar disorder.

Less sever case!!! Ahahahahhah! Uhm, no, I assure you this is not the case. Hospitalized four times, suicide attempts, psychosis, hallucination, on permanent disability, my mother and brothers have it and attempted suicide, my nephew, suicide. At one pint I was on lithium, zyprexa, lamictal, and prozac all at the same time. They also thought I had MS at times because of all the neurological stuff that was happening.

You can say what you want, but they found I have problems metabolizing amino acids (BH4 deficiency) and this is fixed by a low protein diet. (More technically, I have GCH1 deficiency.) Now I only need Klonopin in emergency cases. But watching my exposure to oxidative stressors is important because it destroys BH4.

And you do not even know what causes Bipolar disorder so how the hell could you know what might help it? And this is another problem, no matter how good we feel with lifestyle changes, no one will believe us or even think we were ever sick. They tel me stress is a trigger for my illness yet they make me homeless and do not provide me with stable housing.

Different treatments affect different people differently. This isn't particularly controversial, but the layman suggesting that they know better than scientists/doctors is kind of dangerous. There is of course room to be skeptical and ultimately you know what's going on better in your head than anyone else does, but that's not really actionable across an entire population of people suffering from something similar to you.

It's also dangerous because you're telling people they don't have a problem they need to address and that if they do address it, they just need to eat differently, neither of which are applicable broadly to people with bipolar disorder. Medications that didn't work for you might work for them and are worth pursuing.

There is a problem with how we diagnosis illness today. We diagnose off of symptoms and symptoms only. The reason this is a problem is there can be multiple different things that cause identical or nearly identical symptoms. Today we think of those multiple things as one, but they're not one thing, they're different things. If they were the same, they would have the same cure.

Parent knows he has a BH4 deficiency. Instead of calling that bi-polar, we could instead call it eg, 'bi-polar type 5' out of, say, 12, where 12 is the number of cures we've found for bipolar. Eventually, as time passes, we can map all if the cures, mapping all of the types. However, we can not do this if we think of an illness as a singular thing. This person has one specific type of bi-polar, and just because it only cures a subset of bi-polar patients does not mean it should be dismissed. It should be documented so we can have a list of cures.

Once there is a list of cures a doctor can walk through this list and eventually find the correct cure for the patient. Once everything is mapped it becomes possible to have a 100% cure rate. This is something no single pill can do.

This is why we should not force a one shoe fits all approach. It is toxic behavior to dismiss a solution just because it only works on a subset of patients. If I had bi-polar I'd be glad to know their story, so I could try it and see if it would work on myself. Dismissing psychological solutions is a toxic behavior we as a culture share. Let's do our part to make the world a better place and end this behavior.

This doesn't deviate from what I said at all.

Not everything said has to be in conflict. I'm guessing you're from Reddit? Welcome. ^_^

There's a reason which you chose to respond to my comment rather than creating a new thread or responding to a different parent comment.

I was unaware, so no reason.

> the layman suggesting that they know better than scientists/doctors is kind of dangerous

That's a strawman.

Thank you. Yes, a strawman and so frustrating since I literally have the metabolic and genetic proof that I found out what was causing my mood disorder. And as a result the doctors are providing better and different treatment. This what this "layman" discovered.

Do you or don't you have a disorder? In the first post you made in this thread you very clearly stated you don't. Now you're saying you do.

The problem with your post is that you very discretely stated that you don't have a disorder even though you admit to being bipolar. Despite the fact that your "difference" has pushed you to suicide attempts, psychosis, and more. The fact that an effective treatment for you specifically was a low protein diet (which by your own admission still didn't remove the requirement for medication) doesn't make it not a disorder.

The attitude is dangerous because you are spreading misinformation about something you are suffering from, which in turn can result in someone else being harmed.

The viewpoint that bipolar (and other brain differences) is a difference rather than a disorder can enable a person to have self compassion, and find peace and self acceptance, even though the condition will continue to affect them.

The idea that it’s a disorder and can be treated as such is a reasonable hypothesis for medical science to pursue, but that is all it is. Outside of that it’s just a source of stigma and misinformation.

The viewpoint is based in the reality we live in where we stigmatize abnormality. The correct response isn't to try and normalize abnormality, but to try and remove the stigma surrounding it. Suggesting that it is normal actually creates a stigma for those who are suffering from it from pursuing treatment because they're supposed to feel that way because it's "normal."

Who said anything about normalizing abnormality?

If by abnormality, you mean traits that are far from the center of a population normal distribution, then I agree that this is essential information for a person to have about themselves. Nobody is encouraging people to think they aren’t different from the norm, when they in fact are.

Abnormal, disordered, or diseased are very different things, and should not be confused.

As for treatment - nobody should seek treatment because someone else has told them they are abnormal, or because they are not close to the center of the bell curve for a given trait. This is simply a bad reason.

People should seek treatment if it will help improve their quality of life, and they are willing to accept the trade-offs that come with it. Whether they are ‘normal’ or not is irrelevant.

> Who said anything about normalizing abnormality?

It's implicit in the original comment i responded to.

> If by abnormality, you mean traits that are far from the center of a population normal distribution, then I agree that this is essential information for a person to have about themselves. Nobody is encouraging people to think they aren’t different from the norm, when they in fact are.

People are encourage others to think they aren't different from the norm, this is prevalent throughout society at large, not just in cases of mental wellbeing.

> Abnormal, disordered, or diseased are very different things, and should not be confused.

Disorders and Diseases are both abnormalities.

> As for treatment - nobody should seek treatment because someone else has told them they are abnormal, or because they are not close to the center of the bell curve for a given trait. This is simply a bad reason.

This isn't true. Symptoms can manifest without an individual noticing it themself. Another trusted person telling you about these abnormalities to your behavior or physicality is a perfectly valid reason to seek treatment, even if it doesn't result in anything.

> People should seek treatment if it will help improve their quality of life, and they are willing to accept the trade-offs that come with it. Whether they are ‘normal’ or not is irrelevant.

Which was largely my point from the get go. The exception being cases where their lack of treatment being a danger to others.

You seem to be someone who has a very deep trust in medicine and in particular psychiatry to produce good outcomes for people.

I can respect that difference of opinion.

I don't have a particularly deep trust in either medicine or psychiatry. My personal experiences with dealing with humans in either has been largely negative. That said, I largely attribute that to the people i've interacted with and not with medicine in general.

It’s unclear why you’d be such an advocate for unquestioningly seeking treatment if you neither trust medicine in general, nor have had good experiences with it yourself.

In no way do I think my symptoms are normal and just different. What I am saying is that what causes my symptoms is a different response to a similar environmental input that most people do not react to, ie, diet.

I want you to consider it being like an allergy, not that I have some sort of histmagenic response, just that when you take my trigger away I have no symptoms.

I only have the disorder when I have symptoms. You get it? Those symptoms are caused by my diet and environment.

I am not "Bipolar" because everyone is bipolar, every one has these states, mine are just more extreme when faced with environmental challenges.

If someone has a peanut allergy do they have a disease or a disorder? no, they have a different response when exposed to peanuts.

I use the term Bipolar Disorder because that is what people understand and it is the current medical terminology.

As far as your idiotic comment about the medication I need everyone and a while. Well, have you ever taken as aspirin for a headache? Same thing. The aspirin is only needed when you have a headache. Do you have a headache disorder still?

What I am suffering from was clinically diagnosed. I am no longer considered by my doctors to have Bipolar Disorder. Isn't that crazy!? After 35 years of being told this?

> If someone has a peanut allergy do they have a disease or a disorder? no, they have a different response when exposed to peanuts.

They have an "allergy," which is just another medical term like disease or disorder to define something which is abnormal which negatively affects life. If everyone had an "allergy" to peanuts then we'd just call them poisonous.

> As far as your idiotic comment about the medication I need everyone and a while. Well, have you ever taken as aspirin for a headache? Same thing. The aspirin is only needed when you have a headache. Do you have a headache disorder still?

No, because a headache is atypical, while bipolar disorder isn't, like other mental health issues. We define bipolar disorder differently from mood swings. If someone with epilepsy finds improvement in their condition from following a ketogenic diet, that is also them finding an effective treatment for their condition. It does not mean they don't have epilepsy.

> What I am suffering from was clinically diagnosed. I am no longer considered by my doctors to have Bipolar Disorder. Isn't that crazy!? After 35 years of being told this?

What's important ultimately is you found something that works for you and makes your life better for it. Your insights can be valuable but shouldn't be seen as prescriptive to people that aren't you.

You say bipolar is atypical, but you are wrong. I can go months with no symptoms, just like people with headaches can go months without one. Then I have a trigger; stress, diet, pollution, etc.

and I have never said that my fix was for everyone. Not once ever. It is that thinking that kept me sick for so many years in the hands of the psychiatrists.

Thanks for your insights and sorry for having supposed you had a less severe case, but all of that happened to you and you think it's not a disorder or a disease ?

Disease: A particular distinctive process in the body with a specific cause and characteristic symptoms.

Disorder: Irregularity, disturbance, or interruption of normal functions.

Syndrome: A number of symptoms occurring together and characterizing a specific disease.

I do not care which it is. I just focused on my symptoms and what made them worse and what made them better. To me is is a difference, that is the best way I can put it.

Stop labeling someone who doesn't want to be labeled.

> Spreading such misinformation can lead to people not seeking treatment and getting hurt.

Misinformation? Unless you have expert knowledge in that domain - and unless the alternatives podgaj describes have been exhaustively eliminated by a body of peer-reviewed research - you have absolutely no justification to label that as misinformation.

Calling bipolar disorder not a disorder and saying it can be self-treated with lifestyle & diet changes absolutely is misinformation. Ask any psychiatrist.

I do not need a medical degree to say that, in the same way I do not need a medical degree to say that self-treating cancer or any serious illness with diet and lifestyle change is misinformation and dangerous.

These statements taken as face value are incredibly dangerous. I have family relatives that did not seek treatment for psychiatric illnesses (actually diagnosed bipolar disorder) on the basis that it can be self-managed by diet, lifestyle accomodiations and "natural medicine" such as essential oils. They posed a threat not only to themselves, but to their 12/13yo children, almost stabbing them with a kitchen knive during a manic rage episode.

Bipolar disorder is not a difference in executive function, it is a debilitating, life altering illness which can makes the subject a danger to themselves and others if left unchecked.

This kind of misinformation regarding psychiatric illnesses kills.

I'm sorry about your family. But extrapolating from their uninformed use of essential oils to say that the psychiatrist's recommendation is always right is just swinging from one extreme to another. As podgaj said elsewhere,

> I literally have the metabolic and genetic proof that I found out what was causing my mood disorder.

We aren't talking about essential oils, or anything close. podgaj also says pretty clearly that the psychiatrist's recommendations were doing him no good at all. Don't let your personal grief harm others -- in this case, by denying that there is any alternative to using the antipsychotic medication that a psychiatrist would recommend.

> Ask any psychiatrist.

Only if the evidence is totally conclusive, as I mentioned elsewhere. Otherwise, asking a psychiatrist will only get you 10-20 year old data from the textbooks they read in school, and whatever they've learned to try and keep up to date since then. That's great when you have a fairly normal problem with a straightforward solution and no strange factors in play.

People seem to think medicine is more or less solved, like physics or computer science (ha) -- it's not. We don't even know why people tend to get colds in the winter! Even for that, the best we have are competing theories.

Here's an example: https://pubmed.ncbi.nlm.nih.gov/22340278/. It's about schizophrenia, but as a psychiatric illness it's close enough to illustrate my point. There were even bipolar patients included in the group, though they didn't contribute to these conclusions. A 20 year longitudinal study of 139 psychotic patients; here's a key quote (SZ is shorthand for schizophrenia):

> At the 2-year assessment there were no significant differences in severity of psychosis between SZ on antipsychotic medications and SZ not on any medications. However, starting at the 4.5-year follow-ups and continuing over the next 15 years, the SZ who were not on antipsychotic medications were significantly less psychotic than those on antipsychotics (p<0.05).

> In addition (see Fig. 1), starting at the 4.5-year follow-up and continuing at each assessment over the next 15 years, a significantly larger percentage of SZ not on medications experienced a period of recovery (p<0.01), which also requires adequate work and social functioning.

Dependence on experts can cause irreparable damage, too.

> and unless the alternatives podgaj describes have been exhaustively eliminated by a body of peer-reviewed research - you have absolutely no justification to label that as misinformation.

That's not how that should work. If I say that my farts cure cancer, it's not the job of peer-review research to disprove me, and until then we all just assume that the information I'm giving is good.

> until then we all just assume that the information I'm giving is good.

Fallacy of the excluded middle. There's other alternatives to a) saying it's outright false and b) saying it's outright true. I'm saying it shouldn't be labeled "misinformation" without extensive evidence to back it up, just as you're saying it shouldn't be labeled "truth" without the same level of evidence.

Instead, it's actually possible that we could discuss the theory as if it might be true, or false, until there's sufficient evidence to rule out one or the other. It's Pelic4n's refusal to do this that I take issue with.

Ok, so misinformation may be too strong a word - really it's just unfounded, so that labeling IS wrong. I still think we need to treat it as false until we have evidence it works. I'm sure you wouldn't treat my farts as curing cancer if I made the claim unless there was proof.

Glad we agree on the essentials. There was anecdotal evidence to back up the claim, however; it's not "unfounded." While that's not enough evidence to make any real claims, it is enough evidence to have a conversation.

A conversation is a prelude to an exploration, and an exploration is a prelude to a hypothesis, which is the beginning of an experiment. An experiment is where we obtain the evidence to begin to say that it might be true, or false.

It's entirely possible to think about something and even discuss it without labeling it as either true or false - to be simply agnostic. We don't need to jump to conclusions. If we aren't jumping to conclusions, then it would be incorrect to say that we treat it as false, just as it would be incorrect to say that we treat it as true.

I recommend looking into the few longitudinal studies for dopaminergic illness involving anti-psychotics -- the new "front line" bipolar treatment -- and long term prognosis. The severity and frequency of episodes increases.

Here's a personal anecdote of the moment when I realized that perhaps mental disorders are not disorders at all:

A few years ago I had a job that made me deeply unhappy. The unhappiness came about gradually, but in my last year there it was overwhelming. In my last year on the job I spent a good chunk of my working hours holding back feelings of deep frustration and anger over how things were progressing and over how I was being treated by my boss and by a few coworkers. At times I considered going to see a therapist, but in the end I opted for a more direct solution - I spontaneously quit the job.

Even though my financial situation became a lot less secure, my state of mind improved greatly. I started sleeping better, some stress related physical symptoms went away, I started working on personal projects that I had been neglecting etc.

I'm pretty sure that, had I gone to the therapist, I would have been diagnosed with some sort of depressive disorder and probably would have been prescribed some sort of medication. I probably would have still been in the job I actually hated and I wouldn't have made as much progress in understanding what I actually wanted from my life.

> I probably would have still been in the job I actually hated

If modern psychology has any goals, they are 1) to keep you at work with minimal days off and high productivity, and 2) to keep you from annoying your family. You would have been a success story.

I had a similar situation, although I had already been diagnosed with anxiety and depression multiple times. Medication never had a positive impact other than temporary fixes for anxiety so I reject any daily antidepressents.

Last year I was in a similar work situation but did decide to go to therapy as a kind of check to see if my feelings seemed warranted or if it was maybe something else.Ultimately decided to leave that job. It took 8 months for me to figure out what I wanted to do and actually start working again.

Extremely happy I made those decisions as I've doubled my salary, left an industry that was wrecked by COVID and got into one that has had accelerated growth for the same reason. I think it's good to trust your instincts, even though we both made different decisions they seem to have been the right ones for our particular situations.

This is like saying people with heart disease do not have a disease because they stopped eating poorly and the heart disease went away.

You did have a metal disorder. You were just lucky to find the cause. The cause was job stress.

I have a mental disorder that was harder to find the cause. But I did as well.

> You did have a metal disorder. You were just lucky to find the cause. The cause was job stress.

You could phrase it that way, but the fact remains that for me, I feel, there was an objective external cause to my unhappiness. It wasn't a spontaneous and inexplicable 'chemical imbalance in the brain'. It was a reasonable reaction to a shitty life experience.

> I have a mental disorder that was harder to find the cause. But I did as well.

Indeed I may have stated my conclusion too broadly. I'm sure there are problems out there that can't be fixed by changing your lifestyle/job etc. and that may require serious effort, therapy, medication.

But you see, I was hospitalized several times for my mood disorder. I have come to find out that there was an objective external cause of that as well.

The problem is not with the psychiatric "cures", the problem is the psychiatrists. It took a test to LOOK at my brain chemistry form them to see what was going on with me. It took 25 years of convincing them to give me the test. THAt is the disorder.

Shitty life experiences, and almost every environmental input, will affect chemicals in our brain and body. I mean, how do you think saddness happens? It just appears out of no where? NOPE.


>Shitty life experiences, and almost every environmental input, will affect chemicals in our brain and body.

I think that is a key point many people fail to see. Our present moment (including our thoughts and beliefs in the present moment) determine what chemicals get released in the brain.

Calling something a chemical disorder is overlooking correlation is not causation. (That does not imply pills can not be helpful and should not be considered.)

Did you end up finding a cure on your end? What was it?

I was recently diagnosed with a genetic condition, GCH1 deficiency, which lowers the amount of serotonin and dopamine I make and increases the amount of trace amines. (Trace amines are similar to methamphetamines.)

Heart disease means presence of plaque in arteries, it is physically verifiable, the plaque is physically stuck to the artery walls and is much harder to get rid of. If you are doing something that makes you unhappy because you really need the money and then as soon as you stop doing it you are happy again, I really don't see how you can define this period of unhappiness as a mental disease.

Depression is not just being unhappy.

> I'm pretty sure that, had I gone to the therapist, I would have been diagnosed with some sort of depressive disorder and probably would have been prescribed some sort of medication

100%, everything is a nail to them. Diagnosis is really not that rigorous.

It's amazing to me that the very first course of action suggested is not lifestyle changes, but medication. But money talks and here we are with over-medicated nations.

I think people just need to realise that depression is going to come from when the stressors in our environment overwhelm our ability to cope. It's not just something that arises from out of nowhere for most people. For instance I bet a great swathe of the unemployed would not be depressed if they had a job.

Sounds like you were able to adapt and start doing things that would reduce your stressors.

However I don't think its a 100% correct to equate therapy with medication. If you visited a clinical psychologist they would have probably worked on increasing your awareness of stressors, thoughts and how to increase your ability to cope with them.

Edit: And I just realised you may not have actually had a disorder of any type. A psychologist would have been able to assess you and see if you were just in an acute situation or not.

>For instance I bet a great swathe of the unemployed would not be depressed if they had a job.

I think this is worth a rephrase. Something like:

I bet a great swathe of people wouldn't be depressed if they didn't have to trade their time for food and housing tokens.

I suppose I am speaking from experience. I feel no financial pressure but am greatly unhappy after being made redundant. Work gave me purpose that is hard to replace.

I agree, and this is why I say the majority of mood disorders are environmental, even ones as bad as mine.

That is an unconvincing rephrasing though. The benefits of hard (rewarding?) work to mental health seem obvious [to me subjectively ofc]

It seems you're equating the requirement for a job with hard and rewarding work. What makes you think people won't do hard or rewarding work without the forced incentive of housing? What makes you think most people are doing "hard" and "rewarding" work at their jobs?

incentives drive outcomes- incentives to work cause people people to work [paid or unpaid, for pleasure or profit]. I wasn't making judgements on the reasons we need to work, only taking issue with the idea that working was causing depression.

The sad fact about anti-depressants is they prolong depression for the average person who takes them. Yes, the average person recovers from depression without anti-depressants, but taking anti-depressants stifles that.

I can only theorize, so grain of salt, but I've noticed people who are on anti-depressants are less likely to work on their issues, improving and growing. Many get satisfied in that semi-depressed state. This might be why taking an anti-depressant can prolong depression.

I've had something similar, not depression or whatever, just not feeling in the right place at work. I was offered an (external) career coach to help with it, also because I didn't really want to quit because it was a fairly cushy job with high potential to be challenging. But it hadn't been challenging or gratifying for two+ years at that point.

The tldr with the career coach was to do more about it myself (very generic I know), eventually last year I looked for jobs critically and found one that ticked a lot of boxes. I'm pretty content right now.

Sorry man, the therapist can't prescribe. You are free to read "The body keeps the score" to understand why everything you wrote is wrong/false.

To the downvoters:

Things in life are in different levels. Your knee may hurt a little, you may tear 1 ACL in your knee, you tear all ligaments in your knee, your knee got chopped off, etc etc.

Going to the doctor, doesn't 100% mean your knee will go into surgery. Sometimes, you may just need a professional consult, etc etc.

Telling somebody else they are wrong about their own personal experience deserves a downvote, which I don't have enough points to give you.

Here's a personal anecdote when I realized that perhaps "knee medical issues" are not "medical issues" at all:

I was once running and my knee started hurting. I kept running and it kept hurting. I then saw that the reason my knee kept hurting was because I was using the wrong shoe, or was running not at the right form. After I changed these, the knee didn't hurt no more.

Had I gone to a physiotherapist or an orthopedist, they would've put me into surgery for ACL/MLC reconstruction and 6+ months of therapy so my knee worked again.

I would still be running after the surgery, not understanding why my knee would hurt. I wouldn't have made as much progress in understanding what I actually wanted from my knee.

The reason your assumption doesn't ring true while leto_ii's assumption does is that we have a much, much better understanding of the knee than we do of the human mind, and much more objective tests for knee injuries than for depressive disorders.

So your assumption that you would have been given surgery seems extremely unlikely, while the assumption that a person with depressive symptoms would be prescribed psychiatric treatment rather than being recommended to leave their job seems possible.

For your anecdote, I would expect that you would be given a physical exam and then some kind of imaging investigation before proceeding to surgery. Even if the doctor you went to was incompetent during the physical scan, the imaging would very quickly show whether there is a need for some kind of surgery. Unfortunately, we don't have any equivalent tests for psychiatric problems. If your psychiatrist is incompetent, you may well be prescribed medication that other psychiatrists may have found unnecessary, and your only recourse is to trust your own judgement above theirs (which has its own problems, if you already suspect you have a mental disorder).

Of course, per their story, leto_ii didn't seek professional help, so we can't know what the professional conclusion would have been. Have you ever heard though of psychiatrists recommending job changes to their patients? More so, recommending they leave their job on the spot, without securing another job before hand?

How do you know they wouldn't have told you to use better shoes or better form? This isn't even an anecdote, it's more like half of one.

> everything you wrote is wrong/false.

Well now, this is a bit too harsh. I presented my anecdote as such, not as some universal conclusion that applies to everybody and every life situation.

> Going to the doctor, doesn't 100% mean your knee will go into surgery.

You are right. I do however feel that psychiatry is not exactly as much of a science as other medical fields. I'm not convinced that what is considered a disorder according to the DSM is exactly as much a disorder as, let's say, a vision defect. I'm also really reluctant to try out medication that will alter my mood and mental acuity in unpredictable ways. As much as possible I would prefer to not take things for years and to not end up depending on them for good functioning in the world.

This feels so obvious. 30 years from now, we might very well look back at these labels we applied to people, implying something is wrong with them for responding to their negative circumstances, and feel like we were living in the dark ages.

When we see historic rises in mental disorders following an external event like the coronavirus pandemic, is it not something we should reasonably expect? I can accept that some sliver of the population has an unreasonable reaction to something like this, but for most people, it isn’t a problem in their head as modern psychology tends to imply.


I remember reading about the first expeditions to the Artic by the Royal Navy in the 19th century - they initially found some sailors exhibiting the symptoms of being drunk and would punish them harshly. It took them a while to realise that the symptoms of severe hypothermia and drunkenness are actually pretty similar....

See: https://www.goodreads.com/en/book/show/878082.Barrow_s_Boys

I hope so, and that what we now call depression will be considered as silly a moniker as hysteria or "troubled humours" back when.

Exactly. When it comes to depression the chemical imbalance theory comes from Zoloft. It is a drug that accidentally had the side effect of reducing depression in some patients. Curious scientists wanted to figure out why, so they examined it. Turns out Zoloft boosts serotonin in the brain. This created the chemical imbalance theory, but since then study after study for decades has disproved this, yet for some sort of reason the theory stays in the mainstream.

Ibuprofen can cause an ulcer. Imagine some primitive ape sees this blood loss and assumes the blood loss is what reduces inflammation. The Zoloft serotonin study follows the same faulty logic.

You might be interested in Johann Hari's Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions, who really looks into this and how depression is diagnosed and treated, as well as why it may actually be the 'adaptive response' suggested above.

The money quote:

> Study author Kristen Syme, a recent WSU Ph.D. graduate, compares treating anxiety, depression, or PTSD with antidepressants to medicating someone for a broken bone without setting the bone itself. She believes that these problems “look more like sociocultural phenomena, so the solution is not necessarily fixing a dysfunction in the person's brain but fixing dysfunctions in the social world."

This is EXACTLY what Kaczynski said:

> The concept of 'mental health' in our society is defined largely by the extent to which an individual behaves in accord with the needs of the system and does so without showing signs of stress ... Instead of removing the conditions that make people depressed, modern society gives them antidepressant drugs. In effect, antidepressants are a means of modifying an individual’s internal state in such a way as to enable him to tolerate social conditions that he would otherwise find intolerable.

Kaczynski ends up positing a kind of return to the natural state as the ultimate solution (which he basis his actions on). The issue being that historically, these problems existed in earlier times even if not discussed in detail. Kaczynski blames "the state of the world" without ever listing some state where the problem didn't exist.

> “Research on depression, anxiety, and PTSD, should put greater emphasis on mitigating conflict and adversity and less on manipulating brain chemistry.”

Whereas Kaczynski blames society, the world at large, the paper sets these up as smaller addressable issues. You can identify "kid B needs extra recess" more readily than abolish schools as Kaczynski calls for.

He's a pretty agreeable guy if you ignore all the bombings.

Yeah and also what psychoanalysts have said for the last 100+ years. All Kaczynski offers is a normative stance.

Insights from psychology today from an article originally in Forbes.

About the Author: A pediatrician and writer, Dr. Escalante is on a mission...

+1 but let’s see where your comment ends up ranked in the thread at days’ end.


"Dr. Escalante understands because she is a recovering worried mother herself. "

I am tired of people prescribing their cure to everyone else in the world. Great, it worked for her. And I get it, the whole world is neurotic, but to say it is not a disorder is idiotic.

If I make a mess of my room, it is just disordered. It is just that simple.

I would recommend people watch this lecture by Stanford professor Robert Sapolsky, who studies these things in depth and is an actual expert.


There is a lot of arm-chair thoughts on this matter in this thread, and I feel this lecture sets a lot of things straight.

A helpful quote from the talk: "...the single point I want to hammer in here over, and over, and over, is something that people with depression constantly battle with. Back to semantics, we all get depressed. Bad stuff happens to us. We all get depressed. We feel lousy. We feel withdrawn. We feel a sense of grief. And we're not taking much pleasure. And we withdraw. And then we get better. We cope. We heal. We deal with things in life. What's the deal with you that you can't do that? And there's this lurking sense given that all of us have periods of being depressed and come out the other end. When you look at people who instead go down and stay down there to this crippling extent, there's always this little voice between the lines there of, come on, pull yourself together. We all deal with this sort of thing. I will make the argument throughout here that depression is as real of a biological disorder as is juvenile diabetes."

Honestly, this squares with personal experience. I've had long periods of anxiety, which I'd describe as perceiving outside things as greater threats than they are, excessive worry and overthinking and withdrawal from outside world. I've also endured depression, that is overmuch despair and lack of willpower to complete even simple tasks.

It plagued me for years, badly affecting much of my personal life. I had some therapy (for 3 months), and interestingly a doctor actually voiced the same view put forward in this article. I never took medication.

Latterly, after gaining more life experience and connecting some dots, I realised much of this was fed by my environment when I was growing up. I realised this comparing outcomes with others who had stabler, supportive homes. Bad circumstances leading to social ostracisation, which meant I never developed social skills well, which meant I always dreaded social contact. This fed an endless anxiety cycle.

After ten painful years, wrangling and working through it, I've eventually managed to make better friendships. As a result, my anxiety has dropped and my overall social ability improved. Nowadays, social contact has been reduced and I've been forced to stay in my childhood home thanks to "lockdown". Curiously, I've once again had more of the depression-like symptoms.

I wonder how much of these afflictions are brought on by poor family environments, and even when they are stronger the parents providing little personal input into children's lives. Lack of community generally and increased personal isolation. I'd put it forward that medicalisation isn't the answer to all of life's woes, or the problems we face individually or collectively.

Trying to decide if mental disorders are disorders or adaptations is a false dichotomy. They can be both. For example, the 'dark triad', narcissism, Machiavellianism, and psychopathy, can help an individual succeed. Studies have shown that women are attracted to these personality traits in men.

On a group level, anxiety in individuals may be evolutionarily advantageous to the group while being disadvantageous to the individual. If a person is hyper alert, it may help the group to become aware of danger but cause tremendous stress to the individual.

The key criteria for something to be called a psychological disorder is it has to hurt the patient in some way, causing them a disadvantage in life.

To flesh this out:

>Studies have shown that women are attracted to these personality traits in men.

Woman are attracted to men who are as successful or are more successful as them. NPDs and ASPDs (though more rare than NPDs) can fake being successful and others fall for it. This relationship is often short lived once they realize they were tricked.

The most common form of employment for someone who is ASPD (what you're calling psychopathy) is being a homeless alcoholic. The second most common is being in prison. The leading theory is ASPD is an adult who did not grow out of their terrible twos. This does not help an individual succeed in any shape or form. ASPDs do not and can not maintain relationships for a long period of time, and the few high functioning ones not in prison or homeless roam around like nomads from town to town leaving once they are no longer welcome.

Machiavellianism is a philosophy or a set of beliefs. It is not a psychological disorder. It does not harm the belief holder. Machiavellianism is a sort of game theory on a macro nationwide scale.

I can continue with NPD (narcissistic personality disorder), but I can assure you in the long run it does not benefit them. They believe manipulating people is better for them and will jump through mental hoops to justify their behavior to themselves. When someone is thought of as a con artist or a gold digger, that is most likely someone who is NPD.

>On a group level, anxiety in individuals may be evolutionarily advantageous

Anxiety is assuming (usually unconsciously) a negative outcome will happen. It's a danger feeling. When anxiety moves from a rare feeling to a disorder, it's because they're overly assuming/believing faulty futures. This can come from faulty logic, or being told incorrect beliefs during childhood, or many other situations. Anxiety as a disorder has no advantage to the user.

As someone on disability with a mood disorder I can say without reservation that that article was mostly horrible.

I will agree with them that there is a mismatch, but the mismatch is between each individuals genetics and environment. so they are still disorders, it is just that they have not found the right treatment.

And as someone who has been hospitalized several times it is amazing to me how little testing they do for people with serious mental illnesses. It was not until after I had to learn genetics and neurobiology that I forced them to give me a simple serum amino acid test that showed something atypical was going on. Turned out I have a BH4 (tetrahydrobiopterin) deficiency that limits the amount of serotonin and dopamine I make. BH4 deficiency has already been show to be a cause for anxiety and depression.

So Mood Disorders are all environmental illnesses. I am off of all my medications and I control my mental health by diet and environmental changes. But some neurological damage has been done that I might have to live with. So you youngins heed my advice, if something feels bad, don't do it.

We could rationalize an opposite hypothesis as well, perhaps they are adaptive responses to lack of adversity. It would be interesting if a good experiment can be formulated to figure it out.

One rationale is that life for billions of years and humans for millions have faced harsh conditions never letting us rest and relax for long.

So if we are sitting still, relaxing, often it meant something must be wrong(physically or mentally) and in less sympathetic times mental illness would encourage culling, either by the tribe or yourself to ensure the limited resources were spent on people who are contributing more physical action.

Roles that didn't have to deal with as much adversity obviously formed eventually, but they took a long time to stabilize, likely being poorly tolerated in most ages, and if the hypothesis was true, were plagued more with the OP's issues.

I have had similar thoughts. I think that's why exercise is so much more effective than medicine - it's making your lower physiological self think that you are doing something important and exciting. It also explains why people get so invested in the drama of others. In economically developed countries, we have far fewer life and death situations that help us appreciate it when things are going well.

The other difficulty is that our higher order functions know that exercise is, in the short term, a waste of energy and time. It's not getting us any more resources. I include myself in the subset of people with impulse and procrastination issues, which makes it very difficult to invest in things that pay off over the long term. Depression for me is being stuck in that hole, knowing there may be a way to feel better, but believing the world would be better if I was dead. Maybe my evolutionary contribution would have been as a martyr if I lived in a different circumstance.

More generally, healthcare suffers from the idea that there is "a" population. Our brains and bodies are unique, and until they can identify types of brain patterns and perform studies against those, it's really throwing pills at someone and hoping for the best. Some parts of science have entered into a dangerous dogmatic phase of "this is how we've always done it" which is the opposite of the point.

I would really like to see the mental health community rally behind getting people into recovery-style support groups where people encourage each other to socialize, eat healthier, and get more exercise. That would put all three of the most effective ways to fight depression and anxiety into practice. Of course then the problem is that prescribing virtually free services isn't in the economic interest of for-profit systems.

This strikes me as a pretty clumsy article.

> What if mental disorders like anxiety, depression, or post-traumatic stress disorder aren’t mental disorders at all?

Of course they're disorders. That's why they deserve treatment. This bears no connection to the question of whether they're adaptive. Our capacity for physical pain is adaptive, but doctors still treat pain.

> With a thorough review of the evidence, they show good reasons to think of depression or PTSD as responses to adversity rather than chemical imbalances.

Besides clueless commentators on the Internet, who is suggesting depression is simply a matter of 'chemical imbalance'? If that were the case, it wouldn't be brought on by loneliness, and it wouldn't be treated with CBT and talking therapy.

> Besides clueless commentators on the Internet, who is suggesting depression is simply a matter of 'chemical imbalance'? If that were the case, it wouldn't be brought on by loneliness, and it wouldn't be treated with CBT and talking therapy.

Most of (all?) chemical depression treatments are based on the serotoninergic depression hypothesis that has never been verified. In the recent years more and more arguments come directly against this hypothesis. Yet SSRIs are still the first line of treatment for depressive patients.


And who is to say CBT does not effect chemicals in the brain and body! Of course it does! everything environmental effects the chemicals in our body. If you give someone meth they will have anxiety, if you drink too much you will have depression.

The state of understanding the gene-environment interaction is so backwards and slow to catch up with the science it is a crime.

So much of what we think is knowledge is actually just a construct to allow someone to make some money. You cant make billions of dollars selling pills through educational reform. Carbs have a longer shelf-life, high profit margin and are hunger inducing so fat was demonised. Recycling doesnt work because its not cost effective but the plastics industry pushes it to shift responsibility away allowing them to fill our world with garbage. You cant make money with treatments out of patent so meds like chloroquine are demonised with cherry-picked research. We are swimming in an ocean of garbage presented to us as fact.

PTSD is quite obviously a response to adversity, that is already implied by the name! What am I missing here? Why is this news?

The point is whether it's adaptive, i.e. whether it has evolved because it is beneficial (such as our pain aversion), rather than arising as an unfortunate bug in the system (such as cystic fibrosis, a genetic disorder which seems pretty clearly not to be adaptive).

Of course PTSD is beneficial: it gets you discharged from military, for example, so the chances of you being in the situation where someone is shooting bazooka at you drop to zero.

In general PTSD helps you avoid traumatic experience in future.

In many interpersonal relationships, a trauma response causes you to become more liable to ending up in the same situation, not less. Do not underestimate how many people end up reliving their trauma over and over because they can't overcome that response.

Extra points for using the word "bazooka".

So why didn't anxiety, depression and PTSD abound in historical societies that were always at risk of some bad thing (usually famine but also sometimes invasion)?

Bad stuff has always happened and always will happen. Something about modern society makes us bad at dealing with it in a healthy way.

I don't doubt that there might be some mismatch between the environment our biology is optimized for and the one we live in now but it seems like these conditions weren't common, or if they were they weren't a problem, among our ancestors who lived under different circumstances.

Besides raving on and on about ADHD, the article offers little actionable stuff, dubious reasoning and outright falsehoods at places (like the fact that antidepressants are no better than placebo).

I wouldn't say that that is a false statement, there's been a bunch of research in the area, mostly started by this paper: https://www3.nd.edu/~ghaeffel/Kirsch2002%20Prevention%20&%20...

Note that the above is an analysis of the data used to approve the medications from the FDA, so likely to be optimistic.

The headline finding is that compared to an active placebo (i.e. one with similar side effects), the benefits of SSRIs are very small.

However, if you have a diagnosis of MDD, there is more evidence for an effect (although it's still pretty small).

It's a difficult subject to study correctly, because of the strong commercial pressures (like most drug studies, to be fair), but depression does seem relatively placebo responsive, which would suggest either a connection to inflammation or the body's opioid system.

This does not mean that people should stop taking anti-depressants, I'm not a medical doctor etc, but there is some research to support the assertion around SSRIs and placebo in the article.

I used to get severely depressed, and it was often stress-related; adversity, work, even sickness would make things worse. I completely changed my lifestyle and started working out almost 3 hours a day (walking counts)in addition to removing carbohydrates from my diet almost entirely. After this change, I only get depressed for a second, then I realize I can take action, and then I take action, and it leads to happiness.


my personal theory is that it's related to bacteria in your gut--working out helps promote a good gut microbiome (this is well studied) and removing carbohydrates removes all those bacteria such as lactobactilla which will literally cause psychological changes, these bacteria are part of the metabolic process converting carbohydrates to blood glucose, and they are literally interacting with the nerves in your gut making you feel depressed. It's a biological thing. Psychology never helped me, instead it actively harmed me. The lectures of Robert Sapolsky and the concepts of cognitive behavioral therapy helped the most from the psychological perspective, however. This combination of advice is purely anecdotal of course, but all the steps I took have been widely studied. It's hard to create an industry around the removal of a product, I guess.

"When it comes to what labels we use, a change is welcome. Mental health recovery in part depends on whether patients believe they can get better. Telling our patients that their symptoms may be tied to a healthy response to adversity could be very encouraging."

I find it the exact opposite. For me it seems easier to fix a mental disorder in my brain than to bring the necessary sociocultural changes in the world to mitigate my problems.

This will help a lot of people avoid unnecessary anxiety and shame/guilt.

It took humans thousands of years to adapt to the side-effects of the agricultural(Neolithic) revolution (https://www.discovermagazine.com/planet-earth/the-worst-mist...). I think we are in a similar situation—psychological revolution?—where the side-effects due to social media, globalization, and other related phenomenons are starting to change the landscape. My guess is we will soon see that the plateau we have attained in the form of psychological disorders will slowly fade away in couple more generations as people start adapting to this kind of stress. Maybe our generation is evolution's transition point? At least I hope that it is, I've never seen this at this level of intensity with my grandparents'/parents' generation and I do not want to see this with the next generation.

Anxiety & depression might be useful if handled well but if not...

The problem is often on the line of you get depression & anxiety as a symtom of some other problems if you fix the problems fine. If you don't it can get out control and then you can become conditioned to do "bad" responses to all kind of things making the symptom a illness itself. And making it really hard to get out of it.

Or at least this is how it often did look like to me when I looked at people with depression & anxiety.

Just to be clear with "bad" responses I mainly mean thinks like avoiding problems instead of fixing (or sidestepping) them making it with every time you do so harder to "fix" that underlying problem in the future.

“there is little in our evolutionary history that accounts for children sitting at desks quietly while watching a teacher do math equations at a board.”

In the section that discusses labels, I am particularly struck by this quote. So many things in our evolutionary history seem contrary to the way we live, learn, and interact. Perhaps this is the catalyst that ignites the evolutionary flames. I often think that we are just hitting our heads against a wall and expecting different results other than a bloody head.

The ACE (adverse childhood experiences) study might be one of the most important health findings since Germ theory. In the sense that it finds a true root cause for a lot of health maladies, as well as physical mechanisms that cause these health issues in traumatized kid (all animals respond maladaptively to stress hormones introduced too early in development)

I’d recommend people read “The Deepest Well” - a great book on this topic.

"Anxiety may be due to chronic activation of the fight or flight system. PTSD may occur when trauma triggers the freeze response which helps animals disconnect from pain before they die, and depression may be a chronic activation of that same freeze response." Isn't this a quite good definition of disorders? If a system is chronically activated when it should not, it seems like a disorder.

This is an interesting read on a similar take on major depression,


I'm not a psychologist but this feels pretty intuitively self evident to me. Did anyone ever think otherwise?

Another thing to think about is that these responses may cross generations. i.e the anxiety someone experiences today may be due to trauma suffered by thier grandparents. The mind is a wonderful thing, but there is so much that we don't understand about it/ourselves.

This happens through epigentic changes, not through the mind or the brain.


Couldn't a person have a biological makeup that predisposes them to experience greater or lesser adversity? If mental disorders are adaptive responses, that doesn't seem to rule out that some people may be more prone to interpreting situations as adversarial.

Yes of course one could have more or less of a response. Situations and circumstamces (we’re talking about entire lives worth of experiences) vary so much though that it would be impossible for an outsider to state you are weaker based on the limited knowledge you can have about another person.

Well we surely did not evolve to be happy and content, that’s for sure. Sounds to me like a good bet that most mental disorders are adaptations to adversity in evolutionary time, that are often maladaptive in modern society.

Younger boys who get a lot of exercise consistently perform better in school on average. The "problem" is that girls don't need as much exercise. Coordinating the difference confounds US schools.

Ah yes, yet another occurence of adaptationists trying to shoehorn literally every single trait into their framework. It's basically intelligent design that doesn't say its name.

when these conditions persist after the adversity has passed, that's maladaptive.

Is a leg that remains fractured after a physical shock has passed also maladaptive?

if it doesn't heal in some reasonable amount of time after the trauma and remains fractured indefinitely, then yes.

How do fractures heal without proper medical care?

The "just walk it off" method fares poorly.

Magaret Mead uses this for her exemplar of civilisation foe a reason.

for many fractures, yes.

fractured usually ribs heal by themselves.

I once had a broken, displaced rib. Nothing was done except to let it heal by itself

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