Tell HN: My Brother Died Last Week. His Death Will Not Be In Vain(evanmrose.tumblr.com) |
Tell HN: My Brother Died Last Week. His Death Will Not Be In Vain(evanmrose.tumblr.com) |
Make every day count!
It is exactly this type of attitude we have had since the dark ages that much development of treatment and studies are now only beginning to take more shape.
We have to have a much wider awareness of mental illness and how it affects the basic human rights.
People labelled mentally ill can be imprisoned without a trial.
People labelled mentally ill can avoid prison when another person who did the same actions would go to jail.
People labelled mentally ill can be drugged by force.
This is bad for basic human rights, isn't it?
Yes, it is true that many mental illnesses do not have a "screen" such that if you pass the screen, you have the illness, and if you fail it, you don't.
And yes, it means that the words we use for various mental illness might be catch-all concepts that will eventually fall into disfavor as our biological understanding increases.
And yes, it might also mean that many people who are told they must accept a lifetime diagnosis of "x" have indeed been misdiagnosed, and can later be "cured" (or reject the misdiagnosis, depending on how you look at it).
But. None of those realities mean that people are not emotionally hurting, or that they don't feel trapped to the point of self-destruction. And it doesn't mean they don't need help - emotional or pharmaceutical.
So, while you may have some beliefs or points that are worthwhile in a vacuum, it's extraordinarily insensitive the way you are communicating them, and the implications you are leaving people with. Especially in this thread.
So can people not labelled mentally ill, and involuntary confinement happens well within the confines of our legal and justice systems.
> People labelled mentally ill can avoid prison when another person who did the same actions would go to jail.
People found not guilty by reason of insanity are typically kept in a forensic unit with similar levels of freedom as a prison, and typically are detained longer. It's not as if they're turned loose.
> People labelled mentally ill can be drugged by force.
So can people not labelled mentally ill.
Evan, I'm sorry for your loss. Be with friends everyday this week. The internet can wait.
On a professional level, it is believed (and supported by some research) that this can be a trigger for people who read the article, potentially causing more suicides.
On a personal level (for you), you may want your brother remembered for his life, rather than evoking in readers' minds the image of his last moments alive.
[0] www.sprc.org/library/sreporting.pdf
[1] http://www.samaritans.org/media-centre/media-guidelines-repo...
[2] http://www.theguardian.com/commentisfree/2009/mar/28/media-r...
For all I know it could be anything from autophagia to trichotillomania.
So in other words, conventional psychiatry failed. And the author's solution seems to be to spread it more.
Maybe after a failure like this, where we see that the care providers, hospital and "highly-respected treatment program" don't work, it's time to stop respecting that treatment program so much and consider different approaches.
If you want me to take you or Szasz seriously, please demonstrate that all three of my assertions are incorrect, with citations.
Arguing that someone dying despite psychiatry invalidates psychiatry is like arguing cancer treatment is useless because some people die of cancer.
You seem to be implying that Szasz and I hold our positions due to scientific ignorance, which is demonstrably false, and insulting. But maybe you didn't mean it that way.
No, wait, aforrester made one post on the day it was created, supporting your position in a totally different discussion of suicide. My mistake.
Still waiting for that evidence I asked for, by the way.
He also mentioned that HN is blocking him from posting more, so maybe you can blame Paul Graham for you not getting the answers you wanted. But there's still hope.
Want answers? Want a discussion on a forum that without censorship? Want a discussion where you won't be punished if you say "What You Can't Say"[0], as xenophanes dared do today? I think he, myself, and others would be happy to answer your questions at:
https://groups.yahoo.com/neo/groups/fallible-ideas/info
If you don't come, and instead stick to a forum where hardly anyone continues a discussion for more than 12 hours, then I for one will figure you aren't really that interested, and I won't be motivated to write answers for you.
Anecdotal evidence against the efficacy of any medical treatment is not reason enough to abandon it.
Or are you just trolling? Pretending to be a religiously intolerant bigot? Is this an example of Poe's law in action?
In principle, anything can happen to anyone. In practice, being labeled mentally ill dramatically increases the likelihood of your civil rights being violated in ways that can ruin your life. Changing the law wouldn't solve the problem of mental illness overnight, but it would make it much easier and safer for mentally ill people to seek solutions.
Sometimes people who escape criminal justice via psychiatry get similar levels of freedom. Sometimes significantly less freedom! It can be a way to imprison people for an indeterminate sentence which may last longer than the maximum prison term for their offense. And, sometimes it's quite a lot like they are turned loose. All of these happen.
"Defendants who asserted an insanity defense at trial, and who were ultimately found guilty of their charges, served significantly longer sentences than defendants tried on similar charges who did not assert the insanity defense. Unsuccessful NGRI pleaders are incarcerated for a 22 percent longer time than individuals who never raise the plea."
Citations included there, by the way. For someone demanding citations, you're mainly throwing out "read Szalz!" and citing nothing.
> Want a discussion where you won't be punished if you say "What You Can't Say"[0], as xenophanes dared do today?
I smell astroturf.
Since you are apparently not, as JustinCEO claimed, hellbanned, I'll remind you that I'm still waiting on those citations. You demanded them from everyone else, it's only fair that you should provide your own.
> Mental illness is a metaphor (metaphorical disease). The word "disease" denotes a demonstrable biological process that affects the bodies of living organisms (plants, animals, and humans). The term "mental illness" refers to the undesirable thoughts, feelings, and behaviors of persons. Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish. As the whale is not a fish, mental illness is not a disease. Individuals with brain diseases (bad brains) or kidney diseases (bad kidneys) are literally sick. Individuals with mental diseases (bad behaviors), like societies with economic diseases (bad fiscal policies), are metaphorically sick. The classification of (mis)behavior as illness provides an ideological justification for state-sponsored social control as medical treatment.
Again, this is refuted by twin/adoption studies, which allow for control of environmental causes. One example: http://www.massgeneral.org/psychiatry/assets/Smoller2003_Fam...
It says nothing about what inherently is a mental disease and what is not. Perhaps genetic differences causing certain mental "diseases" in average American society (or whatever society in which you conduct a study) actually benefit the individuals in societies with different cultures or structures. In the same way that certain non-psych heritable "diseases" confer some advantages and disadvantages (sickle-cell anemia and malaria, for instance). Fact is, many genetic differences that some people regard as undesirable are not even classified as diseases, even though they have advantages and disadvantages, if not for lifespan, certainly in social mobility within social environments.
tl;dr: it's patently obvious and beneath discussion that in certain genetic differences might lead two otherwise identical individuals to differ on whether they have different behavior, just as they might differ in many other ways. It's the determination that different behavior in some cases is a "disease" that seems to be at the heart of Szasz's critique of psychology.
I realize that you are simply quoting a passage and not necessarily personally espousing what you wrote.
Thoughts, feelings, behaviours, and mental illness most certainly have biological bases, which makes Szalz's theories pretty loony.
Point (2): the existence of such abnormalities is required for a person to have a disease, but not all abnormalities are considered diseases. This is as irrelevant as saying that not all ice cream contains water because some water is not ice cream.
Point (3) is also irrelevant. Szasz's claim is that mental illness is behaviour that a person undertakes for a reason, albeit a reason that people don't like. That idea that such behaviour will turn out to be caused by a disease is like looking for a hardware fault in your iPhone because you have installed an app your dislike.
I addressed (4) earlier. For my reply to point (5) see my reply to point (3).
As for Shorter, note that his statement that mental illnesses are brain diseases is incompatible with Kendell's points since Kendell is attacking the idea that lesions are necessary for disease while Short alleges that such lesions exist. So which position does the poster actually hold? I have already addressed points (1) and (3) by explaining that mental illness is not biological, so let's skip to point (2). Szasz's point was that if a person was found to have a brain disease, brain doctors would treat him with his consent. Psychiatrists don't do this and so there is some difference between psychiatrists and doctors who deal with brain diseases.
Clarke. Point (1): if a person claims to be mentally ill then he is claiming to have an illness when he doesn't. It is better to face up to this squarely and discuss why the person in question is acting the way he acts. If a person claims he is not a moral agent and refuses to face up to his moral disagreements with others, you're not doing him any favours by agreeing.
Point (2): people get labelled as mentally ill because they have a moral problem, that is, behaviour that is regarded as undesirable by somebody who may or may not be the patient. It is true that such problems would not vanish if we stopped calling them mental illness but Szasz didn't claim that they would. Rather, he claimed that we should face up to those problems squarely and stop using quasi-medical excuses to coerce the kind of people commonly labelled mentally ill. If you want to coerce somebody you should have to make an explicit argument that his behaviour should be treated as a crime.
As for point (3), abandoning treatments that the public dislikes is entirely compatible with picking some other set of treatments that the patient dislikes and imposing it on him.
Once you "accept" his conclusion, it doesn't seem possible to be argued out of it until science advances to an arbitrary point where one feels it adequately explains mental illnesses. "accept" in quotations as I honestly can't tell if his supporters are trolling or honestly believe what they're posting.
The organisation started from a very brief lightning talk that went something along the lines of (me paraphrasing from memory):
"Who here in this room has experienced depression?" (for which the person asking the question put their hand up. After a few seconds, quite a few people in the crowd had their hands up. "Look around, I want you to know that you are not the only ones who experience this, and there are always people willing to talk."
One of the ideas they have is, for anybody who is willing, to put a BlueHackers sticker on their laptop. This little gesture is more than just a decal though, because it informs other hackers that you understand that if they are feeling depressed, they don't need to deal with it on their own. You are telling them that you are willing to discuss anything with them, especially if they are feeling down.
I have had the sticker on my laptop for over two years now. Although I haven't had anybody recognise it, or comment on it, or indeed discuss any issues with me as a consequence of it, and although I myself have been lucky enough not to have to experience depression, I am absolutely, 100% willing to respond to anybody who wishes to chat to me about such issues (on the off chance they recognise the BlueHackers sticker). I would love if this idea took off, so that people all around the world could see that there are so many people who are willing to talk.
[0] - http://bluehackers.org/
The blue sticker says you'll happily talk, and also listen if they have something profound to get off their chest. That's really the important part, it's not about giving advice.
Disclaimer: I have never been psychologically evaluated for depression or anxiety.
Except destigmatising mental health problems is an important step in letting people get therapeutic help.
Someone suffering a mental health problem might not know where to turn to or want a bit of support to go get help. Knowing that colleagues and friends are not judgmental about mental health; or that those people will help access services is a good thing.
I've gone through it myself, both badly and more commonly to lesser extents, and while I'm not a professional and don't claim to be, I do have the personal understanding, and can understand why/how people feel depressed. Myself, I find talking to people helps, not all the time, but often, and I know when I might want to.
As it is, not everyone is such a way either - for many people, just knowing that there is someone that could talk with if they wanted to can be helpful.
As it is, I find the description of depression as a mental illness a bit overbroad - yes, it definitely is a real condition (sometimes lifelong, sometimes intermittent, sometimes temporary) and unfortunately there isn't a better term, but it isn't something requiring drugs (which can make things worse in some conditions)/ doctors all the time, and normal people can and should help if they feel able and willing to.
Excuse me, but what "formal background" is that? It's not as though psychology is a science, or that psychologists know what causes depression or how to treat it -- public evidence clearly proves they do not.
The field of psychology is such a disaster that the director of the NIMH recently ruled that the DSM (psychology's "bible") may no longer be used as the basis for scientific research proposals, for the simple reason that it has no scientific content. The director said:
Source: http://www.nimh.nih.gov/about/director/2013/transforming-dia...
Quote: "While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."
"Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better. [emphasis added]
As to depression specifically, psychological treatments are notoriously ineffective, but alternative neuroscientific approaches like deep brain stimulation (DBS) are showing great promise. A recent flurry of treatment outcomes that apply deep brain stimulation lead to outcomes in which, by throwing a switch, a brain surgeon can literally turn depression on and off.
Source: http://www.nytimes.com/2006/04/02/magazine/02depression.html...
Quote: '"So we turn it on," Mayberg told me later, "and all of a sudden she says to me, 'It's very strange,' she says, 'I know you've been with me in the operating room this whole time. I know you care about me. But it's not that. I don't know what you just did. But I'm looking at you, and it's like I just feel suddenly more connected to you.' '
"Mayberg, stunned, signaled with her hand to the others, out of Deanna's view, to turn the stimulator off."
'"And they turn it off," Mayberg said, "and she goes: 'God, it's just so odd. You just went away again. I guess it wasn't really anything.'"'
I emphasize this procedure is still experimental and is not yet being offered as a clinical treatment. My point is that people need to get over their reverence for psychology -- it's not scientific, and there's no evidence that it is effective in any scientific sense.
This may come as a surprise to some, but within the mental health field, a revolution is taking place -- a revolution that intends to replace psychological treatments with neuroscientific ones.
If you just want something for your laptop, I suggest printing out on a piece of paper and sticky taping it to your machine[0]. Although a license is not specified, I'm quite confident that from speaking to these people (and their philosophy on open source) they'd be more than happy for people to print and share them.
"We’re seeing a lot requests for the stickers, which is great – we’re happy to post some, but we do need to optimise things a bit otherwise the logistics (and cost) won’t be practical. So here’s the deal for the currently remaining roll of approx 500 stickers.
If you are active for a local user group, conference or company, and want a sticker for yourself as well as some to hand out at your next meeting or just among your colleagues, send us an email at l i f e (at) b l u e h a c k e r s (dot) o r g with a brief note on what group/company/conference it is, your address of course, and how many stickers you need.
I think numbers of up to a couple of dozen are practical at this stage. Remember, we’ll be printing more stickers anyway so this is just to get things going and spread the word further. We’ll gather the emails and do a mailout about once a week, and of course we’ll reply to let you know when they’ve been posted, and how many you get. Okidoki?
By the way, if you’re on Facebook you can also join the BlueHackers cause, again to help make the issue more visible." [1]
I don't know if it is still true, but I will try.
[1]http://bluehackers.org/2009/02/02/if-you-want-bluehackers-st...
The last time I was on HN and the topic of suicide came up, I wrote kind of a ranty piece that I am not up to editing it (to remove the rantiness) and reposting. The short version: If you know someone who is suicidal and you care about them, spend time with them. In person. Suicide is almost always committed when one is alone.
My credentials: I attempted suicide at 17 and have been hospitalized once or twice for being suicidal in my teens/twenties. In recent years, when medical issues make me mentally and emotionally unstable, my adult sons "babysit" me (in other words, I am not left alone when I might be genuinely suicidal and not just grumpy about life's stressors). I am 48 and I am okay these days in spite of serious medical problems which have somatopsychic impacts (it's a real word -- look it up). So I know it is a method that works.
"23RD JAN 2014 Recent experiences caused me to examine my motivation for undertaking potentially revenue-generating projects. I initiated this site in order to produce income — a reason which seemed to require no further examination at the time. However, upon further reflection I discovered that I sought something more significant than income.
After pondering more deeply, I realized that income generation is not my ultimate motivation; I recognized that there are contexts in which money is useless or non-existent (e.g. being stranded alone on an island; or when a national government is radically re-structured in the wake of a natural disaster). Money is merely a means to attain other ends — it is a tool. Accordingly, I recognized that creating and producing value is my primary goal, while income generation follows subsequently.
This realization informs my time expenditure; I could cease writing this passage, and instead apply for employment positions via the internet. Conceivably, this strategy could be more effective for increasing my revenue over the short term — prior to my insight of today, I might have pursued this option. However, I now distinguish between income generation and value creation, and currently aim to maximize the latter. Accordingly, I will perform salaried labor for the minimum amount of time necessary to meet my material needs, while devoting all time thereafter to working on my venture."
Insightful, admirable person. Rest in peace.
I've struggled with depression too, though never been suicidal. Both of my parents made multiple suicide attempts last year.
I hope you don't blame yourself for not being there for your brother. You can't predict when someone will need help, it's extremely difficult for most people to offer effective help, and people struggling with depression and other mental illnesses often get good at hiding it.
We will not be able to engage in thoughtful, constructive and mature conversations if one of the unfortunate outcomes of mental illness is so taboo that we can not speak its name in public. Can you imagine a sexual education class where the teacher used terms like "thingies," "who-hahs" or "that other kind of sex"?
Or just 'suicided'. Suicide is typically a noun, but can be used as a verb too. Using the word commit, to me, ties it with judgmental phrases like 'committing a crime' or 'committing a sin'. Part of changing our perspective on mental illness will be to call out the subtle ways in which we demonize or otherwise blame the victim.
I generally agree with you and stated clearly that it sounded like suicide. But, a) my mom says "funerals are for the living". So I think we need to respect the pain of the family here. And b) I have been writing online about very hard, delicate topics for quite a long time. So I have some practice with walking that line which I don't think we can expect or demand from someone in shock and mourning.
Why not take a step back and ask yourself whether this might be a helpful thing to do in a universe which didn't revolve around your debating skills.
> What happened to Stephen and our family is something that “happens to someone else.”
Mental health issues impact everyone at some point in their life – either personally, or through someone close. Unfortunately, society seems to discount mental health issues – they are not an open discussion topic. They are complex and difficult to understand and diagnose. This is something we should all endeavor to correct, for the better health of everyone.
The best solution to depression is often simply finding what works for you through trial and error of available options including medication, therapy, supplements, better nutrition, exercise etc. Unfortunately, this is a long and arduous process that some never make it through. How can we accelerate this discovery process for mentally ill people to find the help they need?
How? People are labelled mentally ill IFF they do things that have a stigma attached.
I am going through something similar right now with my father who has psychotic depression. It is really hard.
Thank you for your post, and for helping to raise awareness about this. I will try to help.
I think you touched on one of the biggest issues: the stereotype that people with mental health problems appear different and have a lower social status. As your story illustrates, the conditions affect all sorts of people, including those who are smart, successful and career-oriented.
Many people fail to recognize the severity of psychological problems because they're too busy looking at superficial measures of well being: a person's career, his or her physical appearance, etc. But depression has made some of us feel as if we're in a deep fog or a war zone, even if, on the surface, we live in nice neighborhoods and succeed in the workplace.
The key is to be more vocal about this struggle beneath the surface — and to speak up very soon. In my observation, the earlier in life a person can overcome depression, the greater his or her chances of becoming happy and stable.
Kudos on taking the initiative to speak up about this important issue and responding constructively to such as a great loss.
THIS.
Being vocal about the struggle is so crucial. My family had no clue what to even look for when these issues started cropping up much less how to get him help. By the time we got him the level of help he needed he had already been in the throes of deep depression and anxiety. Thanks for your kind words.
We lost my sister to depression about 6 years ago. Superficially, life was fine -- good career, no money issues, good friends. But she was carrying baggage around from years earlier, when she was overworked and overloaded in grad school. (In a lab notorious for overwork, and unfortunately, suicide.) She was told she was depressed then, but no one really got the scope of it. I don't know why she wasn't getting treatment years later, other than things seemed to be going alright.
There were a couple of things, that later, seem to be really key. Had we known, or understood, I think things might have been different.
I'm not aware of your brothers mental health issues but I can certainty relate. If I find that my mental health is deteriorating I try to do two things. 1- Start the process of cognitive creativity to stimulate my mind 2- Reach out to the world by attempting to solve someones problems
By taking focus away from my world and looking at others, I can better come to self realization and my drive to good use by connecting with others. Often when times are hard you just need to reach out and get a response from anyone. I decided to make this website http://boopoohoo.com that allows for that feedback loop I need to keep going. I don't know the people there and it doesn't get all that much traffic but I check it daily just encase someone has left me a message. A simple thing such as telling a total stranger your opinion on a delama they are having can make a world of difference in their day.
If you ever need to reach out, I'm happy to help.....
If I were anywhere nearby I'd have come along to the memorial service but the Atlantic is quite big... I hope the service goes well for you all.
Sadly the troll(s) in this thread are demonstrating the kind of prejudice that can make it difficult to have a serious discussion about the more immediate problems faced by people suffering from mental health problems.
My friend committed suicide in a very public way almost three years ago. She was at that the time just completed her master degree, got a high paying job, recently married and fund-raised thousands of dollars for charity. She was pretty much in the traditional 'well on her way' trajectory that many people are dreaming of.
Suicide is hard to understand.
Firstly, people sharing their story. This is exactly what Steve wanted, to share his story, his ideas. Sharing the story is so important to removing the stigma around mental health. It warms my heart to see people with the courage to tell others about their struggles (and then it double-warms my heart to see other people supporting them!!)
Secondly, the sheer support for him. He was a quiet person but a mental giant. Just to have so many people acknowledge him is truly beautiful for me and my family.
Here's my story. If you ever need to bounce ideas back and forth or just need someone to talk to, send me a message via twitter and we can take it offline.
100%, although I wish we talked more about the challenge of determining that someone is suicidal.
Here's what I wrestle with the most about this. I fear that if I "misdiagnose" someone as suicidal, that I might have now given them the idea that there is such a thing as suicide and it may now become an option, completely backfiring against my goal of helping them.
I wonder if there is best practices although it seems a bit silly given we are basically trying to read someone's mind - something that even they(especially them) might not have clarity about.
The next thing I felt about the suicide question was that it was a way of categorising people. If they considered suicide, then they need immediate help, otherwise it's no so important, so offer them some pills, refer them to counselling (which was offered to me with a 4 month waiting list, that was not a lot of help). The pills weren't what I needed anyway, so I didn't really get a lot out of going to see the doctor. Talking to your family about it is a really important step though.
Basically you WANT to talk explicitely about suicide. From what the lady on the phone said, most of the time the suicidal person wants to talk about it.
I'd say that, if you're worried, starting a conversation about it (in person) is just about the best thing you could do. A "missed diagnosis" is far worse than a "misdiagnosis".
Sorry for the pun.
It helps that I have an especially close relationship to them. Also, they were raised by me, so are well educated in certain social paradigms.
I will add that most people who are suicidal will "tell" you. They often talk about suicide, though they may then claim it is a joke. It usually is not. If someone frequently says things like "I wish I were dead", you should take that seriously, basically.
We humans need social contact and this has been known since at least the time of Aristotle (and probably time immemorial).
Perhaps you could answer this question: when your adult sons come over and care for you (this is a really great thing btw, and something we have lost as a society), is that in itself theraputic? Or is it just a stop-gap?
If it is theraputic, then we are missing a key piece of the discussion in the discourse of mental health.
My sons are taking care of me so I can get well, physically. Part of that is dealing with the brain chemistry fall out as I fight the infections that overran my system, etc. Yes, over time, their devoted care is convincing me someone actually cares about me even though neither of them is the gushy type. They do the important stuff. They provide the care I need.
I was a homemaker and full time mom for many years. I took devoted care of them. The three of us are getting physically well together, but I was the sickest. So the care I gave them is coming back to me. That is a first for my life. For the most part, my emotional generosity has gotten me burned by other people.
tldr: It wouldn't be inaccurate to say that it is therapeutic.
Suicide is the most selfish thing one can do, that's my opinion.
People have this bizarre idea that mental illness somehow doesn't "count". That you have to fight it, and that if you lose, it's your own fault.
You are, right here, blaming the victim of the disease. Your brother died from a mental illness. It killed him, just as surely as cancer or a heart attack might have killed him. You'd never, ever, ever say that someone who's killed by a heart attack is "selfish", so don't do it for mental illnesses either.
it accomplishes nothing
It accomplishes nothing for you. For the person committing suicide, it frees them from significant pain of some sort. That might be psychological pain due to a disturbed mental state, but it's still pain.
Guilt is a hard one and you have to learn to deal with it and move on, but blaming the victim isn't going to help there.
Some additional reading material that might help inspire some compassion, also both good and entertaining reads in their own right:
http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-...
http://www.newyorker.com/fiction/features/2010/12/20/101220f...
When he took his own life, I had an initial period of unanswerable questions and great sorrow, followed by deep resentment. He had so many people he could have reached out to and so many people reaching out to him, and he just decided to take an easier way out. It was selfish to leave his family hanging like that with so many questions, and the worst part is how difficult it was for them to move on.
I hope you are just angry that he committed suicide, and don't actually mean that. If you do mean that, you shouldn't be surprised that he killed himself. Suicidal people tend to look frantically for any reason they can find to not carry through with it. This kind of cold, judgmental attitude shown by a loved one at the wrong time can be the final straw.
I continue to appreciate your honest and forthright approach to addressing issues such as this.
I read an article about a sports person here who was going to commit suicide, they had it all planned out, and planned the day. But on the day he planned to do it, his mother stayed home instead of going to Mass. Saved his life.
For example, you might try reading literature with multiple different perspectives on the issue. Then try to figure out which ideas are right and why. (If you've already done this, forgive me, and please please inform me why Szasz is mistaken, I would love to learn something.)
He was an asshole who spent sixty years shitting over real science to promote his politics, and you're an asshole for trying to promote his politics at a digital wake.
Am I still allowed to talk to him on the phone? Email? Can I be within a kilometer of his house? Is it like a restraining order?
All the comment you replied to is saying is that if you notice a friend in trouble, spend time with him. You seriously think that is an awful thing?
http://www.robsheldon.com/blog/depression-programming/
Just submitted it.
https://news.ycombinator.com/item?id=7228491
Very interesting piece (will put my thoughts in the comments of that).
I know that this sort of thing cannot be easily summed up.
However, most of us on the outside have little clue about what sets these things in motion, for various individuals, in the first place.
Broadly and typically, is it a fundamental disillusionment with (and thereby rejection of) the state of affairs of the world and the person's place in that world?
Is it a sense of (perceived) total betrayal of the social contract?
I'm sure any elaboration would help others understand this better.
Then there seems to be a slightly greater sensitivity to problems. Outwardly, I can power through a lot of problems -- financial trouble, management, work, personal life stuff, whatever -- but inwardly, it kills me a little bit.
Annoyingly, other people's problems bother me a lot too, extending all the way out to sociological issues. I think this is part of what created David Foster Wallace's famous speech, "This is Water" (https://www.youtube.com/watch?v=8CrOL-ydFMI) -- he eventually committed suicide. But this can also be a strength, it's what drives me to try to make a difference.
Anyway, the real trouble begins when I'm in a biological downswing and things in life start getting really hard. In a single year, I lost most of my friends over a disagreement, my parents both had serious issues (and I was their counselor for much of it), my business was struggling, and the effort I had put into training for search and rescue all Summer got wasted when the vehicle I was driving died on the way up to the final exam. It was just a lot of stuff all at once, so when the mood problems hit, I barely functioned at all for about a month.
The only common theme that I think I've found so far among people who struggle with depression is a feeling that nobody cares about them, or that they're undervalued in some really big way. Struggling with depression is challenging; struggling with it alone is extremely difficult.
On the other hand, because of the social stigma it currently carries, few people want to make a big deal of depression when they're struggling with it.
So, if you think you know someone who's having trouble with it, it can sometimes help them a lot to just initiate contact and suggest spending just a little bit of time doing something they enjoy: a card game, going out for a bit, watching TV, whatever. It doesn't have to get heavy. It'll help them to know that somebody cares.
Allie Brosh in Hyperbole and a Half puts it as well as I've seen http://hyperboleandahalf.blogspot.com/2013/05/depression-par...
One aspect is the anhedonia (joylessness); another is the pain.
I suppose you might call some of this “disillusionment”, but that makes it sound cognitive, and intellectual, and amenable to argument and reasoning. Whereas it's more an affective and emotional state, not a set of propositions or an intellectual theory about the world.
When I'm not depressed, it's not that I believe intellectually in a god or a purpose to life any more than when I am depressed. It's just that my non-depressed self generally enjoys being alive; or that when he doesn't, he knows that he can wait out a period of blah or even normal-grade sadness or grief to reach a point where he'll again experience moments of joy.
When I am depressed, the subjective experience of being alive is at best deadened and deadening (although my depressed self knows intellectually, from experience, that he'll reach the other side), and at worst so actively painful that it doesn't seem like any period of happiness at the other end could be worth suffering through the bad stretch. As though someone said we're going to torture you on the rack now, but after a month or two you can have a lollipop, so just hang in there.
Anyway, read the Hyperbole and a Half comic. I don't know how many people who have been depressed are depressed in the way that Allie Brosh was, but she nailed it for me.
My health often deteriorates for short periods of time, perhaps a day or two, sometimes a week or so. In these situations there is often some trigger - high workload, poor sleep hygiene etc. My mood doesn't usually reach such an extreme that it causes any significant difficulty day to day.
Episodes of illness that have a significant detrimental impact on day to day life seem to build up slowly. They start out like the episodes described above but they just keep on going until my mood is so extreme that day to day life becomes very difficult to deal with.
My most recent episode of this nature was probably caused by the stress of a couple of deaths in the family, a daughter who doesn't want to sleep, a wife commuting across country to work, a high workload myself and (frustratingly) mental health services not providing care when I could see my health was deteriorating.
It's been around 6 years between my last two episodes of that nature.
Poor sleep hygiene is by far the biggest risk for me and it becomes a vicious cycle if I'm in a manic phase. Other than that, continued high levels of stress are a problem but only really if I'm dealing with multiple stressors.
External factors (financial/relationship problems and the other various pressures of life) can contribute to the problem and either be a trigger for or worsen the symptoms. But there are many instances in which someone who is otherwise successful and happy with things in general (as it sounds like this man was) can suffer from it. Everything can be going fantastic in your life, but the "black dog" comes visiting nonetheless.
I know a fair amount about such things. I suspect bio-medical/brain chemistry issues are much more common than is generally recognized. I manage a lot of my issues in part with diet. I think a lot more can be done. But I don't know how to get the word out.
Depressed people can be disillusioned, of course, but that is a symptom, not a cause. The cause is still somewhat mysterious, but it's biological, physical, not an attitude thing.
Wow. My heart goes out to you. Hang in there.
Further, ssl stripping man-in-the-middle attacks on any http page on a site can force your session to remain in cleartext, even if you navigate to a page that's supposed to be encrypted. Your webserver really needs to redirect to https always, to prevent against this.
One thing that I find helps is a 'mental contract' with my partner.. if she thinks I'm getting elevated etc. then she has a contract which she can enforce and basically frog march me off to the doctors to get a strong sleeping pill for a week or whatever it'll take. Note, she's never had to use it, but having it has given both she and I peace of mind.
7 years and counting here.
And, while I was going to post this on a throwaway account, whatever, my own trigger for bipolar was a 10 day vipassana meditation course. There's audio etc. detailing why I went on the course, what it was like to be manic, sectioned under the mental health act, Depression (with a capital D), and getting better again... at : http://livingvipassana.blogspot.com
Now, 7 years clear, doing very well, and, while I'd not repeat the experience, I feel like I learned a heck of a lot about what humans can go through.
And trying to walk on water was fun ;) (didn't work)
In many (most? all?) people depression has a physical manifestation. It hurts. It aches. It's not a "hole in your heart," it's like having the flu. All the time. It's not like a toothache. It is a toothache. This distinction has to be made because it's important: the pain is real - even if it is just created by brain chemistry.
I'm surprised I see no mention of the poem "Richard Cory" whenever this topic arises
I do agree with the general thesis that talking to someone willing to listen has a neutral to positive effect. I'd also suggest it's especially helpful for people who feel they can't or shouldn't talk to anyone else they know about it.
Someone willing to listen is important to help a person with mental health problems get support. That support doesn't have to be from a professional. It could be self guided from a good quality book or website. Or it could involve professionals, from telephone provided CBT through intensive long term psychological therapies provided by speciList providers.
"Frankly, I have yet to engage in a [discussion of suicide and depression] that
was 'well timed' in the view of those who have not suffered unduly from the
disease of [depression]. For years now I have heard the word 'Wait!' It rings
in the ear of every [parent/friend/depressive] with piercing familiarity. This
'Wait' has almost always meant 'Never.'"I am very familiar with the social factors in suicide. The way I have been treated socially is a big part of why I am often suicidal. I have cystic fibrosis, as does my oldest son. We have figured out how to get well when everyone claims it cannot be done. The world would like us to politely die so doctors and others can feel like they know what they are talking about. I am currently deeply in debt and homeless. I can get almost no one to take me seriously. I feel a bit like Galileo, a prisoner and shunned for speaking the truth about an important discovery. It is the kind of thing other people get Nobel prizes for. But I am an outcast and the world is very content with condemning me to death and putting up obstacles at every turn. So, that is a big part of why I often feel like "what is the point?"
I perhaps made a mistake in returning to HN. I really do not feel welcome here. Plenty of wealthy, influential people here have attacked me or otherwise behaved in a malicious fashion towards me. In the past, it has been okay for people to pillory me here. The community did not care if I got the crap kicked out of me. The rules about "respecting" others and not engaging in personal attacks apparently do not apply so as to protect me. This is hardly unique to HN. It is pretty normal in most online settings.
I am clear that part of the reason for that is that people who are very ill or who have loved ones who are very ill are deeply hurt by the idea that I am getting well when they are not. Trying to share information with them is routinely interpreted as making them look stupid and shaming them, even in cases where the ill person still lives and could yet be helped.
So I have spent a lot of years wrestling with how to diplomatically talk about hard subjects, my health being just one of them. And long experience informs me that speaking of this issue in a manner which could make the OP feel somehow at fault for his brother's death cannot bring his brother back but can do all kinds of harm to him and others involved in the situation.
I am unwilling to suggest that the OP could or should have done x, y, or z differently and then his brother "would" still be alive. We do not know the particulars of this case and that is the worst kind of Monday night quarterbacking imaginable.
I hope the OP's intent to have his brother's death not be in vain serves to get people talking and helps others. It is too late to help his brother. It is not too late to do serious damage to him and others by how we talk about this.
Anyway, I have a headache. I logged in to find my last submission to HN dead. I am not in the best place emotionally myself today.
I hope that helps/sorry if it is TMI (something I am often accused of).
Psychiatry, however, IMO, is for the most part, useless. Psychiatrists should only stick to dealing with things that have a predominately biological basis, like schizophrenia or bipolar disorder. Garden variety stuff like the "common cold" form of depression should be dealt with using talk therapy. Every psychiatrist I've talked to in an attempt to get a mild antidepressant has resulted in frustration - they are all arrogant SOBs as far as I'm concerned who want to stick you onto the heavy duty addictive crap before trying the easier to deal with drugs - as an engineer, my attitude is try the simpler solution first and only if that doesn't work, rewrite bloody everything (if my brain was a software program...) So I've had to self medicate - I found research indicating the particular subtype of depression I suffer from would be best treated with bupripion, but the last doctor ignored me... so now I am going to pretend I'm a smoker and buy Zyban over the internet to get what I am sure I need. Or I could use nicotine patches as a mild antidepressant (according to the latest research). As a hacker, I see nothing wrong with hacking my body :)
But adding a drug into the system known as "me" isn't going to magically fix everything - I have to change my behavior as well, which is harder and that sort of thing require understanding psychological principles, not psychiatric blather about neurotransmitters being the root of all the problems. It's like people want to fix a software problem by replacing chips on the motherboard! And they aren't even sure exactly what chips!
Scientology is a crock of BS, but they do have a good point about psychiatry being a problematic profession. I would never discard what I've learned through psychotherapy, but drugs... treating mental illness strictly as a medical / mechanical issue is very shortsighted.
The trend over the past few decades has been an increasing emphasis on the biological aspects of 'mental illness' - when you examine the history of the two fields, you can see a swing between the two extremes - e.g. when Freud's theories started getting attention, an increased emphasis on the psychological aspects of mental issues became prominent in society and it become fashionable to be seeing a psychoanalyst.
But psychoanalysis, like that promoted by Freud, isn't that helpful for the most part in solving problems, so the trend started swinging back to biological especially after research etc started uncovering the biological aspects of mental illness (serotonin, LSD research, etc). Thus the 'magic bullets' became drugs and since they are cheaper and more profitable than talk therapy (and "easier" for the patient as well) that became the emphasis.
For some reason, viewing the whole issue as the interaction between psychological issues and biological factors isn't viewed as important - as an engineer who understand this stuff better than the usual layperson (though I'm not an expert) it is frustrating because it is so obviously just good engineering to view a person as a system - biology matters but so does environmental issues (family history, current life of the patient...) Drugs are cheaper and more profitable...
But yes, the DSM has gone quite downhill over the years in its usefulness. So if you change, in your post, "psychology" with "psychiatry" I won't down vote you.
And if one's depression is caused by environmental issues, like work related stress, or family, or "meaning of one's life" - they are not going to go away once you start taking the right drug or zapping the depression away. And thus it'll only come back eventually.
Another big problem is that "depression" is such a fuzzy label - there are many subtypes and each need to be dealt with in a specific way. I came across a book a few years ago that correlated what was known about different areas of the brain and their function and how different drugs affected each differently - i.e. something leading to theories on what type of antidepressant would be best for a patient given the symptoms they were exhibiting. Thus my theory on why bupripion would be better for me than Paxil (which was useless). But like with the low fat vs low carb controversy of dieting, medicine is afflicted with fads and trends - just like IT (are all problems solved with NoSQL? of course not, but lots of people seem to think that. same with the virus known as Agile)
First, mental health professionals disagree with you -- the DSM is the standard guide for all mental health diagnosis in the U.S. and to some extent elsewhere, in both psychiatry and psychology.
Second, neither psychiatry nor psychology are scientific enterprises, as you have just proven.
What do I mean? Let's look at a real science -- physics. Within physics there are any number of specialties -- let's look at two: cosmology and particle physics. Cosmologists study nature at the largest scale -- the entire universe. Particle physicists study nature at the smallest scale -- below the size of atoms.
But, notwithstanding this apparent difference in focus, cosmologists and particle physicists recognize their respective fields as both grounded in physics, and they productively attend each other's conferences. These two specialties are united by (a) science, and (b) a common desire to understand nature.
Psychiatrists and psychologists, although apparently specialties in the same field (human psychology), insist (as you now insist) that they're not related. And they're right -- the reason they're not related is because human psychology offers no central corpus of scientific theory to join them together, in the way that the standard model joins cosmology and particle physics, and in the way that the theories of evolution, natural selection and cell biology unite biology and medicine.
If human psychology were a science, psychiatrists and psychologists would endeavor to explain what they are satisfied to describe, these fields would be joined by reliable scientific results and theories, and the DSM would not be rejected by thinking people everywhere, including the director of the NIMH, who recently ruled that the DSM may no longer be accepted as the basis of scientific research proposals, for the simple reason that it has no scientific content.
> I know a tremendous amount about this topic ...
All except the single most important thing to know -- psychiatry and psychology are not sciences -- they're primarily steered by anecdote and belief.
> Psychiatry, however, IMO, is for the most part, useless.
How typical. Need I tell you that psychiatrists say the same thing about psychologists?
> Another big problem is that "depression" is such a fuzzy label ...
This is why the world is moving on from psychiatry and psychology, toward neuroscience, where (among other things) deep brain stimulation is showing very promising results where psychological treatments have failed.
And then again, pretty much everyone knows the existence of suicide. If asking the question and trying to help drives someone to action, chances are something else would have.
On a personal level, I've found that talking frankly about suicide greatly reduces my desire to act on any suicidal feelings. This effect is greatest when talking face to face with somebody I know and trust.
However, worrying about whether or not somebody trusts you should NOT stop you from intervening. If somebody shows a desire to listen and help my in such a situation I'll have a much greater level of trust in them than I did before, even if they were previously a complete stranger or somebody I dislike.
Now I'm curious as to whether the mood swings are more common, or whether that's actually something I should look into. If there is an underlying issue I need to resolve then it might have been masked by my relatively good run of things.
A dear friend of mine is still alive right now because her psychiatrist hammered into her that she needed a list of people to call when she felt suicidal. When the crisis came, she was just barely able to remember to call me before she reached for the knife, and my phone was charged and in my pocket because she'd told me about the psychiatrist's advice and I'd promised her I'd be available 24/7. I'm a pretty forgetful guy, but I forced myself into rigorous phone-care habits because of that psychiatrist, and that's the only reason that she didn't slit her wrists and bleed out on the carpet that night.
With severe depression, your best chance of a positive outcome comes with a solid support network and a well-trained, reliable psych professional. You need both.
Also, Szasz and Laing are closer to opposites than counterparts. See for example:
http://www.amazon.com/Antipsychiatry-Quackery-Squared-Thomas...
Quote from the book, by Szasz:
> In the late 1960s, a group of psychiatrists, led by David Cooper (1931-86) and Ronald D. Laing (1927-89), began to criticize conventional psychiatry, especially so-called somatic treatments. But instead of advocating the abolition of Institutional Psychiatry, they sought to replace it with their own brand, which they called "Anti-psychiatry." By means of this dramatic misnomer, they attracted attention to themselves and deflected attention from what they did, which continued to include coercions and excuses based on psychiatric authority and power. Thus, antipsychiatry is a type of psychiatry. The psychiatrist qua health-care professional is a fraud, and so too is the antipsychiatrist. In Psychiatry.The Science of Lies, I showed that psychiatry-an imitation of medicine-is a form of quackery. In this volume, I show that antipsychiatry-a form of alternative psychiatry-is quackery squared.
> For more than a half century, I have consistently asserted two simple but fundamental propositions: mental illnesses do not exist, and coercions justified by them are wrong. Anyone who seeks to help others must eschew the use of force. Not a single antipsychiatrist has ever agreed with these principles or abided by these practices. Subsuming my work under the rubric of antipsychiatry betrays and negates it just as effectively and surely as subsuming it under the rubric of psychiatry. My writings form no part of either psychiatry or antipsychiatry and belong to neither. They belong to conceptual analysis, social-political criticism, and common sense. This is why I rejected, and continue to reject, psychiatry and antipsychiatry with equal vigor.
For example, there are clear genetic factors in mental illness, which can be seen in the same way that genetic factors for any disease are studies. This doesn't tell you which genes cause it, let alone how they cause it, but it still tells you that it's a biological thing.
My opinion : the dude sounds like an ass and his opinions are eye-rolling.
This being said, the experiences relating to mental illness are very real. The larger question is how we make sense of them as a society. For something like depression how much of the illness is cognitive? How much is biological? How much is social? Somehow that last question never gets asked.
> This being said, the experiences relating to mental illness are very real.
What's the logical basis for this pair of assertions? How can the "experience" be real while the illness is not?
Anyway, I need to go so cannot elaborate.
As for the downvote, I'm pretty sure Xenophanes or one of his buddies is stalking me. After my first post disagreeing with him, everything I've posted in this thread has gotten a single downvote within five minutes, and then climbed back up later. No worries. :)
If you're bipolar and I don't like you, it's probably because of manic-depressive behavior. Not because I heard you say you were bipolar. It's not a stigma, I just can't handle people with wild mood swings.
If you wish to change my mind, tell me where Szasz was mistaken. If you are not familiar with Szasz, perhaps you should try reading both sides of the issue before passing judgment.
my problem with Szasz though is different. He seems to accept the basic assumptions of mental illness that our society does, and therefore never frees himself from the problems of those assumptions. There is no scientific basis for these assumptions, as they form, effectively, the threshold questions under which one can try to make neurochemical inquiry into mental health. These assumptions are:
1. Mental illness, to the extent it exists, is objective and quantifiable.
2. Social context is irrelevant to mental health.
3. Therefore mental health is an individual issue.
Of course a libertarian will accept these assumptions because they are based on the assumptions of personhood behind that movement. But what if both of the first two are wrong? What if mental health is very much subjective and what if social context is an important factor in mental health? If so, then, not only is the science based on bad assumptions but so is Szasz's rebuttal to it, and mental health becomes more an art than a science.
None of this reaches the question of coercive therapy. The fundamental questions are who, when, and how (both regarding the coercion and the therapy). Obviously there are times when this is needed. But we should not ignore the dark side this has had throughout history.
> 2. Social context is irrelevant to mental health.
> 3. Therefore mental health is an individual issue.
None of those are positions Szasz holds. The first two are just kind or ridiculous – he said contrary things, a lot. They are pretty opposite to his actual positions. For the third, he is pro-individualist but the "therefore" is wrong, and also the topic "mental health" includes things like the insanity defense which aren't just an individual issue.
Your supposed anti-libertarian insights are basically correct – but Szasz already knew them and wrote about them.
Of course what is labelled "mentally ill" depends on the social context, rather than being objective. That was a major point Szasz made. Have you read his books?
> Obviously there are times when this is needed.
Here, where you advocate coercion, you have an actual disagreement with me and Szasz. This, not your points 1-3, is your basic disagreement with Szasz. It's the standard disagreement most people have: they favor coercion, he and I do not.
> In 1938, Szasz moved to the United States, where he attended the University of Cincinnati for his Bachelor of Science in medicine, and received his M.D. from the same university in 1944.[7]
Pretty much this. Having just heard about him today, it's clear his [Szasz] statements reflect technological limitations of yesteryear combined with intense personal bias.
Why anyone would still espouse the concepts this guy put forward is beyond me.
Szasz was indeed a deeply unpopular man, but progress often depends upon such people.
For instance, did you know that he was the first psychiatrist to claim publicly that homosexuality is not a disease? (In 'Sexual Inversion: The Multiple Roots of Homosexuality', ed. by Judd Marmor, Basic Books, 1965)
Psychiatry, except in rare cases, does nothing of the sort. Most discussion about mental illness (including your post) is an attempt to induce people to apply fallacious reasoning about it - you've developed intuitions about cancer, now go incorrectly apply that intuition to depression/drug addiction/etc.
http://lesswrong.com/lw/2as/diseased_thinking_dissolving_que...
If you wish to argue that a given animal can fly, "penguins fly just like crows fly, they are both birds" is a fallacious argument. Similarly, "do X for mind disease just like you'd do X for lung disease" is a fallacious argument.
Yes -- except there is no such thing as a "mind doctor", at least in a scientific sense. Psychiatrists and psychologists cannot treat depression, and increasing amounts of neuroscientific evidence demonstrate that depression is not a mental illness, it's a physical one.
A recent study of deep brain stimulation (http://www.nytimes.com/2006/04/02/magazine/02depression.html...) is showing very promising preliminary results, results in which a patient's depression lifts instantly when the stimulating signal is applied, and resumes when the signal is removed. Apart from being a promising indication for future research, this study shows that depression is not a mental illness, the domain of psychiatry and psychology, it's a physical illness, the domain of neuroscience.
In science, the word "probably" is best left behind.
> It is hardly the same as something like diabetes.
But that's just the point -- until we know what causes depression, as scientists we should not arbitrarily assume anything. The recent findings point to a physical, biological cause. The fact that psychiatrists and psychologists cannot treat depression points in the same direction. Or didn't you know that? Studies of psychological depression treatments and drugs have yet to reach statistical significance.
I think perhaps you do not believe that depression is a mental illness. Perhaps you also believe that drugs and hormones can not affect mood, that heroin and alcohol have no affect on the body. Or perhaps you believe that there are absolutely no circumstances in which a human can grow to adulthood without exactly normal sensitivity to mood affecting drugs and hormones. Like how we all evolve slightly different nose shapes and patterns of hair growth, but all the organs in the whole body act with perfect regularity with drugs with no variation at all.
I don't know, as someone whose 8 year relationship ended with a partner who never accepted depression wasn't something I can control. To me its like not believing that lung cancer exists or something. We have evidence, diagnosis and treatment for it. Depression is hardly a made-up condition.
You mentioned your kids live with you. How hard would it be if they didn't? Does the fact that we stigmatize adults living with their parents and make mental illness into an individual problem contribute to it?
Given the problems I have, if they did not live with me, I likely would have died already.
I suffer from mental illness, and it isn't because my behaviors have a "stigma." It's because my behaviors are illogical and cause me a non-trivial amount of distress. So if you're going to rant on this forum about how mental illness is some socially-constructed tool of oppression, how about you go fuck yourself?
Thanks.
> how about you go fuck yourself?
Who is the one ranting?
Science has found biological symptoms for Alzheimer's and rabies. Unfortunately, these can only be firmly identified post-mortem and are thus not useful for diagnostic purposes. Just two examples if diseases with biological markers that are not useful.
> For instance, did you know that he was the first psychiatrist to claim publicly that homosexuality is not a disease? (In 'Sexual Inversion: The Multiple Roots of Homosexuality', ed. by Judd Marmor, Basic Books, 1965)
A broken clock is right twice a day. When you claim mental illness doesn't exist in toto, then of course you will be "right" about bullshit mental illnesses like homosexuality.
What is the difference in value between a $5 bill and a $20 bill? Is this difference not both real and socially constructed?
I.e. why do you assume that what is socially constructed can't be real?
The question is, really, what goes into the experience and what are the limits to the current science. If it is socially constructed, the science is limited to the current cultural context.
I'm assuming you wouldn't say "pneumonia is socially constructed". If you did, I would read that as "pneumonia isn't real".
> The question is, really, what goes into the experience and what are the limits to the current science. If it is socially constructed, the science is limited to the current cultural context.
I honestly don't know what you're trying to say.
That's a complicated question. I probably would not say pneumonia is socially constructed. I would say that health insurance is, just like any other contract.
> I honestly don't know what you're trying to say.
Ok. Let's try again.
The science of mental health, like all science, rests on assumptions which are basically unscientific aspects of our cultural worldview. The creation of scientific theories is, after all, a creative endeavor and one cannot separate the unscientific assumptions that go into interpreting the data from the theory (see Heisenberg, "Physics and Philosophy").
Now, when studying things like physics this is a significant problem. We have multiple "true" theories which are ontologically and mathematically incompatible (see for example quantum mechanics and general relativity). This works in the physical sciences because truth is given a limited meaning, namely something that has predictive value. Thus two propositions can be both true, scientifically, even of they both can't be true logically. A simple way to paraphrase this is that scientific theories are merely models of behavior and are true to the extent that the model's behavior matches the observed behavior, but do not imply any deeper truth than that. (This is exactly parallel to correlation vs causation. Just because the behavior correlates does not mean that the model functions exactly like the modelled.)
This problem is manageable in the physical sciences but it is totally unmanageable when studying the human condition. The problem is that people exist in a social context and that is formative regarding the brain. Therefore, if you are studying mental health of middle class Americans, you have no real expectation that the findings will be perfectly applicable to, say, the aborigines in Australia.
This has some important ramifications. It means that the science can never tell us how culture fits into mental illness. The science has to start off with a assumptions about mental health and illness that are by definition cultural. These definitions and assumptions are not beyond question, and therefore the conclusions one can draw from the science is limited culturally, temporally, and geographically.
http://en.wikipedia.org/wiki/Major_depressive_disorder#Cause...
"In addition, a Swedish study estimated the heritability of depression—the degree to which individual differences in occurrence are associated with genetic differences—to be around 40% for women and 30% for men...."
You seem to think that we must either know the exact cause, or we know nothing about the cause. That is simply not true.
Since I've already crossed the PC/shocking line... It's amazing the similarities between SSRI's and lobotomy. The mechanism of action isn't fully understood, yet some people are improved, and some people are made worse, and everyone has side effects. It was considered a breakthrough at first, then followed by controversy as people began to question the mechanism of action, the ethics of forced surgery (forced drugging) etc.
Depression is completely different from things like sadness and anger. There is a superficial outward resemblance, but that is all. They are conflated because people who have never experienced it try to slot it into what they know, so they decide that depression is just the sadness they know, but stronger. It's not.
But no, I'm sure that saying depressed people are just sad and have control over their own feelings and that Prozac is no better than a lobotomy is going to totally help people.
Perhaps we should should recognise an ill person cannot be held to the same standard expected of a well person, but can still be considered to have some degree of agency in their actions.
It's especially problematic because mental illness is a fault in your thoughts, and not in, say, your arms or legs. But you don't have thoughts in the way you have arms and legs - you actually are your thoughts.
That makes no sense. There are plenty of physical diseases where that doesn't apply, and many where the only cure requires lots of work on your own part.
1. In point of fact, much scientific evidence shows that depression is a physical illness, not a mental illness.
2. The only reason treatments are not available for the physical illness of depression is because of the primitive state of neuroscience.
3. But neuroscience research is moving apace, and is very promising. Read this: http://www.nytimes.com/2006/04/02/magazine/02depression.html...
4. A quote from the above-linked article: '"So we turn it on," Mayberg told me later, "and all of a sudden she says to me, 'It's very strange,' she says, 'I know you've been with me in the operating room this whole time. I know you care about me. But it's not that. I don't know what you just did. But I'm looking at you, and it's like I just feel suddenly more connected to you.' '
"Mayberg, stunned, signaled with her hand to the others, out of Deanna's view, to turn the stimulator off."
'"And they turn it off," Mayberg said, "and she goes: 'God, it's just so odd. You just went away again. I guess it wasn't really anything.'"'
5. Psychiatrists and psychologists, of course, insist that depression is a mental illness and is treatable with therapy and drugs. But there is no reliable scientific evidence for this view.
6. President Obama recently announced a major "brain initiative", meant to speed up the pace of neuroscience research. More here: http://www.whitehouse.gov/the-press-office/2013/04/02/fact-s...
7. Notice that the initiative is not called the "mind initiative". The reason? Psychology had its chance and failed. It's time for a new approach.
> It's especially problematic because mental illness is a fault in your thoughts, and not in, say, your arms or legs.
That's what psychiatrists and psychologists would like you to think, but it's false. Some day this way of describing mental illness will be judged to have been criminally false.
A false dichotomy there.
"Psychiatrists and psychologists, of course, insist that depression is a mental illness and is treatable with therapy and drugs. But there is no reliable scientific evidence for this view."
Stated without actual evidence, naturally. On a scale of One to Clear, how much do you love L Ron Hubbard?
At the same time, at some level it really comes down to a personal choice to either keep fighting against it, or just give up. The nature of despair and depression can make it less appealing choose to keep fighting, but it's still a choice.
But that doesn't change the fact that people should be supportive and compassionate toward people struggling in these ways. It's never ever ever good or healthy or productive to condemn someone who's made some kind of mistake, because mistakes are usually the result of an internal struggle of some kind. Condemning or blaming someone only makes it harder for them to win the fight against whatever they're battling internally, and ultimately we just want everyone to win these internal fights.
You have some control. Far less than the "suicide is selfish" idiocy assumes.
Great, maybe that's the case. However, there's no more evidence for that than the assertion that suicide is a choice.
Would you mind giving me the name of your practice so I can make sure that nobody I care about ever, ever goes there?
The problem isn't just the illness clouding the need for them but also that there are sometimes more significant side-effects as well.
> A false dichotomy there.
Dichotomy, yes. False, no. The evidence is copious. I posted evidence, you posted opinion. Which part of the evidentiary links that I provided caused you the greatest amount of emotional upset?
Which part of "drugs and therapy do not work, but neuroscientific treatments do work" didn't you understand?
> "Psychiatrists and psychologists, of course, insist that depression is a mental illness and is treatable with therapy and drugs. But there is no reliable scientific evidence for this view."
> Stated without actual evidence, naturally.
I said there is no evidence for the belief that psychiatrists and psychologists can treat depression. Your reply? Where's my evidence that there's no evidence? You are clearly unaware of (a) the impossibility of proving a negative, (b) of the role played by the null hypothesis in scientific thinking, and (c) who has the burden of evidence to provide positive evidence for a claim.
Link: http://en.wikipedia.org/wiki/Russell's_teapot
Quote: "Russell's teapot, sometimes called the celestial teapot or cosmic teapot, is an analogy first coined by the philosopher Bertrand Russell (1872–1970) to illustrate that the philosophic burden of proof lies upon a person making scientifically unfalsifiable claims rather than shifting the burden of proof to others ..."
In other words, you are a scientific ignoramus.
Psychiatrists claim to be able to treat depression, the claim is formally unfalsifiable, there is no evidence for this claim and copious counterevidence, and the burden of evidence belongs to psychiatrists and psychologists.
Nevertheless, in spite of the fact that the burden belongs to those making the claim:
Title: "Treating depression with the evidence-based psychotherapies: a critique of the evidence"
Link: http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2007....
Quote: "... the specificity of CBT and IPT treatments for depression has yet to be demonstrated."
Title: "Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration"
Link: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...
Quote: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance."
Title "The Emperor's New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration"
Link: http://alphachoices.com/repository/assets/pdf/EmperorsNewDru... (PDF)
Quote: "If drug and placebo effects are additive, the pharmacological effects of antidepressants are clinically negligible. If they are not additive, alternative experimental designs are needed for the evaluation of antidepressants."
The scientific consensus? Depression drugs and therapy don't work.
That fits with my experience. I have to be very careful with peanut oil, for example. It does terrible things to me.
So, in short, it is possible that depression and other mental illness has biological roots. There are also social factors and other factors, but in some sense mental illness may well be a medical illness.
> This problem is manageable in the physical sciences but it is totally unmanageable when studying the human condition. The problem is that people exist in a social context and that is formative regarding the brain. Therefore, if you are studying mental health of middle class Americans, you have no real expectation that the findings will be perfectly applicable to, say, the aborigines in Australia.
That's reasonable.
> This has some important ramifications. It means that the science can never tell us how culture fits into mental illness. The science has to start off with a assumptions about mental health and illness that are by definition cultural. These definitions and assumptions are not beyond question, and therefore the conclusions one can draw from the science is limited culturally, temporally, and geographically.
I agree.
Your more verbose argument is reasonable and sound, and yet I find it inconsistent with your original statement.
Specifically :
"the conclusions one can draw from the science is limited culturally, temporally, and geographically"
vs.
"mental illness is socially constructed"
Perhaps I'm interpreting it too literally, but I can't find the evidence supporting that strong assertion.
For instance, most of the literature I could find does agree that there is a biochemical basis for schizophrenia. The literature also agrees that how it manifests, including prognosis and rates of remission, differs across cultures. Thus, it seems reasonable to state that certain beliefs regarding mental health are social constructs - but if there is a physical basis for the expression of the disease I don't see how it can be said that it itself is socially constructed.
For any interested, there's an interesting NYT piece on the subject[1]
[1] http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?p...
Basis != the phenomenon though. But try reading Julian Jaynes' "The Bicameral Mind" which will give you an idea into at least one possibility into how culture fits into it.
That there is a biological aspect to mental illness is beyond dispute. However that does not make it a biological phenomenon. There is probably a biological aspect to language too. That doesn't mean that language is biologically determined.
dreamdu5t said neither of those things, and there's no need to be rude.
https://news.ycombinator.com/item?id=7229432
What's rude is going around telling people that depression is made up and comparing SSRIs to lobotomies. Getting a bit snippy when faced with such an affront is only natural.