Comment by maybelsyrup | Hacker News Reader

Comment by maybelsyrup | Hacker News Reader

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> just as depression is a maladaptive persistent overlearned estimate of the world as threatening, unrewarding, and pointless

That we can look at the lives of millions of people in America in 2021 and call their abject misery 'maladaptive' or 'overlearned' is ghastly. I know I'm supposed to offer more in an HN comment, and I'm not trying to call you names. But if I told that to someone in psychotherapy I'd deserve more than just losing my license.

I don't doubt that looking inside people's biology for clues about what's going on when they suffer these kinds of anguish is interesting or potentially helpful, but I can say two things quite confidently on the matter:

1) After 60 years of dominance, the biological-psychiatric project's track record is dismal and has failed to move any population-level needle on the levels of suffering it tries to study and ameliorate

2) Focusing on biology at the expense of questions about "context" or "environment" or "maybe this depressive is reacting exactly appropriately to their horrible existence" is a staggering waste of brainpower and money and time, and it leaves me at a loss for words. Outside of the social strata represented on HN (and probably within it to some degree) the world is "threatening, unrewarding, and pointless" for vast numbers of human beings, and I'd challenge anyone to sit in front of such a person and tell them to their face that it isn't. If there exist "regular experiences which should falsify those beliefs and lead to learning (but doesn't)", I got news for you: those experiences aren't prompting "learning" because they're not enough. This is like telling hungry people to feel more full after feeding them a saltine cracker.

You can't "cure" depression by pumping people full of prescribed psychotropics - the major mental health effort of the past half century - any more than you can do so by pumping them full of vodka. Address poverty, address violence, address a litany of social ills - and I mean really address them - and you'll see what happens to depression.

Excuse me, but this touched a nerve.

That I never understood. US is an extremely rich country. Of course there are poor people, but there are lots of not poor people. In my country we don't have money if one does not work. He'll die from starvation. Well, probably some friends will help him not to die, but you got the idea. If you don't have a house, you don't really have any recourse, you have to live in basements under buildings and you'll eventually die as usual temperatures at winter are around -20 Celsius degrees. You can be beaten to death by some crazy person (well, at least you can't be shot, as guns are prohibited). People drive like crazy, so you can be killed by a car accident. If something unjust happens, you can't really rely on police, it might be corrupt and it happens in everyday life. If you need something from government, you might need to bribe the officials and I'm talking about ordinary person needs, not some enterprise stuff. I don't think that there are many grown-up people who did not bribe officials in their life.

Life is miserable here. And people don't run to hang themselves. They are trying to find happy moments and relish in those moments.

It's absolutely normal for a man to live in misery. Our humanity lived in misery for thousands of years and billions of people are living in misery right now. Our brain should be adapted to it by now.

Agreed, but depression in modern wealthy countries could potentially be less due to objectively comparable misery and pain on average and more due to a combined physiological, neurological, and psychological stagnation effect. It's very common to feel a profound dearth of meaning, purpose, higher goals, terminal goals, interpersonal connection, physical ambulation, sunlight, fresh air, or any idea of anything they should be doing but mindlessly scrolling some stream of text and projected imagery like a drug addict taking their 9th hit of the day while not actually feeling anything from it.

I know it's a tired trope to throw around at this point, but it just shows there are countless variables that factor into one's mood and disposition and sense of motivation even before you dig down to the neurological and biological levels. Leave a healthy, well-fed, "rich" rat or chimpanzee alone in a low-stimuli, not very large room for long enough and they'll often become depressed. Embed someone born in a wealthy country into an indigenous group and they often report feeling more alive and not depressed. Do the reverse and you often get the reverse.

And of course many people feel all these things not due to any sort of stagnation they have any personal control over but due to neurological systems which may be difficult to alter. Or both.

I think the original reply post may have partly misinterpreted what the commenter was trying to say. The hypothesis being discussed is something like that even if you reintroduce the rat back to its previous happy environment, their potential predictive processing dysfunction may cause them to not be able to do anything but treat all stimuli the same: not worth caring about or trying to derive enjoyment from.

> Life is miserable here. And people don't run to hang themselves. They are trying to find happy moments and relish in those moments.

What country is this? Your domain seems to indicate Kazakhstan, but they have one of the highest suicide rates in the world, so I suppose that's not it?

Depression is maladaptive. My environment was shitty and that’s part of how I developed depression, but depression didn’t make surviving that easier. It made it far, far worse. There were also good things in my life; but I couldn’t experience pleasure from those good things because of the depression. Even after I got out of that environment I couldn’t enjoy life.

Meds were a godsend. They allowed me to escape from depression long enough to deal with depression. Could I have done so even while still in a shitty environment? Probably, because the key ingredients for me were: meds, learning to identify good things, and not burying my feelings.

That’s not to say we shouldn’t be solving all these problems, but in the meantime let’s not tear down things that work for people because they don’t directly address a more intractable root cause.

There's a quotation from Abraham Maslow that I really like, which I think is similar to your point.

> I am deliberately rejecting our present easy distinction between sickness and health, at least as far as surface symptoms are concerned. Does sickness mean having symptoms? I maintain now that sickness might consist of not having symptoms when you should. Does health mean being symptom-free? I deny it. Which of the Nazis at Auschwitz or Dachau were healthy? Those with a stricken conscience or those with a nice, clear, happy conscience? Was it possible for a profoundly human person not to feel conflict, suffering, depression, rage, etc.? In a word if you tell me you have a personality problem, I am not certain until I know you better whether to say "Good" or "I'm sorry". It depends on the reasons. And these, it seems, may be bad reasons, or they may be good reasons.

https://en.wikiquote.org/wiki/Abraham_Maslow

Well said.

I’ve used ADs as a “band-aid”: something for three months or so at a time when necessary, to stop me a) killing myself [though thankfully it’s been a long long time since I had those intrusive thoughts] and b) giving me just enough “normality” to go and make whatever changes I can that pushed me in the direction of an episode or made an extant one worse, and lastly c) give me enough motivation that I can work properly with my psychologist/psychotherapist.

I’ve had very good “reasons” for my crippling depression, but usually I can’t see the forest for the trees to work out what it is while deep inside the episode.

Luckily for me, citalopram works with basically no side effects when taken for a couple of months. I’m glad that’s the case, but I’ve seen so many of my friends get no relief from ADs at all, along with so many (sometimes life altering!) side effects, that it makes me sad at times.

Lastly, buprenorphine is remarkable for me in terms of its anti depressive effect. Once monthly Buvidal injection not only solves my past issues with drug abuse, but neatly solves my depression. Fascinating stuff.

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