Comment by mercer | Hacker News Reader

Comment by mercer | Hacker News Reader

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> But in fact it would probably help the first person to know that their depression isn't, in a strict sense, real: they can get out it by improving their external circumstances, while the second person can't.

But that's kind of the crux of the matter, isn't it?

First off, we still know so little about mental health that we can't accurately tell which is which. And it strikes me as really harmful to categorize people's issues as 'real' or 'not real' based on vague notions. Autism, for example, was initially seriously considered a result of bad parenting, and the consequences are noticeable to this day.

Second, even if we can distinguish between, say, depression because 'raised with too much self-esteem' or 'chemical imbalance', this is mostly relevant for treatment, not diagnosis.

If the person in question cannot find their own way out of the situation, the problem is by definition 'real'. The only difference might be how the situation is handled. In fact, in many cases the treatment is the same, regardless of how someone got there.

I've seen a lot of harm caused by people arbitrarily distinguishing problems as either 'nature' or 'nurture' or 'internal' or 'external'. This distinction is not only extremely vague, it doesn't actually matter to anyone except those who are developing or implementing solutions. To everyone else, I'd advise compassion, support, and avoiding judgment.

That said, you do have a point. Personally I've become more and more convinced that for various reasons, some good, most bad, our current treatment models err on the side of adjusting yourself to fit your environment, while the most beneficial solutions I've seen involve shaping your environment to fit 'you', or at the very least a combination of both. Regardless of whether an issue is 'internal' or 'external' (again, I don't think making the distinction is as valuable as it seems).

I'm guessing that where I'm maybe communicating this badly is in the word "real." I don't mean to suggest that people whose problems don't meet some arbitrary criteria shouldn't be taken seriously. And I certainly think hasty, dismissive judgments can have sinister consequences.

What I do think it's productive to do is to assess based on evidence the relative weight of people's issues. I think we'd agree that treatment depends on successfully and accurately identifying the problem. A huge part of that is figuring out what order of magnitude of difficulty you've got in front of you.

I'd say that in distinguishing between 'raised with too much self-esteem' and 'chemical imbalance,' the difference in the resulting treatment is so drastic that it may as well be a different diagnosis. Someone in the former category needs to acquire some combination of acceptance, a sense of agency, and goals to strive toward. Someone in the latter needs medication. The former is easier to solve, because the latter in some cases may not be solvable at all. This doesn't mean we should abandon compassion and start yelling at the person, but isn't it a good litmus test? Shouldn't someone who genuinely wants to get better be delighted to hear that their problem wasn't so big after all?

It sounds like you're less against judgment in general and more against lazy, dismissive, heartless judgments. But that's not what I'm advocating at all. I just have sympathy for the war veteran rolling his eyes when he hears a story about someone who got mugged getting PTSD. Of course no one should be mugged, and getting mugged sucks, but oh come on, let the guy roll his eyes.

> I'd say that in distinguishing between 'raised with too much self-esteem' and 'chemical imbalance,' the difference in the resulting treatment is so drastic that it may as well be a different diagnosis. Someone in the former category needs to acquire some combination of acceptance, a sense of agency, and goals to strive toward. Someone in the latter needs a careful balance of medication.

Thing is, as far as I know, and correct me if I'm wrong, our knowledge of depression and it's causes and solutions is so rudimentary that we can't really make that distinction in the first place, which means we can't really argue whether treatment needs to be 'drastically different'.

I'd argue that based on this lack of knowledge, both categories should probably first try the first solution you mention, and settle for the second if that's no help. Who's to say, for example, that someone who's entire being has been shaped over decades into 'having too much self-esteem' can actually be 'fixed' without medication?

Or consider schizophrenia. Is it nature or nurture, when there's some evidence that it can very well lay dormant until it's 'triggered'.

tl;dr: what's the value in creating ill-supported distinctions on an issue that is already rife with judgment, unwanted advice, self-esteem issues (across the board, whatever you suffer from), and so on?

> It sounds like you're less against judgment and more against hasty, lazy, dismissive, or leave-them-out-to-dry judgments. But that's not what I'm advocating at all. I just have sympathy for the war veteran rolling their eyes when they hear someone who got mugged telling a story about PTSD. Of course no one should be mugged, but come on, let the guy roll his eyes.

Such a person is free to roll their eyes, but I don't see how we should have sympathy for the 'my situation is worse than yours' kind of judgment. We can tolerate it and perhaps understand it, but it's still harmful, judgmental, and pointless.

I lost my sympathy over this behavior once I realized that much of the worst judgment I've seen and, sadly, experienced, is caused by this attitude. The people with the worst attitude to the poor are often those who used to be poor but are not anymore, obviously by not being lazy like the rest of them. The same goes for the attitude of people who used to be fat, ugly, insecure, etc. At least in my experience (and overwhelmingly so).

Hm, yeah, good point. I'm not sure how much we know. Maybe you're right and we really don't know enough to make those distinctions.

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