[funkysquid]

> Or if you are outside for a long time in the cold with no jacket, upon feeling very cold, you don’t say that you have "a coldness disorder".

A better example for anxiety or depression would be standing inside in a warm room, and despite everyone else in the room being comfortable, you are unable to warm up at all. When you complain, you are told that "everyone gets cold sometimes".

This article doesn't seem to have any new information, it's just repeating the old ideas that depression and anxiety are the same as temporary sadness and worry due to legitimate problems.

[themgt]

The problem with using a purely neurochemical explanation like this is the rates of these disorders differ dramatically between societies and within societies geographically, demographically and over time. It is clear that the United States in particular is, especially in recent years, churning out unprecedented numbers of severely psychologically ill individuals. The idea this is solely due to previously undiagnosed individuals or otherwise not representative of a sickening society is difficult to support.

Frankly we have spent too long acting as if mental disorders could not possibly have anything to do with ones surroundings, upbringing and life in general, when it's beyond obvious that they have very much to do with those things, as well as genotype/phenotype/etc. We've used this idea that it shames individuals to suggest that the actual problems they deal with could contribute to mental damage in much the manner they can physical damage, which is simply dogma masquerading as science.

In fact, using purely neurochemical explanations denies people's humanity and lived experience, denies that we are sentient humans not some organic robots that need an serotonin oil change and some dopamine transmission fluid.

[dilemma]

Medication is essentially victim blaming by society unto the individual reacting against its conditions. And the medical health specialists are agents of society, not the person they're ostensibly helping.

[pzone]

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

[sowhatquestion]

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

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

[phineastcat]

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

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

[zamalek]

> organic robots

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

[lotyrin]

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

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

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

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

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

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

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

[oconnore]

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

What sort of therapy is that?

[DanBC]

Air in face is APAP for sleep apnea.

Belt under the feet is a treadmill for exercise.

[retbull]

The belt one was funny.

[Fordrus]

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

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

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

[danharaj]

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

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

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

Kind of a straw man don't you think?

[Fordrus]

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

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

[danharaj]

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

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

[Fordrus]

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

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

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

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

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

[danharaj]

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

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

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

[_archon_]

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

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

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

[stephenboyd]

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

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

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

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

[golemotron]

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

[fucking_tragedy]

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

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

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

[jolux]

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

[DanBC]

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

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

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

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

[0xcde4c3db]

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

[themgt]

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

[TeMPOraL]

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

[themgt]

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

[TeMPOraL]

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

[jolux]

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

[tim333]

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

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

[jolux]

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

[smegel]

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

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

[TeMPOraL]

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

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

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

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

[smegel]

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

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

[TeMPOraL]

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

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

[smegel]

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

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

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

[noxToken]

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

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

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

[superuser2]

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

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

[jolux]

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

[jakegarelick]

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

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