Amen to this article. As one who myself once believed my depression "came out of nowhere" (but which, in retrospect, was an obvious symptom of my emotionally destructive family and school environment) and who tried for many years to smother those feelings with antidepressants, I feel strongly that this article presents a wiser path.
Evolutionarily speaking, it seems likely that depression/anxiety are there for some purpose, and yet we treat them both like meaningless pain meant only to be banished using drugs. I believe both are signals that something in our environment is not working for us. They indicate emotional or physical needs unmet---needs for safety, autonomy, connection, etc.
Often the individual suffering is fundamentally unaware of their own circumstances. I didn't realize how messed up my family relationships were growing up until much later. There are various reasons for this unawareness, but I believe the depression/anxiety are there to force our conscious self and the people around us to acknowledge that something is wrong.
This isn't just the old nonsense about depressed people needing to cheer up, and that it will pass in a day. This is a completely different paradigm that explains depression and anxiety as meaningful signals of underlying problems rather than as inexplicable suffering to be numbed through prescription medication. I believe it will prove the more robust and also the wiser way of looking at these experiences.
> Evolutionarily speaking, it seems likely that depression/anxiety are there for some purpose, and yet we treat them both like meaningless pain meant only to be banished using drugs. I believe both are signals that something in our environment is not working for us. They indicate emotional or physical needs unmet---needs for safety, autonomy, connection, etc.
> Often the individual suffering is fundamentally unaware of their own circumstances. I didn't realize how messed up my family relationships were growing up until much later. There are various reasons for this unawareness, but I believe the depression/anxiety are there to force our conscious self and the people around us to acknowledge that something is wrong.
If a situation is causing no problems outside of depression/anxiety, and you took away the depression/anxiety mechanism, there would be nothing wrong with it.
If there are other problems, then piling depression on top makes it harder to fix.
A lot of medical conditions cause chronic pain. The pain helpfully signals "something is wrong" once, and then keeps unhelpfully reminding over and over. You want to treat the pain itself in that situation. Sometimes the pain is the only thing you need to treat at all.
Being an indicator of other problems does not make chronic pain useful. Depression is similarly crippling and unhelpful.
Oh, this is a fantastic and beautiful deconstruction of this argument, I LOVE this. The comparison to chronic pain is fantastic, because indeed, chronic pain is a side effect of many conditions, and if we were able to relieve the chronic pain somehow, we certainly would, but being currently unable, we seek means to treat the chronic pain.
I've often held that the most insidious part about clinical depression is its self-reinforcing nature. Deep clinical depression is throwing a person into a deep hole with thorns sticking out of the sides- every attempt to climb out of said hole results in swollen cuts and pain to the arms and body, rendering eventual escape more difficult with each struggle.
Eventually, it becomes like trying to climb out of said hole with no arms at all. It's one of my life goals to discover biochemical methods to help such people regain the use of their arms, or even essentially grow new ones.
I find articles like this one useful ONLY* insofar as they assist those who have gained use of their arms and cut away the brambles on the walls of the pit- for most others, it merely ends up encouraging more struggling, self-recriminations, and effectually a deepening of the hole. :(
Depression is sometimes described a numbing experience. Everything loses color, loses that spark. Sometimes, everything hurts, nothing feels good. Making the same daily decisions is painful and slow, like walking through an ocean of glass.
Depression gives you the power to make really big decisions. Everything hurts about the same. Going to work is about as painful as staying home, meaning it's easier to quit a horrible job. It's easier to divorce an abusive partner. It's easier to pack up life and start over.
Having been through extreme depression multiple times, I can say with confidence that it makes those really big, really scary decisions a lot easier. You get thoughts like "it would all be over if I never saw that person again". "I would enjoy life if I got a divorce and moved back to my home town". "My job is abusive and it's slowly killing me, having no income is better than hating 70 hours of every waking week".
If you are depressed and having those types of thoughts, you might actually be right. Following through on those major, traumatic changes might actually be what you need to do. And depression makes it easy to do so. Normal life becomes so bad that change is welcome, because change feels like a way out.
Just thinking out loud here: What about allergies?
In that model, what you need to fix is not to remove the trigger (e.g. the pollen may be safe) nor to inhibit the ability to respond (sometimes you need a big immune reaction) but instead to focus on whatever's gone awry with the fiddly logic in the middle that normally regulates frequency/severity/duration.
If that were the case, then the "depression reaction" might be a useful adaptation... but for some people it's occuring disproportionately.
>If a situation is causing no problems outside of depression/anxiety, and you took away the depression/anxiety mechanism, there would be nothing wrong with it.
The article's premise is that having one's core psychological needs go unmet is like having a broken bone.
If you take away the pain from a broken bone, you still have a broken bone. As you say, there is nothing wrong with taking the pain away. But the bone is still broken, and limits you in ways that a healthy bone would not.
Taking away the symptoms of an unwell psyche still leaves you disabled, even if it isn't as outwardly evident as a broken bone.
A large proportion of chronic pain is iatrogenic, or the product of maladaptive coping strategies. The canonical example is back pain; Standard medical advice was once a long period of bedrest, but this further weakened the supportive musculature of the back, creating a vicious cycle of pain and inactivity. The standard advice is now the exact opposite; Exercise is essential in spite of the pain, for both physical and psychological reasons.
There are often complex psychosocial factors involved, with access to disability benefits playing a substantial role in a large proportion of cases. Long-term use of opiates can cause hyperalgesia and rebound pain due to tolerance and withdrawal. Chronic pain is not simply a spontaneous biological phenomenon.
In the relational frame theory that underpins acceptance and commitment therapy, similar mechanisms are seen as integral to chronic anxiety and depression. Experiential avoidance is a common response to unpleasant emotions, but avoiding stimuli that trigger painful emotions tends to cause a paradoxical increase in the intensity and frequency of those painful emotions. Managed exposure to these stimuli is an essential component of a wide range of behavioural therapies.
> If a situation is causing no problems outside of depression/anxiety, and you took away the depression/anxiety mechanism, there would be nothing wrong with it.
My experience with SSRI's has been that taking away that mechanism is taking away creativity, emotional range, and introspective ability. Reality distortion is reality distortion. I reject procrustean medicine that fits humans to the mold of what is best for society, which is the primary environment in which anxiety/depression originate.
Bad metaphors for chronic pain don't really help here.
There probably aren't any scenarios where, if you just removed the depression/anxiety "everything else" would be just fine.
What has happened is this: mainstream culture claims that these scenarios are fine when they are not, and so people seek to remove the depression and/or anxiety from them without even questioning whether the scenarios themselves are very healthy.
You're unable (unwilling) to accept that these circumstances are bad. You don't want to change them, you want reality to be something other than it is so that your culture can continue as it has without changing and growing. You would prefer that people numb themselves to it rather than address these defects.
The article's example is full of these.
* People pushed into college who do not want to be there
* Parents of young children divorcing
* Parents of young children remarrying
* Shallow friendships
* Hookups
These are not problems that will be easier to fix if he's doped up on prozac, they aren't problems you probably even want to acknowledge as such.
I appreciate this challenge to the article's viewpoint. My response would be that regardless of our unawareness of the causes, both emotional and physical pain are signals of things we need to pay attention to. Maybe chronic pain is the perfect analogue to depression/anxiety exactly because it seems to have unknown or untreatable causes. Maybe there is a need for painkillers in difficult chronic cases, but the vast majority of experiences of pain are functional and helpful.
Additionally, chronic pain conditions generally strike late in life whereas depression/anxiety come earlier. The emotional pain seems more likely to be adaptive whereas the seemingly meaningless physical pain later in life seems more like people's bodies breaking down.
> If a situation is causing no problems outside of depression/anxiety, and you took away the depression/anxiety mechanism, there would be nothing wrong with it.
The problem is that the connection between depression/anxiety and interpersonal relationships has been programmed into our systems by evolution. So the question remains if it is wise to alter our biochemistry to suppress mental illness.
Though it must have some function or evolution would have got rid of it. My theory is keeping your head down may be helpful if you are screwing up socially. These days if the people who know you don't like you you can just move but in the hunter gatherer days that may have been fatal.
Therese are degrees of chronic pain. In its acute form painkillers are helpful. In its mild form there is always danger of suppressing a useful signal. The signal gives clues how small changes affect it allowing one eventually to find a remedy that works.
Similar with depression. Unless it is severe, it gives a hint to try to change something. Those changes can be really small, like getting enough sleep, or going to sea once in a while, or talking to an old buddy, or joining some volunteer activity. The key is to try and recognize the feedback that is impossible under antidepressants.
Thanks for the perspective, and ditto. It sounds condescending, and obviously physical brain damage (e.g. CTE) can cause depression completely separately from life circumstances, but I would venture that for a majority of people who say "My life is just fine but I am depressed anyway", their life is not actually fine.
It's not even that they are lying, but we humans are very good at hiding truths, even from ourselves. It can be very hard to truly admit that one is unhappy about one's life, and frankly many people have never really experienced a true sense of fulfillment, peace, belonging, purpose and happiness, and don't know what it would feel like or understand how lacking the feeling is in their lives.
"My life is fine" generally means "I've checked the right boxes: 'success', 'friends', a relationship, but I still feel empty." Don't use drugs to numb that feeling. Listen to it.
These symptoms can be caused by trauma that happened in the long ago past. Your current life situation could actually be fine but you have symptoms of past trama.
Seen too many people running around making drastic changes in their lives in an attempt to feel happy but each change just brings more depression because it doesn't work.
"Just make a change in your life" is some feel good bullshit. It's not that simple.
Seriously though, compared to being depressed when you can't fix it because you don't have any idea that something is wrong, drugs are fucking amazing. The shitty part is people end up trapped now as the drugs can fuel the negativity which lead to the depression in the first place.
Definitely agree with this. The exchange the doctor describes to begin the article is also common online. I've spent a lot of time in anxiety and depression support forums and chat rooms for my own problems with anxiety. The most common view is that anxiety and depression are diseases that you need to take medicine to treat.
No doubt medicine has its uses in treating anxiety and depression, a momentary reprieve can grant you the clarity to see what you do need to change to feel better. However, I see many people online who cling so strongly to the idea that anxiety and depression are chemical imbalances that you are unlucky enough to be predisposed to developing and that balance can only be restored through medication, that when you suggest that anxiety and depression are not diseases and so can be treated to the point that they are not a problem anymore, people will react violently, as if you just assaulted their identity.
This line of thinking makes it extremely difficult for them to get relief. It is also beneficial to pharmaceutical companies who can make a customer for life by convincing customers that if they don't have a certain medication they will always feel miserable.
Unless we can more reliably distinguish between the cases where it is a neurochemical imbalance that needs medicinal intervention and not, then it can be just as damaging to fight against that viewpoint as it is to fight for it.
What we need is to foster open discussion of both viewpoints because both are fully valid explanations of anxiety and depression. For those who truly do need[1] such medicine it is demeaning and disheartening to hear views like yours touted as the only valid point of view because it implies they are invalid, or that they're cheating because they're not managing without drugs.
I similarly take issue with the article's claim that "anxiety and depression are symptoms of psychosocial needs and threats" because it completely rejects neurological causes of anxiety and depression. There's nothing that says predisposition to neurochemical imbalances will never be more severe than what can be managed without medication. And the same can be said for environmental factors (e.g. ingested and inhaled compounds from the area around where you live, just by happening to live there).
Has anyone done a scientific study on the common root causes of anxiety and depression? Do we even know enough about the brain to be able to confidently identify the root cause?
[1] If you know there are no such people, I'd like to learn about how you know that.
There are also some forums where people discuss abusing a depression/anxiety diagnosis to claim disability welfare. This is much more widespread than most people realise since the rates are higher and the requirements much lower than regular welfare.
It's a surprisingly cushy lifestyle, and some would do anything to keep it. And that entire structure is dependent on depression/anxiety being seen as a medical problem with no solution, only medication.
..or that for some individuals, those who suffer bipolar (such as myself) or clinical depression, there's a biological factor that has little relation to past circumstances.
I'm not sure why you are calling this a new paradigm. Don't most, if not all, therapists deal with depression as a symptom for necessary changes in life circumstance? Yes, every particular case is different, but in general, therapy is meant to motivate you to make a change---either in perspective, or practice or upon external sources of angst.
You're right, this is not new to psychology itself. It's more of a direct challenge to the culturally powerful psychiatric/biomedical approach to depression and anxiety.
My experience is no, most therapists don't deal with depression as a symptom for necessary changes in life circumstances. They'll expect you to talk about your feelings and so on. I've never heard of one saying your life sucks, change your job and make some friends. Which would often actually be helpful.
I often notice people assume evolution to be "wise" and "nice" when searching for evolutionary explanations, which it is neither.
Evolutionarily speaking, just because something has evolved does not mean it happened for a purpose, or is useful at all.
Pathological anxiety and depression may actually be purely disadvantageous mutations which nevertheless still passed evolution filters because they are not disadvantageous enough to wipe out 100% of their carriers.
Or they may have a much uglier purpose than you have assumed, for example, to force weak individuals (in)voluntarily withdraw from consuming resources useful to others, or even to kill themselves completely, which might be "wise" during foraging times but is nothing but useless breakage in civilized age.
But most human variations are recent! We've changed more in the last 50,000 years than the previous 1M years. I'd say, instead of a real purpose, any 'breakages' are likely coincidental to some other, more advantageous adaptation. Getting smaller and more calorie-efficient (to suit the village/town/city/urban environment) may mean biochemical changes that change our mental state. Not because we 'need' that mental state, but because its better for the clan if more of us fit closer together.
So many adaptations are sledgehammers for a smaller problem. Evolution doesn't plan; it just diddles around until something (sort of) works. And our bodies are the unfortunate result!
First let me preface this by saying that I have no training in psychology or related fields, so this comment may be complete bunk.
I think that suicide could have some evolutionary advantage in a group. Say there is a member of a group who has become sick, injured, or otherwise incapacitated and is unable to contribute to the group. The group must spend more work to take care of the member than they receive back from the individuals paltry, or nonexistent contributions to the group. If the member's ailment is temporary, then it would be advantageous for the group to bear the burden of taking care of the member, as they would benefit more in the long run.
However, if the member's condition is more permanent, then they represent a net loss to the group's well-being. It would then benefit the group as a whole if that member were to commit suicide, eliminating their burden from the group.
I think this is something that many individuals with suicidal ideation feel on some level. They think that they cannot contribute to their group (family, friends, job, community, country, etc), and that their lack of contribution will be indefinite. For example, a person with anxiety so bad that they are unable to leave the house or get a job might feel like a burden to their family, and unable to contribute. Or, a person with depression might have such a low opinion of themselves that they are unable to see the contributions they are making, or think that their contributions are meaningless and so feel like they are not contributing anything at all worthwhile.
Even though suicide could have had evolutionary advantages in the earlier days of human existence, in modern times I don't think this is the case any longer. With modern medicines and technologies, medical conditions are not as crippling as in the past, and there are more ways to contribute to a group than ever, even without being able to walk or leave the home. The difficulty would then seem to be either helping the suicidal individual to find a group and method of worthwhile contribution, or helping the individual to understand the ways they are already contributing to a group and why that contribution is worthwhile.
Of course, this is just a baseless theory of mine, and I would be very curious to see if there is any actual evidence to back this up.
The author addresses social structures and we seem to live in an age of increasing isolatedness amongst people. I thought it would have been a hard read (I suffer from depression) but it's also liberating to see it in a different light.
My favorite pet theory is that depression is the equivalent of autoimmune reaction for the brain. The same way we need some exposure to dirt to calibrate our immune system to not go berserk with some food allergies or lupus, probably we need something in our life to calibrate our brains' loopback feeds.
So, people who've led relatively normal, successful lives with good relationships and have depression might be experiencing it so deeply because they haven't had much exposure to sadness? Sounds like a reasonable theory to me.
That would also explain how people are able to get out of unexplainable depression after a period of time, and why people sometimes seem to seek out more sadness when they're already sad. They're looking for perspective.
Awareness is the goal of some forms of meditation. I'd like to see more studies on the effects of meditation on those who have various forms of depression.
>Evolutionarily speaking, it seems likely that depression/anxiety are there for some purpose, and yet we treat them both like meaningless pain meant only to be banished using drugs. I believe both are signals that something in our environment is not working for us. They indicate emotional or physical needs unmet---needs for safety, autonomy, connection, etc.
Yes, that's all true IMO, but the problem is that many times, it simply isn't feasible to change your environment. So antidepressants are a good way to deal with the problem.
For instance, suppose you live in the ghetto and are constantly struggling to make ends meet. How do you change your environment here? Well, here in American, you don't. You just suffer. If it were that easy to get out of poverty, most people in that trap would do it. Indeed, many things in society seem to be actively designed to keep people trapped in poverty.
What if you're lonely because you're single and have never had any success dating, and the reason is that you're cursed with being extremely unattractive? There again, there's only so much you can do to change that. (Or worse, you have a serious physical disability, which really limits how many people are willing to date you.)
>but I believe the depression/anxiety are there to force our conscious self and the people around us to acknowledge that something is wrong.
Sounds like an interesting theory, but in reality, at least in this society, it seems to have the opposite effect: it makes you an outcast. No one wants to be around depressed people, so they're stuck being lonely, which feeds the depression, it's a vicious cycle. Antidepressants can really help a lot here, by giving you a short-term boost to jump-start your social life and just to help you cope with life in general.
>This is a completely different paradigm that explains depression and anxiety as meaningful signals of underlying problems rather than as inexplicable suffering to be numbed through prescription medication. I believe it will prove the more robust and also the wiser way of looking at these experiences.
I think the problem with this idea is that this seems to require some gigantic changes in our very culture and how we deal with people who are depressed.
The comments here are depressing. People who are actually depressed are saying that the author is completely wrong about their depression, while others with no experience of depression are nitpicking at them with for what passes for logic on the internet.
The truth is, this PhD is not a psychiatrist, appears to have little clinical experience except whatever his "practice" has thrown his way, and, tellingly, refers to "clients" instead of "patients".
Some depression is situational, for sure, but this is not a deep observation or original thinking. The author is perhaps qualified to treat situational, temporary depression but cannot speak to clinical depression or depression that arises from mood disorders. To the extent he is in denial that these forms exist he is mistreating his "clients", and he shouldn't have the support of a bunch of smarty-pants nerds when he does it.
His bio states: "Gregg Henriques, Ph.D., author of A New Unified Theory of Psychology, directs the Combined Clinical and School Psychology Doctoral Program at James Madison University. He is a licensed clinical psychologist..."
You're right that he isn't a psychiatrist, but he is a clinical psychologist. My educated layman's understanding is that this informs the more behaviorally/environmentally-driven view in his article, but because psychiatrists are trained from a traditional medicine/biology-focus, they are just as likely to be shifted towards the (also valid) biochemical explanations of depression (and the pharmaceutical treatments).
Indeed. Speaking as a sufferer of a serious depressive disorder, one well educated on the current medical science, I find these discussions incredibly frustrating.
Everyone brings out their anecdotes about how their aunt 'just got better through positive thinking, and you can too!' Or people just throw in whatever pop-psychology is currently in fashion. If we were having this conversation in the 1950s, all the smarty-pants would be talking about how depression is simply one of the many materialisations of conflicts between the concious and unconscious mind a la Freudian psychoanalytic theory.
Thankfully our methods of scientific inquiry (if you could categorise past efforts as such) have advanced significantly, and continue to do so. Our understanding of genomics suggests that mood disorders like unipolar and bipolar depression, and even psychotic disorders like schizophrenia, represent a spectrum of possibly thousands of different 'diseases', rather than the few 'categories' arbitrarily delineated in the DSM.
Advances in neuroscience and medical imaging allow us to directly observe how different symptoms are associated with inefficient information processing in different topographically localised brain regions. As we gather more data and the verisimilitude of our observations increases (as tends to occur with rigorous scientific study), we will be able to develop new treatments; be they psycho pharmacological (e.g. drugs) or physical (e.g. trans-cranial magnetic stimulation).
Yes, psychological therapy has its use, and has proven effective in certain situations. But it is just one tool in our ever-growing toolbox. To just blithely deem the rest of the tools to be useless and throw them out is to condemn people like me to a (short) life filled with suffering.
At the risk of sounding snarky or disrespectful, I can't fail to notice how often people suffering from depression become all passionate and fiery when discussing the cause of (their) depression.
From my own experience, I do trust anyone doing actual psychotherapy more (hence 'client') than a psychiatrist who see their patients for 10 minutes max.
My therapist knows me so much better than any of the doctors. I've been enjoying going to my therapist, even though they force me to go there. Not so much the doctors they force me to go there (see http://jglauche.de/posts/misc/2016-01-30-discrimination-by-l... )
> People who are actually depressed are saying that the author is completely wrong about their depression, while others with no experience of depression are nitpicking at them with for what passes for logic on the internet.
There are a number of comments in here from people who say they were depressed for years and found some solution. People share their personal stories on the internet. It's an anonymous outlet. It is what we do. Readers can make up their own minds who to listen to. I don't hold any power over you with the words I write and nor do you over me.
"For clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, nearly every day" [1]
Couldn't agree with you more; out of the half dozen bouts of serious depression I've had in my life (I'm 32) only 1 of them had a series of direct triggers. The rest had no basis, and this is what makes them all the more discomforting; you know in your bones that there is simply nothing you can rectify in your life to make them go away.
I have a close family member that suffers from treatment-resistant rapid cycling depression. Basically, throughout the year, she cycles from hypomania to normal to depression. And there's no real/consistent trigger for these episodes. There's a history of bipolar disorder in the family, so clearly it's genetic.
Perhaps he should have clarified that the cause of the symptom might be situational, or it might be the result of another medical problem, e.g. brain malfunction/chemicals, genetics, nervous system disorder, cortisol issues, thyroid, hormone disorders etc., all shown to correlate with high levels of depression.
Most people who I've talked to who say it's a disease seem to believe so because they haven't identified the cause, and that brings them comfort.
But the meds, while necessary in some cases, should be avoided when possible, or weaned off quickly. They're bad news pushed by an industry that's making so much money from them, and the side effects are worse than what's being disclosed.
You are wrong. Many mental illnesses, over the past decade, have been proven to be diseases. They can be tested for. Currently there are a whole hosts of tests and treatments going through the phases.
Gregg and his ideas run parallel to a line of thought associated with The Citizens Commission on Human Rights, a group hell bent on denouncing mental illness as a disease. CCHR are/were a nonprofit organization established in 1969 by the Church of Scientology and psychiatrist Thomas Szasz.
I can't believe people are still pushing these ideas, but this thread is rife with them. Please review your position, and make an effort to update yourself to the state of the art.
Right on. Most people with actual depression are rarely able to visit a doctor, let alone survive the hoop jumping required to see a psychiatrist, yet alone get a referral for a psychologist, yet alone participate in a study. Frankly, I doubt there has ever been a study ever done on depression where the majority of participants actually had it. It is simply not realistic. You'd have more luck getting a paraplegic into the Olympics than a depressed person into anything more an appointment with a GP.
But every man and his dog has claimed they've had depression. It's like listening to a student who had to survive on ramen noodles for a few years, claim they know what starvation and poverty is like. Unbelievable.
Perhaps there are some who exaggerate. But I wonder how many people who never experienced life-altering depression would be interested in this thread, and how many people who did would follow it. My intuition says the second number is bigger and that generally speaking, most people here have had experience with either meds, therapy, or untreated life-altering depression.
> 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.
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.
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.
> 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.
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.
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.
> 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.
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.
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.
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.
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.
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.
>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.
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.
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.
I have been suffering depression for long time and can tell you right now that this article is as wrong in describing how I feel as one could get it. Regardless of how my need are taken care of and how satisfied I should be with the status quo depression takes it all away from you without you understanding why and how. There are days that I feel like I am the luckiest man in the world, technically speaking, yet I feel the 'saddest' and most depressed I have ever been. Don't believe for a second what the author claims here - depression is a disease and it needs to be treated as one. Very dangerous post indeed.
I don't really understand how any part of what you said refutes the article.
> There are days that I feel like I am the luckiest man in the world, technically speaking
The reality is that each person's needs are different, and just because you are the luckiest man in the world based off society's values doesn't mean your individual needs are being met.
I sympathize with the fact that you have depression but I don't really see how the article is dangerous. If anything I would think that it's good to try and find/fix any underlying issues which cause the depression if possible rather than just hoping medication will make everything go away.
We still don't have a good understanding of the brain and psychological disorders..
The biggest issue I take with the article is a classic chicken and egg problem. The article takes the stance that your depression is there because of your life choices and some factors that aren't in your control. I'm of the very strong opinion that the exact opposite is true.
Depression could be a symptom of a bigger physiological problem.
Sudden pain isn't itself a disease, but a symptom of some other underlying issue. Why can't depression be the same way? No one here is discounting the discomfort of the depressive experience.
how satisfied I should be with the status quo depression
I'd be pretty damn depressed if I were thinking in terms of how satisfied I should be with the status quo. A person needs more than having his/her needs taken care of -- what is it? That search is part of the whole life, and you won't find any answers at all for yourself unless you're harnessing the power of depression. Labelling it as a disease will not get you anywhere but just leaves you as a bystander who unfairly got sick.
i'm with you on your description of 'those days'. i feel like (and technically true) all my needs are met and i'm much, much luckier than most people. but those are the worst days. i just hope this feeling would end, and for you too.
While there's truth to this, it's a generalization. Twin studies show that there's a moderate genetic factor in depression, and a strong one for manic depression
Maybe these individuals with genetic "risks" evolved to live in an environment different from our modern society. Everyone has a different optimal operating environment. These studies don't really conflict with anything the author said.
How would you describe the difference between a symptom and a disease?
To me this article is akin to saying that the various forms of heart disease are not actually diseases. Instead, they are symptoms of a poor diet and lack of exercise.
I'm not a psychologist or have received any other professional training in this direction but really I think there are two types of depression.
- Clinical depression. The disease type that for many "comes out of nowhere" and paralyzes people to the point where they can't leave bed any more. I'd venture to say it's the minority of cases but the author may be wrong in putting them in the same group as the...
- Symptom depression. That's what I think the author is talking about and what I think is the majority of cases. People who work a lot call it "burn-out". Those affected can still function in daily live but quality of life is still pretty poor.
It's probably a mistake to put the first kind in the same class as the second kind. However I think it is a far bigger mistake to treat the second kind like the first kind and that's I think what the author was trying to say (and I would very much agree with it).
Clinical depression is frequently caused by extreme emotional long-term fatigue which is self-sustained because of not identified and fixed issues that cause the depression. So it's not a pathology, it's just very extreme fatigue. To make an analogy -- loosing weight because of not eating is not a pathology. Fix nutrition and you will stop losing weight. But if you don't fix it -- you can get into a very severe condition. Again, not because of some pathology, but because of malnutrition.
is that the medical establishment ought to respond to those who approach it in immense pain by saying, "this is working as expected, go away."
To use your analogy, if a patient presents with a problematic degree of weight loss, the appropriate response is not "yeah, that's what happens when you don't eat, bye." It's to figure out why they aren't eating, and how to get them to eat. Loss of appetite is a symptom of all sorts of pathologies, from an obsession with mass-media standards of beauty to all sorts of fun physical disorders, and a doctor would investigate these avenues and resolve whatever is responsible so that the patient starts eating again.
So I have depressive symptoms for quite some time. I've talked to my doctor like 2 years ago about it. He told me that the only way to get a therapy is to seek out a therapist on my own. This is fine, I can understand that. Just like an alcoholic must accept that he has problems and seeks out for help. I am not going to lie, it is a tough thing to do.
But as an general scepticist I have the huge problem to find someone to trust. I find it absurd that I have to check the phone book or the internet to find some nice looking person that maybe can help with my mental health. Eventually, a therapy is something that both therapist and patient have to agree about. But I can't really see myself to visit mutliple therapists just to find someone that can work with me.
So if someone lives in germany and can give me a hint to find someone, or anyone else in any way I'd appreciate it.
Finding a therapist isn't so magical. The key things they will do is provide empathy and view your life from a third person perspective, and has training in the way the mind works, particularly how it goes wrong. If you can find a therapist who does a good job understanding you and who you respect, they can help you solve many problems.
Depression is commonly defined as the inability to recover from negative emotional state. To then call that a symptom of emotional needs seems to miss the distinction.
If we compared this to injure and clotting, it would be weird to describe a clotting disorder as a symptom of injuries. Preventing more injuries is likely going to help and is a good step forward, but it do nothing to address the issue on why the recovery process is impaired.
The article is talking about ongoing the emotional effects of ongoing circumstances. I'm not sure how the concept of recovery can be applied when the cause of the state has not abated.
It isn't a clotting disorder if your foot keeps bleeding because you haven't taken the tack out of your shoe.
I don't know how accurate the author's characterisation of depression is, but I don't think a useful analysis will result from applying that definition of the word depression so literally in this particular case.
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Evolutionarily speaking, it seems likely that depression/anxiety are there for some purpose, and yet we treat them both like meaningless pain meant only to be banished using drugs. I believe both are signals that something in our environment is not working for us. They indicate emotional or physical needs unmet---needs for safety, autonomy, connection, etc.
Often the individual suffering is fundamentally unaware of their own circumstances. I didn't realize how messed up my family relationships were growing up until much later. There are various reasons for this unawareness, but I believe the depression/anxiety are there to force our conscious self and the people around us to acknowledge that something is wrong.
This isn't just the old nonsense about depressed people needing to cheer up, and that it will pass in a day. This is a completely different paradigm that explains depression and anxiety as meaningful signals of underlying problems rather than as inexplicable suffering to be numbed through prescription medication. I believe it will prove the more robust and also the wiser way of looking at these experiences.
> Often the individual suffering is fundamentally unaware of their own circumstances. I didn't realize how messed up my family relationships were growing up until much later. There are various reasons for this unawareness, but I believe the depression/anxiety are there to force our conscious self and the people around us to acknowledge that something is wrong.
If a situation is causing no problems outside of depression/anxiety, and you took away the depression/anxiety mechanism, there would be nothing wrong with it.
If there are other problems, then piling depression on top makes it harder to fix.
A lot of medical conditions cause chronic pain. The pain helpfully signals "something is wrong" once, and then keeps unhelpfully reminding over and over. You want to treat the pain itself in that situation. Sometimes the pain is the only thing you need to treat at all.
Being an indicator of other problems does not make chronic pain useful. Depression is similarly crippling and unhelpful.
I've often held that the most insidious part about clinical depression is its self-reinforcing nature. Deep clinical depression is throwing a person into a deep hole with thorns sticking out of the sides- every attempt to climb out of said hole results in swollen cuts and pain to the arms and body, rendering eventual escape more difficult with each struggle.
Eventually, it becomes like trying to climb out of said hole with no arms at all. It's one of my life goals to discover biochemical methods to help such people regain the use of their arms, or even essentially grow new ones.
I find articles like this one useful ONLY* insofar as they assist those who have gained use of their arms and cut away the brambles on the walls of the pit- for most others, it merely ends up encouraging more struggling, self-recriminations, and effectually a deepening of the hole. :(
Depression gives you the power to make really big decisions. Everything hurts about the same. Going to work is about as painful as staying home, meaning it's easier to quit a horrible job. It's easier to divorce an abusive partner. It's easier to pack up life and start over.
Having been through extreme depression multiple times, I can say with confidence that it makes those really big, really scary decisions a lot easier. You get thoughts like "it would all be over if I never saw that person again". "I would enjoy life if I got a divorce and moved back to my home town". "My job is abusive and it's slowly killing me, having no income is better than hating 70 hours of every waking week".
If you are depressed and having those types of thoughts, you might actually be right. Following through on those major, traumatic changes might actually be what you need to do. And depression makes it easy to do so. Normal life becomes so bad that change is welcome, because change feels like a way out.
In that model, what you need to fix is not to remove the trigger (e.g. the pollen may be safe) nor to inhibit the ability to respond (sometimes you need a big immune reaction) but instead to focus on whatever's gone awry with the fiddly logic in the middle that normally regulates frequency/severity/duration.
If that were the case, then the "depression reaction" might be a useful adaptation... but for some people it's occuring disproportionately.
The article's premise is that having one's core psychological needs go unmet is like having a broken bone.
If you take away the pain from a broken bone, you still have a broken bone. As you say, there is nothing wrong with taking the pain away. But the bone is still broken, and limits you in ways that a healthy bone would not.
Taking away the symptoms of an unwell psyche still leaves you disabled, even if it isn't as outwardly evident as a broken bone.
There are often complex psychosocial factors involved, with access to disability benefits playing a substantial role in a large proportion of cases. Long-term use of opiates can cause hyperalgesia and rebound pain due to tolerance and withdrawal. Chronic pain is not simply a spontaneous biological phenomenon.
In the relational frame theory that underpins acceptance and commitment therapy, similar mechanisms are seen as integral to chronic anxiety and depression. Experiential avoidance is a common response to unpleasant emotions, but avoiding stimuli that trigger painful emotions tends to cause a paradoxical increase in the intensity and frequency of those painful emotions. Managed exposure to these stimuli is an essential component of a wide range of behavioural therapies.
My experience with SSRI's has been that taking away that mechanism is taking away creativity, emotional range, and introspective ability. Reality distortion is reality distortion. I reject procrustean medicine that fits humans to the mold of what is best for society, which is the primary environment in which anxiety/depression originate.
There probably aren't any scenarios where, if you just removed the depression/anxiety "everything else" would be just fine.
What has happened is this: mainstream culture claims that these scenarios are fine when they are not, and so people seek to remove the depression and/or anxiety from them without even questioning whether the scenarios themselves are very healthy.
You're unable (unwilling) to accept that these circumstances are bad. You don't want to change them, you want reality to be something other than it is so that your culture can continue as it has without changing and growing. You would prefer that people numb themselves to it rather than address these defects.
The article's example is full of these.
* People pushed into college who do not want to be there * Parents of young children divorcing * Parents of young children remarrying * Shallow friendships * Hookups
These are not problems that will be easier to fix if he's doped up on prozac, they aren't problems you probably even want to acknowledge as such.
Additionally, chronic pain conditions generally strike late in life whereas depression/anxiety come earlier. The emotional pain seems more likely to be adaptive whereas the seemingly meaningless physical pain later in life seems more like people's bodies breaking down.
Thanks for the critique.
The problem is that the connection between depression/anxiety and interpersonal relationships has been programmed into our systems by evolution. So the question remains if it is wise to alter our biochemistry to suppress mental illness.
Though it must have some function or evolution would have got rid of it. My theory is keeping your head down may be helpful if you are screwing up socially. These days if the people who know you don't like you you can just move but in the hunter gatherer days that may have been fatal.
Similar with depression. Unless it is severe, it gives a hint to try to change something. Those changes can be really small, like getting enough sleep, or going to sea once in a while, or talking to an old buddy, or joining some volunteer activity. The key is to try and recognize the feedback that is impossible under antidepressants.
It's not even that they are lying, but we humans are very good at hiding truths, even from ourselves. It can be very hard to truly admit that one is unhappy about one's life, and frankly many people have never really experienced a true sense of fulfillment, peace, belonging, purpose and happiness, and don't know what it would feel like or understand how lacking the feeling is in their lives.
"My life is fine" generally means "I've checked the right boxes: 'success', 'friends', a relationship, but I still feel empty." Don't use drugs to numb that feeling. Listen to it.
These symptoms can be caused by trauma that happened in the long ago past. Your current life situation could actually be fine but you have symptoms of past trama.
Seen too many people running around making drastic changes in their lives in an attempt to feel happy but each change just brings more depression because it doesn't work.
"Just make a change in your life" is some feel good bullshit. It's not that simple.
Seriously though, compared to being depressed when you can't fix it because you don't have any idea that something is wrong, drugs are fucking amazing. The shitty part is people end up trapped now as the drugs can fuel the negativity which lead to the depression in the first place.
No doubt medicine has its uses in treating anxiety and depression, a momentary reprieve can grant you the clarity to see what you do need to change to feel better. However, I see many people online who cling so strongly to the idea that anxiety and depression are chemical imbalances that you are unlucky enough to be predisposed to developing and that balance can only be restored through medication, that when you suggest that anxiety and depression are not diseases and so can be treated to the point that they are not a problem anymore, people will react violently, as if you just assaulted their identity.
This line of thinking makes it extremely difficult for them to get relief. It is also beneficial to pharmaceutical companies who can make a customer for life by convincing customers that if they don't have a certain medication they will always feel miserable.
What we need is to foster open discussion of both viewpoints because both are fully valid explanations of anxiety and depression. For those who truly do need[1] such medicine it is demeaning and disheartening to hear views like yours touted as the only valid point of view because it implies they are invalid, or that they're cheating because they're not managing without drugs.
I similarly take issue with the article's claim that "anxiety and depression are symptoms of psychosocial needs and threats" because it completely rejects neurological causes of anxiety and depression. There's nothing that says predisposition to neurochemical imbalances will never be more severe than what can be managed without medication. And the same can be said for environmental factors (e.g. ingested and inhaled compounds from the area around where you live, just by happening to live there).
Has anyone done a scientific study on the common root causes of anxiety and depression? Do we even know enough about the brain to be able to confidently identify the root cause?
[1] If you know there are no such people, I'd like to learn about how you know that.
It's a surprisingly cushy lifestyle, and some would do anything to keep it. And that entire structure is dependent on depression/anxiety being seen as a medical problem with no solution, only medication.
They are very vocal in it's protection.
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Evolutionarily speaking, just because something has evolved does not mean it happened for a purpose, or is useful at all.
Pathological anxiety and depression may actually be purely disadvantageous mutations which nevertheless still passed evolution filters because they are not disadvantageous enough to wipe out 100% of their carriers.
Or they may have a much uglier purpose than you have assumed, for example, to force weak individuals (in)voluntarily withdraw from consuming resources useful to others, or even to kill themselves completely, which might be "wise" during foraging times but is nothing but useless breakage in civilized age.
So many adaptations are sledgehammers for a smaller problem. Evolution doesn't plan; it just diddles around until something (sort of) works. And our bodies are the unfortunate result!
After all, there are quacks out there trying to explain away cancer as a symptom, not a disease (see: http://www.goodreads.com/book/show/163184.Cancer_Is_Not_a_Di...).
You can accept or ignore this, and it won't change the science at all.
I think that suicide could have some evolutionary advantage in a group. Say there is a member of a group who has become sick, injured, or otherwise incapacitated and is unable to contribute to the group. The group must spend more work to take care of the member than they receive back from the individuals paltry, or nonexistent contributions to the group. If the member's ailment is temporary, then it would be advantageous for the group to bear the burden of taking care of the member, as they would benefit more in the long run.
However, if the member's condition is more permanent, then they represent a net loss to the group's well-being. It would then benefit the group as a whole if that member were to commit suicide, eliminating their burden from the group.
I think this is something that many individuals with suicidal ideation feel on some level. They think that they cannot contribute to their group (family, friends, job, community, country, etc), and that their lack of contribution will be indefinite. For example, a person with anxiety so bad that they are unable to leave the house or get a job might feel like a burden to their family, and unable to contribute. Or, a person with depression might have such a low opinion of themselves that they are unable to see the contributions they are making, or think that their contributions are meaningless and so feel like they are not contributing anything at all worthwhile.
Even though suicide could have had evolutionary advantages in the earlier days of human existence, in modern times I don't think this is the case any longer. With modern medicines and technologies, medical conditions are not as crippling as in the past, and there are more ways to contribute to a group than ever, even without being able to walk or leave the home. The difficulty would then seem to be either helping the suicidal individual to find a group and method of worthwhile contribution, or helping the individual to understand the ways they are already contributing to a group and why that contribution is worthwhile.
Of course, this is just a baseless theory of mine, and I would be very curious to see if there is any actual evidence to back this up.
That would also explain how people are able to get out of unexplainable depression after a period of time, and why people sometimes seem to seek out more sadness when they're already sad. They're looking for perspective.
Awareness is the goal of some forms of meditation. I'd like to see more studies on the effects of meditation on those who have various forms of depression.
Yes, that's all true IMO, but the problem is that many times, it simply isn't feasible to change your environment. So antidepressants are a good way to deal with the problem.
For instance, suppose you live in the ghetto and are constantly struggling to make ends meet. How do you change your environment here? Well, here in American, you don't. You just suffer. If it were that easy to get out of poverty, most people in that trap would do it. Indeed, many things in society seem to be actively designed to keep people trapped in poverty.
What if you're lonely because you're single and have never had any success dating, and the reason is that you're cursed with being extremely unattractive? There again, there's only so much you can do to change that. (Or worse, you have a serious physical disability, which really limits how many people are willing to date you.)
>but I believe the depression/anxiety are there to force our conscious self and the people around us to acknowledge that something is wrong.
Sounds like an interesting theory, but in reality, at least in this society, it seems to have the opposite effect: it makes you an outcast. No one wants to be around depressed people, so they're stuck being lonely, which feeds the depression, it's a vicious cycle. Antidepressants can really help a lot here, by giving you a short-term boost to jump-start your social life and just to help you cope with life in general.
>This is a completely different paradigm that explains depression and anxiety as meaningful signals of underlying problems rather than as inexplicable suffering to be numbed through prescription medication. I believe it will prove the more robust and also the wiser way of looking at these experiences.
I think the problem with this idea is that this seems to require some gigantic changes in our very culture and how we deal with people who are depressed.
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The truth is, this PhD is not a psychiatrist, appears to have little clinical experience except whatever his "practice" has thrown his way, and, tellingly, refers to "clients" instead of "patients".
Some depression is situational, for sure, but this is not a deep observation or original thinking. The author is perhaps qualified to treat situational, temporary depression but cannot speak to clinical depression or depression that arises from mood disorders. To the extent he is in denial that these forms exist he is mistreating his "clients", and he shouldn't have the support of a bunch of smarty-pants nerds when he does it.
You're right that he isn't a psychiatrist, but he is a clinical psychologist. My educated layman's understanding is that this informs the more behaviorally/environmentally-driven view in his article, but because psychiatrists are trained from a traditional medicine/biology-focus, they are just as likely to be shifted towards the (also valid) biochemical explanations of depression (and the pharmaceutical treatments).
Everyone brings out their anecdotes about how their aunt 'just got better through positive thinking, and you can too!' Or people just throw in whatever pop-psychology is currently in fashion. If we were having this conversation in the 1950s, all the smarty-pants would be talking about how depression is simply one of the many materialisations of conflicts between the concious and unconscious mind a la Freudian psychoanalytic theory.
Thankfully our methods of scientific inquiry (if you could categorise past efforts as such) have advanced significantly, and continue to do so. Our understanding of genomics suggests that mood disorders like unipolar and bipolar depression, and even psychotic disorders like schizophrenia, represent a spectrum of possibly thousands of different 'diseases', rather than the few 'categories' arbitrarily delineated in the DSM.
Advances in neuroscience and medical imaging allow us to directly observe how different symptoms are associated with inefficient information processing in different topographically localised brain regions. As we gather more data and the verisimilitude of our observations increases (as tends to occur with rigorous scientific study), we will be able to develop new treatments; be they psycho pharmacological (e.g. drugs) or physical (e.g. trans-cranial magnetic stimulation).
Yes, psychological therapy has its use, and has proven effective in certain situations. But it is just one tool in our ever-growing toolbox. To just blithely deem the rest of the tools to be useless and throw them out is to condemn people like me to a (short) life filled with suffering.
There are a number of comments in here from people who say they were depressed for years and found some solution. People share their personal stories on the internet. It's an anonymous outlet. It is what we do. Readers can make up their own minds who to listen to. I don't hold any power over you with the words I write and nor do you over me.
"For clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, nearly every day" [1]
[1] http://www.mayoclinic.org/diseases-conditions/depression/exp...
Perhaps he should have clarified that the cause of the symptom might be situational, or it might be the result of another medical problem, e.g. brain malfunction/chemicals, genetics, nervous system disorder, cortisol issues, thyroid, hormone disorders etc., all shown to correlate with high levels of depression.
Most people who I've talked to who say it's a disease seem to believe so because they haven't identified the cause, and that brings them comfort.
But the meds, while necessary in some cases, should be avoided when possible, or weaned off quickly. They're bad news pushed by an industry that's making so much money from them, and the side effects are worse than what's being disclosed.
Gregg and his ideas run parallel to a line of thought associated with The Citizens Commission on Human Rights, a group hell bent on denouncing mental illness as a disease. CCHR are/were a nonprofit organization established in 1969 by the Church of Scientology and psychiatrist Thomas Szasz.
I can't believe people are still pushing these ideas, but this thread is rife with them. Please review your position, and make an effort to update yourself to the state of the art.
But every man and his dog has claimed they've had depression. It's like listening to a student who had to survive on ramen noodles for a few years, claim they know what starvation and poverty is like. Unbelievable.
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.
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.
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.
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.
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.
What sort of therapy is that?
Dead Comment
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.
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?
...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.
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.
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.
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.
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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.
Related: https://en.wikipedia.org/wiki/No_true_Scotsman
> There are days that I feel like I am the luckiest man in the world, technically speaking
The reality is that each person's needs are different, and just because you are the luckiest man in the world based off society's values doesn't mean your individual needs are being met.
I sympathize with the fact that you have depression but I don't really see how the article is dangerous. If anything I would think that it's good to try and find/fix any underlying issues which cause the depression if possible rather than just hoping medication will make everything go away.
We still don't have a good understanding of the brain and psychological disorders..
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Sudden pain isn't itself a disease, but a symptom of some other underlying issue. Why can't depression be the same way? No one here is discounting the discomfort of the depressive experience.
I'd be pretty damn depressed if I were thinking in terms of how satisfied I should be with the status quo. A person needs more than having his/her needs taken care of -- what is it? That search is part of the whole life, and you won't find any answers at all for yourself unless you're harnessing the power of depression. Labelling it as a disease will not get you anywhere but just leaves you as a bystander who unfairly got sick.
http://www.ncbi.nlm.nih.gov/pubmed/558030
http://www.ncbi.nlm.nih.gov/pubmed/16390897
To me this article is akin to saying that the various forms of heart disease are not actually diseases. Instead, they are symptoms of a poor diet and lack of exercise.
- Clinical depression. The disease type that for many "comes out of nowhere" and paralyzes people to the point where they can't leave bed any more. I'd venture to say it's the minority of cases but the author may be wrong in putting them in the same group as the...
- Symptom depression. That's what I think the author is talking about and what I think is the majority of cases. People who work a lot call it "burn-out". Those affected can still function in daily live but quality of life is still pretty poor.
It's probably a mistake to put the first kind in the same class as the second kind. However I think it is a far bigger mistake to treat the second kind like the first kind and that's I think what the author was trying to say (and I would very much agree with it).
>it's not a pathology
is that the medical establishment ought to respond to those who approach it in immense pain by saying, "this is working as expected, go away."
To use your analogy, if a patient presents with a problematic degree of weight loss, the appropriate response is not "yeah, that's what happens when you don't eat, bye." It's to figure out why they aren't eating, and how to get them to eat. Loss of appetite is a symptom of all sorts of pathologies, from an obsession with mass-media standards of beauty to all sorts of fun physical disorders, and a doctor would investigate these avenues and resolve whatever is responsible so that the patient starts eating again.
So if someone lives in germany and can give me a hint to find someone, or anyone else in any way I'd appreciate it.
You want help, right? If so, then pick up the phone, and keep searching until you find a fit.
If we compared this to injure and clotting, it would be weird to describe a clotting disorder as a symptom of injuries. Preventing more injuries is likely going to help and is a good step forward, but it do nothing to address the issue on why the recovery process is impaired.
It isn't a clotting disorder if your foot keeps bleeding because you haven't taken the tack out of your shoe.
I don't know how accurate the author's characterisation of depression is, but I don't think a useful analysis will result from applying that definition of the word depression so literally in this particular case.