[Domenic_S]

> First of all, not sure I would call depression mental illness. In fact, I am offended by the word. It’s like saying that having a fever when you get a cold is having a muscle illness. I think the majority of people out there are depressed at some point and have no idea because society deems depression as a “mental illness” and therefore as something foreign and strange that only mentally ill people have. Key to addressing this ever growing phenomenon, especially in today’s social networking age that the tech community has helped bring about, is to accept it as a natural consequence of life and address it as such.

Founder 2 is dangerously wrong. This person shows the fundamental misunderstanding of mental illness and turns it into a shameful thing -- mental illness is for crazy people!. Brain:body :: mental illness:physical illness.

Further, he dismisses depression as "a natural consequence of life," which is one step from saying "everyone feels sad sometimes, get over it."

People find it so difficult to get treatment for depression, which is absurd to me. If your arm gets broken, you don't "suck it up" and say "that's life", you go to a doctor and get treated. It's no different when your brain gets broken.

[wuliwong]

I think get what you are trying to say, and as someone who has dealt with panic disorder, severe depression and addiction in my life, I certainly am glad that there is support, that people take it seriously and that there were some people that didn't judge me along the way. That being said, the way you are express your arguments yields some unintended consequences in logic.

I believe that your implication that a broken arm and a "broken" brain are synonymous is over simplistic if not outright wrong. There is very little debate as to the proper functioning of a healthy arm and how to return a broken one to that state. Obviously this is not true for "mental" issues. The idea that all "mental" issues are a result of something "broken" in the brain is something very much up for debate.

There are serious, fundamental open questions in neuroscience related to consciousness, memory and disease. Also the assumption that our "mental makeup" is entirely physical without any "meta-physical" component certainly isn't known. That last part maybe a bit outside the scope of neuroSCIENCE but it doesn't mean it is incorrect. I actually got my Ph.D. studying problems in neuroscience and I often found myself pondering some pretty strange ideas as possible explanations for observed phenomenon.

[Domenic_S]

> Obviously this is not true for "mental" issues.

It's simplistic, sure. But just because we know less about fixing neurons than we do knitting bones doesn't mean we shouldn't visit a doctor.

> The idea that all "mental" issues are a result of something "broken" in the brain is something very much up for debate.

Sort of, but only really because we don't fully understand what's going on in there. Antidepressants work, we know that, but good luck finding out exactly why they work.

Is depression caused by faulty mood regulation? Genetics? Environment? We're not sure. But we do know that we can treat it -- and usually pretty successfully -- with some chemicals and some talk therapy.

On the science side, yes, it's an interesting problem that we have a lot to learn about. On the patient side, we can do a LOT to make a depressed person's life livable.

[gonehome]

Was with you up until that last paragraph. Strokes and poking around in the brain seem to provide pretty strong evidence that it's all physical. Maybe I'm misinterpreting what you were suggesting, since meta-physical doesn't really imply much.

[onnoonno]

What is a mental illness then? It's just a brain with a somehow different state configuration - and why should one care? It is just a bunch of atoms and their relations anyways..

Can you really explain in your worldview why you would care at all?

[gonehome]

I don't really think that worldview conflicts with caring.

I care because people with brain issues have a hard time in our society, why would it being physical make me not care?

With strokes and 'poking around in the brain' I just meant that there's a lot of evidence that when part of the brain is damaged it causes certain expected behaviors which would suggest that it's a physical system.

'Metaphysical' can be used by different people to mean different things since it's loosely defined as relating to things that are thought to exist which 'can't be seen'. This is why I asked for clarification, but I was mainly disagreeing with the idea that it's something supernatural or magical.

[seunosewa]

The patient's unhappy state as a result of the misconfiguration of his/her brain.

[wuliwong]

I'm not sure what you mean by "strokes and poking around in the brain"?

[badman_ting]

> If your arm gets broken, you don't "suck it up" and say "that's life", you go to a doctor and get treated. It's no different when your brain gets broken.

People say this sort of thing a lot, but it strikes me as unhelpful. The stigma against seeking help for mental health exists and is real, whether you think it's absurd or not. And that stigma often exists in the very people who need help, so just saying "oh you're being silly" is super not empathetic. It's actually not that different from the founder you mention.

Furthermore, 5 separate doctors will all concur that my arm is broken. But they will not concur that I have schizophrenia, or borderline personality disorder, or whatever. There are a number of reasons why that is, but my point is that none of this is as cut-and-dried as a fracture -- not the diagnosis, not the treatment, not the patient's acceptance that something is wrong.

[kendalk]

> "The stigma against seeking help for mental health exists and is real"

Not only is it a societal stigma, but it is nearly a form of accepted discrimination set in concrete.

Within the past year some states have been pushing to start collecting all mental health records. There are people who really who really do need to seek help, but actions like that will only make them afraid to come forward.

[incision]

>'The stigma against seeking help for mental health exists and is real, whether you think it's absurd or not.'

Absolutely true.

Not just stigma, but plain discrimination. Good luck getting an interview if you list Haloperidol [1] under 'Current Medications'.

1: http://en.wikipedia.org/wiki/Haloperidol

[wuliwong]

I agree. I've battled with all types of "mental problems" throughout my life and honestly, the poeple around me that cared accepted that I needed help well before I did.

[iza]

> People find it so difficult to get treatment for depression, which is absurd to me. If your arm gets broken, you don't "suck it up" and say "that's life", you go to a doctor and get treated. It's no different when your brain gets broken.

Yes, it is absurd. And those of us with depression are well aware of how absurd it is. But that doesn't make it any easier to actually go and get help. In fact the inability to seek help is yet another item on the long list of things that should be easy to do but aren't when you are depressed. All of which further reinforces the low self-esteem.

I wouldn't so readily dismiss the opinion of someone who actually has experience with depression when you clearly do not. Yes he is misunderstanding the term "mental illness" but this is the interpretation that most of the rest of society holds. Depression is not like a broken arm. It is not a "thing" that you "have". It is more of a description of a state of mind. There is no silver bullet cure because there is no single cause, it is deeply rooted in other issues.

[mikegioia]

I definitely agree with you. He seems to be perpetuating the notion that depression is somehow a character flaw. There are so many different reasons why people get depressed that I think it clouds the distinction between general sadness and actual psychological depression. The only thing I found to truly help was pure empathy from any combination of loved ones/professionals.

[wdewind]

No, not as a character flaw, but as a reasonable response to a huge amount of stress.

I still agree that he is dangerously ambiguous and mostly incorrect though.

[jmathai]

It's one thing to have external factors such as stress cause depression. Most of what I read concerning "founder depression" is along those lines. It sucks and isn't something to take lightly, even if some view it as self inflicted.

But there's an entirely different class of mental illness that's closely tied to depression; those caused by chemical imbalances in the brain. Stress often amplifies the symptoms (think of people with multiple personality disorder, schizophrenia, etc) but isn't the root cause.

I imagine the founder you're quoting has never had a close friend or family member that suffers from the latter. I get that they might not understand but it's unfortunate they hit "depression" with a sledge hammer by generalizing it so much.

[curun1r]

> I imagine the founder you're quoting has never had a close friend or family member that suffers from the latter.

I would imagine the same, except for the description s/he gives for depression where s/he describes it as being a numbness that can be addictive to fall back into. It is such a spot-on description that he either read it someplace or went through it personally.

[wdewind]

It's complicated. You could argue stress is always the root cause and what varies is simply one's reaction to the stress. I feel deeply uncomfortable drawing a line between people who have "real depression" and "stress caused" depression. You wouldn't make the same comparison with people who have less advanced degrees of cancer, and yet those too can be stress induced, and thus viewed as "self inflicted."

[jmathai]

Isn't cancer much easier to diagnose than mental illness? I think the complexity of mental illness is why we struggle, as a society, to properly understand and deal with it.

That being said I agree that drawing a line is difficult and possibly counter productive. When dealing with people's lives it can lead to more confusion than it helps explain.

[johnward]

If you've ever tried to get help you'll know that they just put you on whatever pill gives them the biggest kick back. When that doesn't work they put you on another, and another. I've been dealing with trying to get some help for years and I'm pretty sure they think I'm just making up shit at this point.

[wdewind]

> If you've ever tried to get help you'll know that they just put you on whatever pill gives them the biggest kick back.

I have to heavily disagree with you because I don't want your post to dissuade anyone who may be considering looking for help from doing so. It is not an intractable problem. I have tried to get help, and received it with zero medication. The key is to see a therapist (PhD - talk therapy) not a psychiatrist (MD - prescribe drugs).

Weekly talk therapy + mindfulness + meditation worked extremely well for me, over the course of about 9 months, in terms of dealing with anxiety and depression. I don't feel "cured" but I feel way more in control than I did before, and I am no longer afraid of depression and anxiety, I've literally learned to cope.

As someone who is very comfortable with the fact that I was in therapy at one point, I really want to encourage everyone to try it, even if you are completely happy right now. Think of it as casually taking intro classes in learning to deal with the stress of life, and learning some basic emotional coping skills, not some way to fix yourself.

All that being said, there are people for whom I would guess drugs are preferable. I had that discussion with my therapist and we agreed they weren't for me. I can't speak for you, but I would highly suggest the multitude of non-drug opportunities for addressing mental health issues since it seems like the drugs aren't necessarily helping. Your doctor should be able to refer you to a talk therapist, but if not you should really consider switching doctors.

Finally, my contact information is in my profile, anyone who might have any questions about any of this or who is considering trying therapy, please feel free to contact me.

[marincounty]

I'm glad you found a workable solution. I have found no difference between a Psychologist with a Masters, or PhD though--at least here in America. At my age, I would question the motives of any Therapist who felt they needed to get the PhD? Motives--meaning a PhD in Psychology is kind of a joke. Personally, I think they like to use the "Doctor" thing, and charge more. I can guarantee one thing, and there's probally a double blind study floating around, there's no difference in quality of Therapy with going with a PhD, as compared to a MS in Psychology. (One of the funniest stories I heard is the guy who wrote, "Men are from Mars, and women are from Venus" got his PhD from Columbia College in San Rafael, Ca.--yes it's true.) As to medication, I'm on you side. Patients and Doctors have been lied too requarding the efficacy of medications. That said, if you have crippling anxiety, and killing yourself with Alcohol; There are better alternatives. Anyone reading this with who feels terrible, I can honestly state that you will feel better with time.(And no I not a health professional, information is antidotal, blah, etc.) If anyone reads this knows someone who is going through some type of mental illness; you will never know just how bad they feel--be supportive.

[wdewind]

> At my age, I would question the motives of any Therapist who felt they needed to get the PhD?

As someone who doesn't have a degree believe me I am sympathetic to that view, but the PsyD (PhD) who helped me was pretty great. I don't think it's the degree alone that did that, but it's certainly not worth treating a degree as a negative signal.

[johnward]

It's not that I want to avoid medication I just want whatever can help. I am talking about when you see your general practitioner and they prescribe you the usual antidepressants. A psychiatrist can prescribe much more powerful drugs and probably provide a better diagnoses too. I have not been referred to one of them. I've been to a clinal therapist and while it helped a little bit I'm still no where near what I feel is normal. Going to a therapist is a major time and money commitment. I luckily have a job that is pretty flexible. The most helpful thing for me is exercise which gives me a temporary relief for a few hours afterwords but sometimes I don't have enough energy. I also keep injuring myself and that prevents me from being able to get a good workout.

[wdewind]

Yeah, I don't mean to imply there is anything wrong with medication, but what you've found is that you've exhausted the limits of what your GP can do for you. So it's time to move on to a specialist. I would suggest starting with talk therapy simply because it's the less extreme response than psychiatry + drugs and it's always easier to escalate, but I really don't know you and I don't know what you're going through.

Going to a therapist is absolutely a major time and money commitment and those are the things that stopped me from doing it for way too long. My basic experience finding a therapist was that there were two kind: one that was in my network, and one that could see me at a reasonable time. I ended up just paying out of pocket and getting somewhat reimbursed later by the insurance company. It wasn't great, but it was totally worth it and I really wish I'd done it sooner.

I don't mean to sound pretentious, but this line:

> I'm still no where near what I feel is normal.

Tells me that you hardly scratched the surface of what therapy can offer you, at the very least in terms of perspective.

It sounds like you're in a rut, and you aren't making progress. Regardless of if you enter therapy, it's time to try something else. If you happen to be in NYC feel free to email me and I can set you up with a great therapist who really helped me. Either way, best of luck to you and keep up the good fight.

[thinkharder]

As someone who has had, what sounds like a very similar experience to yours, I understand and feel your pain. Folks who have never had to deal with it think it's as simple as going to the doctor. Folks who live in SV tend to forget that in the vast majority of the rest of this country, good mental health help is really hard to get. Outside of the major US cities, your typical family doctor has about the same level of understanding of mental health issues as he has about quantum physics, but he thinks he knows everything he needs to about it. And the vast majority of Mental Healthcare professionals require a referral from your PCP or they won't take you as a patient. The scenario typically goes like this: I go see my Primary Care Physician and complain about depression or some other mental health issue. He listens for a couple of minutes then wants to prescribe zoloft (or celexa or whatever). I ask about seeing a Psychiatrist and get something like "well, he's just going to have his intern ask you a bunch of questions then prescribe the same drug I would..." I ask about seeing a Psychologist, and after some pushing he grudgingly gives me a referral. The psychologist is a really bad fit with me, and isn't helping so now I've got a open-ended prescription for zoloft and no fucking help. Been thru slight variations of the same theme with 3 different primary care doctors. And no, I don't really think any of them believed I actually had a problem, but they'll give endless supplies of zoloft et al., to anyone, for any reason. And they'll happily prescribe it for you forever, without also setting you up with some form of counseling, which is specifically warned against in the drug literature.

What I finally had to do, was talk to a close friend who knows a lot of Mental Health practitioners, partly from using their services, partly from the fact this guy knows everyone in town. He was able to call a friend who is a retired Psychiatrist, who was able to help find someone who would take me without a referral, and further refer me to a good psychologist. There's also the issue that most insurance plans have pretty crappy coverage for this stuff. And since I can't get an in-network referral to an in-network doctor, I'll be paying for most of this out of pocket.

My advice, for the little it's worth, is first... Don't Give Up. It's a fucking absurd pain in the ass, but it is possible to overcome. Think about finding a doctor the same way you would about hiring an employee, that's basically what you're doing. Use your social network, do you know anyone who is in a high-risk group for depression or other mental health issues? It's likely you know someone who has struggled with this and just never said anything. Ask around. It sucks to have to reveal yourself that way, but it's really not as bad as it seems in one's imagination. You will probably be surprised how many people not only get it, but want to help. Try a doctor out, if he isn't working, fire his ass and get another. No different than hiring a contractor. It's easy to load a lot of emotion into the process, but avoid doing this and stick to business. And try not to get sucked into the psychiatry vs psychology wanking contest. They're different approaches, have different tools, and different efficacies for different issues. CBT is great for moderate depression. There's much less evidence it's helpful for ADHD. There's a whole class of medication that's quite effective for ADHD. There's much less evidence that zoloft and friends are useful long term for depression. Extrapolate that out for all the other possible mental health issue a person might have.

At any rate, you're not alone, my friend, and you're not the only one who has had to go thru this shit. It is possible... Email is in my profile, if you need someone to talk to, feel free to contact me. Best of luck.

[wdewind]

> And the vast majority of Mental Healthcare professionals require a referral from your PCP or they won't take you as a patient. The scenario typically goes like this: I go see my Primary Care Physician and complain about depression or some other mental health issue. He listens for a couple of minutes then wants to prescribe zoloft (or celexa or whatever). I ask about seeing a Psychiatrist and get something like "well, he's just going to have his intern ask you a bunch of questions then prescribe the same drug I would..." I ask about seeing a Psychologist, and after some pushing he grudgingly gives me a referral. The psychologist is a really bad fit with me, and isn't helping so now I've got a open-ended prescription for zoloft and no fucking help.

Holy shit. That is so fucked up dude. I'm sorry.

For what it's worth the vast majority of therapists do not require referrals, but not having a referral can make it impossible to get reimbursed via your insurance, which I know can make it a nonstarter for some.

> There's also the issue that most insurance plans have pretty crappy coverage for this stuff. And since I can't get an in-network referral to an in-network doctor, I'll be paying for most of this out of pocket.

Yeah, it really sucks.

> My advice, for the little it's worth, is first... Don't Give Up. It's a fucking absurd pain in the ass, but it is possible to overcome. Think about finding a doctor the same way you would about hiring an employee, that's basically what you're doing.

I agree 100000%. It's so worth it. I also love using our existing startup skills as a platform for addressing these issues, nice.

[jeffreyrogers]

I'm in the United States and want to comment to say your experience doesn't have to be this way.

In the past I've had severe depression and anxiety attacks and tried both medication and therapy. SSRI's were great for relatively quick relief from a lot of the problems I was dealing with, but the biggest benefit came from lifestyle changes and talking to a psychologist/therapist. It's important to realize that their are two different types of doctors you can see when dealing with depression: 1. a psychiatrist (MD), who primarily treats symptoms by prescribing medication, and 2. a therapist/psychologist (PhD), who primarily works with things such as CBT or other forms of therapy, and may recommend you to a psychiatrist if s/he thinks you'd benefit from medicine.

I'm fortunate that now I have a very happy and successful life, but getting to this point required a lot of hard work, honesty with myself about things I was doing that were setting me back, and large lifestyle changes.

[DanBC]

Things change. Now if you're in England the first line treatment should not be meds, but either a talking therapy or a combination of talking therapy and meds.

[Raphmedia]

This, this a million time.

This guy has no idea what he is talking about. Hell, over here (Canada) we have ads and public campaigns all over that say "Depression is a mental illness, do not be shameful, consult a mental health professional".