There is an organisation called BlueHackers.org [0] which was started at the Open Source Developers Conference. It has a strong presence at linux.conf.au as well.
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.
Cool sentiment, but what makes you think other "hackers" have the formal background to reach out and to a depressed person? If i was depressed, the last person I'd want to talk to about it are my hacker friends. The vast majority of the population simply have no idea how to talk to mentally ill people.
Well, that's part of the problem, the idea that you need a formal background to help a depressed person at all, and that the rest of us should go hands-off and pretend it isn't happening. Sometimes just knowing that someone cares can help. It's not universal, it's not a cure, but it is something.
Couldn't agree more. Not only is it part of the problem, the so called mental health "professionals" are hardly qualified to help themselves. For all their education, they're no better than anyone else at preventing tragedy or helping others. The only thing they are better at is fooling people into thinking that they are professionals at all. This is a sad story, but as it states at the beginning, Stephen tried to call and talk to the hospital and other "professionals." If these people had any training that qualified them to provide help that laypeople don't, they would have helped. In fact, I'd go as far to say that someone who is not a professional is more likely to help because they might genuinely care for something more than money, something a professional trains not to care about.
Uh, no. That's not what I said at all, and it's not true.
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.
I'm not sure why you've been down voted. I didn't intend for my post to say that talking to friends or colleagues is a replacement for professional help, just that any extra help is a positive, especially when people might have a tendency to feel isolated.
Don't worry, I think you expressed yourself clearly. I was just responding to the other folks who seemed to be explicitly saying that you only needed one of [support network/psych professional] and that the other was useless.
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. :)
Depression doesn't really need a qualified person. You're not talking to a mentally ill person, at least not in the sense that you cannot spring a bolt in a depressed person's mind and have him go on a killing spree.
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.
Most 'mental illness' is completely unrelated to 'likely to go on a killing spree' and this kind of ignorant crap supports exactly the kind of stigma that prevents people getting help.
Just to be clear we're not trivializing the condition, you're right that some sufferers of depression don't really need a qualified person (particularly if they have a good support network and sufficient strength of mind) but some people only turn around after CBT, for example.
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.
Sadly it's well known that non-specific counseling has a neutral or negative effect. Obviously studies about this are difficult.
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.
When I get depressed, which usually happens around this time of year, I typically enjoy talking to other hackers. We can talk about something that isn't our own mind(s). This goes for music, too. A huge key for me is to distract my mind with something that interests me, and makes me feel productive, rather than "sitting & spinning" on a subject that is making me feel bad about myself. Talking about things that interest me makes me feel better about myself.
Disclaimer: I have never been psychologically evaluated for depression or anxiety.
Another reason to put the sticker on there is to spread awareness and end the stigma. Some people think that mental illness isn't a real illness. But if you have something wrong with your lungs, you go to a lung doctor; so if you have something wrong with your head/mind, you should go to a mind doctor.
Lung cancer and most other physical ailments have legitimate, objective diagnostic criteria. You get a test or two and find out if you have a specific disease. I.e., science.
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.
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.
> if you have something wrong with your lungs, you go to a lung doctor; so if you have something wrong with your head/mind, you should go to a mind doctor.
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.
No, all it shows is that there is a physical component - and probably for only some people. It is hardly the same as something like diabetes. On that note, I am now going to a therapy group for people with diabetes, because the NHS has realized the psychological aspects of dealing with diabetes are important enough that giving people support (in that manner) are cost effective over the person's lifetime - i.e. they learn how to deal with the psychological stress of it and so the long term consequences are lessened at a lower cost for the health care system. Thank god I do NOT live in the US anymore!
> No, all it shows is that there is a physical component - and probably for only some people.
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.
Yes, and there are a lot of people who have been helped by astrologers. But I don't think this is a point anyone would want to make in a discussion of science, where explanations trump descriptions.
I've been depressed and it's precisely because of that i'm certain i couldn't be of help to someone depressed. Thinking back, i can't think of anything my friends could've said that would've helped. I mean, i was basically a pessimistic, cynical asshole that shot everything down, be it "it'll be ok" or "Lets go to the cinema".
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.
> Cool sentiment, but what makes you think other "hackers" have the formal background to reach out and to a depressed person?
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:
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.
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.
The DSM is not the "bible" of psychology, but psychiatry. They are two completely different areas of science, and the therapists I've talked to over the years have all, more or less, been very useful for getting a handle on my depression and understanding myself and why I operate like I do. I know a tremendous amount about this topic, having gone through several nasty bouts myself - and having a B.S. in psychology (and computer engineering, as well, which is why I'm on HN)
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)
> The DSM is not the "bible" of psychology, but psychiatry. They are two completely different areas of science ...
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.
Traditionally, they are handed out for free at conferences. I'm quite confident that if you are going to a conference or a user group, they'd be happy to post some to you (I'm not part of the organisation, just like what they do).
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 get the impression that this is a long, polite way of saying Steve committed suicide.
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.
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.
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.
I am not shy. I tell my kids when I am suicidal. They still live with me and monitor my medical issues closely, so they know when I am being really, really wonky and not just bitching, if that makes sense.
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.
A while ago I had a problem with anxiety and basically panic attacks. Back then I didn't know how to deal with this, so eventually when it got too much I asked for help. I went to a doctor and the first thing they asked about was suicide. I thought, well, I hadn't really considered that, but now that you mention it, it's probably something I should think about. I wasn't suicidal, so I guess it didn't matter, but it sure does make you think about it when everyone is asking you. Overall though I think it is better to ask about it, because you really do need to know. I've heard though that a lot of people that do commit suicide are good at hiding things from people, even their family may not be aware that something is wrong, so even asking that question is not sufficient. When I hear about people committing suicide, I often think why didn't anyone help them. Often the truth is that nobody was aware, that's sad in it's own way, but it does show that a lot of people can keep these things to themselves.
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.
I dealt recently with a friend who was suicidal. Since I didn't know what to do I called Suicide Action to ask how to deal correctly with the situation and get some pointers on dos and donts.
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.
Interesting. How did you know he was suicidal? If I am convinced he is suicidal, it is easy to have a conversation. But I feel there is so much gray area and the last thing I want is to make someone who is just feeling a bit down in life from thinking about suicide.
She wasn't feeling her usual self and I had to ask explicitely(Do you consider suicide?). For someone who is just feeling down and not suicidal the question might be a bit of a shock, but in the end you are showing that you care and that you are present if things go really bad.
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.
As somebody who's been there (on both sides) I don't believe that anybody who might act on suicidal ideation would not have already considered suicide as an option.
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".
I haven't examined the statistics myself, but isn't it known that suicides go up when there are news stories about them, even in a preventive effor? This implies that suicides are, in fact, somewhat suggestible.
Reading about suicide in the news is incomparable to the kind of direct intervention I'm talking about. As john_fushi commented[1], the best thing you can do is talk about it and his suggestion of calling your local suicide helpline for advice is an excellent one.
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.
100%, although I wish we talked more about the challenge of determining that someone is suicidal.
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.
The best actors in the world are the depressed. No one who knows me knows how many times I have almost died. I say this in the hopes that it helps with the hurt a bit, though losing your brother never goes away. I lost mine to a motorcycle accident when a driver got impatient with traffic.
Something occurs to me when reading what you wrote here. I have heard folks who have struggled with depression (and not just suicidal depression) talk a lot about how important in person time was to recovering generally. I wonder how much depression is a social as opposed to a purely mental/neurological illness.
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 still live with me. They are both ASD and not very touchy-feely people. But they are very loyal to me. I have a deadly medical condition. Doctors told me "people like you don't get well" and washed their hands of responsibility. Since I have defective genes, it won't hurt their professional reputation if I die while under their care. That feels pretty awful to be on the receiving end of.
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.
My brother committed suicide. He died for nothing,and nobody in the family even knows why he died. 10 years later, I feel like I dont care he died anymore, I just cant feel sorry for people committing suicide, it accomplishes nothing,except destroying a family ,making relatives feel guilty all their life.
Suicide is the most selfish thing one can do, that's my opinion.
Would you be saying that if he died of cancer instead of mental illness?
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.
I agree it is not useful to blame suicide victims, but this issue cuts to heart of free will and personal responsibility and is not clearly resolved. I wish depression was the same as a physical illness, because then I could simply go to a doctor and be given a cure. But the only effective cure for depression is therapy, and no-one else can do it for you - therapist can only assist you to cure yourself. So without taking personal responsibility there is no hope of recovery.
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.
"I wish depression was the same as a physical illness, because then I could simply go to a doctor and be given a cure."
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.
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.
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.
"1. In point of fact, much scientific evidence shows that depression is a physical illness, not a mental illness."
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?
>> "1. In point of fact, much scientific evidence shows that depression is a physical illness, not a mental illness."
> 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.
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"
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"
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.
As someone who struggles with mental illness daily, I agree with the sentiment that the world should really treat this kind of disease with a lot more compassion and support, rather than a blaming and negative attitude. It really is a constant uphill battle, and the cards are stacked against us.
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.
People disagree with that perspective because it implies that the brain is entirely deterministic biologically and has no plasticity. That you have no mental control over your physiology. That you don't have control over your attitude and outlook, etc.
Attitude is proven to have an effect on cancer remission rates. Yet we still call it a disease and say that it killed you, not that you selfishly killed yourself due to not getting better.
You have some control. Far less than the "suicide is selfish" idiocy assumes.
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.
Actually I might say about someone who had a heart attack or cancer. A father whose doctor and family begged him to change his diet and exercise habits for years before his fatal heart attack, or a mother who continued smoking even after the cancer set in, for example. Yes, mental illness is very much like any other illness, and like any other illness it can often be prevented and managed through lifestyle changes under a doctor's direction. I'm with GP - with a few rare exceptions suicide is a purely selfish and preventable act.
Refusing to take preventive measures could potentially be called selfish. (Although it's much less clear with mental illness where the disease itself hinders such action.) The death itself is not, especially since these things can still kill you even if you do everything right.
Would you mind giving me the name of your practice so I can make sure that nobody I care about ever, ever goes there?
It isn't selfish of someone to have had a mental illness that drove them to commit suicide. I'm sorry for your loss, but I disagree with your assessment of suicide being a selfish act.
Most (not all) people who commit suicide aren't in their right minds and aren't thinking clearly. Denigrating it as being selfish misses the point of what's going on for the person.
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.
I used to think the same thing. I have never been suicidal so I don't know from personal experience, but I recall reading something that helped me understand suicide as something more than self-absorption. That the pain of deep depression is so real and intense that it can be compared to physical pain, and when it gets strong enough, simply ending it becomes its own imperative. That suicide is like jumping from a burning building - it's hardly even a choice, the pain compels the body to do it.
Some additional reading material that might help inspire some compassion, also both good and entertaining reads in their own right:
Depression isn't just /like/ physical pain. It can cause real, physical pain. Pain, for which you go to doctors who say "oh, you're fine." Pain for which you go to dentists only to hear "oh, you're fine."
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.
Suicide, ingestion of drugs (incl. alcohol), addiction, religious fervor - all of these can be thought of as ways to escape the weight of "the self". A more abstract theory than "neurotransmitters being out of balance", but more useful perhaps in understanding what compels a person to act in those ways. People who commit suicide out of the blue, surprising friends and family, probably felt they were living a lie in some way, and couldn't see any way to get out of that other than escaping it entirely. If someone says "but they seemed to have it all under control" then ... how does anyone know what goes on in the head of another person?
I'm surprised I see no mention of the poem "Richard Cory" whenever this topic arises
My best friend from childhood threw himself in front of a train almost exactly 1 year ago (Feb 18th). He had just got his college degree, had an amazing family and all the support in the world.
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 get the point but there are definitely more selfish things one can do. Blow up buildings, serial kill, rape people, etc. While suicide clearly affects others, on some level we and only we should have a say over what we do with our own lives.
Someone who's depressed enough to consider suicide probably also experiences a crippling loss of hope which prevents them from taking the steps necessary to make local friends in the first place whom they would be able to reach out to. At least that's been my experience.
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.
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.
In person isn't always possible - I'd expect the assumption any friends you know that closely are local from people in most communities, but not here. I've spent time talking to people who I've never met in person who I know consider me a close friend as do I them.
I have also given and gotten support online and by phone. That can also make a difference. But in person, just your presence can prevent someone from acting without having to be confrontational or whatever.
So your credentials consist of personal anecdotes? Maybe it's time to start taking the issue more seriously. I think it's a serious issue deserving a more serious approach.
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.)
I don't give two shits what Thomas Szasz thought about mental illness, because he wasn't a scientist or even a doctor, he was a goddamn libertarian philosopher. He found mental illness philosophically inconvenient because he couldn't see a way around the State being morally justified in providing coercive treatment to the mentally ill, so he just decided they didn't exist.
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.
> 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]
Fine, he was a morally bankrupt doctor. I agree I should not have claimed otherwise in my initial invective and apologize for my error, but let me reiterate: his stance on mental illness did not originate from his medical or scientific observations, but from his philosophy. And despite living through fifty years of startling advances in medicine, where huge swaths of mental illness were found to have biological origins in the brain, he never recanted. So fuck him, he was an asshole.
> And despite living through fifty years of startling advances in medicine, where huge swaths of mental illness were found to have biological origins in the brain
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.
If science had found biological origins or symptoms for mental illness in the brain, don't you think these would be used for diagnostic purposes?
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)
> If science had found biological origins or symptoms for mental illness in the brain, don't you think these would be used for diagnostic purposes?
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.
At the same time, I think it is inescapable, when studying how different cultures look at mental health and mental illness to see this as something which culturally constructed. Personality disorders for example, or ODD, or the like can only be thought of as disorders of inconvenient personality traits and therefore the way mental illness has always been used, and in the historical context, there is a very dark side to coerced therapy (which btw is no less dark when we convince parents to give their kids antipsychotic drugs because their kids are defiant).
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.
> 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.
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.
I like Szasz too, as well as his hippie counterpart R.D. Laing (whom you might check out if you're interested), but please, don't play intellectual hardball in this thread. The OP just lost his brother.
> 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.
FYI: I have done lots of reading. I spent time in therapy. Etc. And, for a time, I essentially had an unpaid "consultancy" where parents who had super difficult kids who had been failed by all the experts would get given my email address and talk with me a bit and a year or so later I would hear back that their "impossible" kid was getting their act together. So I strongly suspect that I know what I am talking about, better than most so-called experts.
If I understand the parent correctly, he agrees with a certain Thomas Szasz' [1] opinions on psychiatry. Central among his opinions is the assertion that mental illness is a "myth" due to the lack of observable changes at the cellular level (or at autopsy), and that mental illness patients are "malingerers".
My opinion : the dude sounds like an ass and his opinions are eye-rolling.
Mental illness is a really tough thing to discuss in an objective way. See the debates about the DSM-5. I personally think mental health and mental illness are socially constructed.
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.
That last is very hard to ask because the vast majority of people are raised with either a guilt or shame model, thus asking it comes across as finger pointing.
It's not a question of finger pointing so much as asking what social structures we have that make this harder.
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?
> What's the logical basis for this pair of assertions? How can the "experience" be real while the illness is not?
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.e. why do you assume that what is socially constructed can't be real?
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'm assuming you wouldn't say "pneumonia is socially constructed". If you did, I would read that as "pneumonia isn't real".
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.
That's a cogent explanation. I can see where you're coming from, and I appreciate you taking the time to elaborate.
> 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]
> For instance, most of the literature I could find does agree that there is a biochemical basis for schizophrenia.
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.
"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."
Thank you for starting a conversation about this. I know it's difficult, but it's important for the health and wellbeing of many other people struggling with the same problems that there are conversations like this one.
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.
Without sounding insensitive, may I ask what it is - that you think - that is at the root of this stripe of depression that you seem to be well acquainted with.
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.
I'll chime in here, if you don't mind - I'm bipolar[1].
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.
Do you keep a sleep diary? Are you aware of when your patterns are changing?
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)
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.
I cannot answer for Rob, but there can be significant bio-medical factors. I am not really prone to depression. If I am depressed for more than a short period of time, you can bet I am anemic, not sleeping well enough, etc. But I have a serious medical condition and have lived with quite a lot of crazy-making stress over the years. If my brain chemistry is wonky enough, I can be suicidal, in spite of not being the depressive type.
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.
For me, it seems to be multi-faceted. There's definitely some kind of mood swing component that seems entirely biological; regardless of whether things are going well in life or not, there are periods of between a week and sometimes as long as a month where I simply have difficulty getting up in the morning, focusing, socializing, and maintaining healthy habits like regular exercise. Usually my sugar consumption skyrockets when this happens and I keep bad hours and the cycle feeds into itself.
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.
Man, the mood swing part rings true for me. In my case they're usually 1-2 weeks. There's some anxiety/depression on my mother's side of the family but I wouldn't say that I've got any issues with it.
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.
It can worsen (or improve) with age or biology. If you can, it could be worth finding a doctor you trust and talking to them about it, and try to determine whether it needs to be addressed or not.
Mental illness is a physical disease, not something to do with "disillusionment" or anything like that.
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.
According to what? You assert that the cause is "still somewhat mysterious" (you mean completely?) in the same sentence you claim the cause is biological. That's pretty contradictory.
No it's not. You can have an idea of the general area where the cause lies without knowing precisely what it is.
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.
There are not. There are no conclusive genes or genetic markers for depression. All that is required for someone to be depressed is to self-report as depressed and experiencing those symptoms.
"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.
No, I think psychology has medicalized a range of normal emotions and behaviors, like sadness and anger for example, and that there is not necessarily any such disease as depression. I know that's not PC and some may find that shocking, but it's pretty plausible when you look at the history of psychology.
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.
I'm not shocked. It's a sadly common opinion. I do think you're full of shit, though.
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.
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.
Clinical depression is often a result not of one's external environment or social situation, but a chemical imbalance in the brain (Serotonin in particular). I'm certainly no expert on the topic, but from what I know science still doesn't have a definitive answer to what brings such an imbalance about. Also it is sometimes hereditary.
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.
The fact that talking about mental health issues is beyond "the fringe of acceptable conversation" is harmful. I wholeheartedly agree that something needs to change on this front in order to prevent more tragedies. One small step would be to stop saying "lost the battle and passed from this world" and say "committed suicide."
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"?
> One small step would be to stop saying "lost the battle and passed from this world" and say "committed suicide."
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.
My original comment was motivated by genuine compassion and empathy. I have been starting and stopping a response to OP's reply to me for an hour now and I am unsure of how to phrase things. Your mom has a point, but when do we respect and try to prevent the pain of the next family? Every time this happens I understand and am tempted by the "now is not the time" reaction but I am also reminded of my favorite piece of writing:
"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 don't know the answer to that. I do know that conversations which make people feel blamed for something terrible that has happened and which cannot be reversed are disastrous.
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).
I'm sorry for your loss. I lost my son to suicide in 2009. He was brilliant, very sociable, very mature and he too struggled with mental illness. Today I know a lot more about the subject and I'm trying to help preventing more suicides from happening and mental health from being poorly diagnosed and treated. Right now I'm working on a project to develop apps for smart devices that can help people at risk of suicide. If anyone wants to help, please, contact me.
I'm doing the same thing. Going to be writing a social SOS app for iphone/android using Ionic Framework. Coding helps ease the pain. Shoot me an email. evanmrose at gmail dot com
Have you read Szasz? Have you refuted his arguments? If you have not considered arguments which say what you're doing is actively bad, but you're going ahead anyway, isn't that irresponsible? If you have considered them, could you tell or link me the answer?
> 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.
EMRo, I'm so so sorry about your loss and your family's loss. Thank you for writing about it. Please take care of yourself as well—and let others take care of you. Grief lasts a lifetime, but it won't always hurt as acutely as it does now. Along the way, you might find some of this helpful; I know I do. http://quinnnorton.com/revived/tips.html
I can only sympathize with what Evan and Stephen went through. We must break the stigma against mental illness. It is far too wide reaching and impactful not to be at the forefront of technology innovation and health research. I challenge new startups to start attacking depression and anxiety disorders.
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?
Please, just stop. You are disrespectful, rude and wrong to boot. Show some restraint, this is a thread to mourn someone who just died under violent circumstances.
I don't believe that's true. There are plenty of mentally ill people (depression, anxiety, bi-polar) that act completely normal like Stephen. They often suffer in silence.
There isn't really a stigma on anxiety disorder or being bipolar, that I know of. There is a stigma on some of the things people with those disorders sometimes do, but that seems reasonable.
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.
How could he possibly have been, "in a highly-respected treatment program", or labelled mentally ill, if he acted completely normal and suffered in silence?
The parent comment was merely questioning the validity of your weird assertion that "People are labelled mentally ill IFF they do things that have a stigma attached". Perhaps you meant "people who do not self-identify as mentally ill but have that designation imposed on them." Maybe you'd have a case there. But the fact remains that many people suffer from mental illness, and it isn't always just a case of society rejecting them for being "different."
You're informing me of a "fact" without a citation. You have not succeeded at persuading me.
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.
Well I can think of at least one counterexample: myself. I suffer from a moderate case of obsessive-compulsive disorder. I have paced back and forth, obsessively checking that the sink in my bathroom is truly off, feeling my anxiety continuing to rise despite obvious visual confirmation. I once ripped the door handle off the front door of my parents' house because I had been strenuously pulling on it, neurotically ruminating on the idea that maybe, just maybe, the door wasn't completely closed.
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?
He was what doctors call 'high functioning.' He was able to operate in society and shroud his pain though it was incredibly painful to do so for him. He wasn't 'completely normal'. He was in a very well respected program in Boston and working through his issues to have the life he wanted.
I am unable to comprehend your lack of understanding. He was mentally ill. He was treated for it. He operated within society in a fashion that does not comply with the stigma of mental illness (no murdering people, no sociopath manipulation). We need to remove this stigma (that all mentally ill are dangerous psycopaths). This will help those who are mentally ill find treatment.
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.
Terribly sorry for your loss. My condolences and sympathy are with you and your family. And I mean that for real. HN has been there for me through death and we are here for you too bro.
This story about your brother's struggle was moving...I'm sorry to hear about your loss. Mental health-related causes are personal to me as well.
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.
"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."
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.....
Hey thanks for sharing your story. My brother was just starting a blog and hoping to share his ideas with others. He was an avid problem solver and I wish he had found ways to reel himself back in like you did. Will check out your site!
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.
I wanted to take a minute to just say that this thread has moved me to tears.
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.
So sorry for your loss. I lost my father about seven years ago. The time following that period was excruciating. It sounds like your mindset is in the right direction. Just make sure to surround yourself with people that support you.
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.
No one has posted a link to this poem which I learned about ... many years ago in high school. It has always stayed with me and touches upon the fundamental philosophical issues around suicide - survivor's guilt, the "why?", the essential loneliness of every individual...
This was well written. It also sounds like suicide and I can't imagine how one must feel to do such a thing. But it reminds me that despite all cool toys and great achievements, what really matters in this life is others we can talk to and rely on. And this shouldn't only include friends and family but society as a whole.
I was caught thinking whether he committed suicide. It is a brave idea to discuss the intimate details of such a grave news, but transparency to the last mile will only help others a little more.
However, POSTing from a http login page to https "logged in" page opens you up to javascript injection attacks that can sniff credentials as you perform the login action.
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.
I would start out by saying there's a stigma around mental illness and that it's not a "real" illness and that it's "all in the head therefore not real".
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.
There exist some good points that you might agree with, but you're being insufferable.
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.
> People labelled mentally ill can be imprisoned without a trial.
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.
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.
So there's other bad things in the world, too. What's your point?
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.
There's probably a strong selection bias here though. If one's trying the insanity defense it's either a.) they're insane and really didn't know what was going on, or b.) they have no other defense and are going for a hail mary. People in both camps are very unlikely to receive shortened sentences or early parole.
Just so you know, it's considered good form for journalists reporting on suicide to refrain from describing the method (to the extent possible)[0][1][2].
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.
While it's a tragic loss, it's purpose is moot because many people read the entire thing and still don't know what his symptoms were. If you want to desensitize the discussion about mental illness, you need to expose the underlying conditions and make people aware.
This is true. I was an advocate of complete openness. My mother is understandably very sensitive about the wording used so I wanted to respect her wishes.
> he did all the things he was supposed to do to get help in a moment of crisis - made multiple calls to his care providers, to 911 and even went to the hospital. He had been experiencing symptoms for several years but was in a highly-respected treatment program that was working intimately with him.
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.
I've just spent 20 minutes (all I can spare right now) reading up on Thomas Szasz, both at your link and on Wikipedia. He certainly had some good ideas (he's against homophobia and the drug war), but his position on mental illness seems to be that it doesn't exist, that people with debilitating mental conditions are faking it for attention or to get out of responsibilities, and that the correct response to someone considering suicide is to hand them a noose and say "have at it."
If you want me to take you or Szasz seriously, please demonstrate that all three of my assertions are incorrect, with citations.
Szasz thinks mental illness has no biological basis, which flies in the face of the empirical fact that twin/adoption studies have shown a clear hereditary basis for a variety of conditions like bipolar, schizophrenia, etc.
Arguing that someone dying despite psychiatry invalidates psychiatry is like arguing cancer treatment is useless because some people die of cancer.
Do you want to discuss this seriously? If so, cite an actual study and say specifically what conclusion it reaches and specifically how that contradicts Szasz.
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.
> 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.
What does that say, other than: that, in a modern sociological environment, certain genetics-mediated brain differences cause people to behave (react) in different ways to their environment?
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.
Yes, I don't understand how is this study conduced since the diagnosis for bipolar disorder is not conclusive itself..
It doesn't tell anything on how it's purported that the brain is 'faulty'
How do twin studies rule out "environmental" that is, non-genetic, causes. Twins look alike, so if there are ideas about how people who look alike ought to act alike we would be expect a correlation between genes and behaviour that has nothing to do with the content of the genes. Rather, that behaviour would be motivated by similar ideas.
Szasz entire screed appears to be based on mental illnesses not being able to be concretely diagnosed or detected, but then jumping to the conclusion that they are completely made up and abused by society to control everyone's behavior.
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.
You have admitted you don't understand Szasz's position, presumably you should be interested in finding out more, see:
http://fallibleliving.com/thinkers/szasz
and the reading list at the bottom.
Kendell point (1). Szasz's position is not that diseases must be diagnosed by looking for chemical or structural abnormalities. Rather, such abnormalities are a criterion for having the disease. It may not be possible to find those abnormalities until after the person dies.
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.
It sure is interesting that your two primary supporters in this discussion (JustinCEO and aforrester) were created more than a year ago but haven't posted anything on HN until today, when they showed up to support you.
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.
I don't appreciate the implication that I'm not a person. Xenophanes posted the link to this discussion to a public email list where (you may find this shocking), some people agree with him and are interested in this kind of discussion.
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:
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.
Does the person behind Xenophanes consider each of their online identities to be a "person"? Nice dodge with that choice of word. It's easier to claim that a fake online identity is a person than it is to claim that a fake online identity is a human.
> Want a discussion where you won't be punished if you say "What You Can't Say"[0], as xenophanes dared do today?
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.
i was blocked from posting for around 3 hours, which is why i didn't answer most of my critics. email me curi@curi.us if you want to discuss it further.
Pancreatic cancer kills about 75% of patients within a year and 95% within five. From this, we take away "let's improve treatment methods", not "oncology is a scam that the free market should eradicate".
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/