[mikeash]

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.

[billyjobob]

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.

[mikeash]

"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.

[lutusp]

> I wish depression was the same as a physical illness, because then I could simply go to a doctor and be given a cure.

1. In point of fact, much scientific evidence shows that depression is a physical illness, not a mental illness.

2. The only reason treatments are not available for the physical illness of depression is because of the primitive state of neuroscience.

3. But neuroscience research is moving apace, and is very promising. Read this: http://www.nytimes.com/2006/04/02/magazine/02depression.html...

4. A quote from the above-linked article: '"So we turn it on," Mayberg told me later, "and all of a sudden she says to me, 'It's very strange,' she says, 'I know you've been with me in the operating room this whole time. I know you care about me. But it's not that. I don't know what you just did. But I'm looking at you, and it's like I just feel suddenly more connected to you.' '

"Mayberg, stunned, signaled with her hand to the others, out of Deanna's view, to turn the stimulator off."

'"And they turn it off," Mayberg said, "and she goes: 'God, it's just so odd. You just went away again. I guess it wasn't really anything.'"'

5. Psychiatrists and psychologists, of course, insist that depression is a mental illness and is treatable with therapy and drugs. But there is no reliable scientific evidence for this view.

6. President Obama recently announced a major "brain initiative", meant to speed up the pace of neuroscience research. More here: http://www.whitehouse.gov/the-press-office/2013/04/02/fact-s...

7. Notice that the initiative is not called the "mind initiative". The reason? Psychology had its chance and failed. It's time for a new approach.

> It's especially problematic because mental illness is a fault in your thoughts, and not in, say, your arms or legs.

That's what psychiatrists and psychologists would like you to think, but it's false. Some day this way of describing mental illness will be judged to have been criminally false.

[illuminate]

"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?

[lutusp]

>> "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.

Link: http://en.wikipedia.org/wiki/Russell's_teapot

Quote: "Russell's teapot, sometimes called the celestial teapot or cosmic teapot, is an analogy first coined by the philosopher Bertrand Russell (1872–1970) to illustrate that the philosophic burden of proof lies upon a person making scientifically unfalsifiable claims rather than shifting the burden of proof to others ..."

In other words, you are a scientific ignoramus.

Psychiatrists claim to be able to treat depression, the claim is formally unfalsifiable, there is no evidence for this claim and copious counterevidence, and the burden of evidence belongs to psychiatrists and psychologists.

Nevertheless, in spite of the fact that the burden belongs to those making the claim:

Title: "Treating depression with the evidence-based psychotherapies: a critique of the evidence"

Link: http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2007....

Quote: "... the specificity of CBT and IPT treatments for depression has yet to be demonstrated."

Title: "Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration"

Link: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...

Quote: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance."

Title "The Emperor's New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration"

Link: http://alphachoices.com/repository/assets/pdf/EmperorsNewDru... (PDF)

Quote: "If drug and placebo effects are additive, the pharmacological effects of antidepressants are clinically negligible. If they are not additive, alternative experimental designs are needed for the evaluation of antidepressants."

The scientific consensus? Depression drugs and therapy don't work.

[sdegutis]

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.

[dreamdu5t]

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.

[mikeash]

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.

[dreamdu5t]

So you're claiming suicide is caused by a biological mechanism? That once we identify that mechanism, we could prevent suicide?

Great, maybe that's the case. However, there's no more evidence for that than the assertion that suicide is a choice.

[Mz]

There is some evidence that brain chemistry is influenced by diet and dietary changes can help with depression. For example: http://www.mayoclinic.org/diseases-conditions/depression/exp...

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.

[grahamburger]

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.

[mikeash]

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?

[illuminate]

"Refusing to take preventive measures could potentially be called selfish"

The problem isn't just the illness clouding the need for them but also that there are sometimes more significant side-effects as well.