Hacker News Reader

> "thinking your way out of it" is something that's going to be regarded in the future the way that we regard blood-letting a fever now

As someone who spent more than a decade struggling with a diagnosed depression and the numbness that came from trying to get better with 5 different prescription drugs that addressed a few symptoms while making the whole thing a lot worse, what worked for me was, eventually, thinking my way out of it. And it's funny that you compare it to some medieval treatment because the method I used to think my way out of it has been taught for 2500 years. The key is you can't just try to think your way out of it. There is a specific technique to meditation and mindfulness that the watered down versions of mindfulness training miss. Go to the source and learn the traditional practice, not the bits and pieces that psychiatrists have tried to marry with more recent psychotherapeutic theory.

Now with daily anapana/vipassana practice, I'm able to live much more in the present moment, which allows for enjoyment and sadness free from the suffering that I now realize was manifesting in my depression. It's a form of delusion to deny or ignore the truth of what's happening right now, no matter how simple that truth might be. And when I delude myself often enough, I start to feel depressed. It's cause and effect, and I see it so clearly now. But now that I understand the cause and how to stop causing it, I can recognize when I'm feeling depressed and bring myself out of it.

Nothing used to frustrate me more than people insinuating that I could fix my depression by just trying harder. And that's what "think yourself out of it" sounded like to me. My motivation was so zapped that that kind of advice just made me more despondent. So I want to make it clear that thinking your way out of depression is not a matter of trying harder. In fact once it clicks, it becomes easier...like riding a bicycle downhill. And that's a good metaphor, because if thinking your way out of it is riding a bicycle, how effective you are at it and how hard you have to work depend entirely on which direction you point, not how hard you pedal.

I appreciate your opposing take. There is a lot of push back against non traditional remedies, and also against the pharmaceutical route (in both cases, deserved). As someone else who is suffering, I have found comfort in meditation, mindful practices, and most importantly acceptance. These mental states allow me to function enough to exercise or eat well, or mind my sleep or stay away from drugs (which provides a physiological basis for "getting better"). So I agree you can't just think your way out, but the right frame of mind can provide the momentum to put the rest of the pieces together.

I think depression is closer to an inability to walk because of muscle atrophy: you can't tell them to just get over it and start walking, but retraining the muscles is a critical part of treatment.

I like this a lot, fwiw. I don't disagree with anyone that says changing mindset is part of an effective treatment, nor will I argue with anyone that says it worked for them.

I've been severely depressed in my life. I think both you and OP are correct.

You're applying the broken arm analogy incorrectly.

Depression is a broken mind. Yes? A broken thought pattern, or response system, or something along those lines. Right?

Therefore beating depression requires fixing that. Fixing your mind. When you put it into words, that comes out as: "requires mastering one's own inner life and changing the mechanics of how one thinks and interprets the world"

Because that's what fixing your mind is.

Applied to the broken arm analogy it becomes: "fixing a broken arm requires fixing your broken bone and learning how to use that arm again"

Doesn't sound so crazy anymore does it?

> Depression changes the way you think. It removes your motivation for improving.

Which is why fixing the way you think is the only way you can fix depression. Whether that's through drugs, through sheer willpower, or by chanting prayers on top of a mountain in the himalayas. It all boils down to fixing the way you think.

Replying to you and the wu-ikkyu's sibling comment here: please see my comment at https://news.ycombinator.com/item?id=13118079

There's mounting evidence that depression is a biological disease, not a woo-woo problem with your mind. You seem to be presupposing that the mind somehow exists outside of biology, and that probably isn't the case.

At best, advice like this is geared towards coping with it.

While advice for coping -- from people, like you, who know what they're talking about -- is good and helpful (when limited to that context), the notion that depression is a thing that can be beat through sheer willpower should be beat back with the same intensity as the argument that sleeping with virgins will cure AIDS, and for the same reason.

I'm not saying it's a woo-woo problem of the mind. But it is a problem of the mind in that it's literally defined as "a mental disorder characterized by at least two weeks of low mood that is present across most situations.[1] It is often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause."

"mental" disorder --> mind stuff; Symptoms: "low mood, low self-esteem, loss of interest, low energy, pain". All mind stuff as well.

Yes, it often requires drugs, and yes it usually/often/maybealways has an underlying cause of biological issues. But fixing it still requires fixing your mind. Because that's what's broken - your mind.

The point is that just because something is a mental issue, doesn't mean you can fix it with will power and thought changes alone. But you definitely can't fix it without will power and thought changes.

I like to think of beating depression like beating addiction. You first need to fix the biological stuff, and then you have to mentally keep making sure you don't slip back. Maybe forever. You need willpower to not go back down that road, to avoid situations that trigger depression in you, or hell, just to keep eating right and exercising and to make your mental health a priority because it does help.

As my shrink used to say: the drugs give you the chance, but you do the work to fix your thoughts.

Does that make more sense?

Yeah, I get where you're going with it, and believe me, I'm not looking for excuses to disagree with you. (I upvoted you above; not sure why your comment in particular, of all the responses, got downvoted.)

There are a couple of points I feel compelled to push back on though.

First is the word "fix". This might seem like quibbling, but that really bothers me, and I think for not-trivial reasons. When a problem is fixed, it doesn't recur. Addiction and depression are never fixed. They can be coped-with, they can be treated, a person can live a (well, mostly) normal life as an addict or with depression. I think this is important because any advice or treatment offered to people with depression should be practical and it's critical not to imply, "this will fix you."

The other is that we have to be exceedingly careful when suggesting mental changes as a treatment for depression, because that can easily be misinterpreted by other people to mean that depression is caused by "bad thinking", or that a person struggling with depression can "just think their way out of it", and I submit this entire HN thread as evidence for that (and could probably dig a few more out of my comment history). That, I think, is distinctly unhelpful for people struggling with depression. They will tend to already be struggling with those thoughts as it is: "why am I broken? Come on me! Be better! Just be happy! Everyone else is happy!" and having other people show up and offer, essentially, the same advice, is really harmful.

And fwiw I too am speaking from far too much experience, both personal and family.

You're right, fixing is the wrongf terminology to use because depressed peoplr aren't broken per se. It's harmful to suggest they are especially since thinking that is one of the core tenets of depression.

Fwiw I don't think mental changes treat depression. I think they're the result of treating it. At the least they go hand in hand with the process.

Mental changes aren't a sufficient step to get out of depression, but they are a required step.

It's hard to put these things into words because they're on the intuitive side of my brain, but thanks for the chance to try.

As for the downvoters, screw 'em. I got points to burn. Maybe what I'm saying can help some people make some sense of the process.

I think you and the other commenters may be closer to agreement than you think, and perhaps just mixing terminology. By my reading they are both saying that sheer will is not the answer, and are not suggesting a dualistic mind either.

If the mind is the brain and vice versa, then it might stand to reason that in some cases the thought<->physiology<->environment feedback cycle that traps one in depression can be addressed not by willpower, but by selectively interrupting whatever part of the feedback cycle is easiest to access or most pronounced for a particular depressed person.

> in some cases the thought<->physiology<->environment feedback cycle that traps one in depression can be addressed not by willpower, but by selectively interrupting whatever part of the feedback cycle is easiest to access or most pronounced for a particular depressed person.

I've wondered about that for many years, and it's the strategy I adopted for myself a very long time ago, but I've seen scant evidence for either its effectiveness for most other people or any evidence for its basis in reality.

Like I just said elsethread, I'm more concerned here with other people misinterpreting the suggestions being offered and then sharing those with people with depression in a way which is ultimately harmful. I'm probably being a little louder than I need to be about it.

>depression itself is not something you "beat". At best, it's something you learn to live with: having a broken brain for the rest of your life.

How do you know depression can't be overcome?

This comment is also well intentioned, but you're really trying to counter someone who might not be 100% correct with an analogy that gets us farther from the truth.

Learning to live with depression _is_ the super power that the parent comment mentioned. That's the ultimate solution you say anyone can come to, and in fact, that is exactly what OP has described; you just put it more blandly.

Depression is the result of how you interpret things. While genetics can make you more susceptible, thought is always the root cause. Your belief in the inevitability of depression is only leading to more depression.

> Depression is the result of how you interpret things.

This kind of thinking is precisely why I stick around to argue about this subject when it pops up.

You have cause and effect reversed, and you're not up-to-date on current medical research. The science has advanced far beyond, "you're depressed because you're thinking bad things."

There is evidence linking it to intestinal bacteria: https://www.newscientist.com/article/2095769-gut-bacteria-sp... and also http://www.nature.com/news/gut-brain-link-grabs-neuroscienti...

And inflammation: http://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7...

And circadian rhythm / sleep: http://www.independent.co.uk/news/science/new-forensic-techn... and https://www.scientificamerican.com/article/fighting-depressi...

I think it's likely that within the next 50 years a treatable, biological, root cause will be found which is somehow related to all of these, and I hope that by then the lay-public will have moved away from the opinion they share with Scientology.

> Your belief in the inevitability of depression is only leading to more depression.

You have misinterpreted the purpose of my comments. I'm not here to tell people with depression how to improve their lives, because I'm not qualified to do that (words which I wish everyone on HN would hear in their head before they write anything about anything). I'm just here to clear up common misconceptions about the causes of depression and what it's like to experience it.

My experience is very similar to the post/experience from throwaway7312 above.

> You mean well, and what you're saying may be helpful to people who struggle with certain feelings from time to time. But statements like these are extremely frustrating for people with actual depression.

Discussing depression goes down-hill everytime someone pivots to what people "should" or "shouldn't" say. We're not trying to actively console someone with depression here, we're merely having a discussion on our thoughts/ideas/experiences of depression, so I think your defensive retort is quite misguided.

Regardless, I agree with your statement, but I'm at a loss to your intent. I've been depressed and yeah, it's not really helpful when others say something that translates to:

> Depression is the result of how you interpret things.

But looking back on it - at least from my perception and reality of the world; it's 100% truth. However, is stating this helpful? is it the right approach to trying to help someone who is going through depression? absolutely not.

Don't let the social politics muddy the raw discussion when appropriate, please.

> Your belief in the inevitability of depression is only leading to more depression.

This was definitely the biggest hurdle for me. The echo-chamber of "This isn't your fault! depression is a disease we'll have a cure for one day!". The vortex of negativity and the constant apathy was fed by these sorts of statements.

Mindfulness was my cure. An ultimatum of either "I end my life" or "I do what is within my control, to change the way I think." It's alot more complicated than that in reality, but the heart of what I'm trying to say is there.