Garzik: An Andre To Remember(lwn.net) |
Garzik: An Andre To Remember(lwn.net) |
I've got clinical depression. What this means is that there is something fundamentally wrong in my brain that causes me to be depressed. There is no direct environmental cause that makes me depressed. Now, here's what many people get wrong about severe depression:
Severe depression does NOT mean that exercise, a healthy diet and getting a social life won't help at all.
Rather, depression completely drains your motivation to do any of those things. Which in turn make you more depressed. Which makes you even less likely to do any of them. And so on and so forth. It's 'positive' feedback, but it starts with a neurological problem. This is why all the 'cheer up'-sort of advice doesn't help people who're depressed, and why it tends to only make them more miserable.
Of course, this is only my experience. I'm quite sure there are plenty of people who are depressed for reasons found in their environment, and then get stuck in the same loop. But it would be ridiculous to presume that I'm unique in this regard.
Something which also adds to the problems is that people so often condescend - 'you won't feel better unless you do X, Y or Z' and actually essentially accuse you of bringing it on yourself. And a lot of the problem is the guilt you feel about everything, so it's the worst possible thing you can do for a depressed person.
I find having some project that gives you an output is important, to contradict the standard 'oh don't spend so much time on a computer project' points. The alternative a lot of the time for me is spending all day in bed because I feel so low, so having an outlet matters. But of course you then find it hard to balance that.
Having said that, all the standard healthy advice is important too. It's just really important to differentiate between mild and severe depression - it's like the difference between having the flu and people recommending painkillers and having a serious chronic disease. The advice is good for mild depression but really not going to touch anything for the severe variety.
For people who are lucky enough not to suffer from severe depression - don't presume to know what it's like because you've felt a little bit low before.
/rant
But when we look at depression diagnosed by experts we see a variety of forms, and a variety of strengths.
I agree that well meaning people sometimes offer really bad advice.
But advice about developing a healthy lifestyle (being careful with caffeine, alcohol, recreational drugs; eating better; sorting out sleep; getting exercise) and developing a social life are important, because these thing help people with very serious, life threatening, illness. In combination with therapy they can be part of an effective cure for many people. (At least leaving others with several years of recovery). If needed, this advice can be combined with medication. And, if needed, all of this stuff can be started if the patient is in hospital. (At least in England all MH hospitals should have programmes of OT to start social life outside hospital and they should have some kind of exercise stuff, and contacts with local gyms.)
I've known people who are ill enough to require electro convulsive therapy and they said that this other stuff was important to them, but that they needed help to apply it.
And that's the important thing. Saying "I am to ill to do this stuff" is not the same as saying "this stuff would not be helpful to me if I did it". What people need is help to apply this stuff.
In my case, environmental changes ensure that it won't show up again as strong or as fast. I'm pretty sure I don't need medication right now.
But that's not to say I'm cured by any means. Just that I'm doing better and finding ways of coping with it.
> There is no computing project that is worth your life. Turn off the computer. Seek help. Get outside, enjoy the green grass, the birds in the trees. Talk to people you know. Talk to strangers! Drive to Wisconsin, and find out whatever it is they do there. Build a treehouse. Park on a parkway and drive on a driveway. Make a macaroni necklace. Visit a dairy. Climb a rock. Seek life.
Every point except for Seek Help is just "cheer up, pal" bunk.
This is advice for someone who had a bad day. This is not advice for someone who is depressed! These suggestions assume that the person has hope. Or even considers the possibility of ever having hope again. There's just no way I can tell someone who hasn't been on this train what it's like to ride it. It's like being dead in a way. Would you tell a dead man to get out and enjoy the grass? It's a bit like that.
These days I think of programming the way I think of working out: intense bursts of focus on creativity for maybe 2-4 hours if I'm lucky, and then hours to days of melancholy because the tools and methodologies I'm using are all garbage.
Examples of mainstream trash: ios, objective-c, flash, php, c++, 802.11, usb, xml, html5, mpeg, mp3, dram caches, opengl, just on and on and on. Literally every tool I use on a daily basis, every file format, every communication protocol, everything, all fatally flawed in some way. My life has been an almost complete waste.
I don't know much about IDE/ATA but it must be quite a garbage dump to traverse. Turning that into something clean like a socket/file reference is remarkable. Just think of all the things that don't work on hard drives: how they fail to write the last bit of data in a power failure or maintain directory consistency, how they were so far behind on caching and hybrid flash/platter drives, just on and on, a tower of babel of remarkably cheap but inadequate hardware. Dealing with that, and the layers of politics that perpetuate such monstrosities would be enough to drive a person mad.
Thank god I'm not depressed though. I was severely out of it from 2000-2010 for a lot of obvious reasons but I finally let everything go and have never been happier. I. Am. Not. Depressed. It's glorious to say, I feel it all the way to my core. Life can turn around, and one day you'll wake up and realize that you don't give a crap about solving the world's problems anymore, because it's all too far gone. It's not your fault. Just find your niche and reach some level of sustainability, and save the world later.
If you feel like making a difference I'd recommend donating to the Brain & Behavior Research Foundation. They fund studies into mental health disorders, an area of science that is still only vaguely understood.
I think though that mental illnesses are a lot more common than we realize, and to some degree society is actually breeding them. It's a very complex topic though, so take that as an opinion, not as facts or anything.
Towards the end of my internship, I was there until 10 PM some days working on code. Andre would see my cube lights on and come over to talk to me. Considering how I was just working all alone when there that late, I really appreciated the brief talks, as they provided me when an opportunity to think about something other then the problems within my code for a few moments. He would often share a few technical tips or an interesting story with me during our conversations.
Although I didn't work with him much, it's disappointing to hear of his death. It seems like most of the comments in here (on HN) are regarding mental illness -- something which I never observed during the brief period of time that I knew him. Regardless of his reason for taking his life, I'm glad I had the opportunity to meet him and thank him for those brief conversations.
What does that mean? Nothing, except I completely see myself in Andre's description. What am I doing about it? Exercising, reading affirmations, trying to watch the diet (tough when broke) etc, etc.
But I read Andre's story and it makes me very sad.
He was working in patent law in NYC for a few years, and then abruptly quit and moved back home. He said he had some ideas on businesses, and it seemed rational. He started venturing into religion, not for the sake of religion, but to explore the concept of morality. He didn't have a Jewish background, but he became very interested in Judaism because of it's views on morality, and I even bought a book on the Talmud at his insistence, so that we could talk about it. We would have pretty elaborate discussions on morality, etc, over email. He was engaged to get married to a lovely girl, and things looked fine.
Then, just before they got married, they abruptly cancelled their wedding. I emailed him, and I asked him "How are things going? Enquiring minds want to know!"
His only response was "Who are these enquiring minds that you are asking on behalf of?" We exchanged a few emails after that, he accused me of being immoral, and then I never heard from him again.
I contacted his fiancee, and apparently he was exhibiting signs of paranoid schizophrenia. He had become increasingly paranoid over the last few years, and become more and more disassociated with reality.
After that, he basically disappeared. He was always a bit paranoid about leaving his mark on the Internet, and had multiple fake email addresses, so trying to track him down was basically impossible.
Last year, after many years of no contact, I got a phone call from him, presumably from a number that wasn't his, because he had recently realized that in one of his discussions on his business over 10 years ago, he may have gotten me to agree to terms that would have been personally unfavorable, and he wanted to release me from all obligations from this agreement. I didn't know what he was talking about, but we never did anything more than talk about things, and his "businesses" never amounted to anything except talking. But I agreed to be absolved from those obligations. Then asked how things were with him, and he was extremely vagued, and then hung up on me.
It's very sad, because he was very brilliant, but it's clear he is mentally ill. And there's nothing I can do about it. He has no siblings, and both his parents are dead, so there's no one I can even contact.
It sounds similar to the case of Garzik in that I don't know if the concept of "take care of yourself" is relevant. He probably didn't realize he was mentally ill, if what the original emailer said was true about him being paranoid. It probably would have been something the family would need to pursue, but getting someone evaluated, etc, is hard, and as the emailer said, it would only increase the negative feedback loop for Garzik, since he would suspect everyone was out to get him, so it's a really tough problem to solve.
Citation needed.
I also disagree with the implication that there is something inherently unworthy with selling things on the free market. This is the way most people on earth get most of the things they need and in many cases it is the most efficient rationing mechanism practicable.
Beyond all this, it's good to do things you love. If someone really enjoys the activity then it is none of my business to say they shouldn't because it is at worst quite harmless.
Currently, we have two gold standard treatments, SSRI drugs and Cognitive Behavioural Therapy.
SSRI drugs probably sort of work a bit, depending on how much weight you place on non-publication bias. The most flattering data suggests that SSRIs beat placebo by about 30%, meaning that over 75% of the effect of SSRIs is accounted for by placebo - the patient's own beliefs about the efficacy of the treatment.
Cognitive Behavioural Therapy is based upon the idea that a patient can learn to think differently about daily events and their emotional responses to them, and in doing so improve their overall mood and reduce specific symptoms of psychological distress. The entire basis for CBT is the idea that people control their own moods through cognition, with the goal of making the patient self-sufficient in managing their mood. The notion that only clinical intervention can improve depressive symptoms directly contradicts the most effective treatment for depression.
In the best case, either of these treatments is only marginally more efficacious than arbitrary interventions that generally improve wellbeing - exercise, better diet, mindfulness practice etc.
There is simply no scientific basis for arguing that depression can only be alleviated through clinical intervention. Study after study has shown (though rarely highlighted in the abstract) that placebo is an incredibly powerful treatment for depression, to the extent that basically anything is a good treatment so log as the patient believes in it.
The belief that clinical intervention is the only way to improve depressive symptoms is at best inaccurate and baseless, at worst actively harmful. It is an irrational and essentially depressive belief and propagating it runs counter to all our interests.
Starting someone on a course of CBT (whether applied by a skilled practitioner, or self guided[1]) and then pushing them to exercise and to social life improvement, with meds if needed, is an excellent treatment.
Practical suggestions are the kind of things a therapist will recommend when you do seek help: cognitive behavioral therapy, or pharmacological solutions. They're practical because talking to someone on a set schedule every week, or taking a pill on a set schedule every day, requires much less willpower than the things people usually suggest, but has effects which increase your willpower, and thus your capacity for attempting those other things.
That being said, although the article doesn't show a deep understanding of mental illness, the things he mentions in the last paragraph can help ameliorate depression. One of the big problems is that it's really hard for a mentally ill person to motivate themselves to try to fix things - mental illness is really insidious; even if you know you have an illness, you may not realise you're having an episode.
May be bipolar disorder, or something more serious
But it's true, it's a misunderstanding, this has nothing to do with "staying in the computer too long" or "being stressed out" or "not going to the park"
Unfortunately, it seems that genetics is a key factor of causing mental illness, rather than the time you spend on the computer. So even if you're the healthiest person physically, you can still be at risk of a mental disorder...
Reminds me, I need to work out and free my mind more often :)
I know I would go absolutely crazy if I could not go outside to do things like ride a mountain bike, eat some ice cream or simply just not sit in front of a monitor every day.
If you are feeling stressed, take a break. :)
Edit:
I know it can be hard, and I know people who suffer from depressions can seem perfectly fine.
A girl I went to school with recently killed herself, much to my surprise, as through my very limited contact with her these past years she seemed very happy in a relationship and about to finish school. The next thing I know she had ended her life. Depression is not something to be taken lightly.
I wish I had known, and I wish there was something I could have done or said.
Correct, no job/task does.
But burnout can, and any task/job/what-ever can cause that if you let yourself get into an unhealthy cycle while performing it. Development seems to be a task that is more prone to this though, I think because with many other tasks (that are more physical) other parts of your body tend to give out first and you have to take a break (if only to sleep or (eventually) pass out if you don't sleep voluntarily) before the point where your brain jumps track.
If so, may I ask a question?
I imagine it is true that people who are depressed may have a mental blockade to self-diagnose and independently coming to the conclusion that they may be suffering from depression. But is it also true that people who are depressed may also (always, sometimes) be resistant to the suggestion from others that they may be suffering from depression? ie: Is it common that depression may be accompanied by a self-defense mechanism whereby the afflicted may be highly resistant to the suggestion or any discussion of the topic?
Secondarily....if you are worried about someone, what would be a good approach? Talk to them on one of their "up" days, hoping that they may be thinking more clearly than usual?
I had a girlfriend once, who suffered from bipolar disorder. The problem is the feelings that you have while having a depressive episode are real problems to you, in the sense that they affect you very deeply at that point. When someone suggests to that person that maybe you are just depressed, it often seems to them that you are trying to ignoring the issue and instead trying to shift the blame on them. This infuriates them further and they either lash out against you or shut up. After screwing up a couple of times,every time I realized she was possibly having an episode I tried to put it very gently to her and only after talking about whatever is bothering her. I will also suggest going through this link to understand how people having a depressive episode feel(Even though the article is about lupus). http://www.butyoudontlooksick.com/articles/written-by-christ...
Some clinical trials have shown St. John's Wort is effective for relieving mild depression - and you don't need a prescription to get it.
Get some, then literally beg the person to take some while you have some too.
Independently of the effects of a disorder, most people don't easily accept any kind of criticism exposing a weakness.
This is what becoming a parent is like!
Have a kid and you'll do a lot more of this stuff!
Thanks in no small part to the kid, I'm getting more outdoors time, more exercise, better diet, and socialization with the kid's friends. My mood is still inching downward.
I feel so sad when I read stories like yours of friends and loved ones who need help but don't get it :(
Not to say that other solutions could contribute to a more whole solution, but fundamentally it's people with problems either becoming a danger to themselves and others. And we have no support system for this.
By the way, thanks for sharing the story of your friend.
I'm making an effort to be more sociable, which is difficult. I'm middle-aged and haven't dated or had a relationship since high school and so I've got some real hurdles to overcome there. That part may be impossible to overcome, but I'm trying it, slowly.
The very affectionate cat I've had for a couple of years helps, too. A pet forces you to focus on something other than your own misery. Plus, it's hard to have a suck day when the cat is standing on your chest, headbutting you in the chin or trying to eat your hand while you type.
This isn't necessarily the answer for everyone. It may only be me. I do know that a year ago I was very miserable, felt worthless and dead inside, and now I don't feel like that anymore.
There's some sense in:
1. If you're stressed and/or avoiding sunlight, you're more likely to be depressed and fall ill.
2. You feel less pleasure while severely sick. Personally, I notice my affect when thinking about everything is dramatically different. I discount it for that reason.
3. Depression apparently involves some feedback loops that can make it a fairly stable equilibrium; so the shift in experience during the sickness might linger (perhaps the isolation and lack of sun while sick lingers).
I don't see any studies showing a strong link. To present my own anecdote, I had a dozen ear infections before my teens and have never experienced depression. This is a very small bit of evidence, though.
This, too shall pass.
Or Seattle. Two examples off the top of my head:
The cafe where a well-known Rails meetup happens had a multiple homicide recently. A mentally ill man ended up killing six people total. His family said "we could see this coming." http://healthland.time.com/2012/05/31/seattle-shootings-six-...
A mentally ill man literally axe-murdered another man (who he didn't know) two years ago a half-block away from where I live: http://thesunbreak.com/2010/11/24/mental-illness-drove-capit....
I saw a news report that the number of people applying for a gun license in Aurora after the shootings at the cinema went up quite a bit.
To me, as a non-American, that is quite scary. A guy kills and injures a lot of people and the reaction of the public is not "how could we have prevented this?" but "I need a gun so when this happens again I can kill the guy before he kills as many people!"
Scary and quite sad :(
I do not know if James Holmes is suffering from mental health issues and if they are the cause of his violent attack on the people of Aurora however I would suspect mental health problems are involved somewhere and perhaps this tragedy could have been averted had he had the proper help.
Sure, and it does vary a lot. So perhaps I meant to say severe vs. mild.
People overstate these things to a degree. Like I said, sure they help, but it's scratching the surface IMHO. What's more important is to attack the depression itself, directly.
And, though anecdotal, I've been through periods being severely depressed despite going to the gym a lot, and eating relatively well, and had it make very little difference. I've also socialised a lot and had that make no difference. So this isn't just conjecture.
I guess part of it is that it varies from person to person. Also the degree of the depression at any given time waxes and wanes.
And agreed, a key thing is to admit you can't do it all by yourself, and go and get help.
The key thing, however, is for people to lose that attitude of 'go get a life doing things I think are healthy/fun and you'll be happy' because, basically, that's b.s. projection, and for some it borders on blame-the-victim mentality.
I think diseases like depression are particularly problematic because people don't take them seriously and imagine that they're not all that serious, perhaps slightly made up, or not as solid and easy to diagnose and understand as a physical illness. Perhaps people need to come to respect it more.
> The key thing, however, is for people to lose that attitude of 'go get a life doing things I think are healthy/fun and you'll be happy' because, basically, that's b.s. projection,
Yes, I agree.
If you want to know more about the technical meaning of "depression," consult DSM.
'Clinical depression' is a way of specifying something more problematic than simple sadness. When your sports team loses, you get depressed.
That would be incorrect, sir: http://www.mayoclinic.com/health/clinical-depression/AN01057
Medical professionals do not ever call something clinical depression. They'll use words like reactive or endogenous etc.
The solution to people mis-using the term depression to apply it to things which are not depression is to stop people mis-using that term, not to invent other terms.
> When your sports team loses, you get depressed.
No, you are sad, fed-up, gutted, sick as a parrot, annoyed, frustrated, mournful, etc. You are not depressed, because depression is an illness.
The other problem with "clinical" is that it is widely used by cranks - see for example "clinical nutritionist".
Medical professionals do not ever call something clinical depression.
I used to work in a neurology lab, and I heard consultant neurologists use the term. I do not agree with 'do not ever'. Unless you're counting medical specialists that take 13 years to train as somehow not being 'professionals'.
Just googling 'clinical depression' comes up with a few links of professionals (like the Mayo Clinic) using the term. The important thing to not is that just because a term might not be in the DSM does not mean that the term is not used or meaningless. Yes, I'll agree, it's not used to refer to one specific disorder, but that doesn't make it meaningless.
You are not depressed, because depression is an illness.
Depression is an illness. It is also a transient state. You're doing the same thing as those people who say "but 'kid' actually means 'baby goat'".
The other problem with "clinical" is that it is widely used by cranks
Fallacy of association: Cars are widely used by criminals, therefore we should not use cars. Would you really correct a co-worker who said 'bob is depressed because his team lost last night' with 'no he's not, because depression is an illness'?