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Comment by ajsnigrutin | Hacker News Reader

The bar also got a lot lower than back then.

You jump over the gaps in the tiles on the road? You must have OCD. You broke up with your bf/gf.. you must have depression. You're happy a bit? Bipolar disorder. You're a guy and play with a barbie... trans. Less horny, asexual. And let's not forget a bunch of adhd/autism and other disorders, when a kid gets bored in school.

On the other hand, we have professionals (doctors, etc.) reinforcing this, by (eg.) giving pills to kids who can't sit still for 8 hours in school without any physical excercise during that time, and parents give their kids pills,because it's easier than actually parenting that kid.

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The language has shifted as well.

You’re not sad, you’re depressed.

You don’t worry, you have anxiety.

Depression and anxiety are medical diagnoses. The other are normal emotions everyone can, should, and does experience.

If you don’t ever worry or get sad about anything there’s probably something else wrong with you.

In terms of diagnoses, the DSM-4 included a “bereavement exclusion” from the depression diagnostic criteria. Thinking being if someone close to you dies a normal person almost should feel the symptoms of depression for some period of time. You don’t have depression, you’re mourning.

It was (controversially) removed in DSM-5:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204469/

The “slap a medical diagnosis on a normal feeling” described in the article seems to have entered society across the board.

That’s wildly wrong. The medical community adopted depression and anxiety from general use dating back to the 1500’s rather than the other way around.

“The meaning "dejection, state of sadness, a sinking of the spirits" is from early 15c. (as a clinical term in psychology, from 1905);” https://www.etymonline.com/word/depression

“anxiety (n.) 1520s, "apprehension caused by danger, misfortune, or error, uneasiness of mind respecting some uncertainty, a restless dread of some evil," from Latin anxietatem (nominative anxietas) "anguish, anxiety, solicitude," noun of quality from anxius "uneasy, troubled in mind” https://www.etymonline.com/search?q=anxiety

I think we’re talking past each other here?

The medical diagnoses are generalized anxiety disorder and major depressive disorder (with a variety of variations). Both of which, in common usage, have meaning.

The average person with their arm in a cast doesn’t say they “have a compound fracture of the radius and ulna”. They say they broke their arm or MAYBE fractured their arm. In this case the simple language and medical diagnosis is fracture.

Just like people with SERIOUS, life ruining disabling and debilitating depression don’t say they “have non-psychotic major depressive disorder”. They say they have depression. I’m not gatekeeping, just being extreme for the purposes of discussion.

To me, you can be depressed about something and not have depression. You can be anxious about something and not have anxiety. Those are slightly more sophisticated uses of sad and worry.

To me (again) the issue comes in when you apply a diagnosis to a feeling. When you bump your funny bone you don’t tell people your arm is fractured.

> To me, you can be depressed about something and not have depression. You can be anxious about something and not have anxiety. Those are slightly more sophisticated uses of sad and worry.

You are contradicting your own examples:

> You’re not sad, you’re depressed. You don’t worry, you have anxiety.

It's possible the people are expressing they are feeling depressed or having anxiety in a colloquial way without confusing the emotion for the diagnosis. Your prior examples indicated that to use those words is problematic, yet you now say that "you can be depressed about something" and that "you can be anxious about something."

You missed the sarcasm/jest on my first examples. I should have tagged them or been clearer.

On the later the separation is:

“I’m depressed” = Sad or a variation of it.

“I have depression” = Diagnosis of a disorder

I really don’t believe people are casually using self-diagnosing language over using the variation that simply indicates their mood. Perhaps feeling depressed or anxious are more intense versions of feeling sad or worried, as they indicate persistence of negative feeling. But given all that has happened over the last couple of years, it is arguable that society as a whole is more susceptible to intense feelings.

I've always wondered what it means that Germans say "I have hunger" instead of "I'm hungry".

Maybe they think hunger is a disorder to be cured by prescribing food, instead of a feeling to be satisfied by eating. ;)

French is the same: j’ai faim, and Italian is too: ho fame. Both mean “I have hunger”. I wonder if English is in the minority of languages that use “I am” instead of “I have”? Interestingly, German doesn’t use the same construction for thirst. Ich bin durstig.

I think you have been reading to much into this. Less formal language get’s odd when you take it literally.

People casually describe emotions in a silly number of ways. Sometimes it’s possessive like “I got (hungry, depressed)” Other times it’s a state like “I am (hungry, depressed).” Sometimes it’s a transformation “That makes me so (hungry, depressed, happy, angry).” etc

Most people aren’t suggesting a medical diagnosis any more than “I have a crush” suggests you physically caught someone.

Also, “I broke my arm” doesn’t always imply someone broke a bone. Ex-pitchers for example sometimes use the phase to refer to a lack of functionality, though busted is more general.

It made us feel so insulted and betrayed that when my wife would cry in the NICU for any reason the nurses would tattle on her and she’d get a call from the pill pushers trying to prescribe her psych meds.

It’s like look, my kid has literally been in the NICU for 6 months now (it ended up being 9 months total) and you’re strongly pressuring us to get her a tracheostomy (let’s not use medical euphemism here though, they wanted to put a tube into our babies throat which would make her unable to cry and necessitate round the clock nursing care) as the “standard of care” (bullshit, it would have made her quality of life worse). But she’s a little upset, better prescribe her happy pills!

For anyone wondering, this was 2019 and my daughter is right this moment peacefully sleeping in her bed with no external breathing aids necessary aside from a wedge pillow to help with her sleep apnea. My blood boils when I think of what we were forced through (especially my wife) dealing with the medical establishment after our daughter was born, but the psych meds being dangled in front of us is a particularly sore spot.

> she’d get a call from the pill pushers trying to prescribe her psych meds

If your only tool is a hammer....

This is part of why I avoid the medical establishment.

I’m sorry for this entire experience that you’ve had. It sounds like a waking nightmare.

I’m curious, did any doctor bring up therapy?

I have major depressive disorder and I take antidepressants to help manage it. There was a landmark study a few years ago indicating that, while SSRIs/SNRIs are beneficial for people like me, they are no more effective than the placebo for people experiencing transient depression.

Therapy, however, would’ve been a sound recommendation for her. In this case it would have given her a place to vent and taught her some tools to cope.

Finally, you should consider whether you and your wife experience any post-traumatic stress from this experience. Your experience meets the qualifications for one that can lead to PTSD in DSM V. There are extremely effective therapy approaches that can put PTSD in complete remission.

Crying when sad has been helpful for a very long time. I’m not saying therapy is never helpful, but as a parent I’m also annoyed by the medical folks in wincy’s story for pushing pills when they faced a tougher situation than any I have ever experienced and crying was certainly a very normal response. And venting to friends and receiving hugs probably helped even though the expected ache might remain while the baby was struggling. There are too many pills in the USA where people need a lot more compassionate friends and acknowledgment that feeling bad is actually not so bad.

Are you an able bodied person? Because when someone says people in America take “too many pills” it sounds like a very able bodied mindset.

I take 8 daily prescription medications to cope with chronic pain and chronic mental health issues. Removing any of them would diminish my quality of life in some way.

How are compassionate friends going to help me manage depression which is endemic to my brain and has no cause in my perceived reality?

Life comes in many perspectives. Before you prescribe how the disabled should live, please at least imagine walking a mile in our shoes.

Trust me, I'm not saying I've walked any miles in your shoes. I have relatives who have been disabled. I also have relatives who have taken many pills, and I have no doubt that many are necessary. As an American who grew up partly abroad, I have a desire to see increased relational commitment and support and believe that for many people, so many pills would not be necessary. I don't know you, I mean you no offense, and I don't believe I'm talking about someone in your situation. Based on news reports for the past several years, it's no secret that there are too many pills in the USA that are often being given to people who probably don't need them, and instead need something else. Medicate first and actually deal with it later (or never deal with the underlying problem) is not always the best course of action for many people.

> My blood boils

Better get some prescription for that. ;)

I think the main point of removing this exclusion is that you can be depressed and bereaved at the same time. Or you could be so depressed due to bereavement that you still need treatment. In DSM-V it's left to the clinician to distinguish between clinically significant depression and a healthy, transitory reaction to bereavement. The reason for this is to avoid cases where people who need treatment are dismissed too easily because they happen to be bereaved. There is still a distinction drawn, it's just that it's not currently easy to make that distinction in a standardised way, and so it was decided to remove it from the DSM, which is meant to be as rigorous and statistically grounded as possible.

As the other comment with his wife and the NICU situation noted, the point here is people should be left to deal with life if they’re going through some shit.

IIRC the bereavement exclusion was six months? This made sense to me, if you had some terrible event in your life and you’re not back to something resembling your baseline mood and function after roughly that time period there’s probably something going on that needs to be looked at.

To me this is the mental health equivalent of “Sorry you sprained your ankle and it hurts a little, here’s a month of OxyContin and what could very well be a lifelong addiction”. We don’t do that anymore - today you’ll get ibuprofen and ice.

Even with more serious injuries you’re more likely to get lifestyle suggestions, physical therapy, etc than opioids.

In many cases we’re throwing pills that change mood and brain chemistry at people suffering from what is basically “life”. I’m not saying people shouldn’t be treated, I’m saying general practitioners throwing SSRIs at someone and diagnosing them with depression after talking to them for literally five minutes doesn’t seem right to me.

But it is easier and faster than hours and hours of therapy.

What comes first? An irresponsibly written anti-depressant prescription because someone said they have depression, or someone says they have depression because someone irresponsibly wrote them a prescription for an anti-depressant?

The point is that it's non-trivial to determine whether someone is simply bereaved. Or depressed, and bereaved. If someone is already depressed, bereavement is one of those things that can push them over the edge into attempting suicide. The exclusion criterion was too simplistic to cover the nuance of the differential diagnosis, so it was removed. It is a non-sequitur to say that the removal from the DSM is an endorsement of diagnosing MDD in all bereaved people. Some doctors might be doing that, but then the problem is that those doctors are doing the wrong thing, and whatever societal pressures might have affected them to do so. There is still disagreement about it in the field, and if the consensus shifts again it could very well end up being added back in, but probably I think it will evolve into a more specific diagnostic procedure to tell the cases apart.

Just because it is a "normal" thing doesn't mean it isn't something that medicine can address. Many of the unpleasant things our bodies go through are "normal" reactions to events.

The fact that bereavement may be different than other causes of depression may be a reason to treat it differently, but not a reason to ignore it.

But should we be treating those kinds of things with a medication or should we be treating it with education? Should we be more forgiving to people and allowing them the space they need to process life events instead of worrying about money or their jobs or all this crap.

The difference is handing someone a bottle and saying "here this will go away quick!" Vs just generally having a better more emotionally aware society.

Some processes that are brains go through should be allowed and it should be accepted that they run their full natural course given that the human that has the brain is also being cared for and guided in some sort of way during this process and not just isolated and shunned away.

No, just because something is diagnosable doesn’t mean the treatment is a pill.

It is perfectly reasonable to address concerns about the bereavement process with therapy.

I strongly disagree. I think most people I know are careful to not throw around the word "depression" when they talk about being sad. They are keenly aware of the difference. And they know the difference between "being anxious" or "having anxiety" and having an actual anxiety disorder. Of course, a lot of times the lines are blurred. Whole most medical professionals are forced to draw a stark line in order to make an actionable diagnosis, actual people realize that these are all on a spectrum. Some of us may have occasional OCD tendencies or mild body dysmorphia without needing medical intervention. Though self-awareness and discussing the issue with friends and a therapist always seem to help, even if meds or more involved therapy aren't needed.

No offense but if most people around you are throwing around the word "depression," I would personally consider that a red flag (unless you're in the medical profession). Either your friend circle are unusually showing symptoms of depression or they're misusing the term/self-diagnosing themselves.

I clearly stated that "most people I know are careful to not throw around the word "depression". The rest of what I wrote syncs with this perspective. Not sure what you read.

> Depression and anxiety are medical diagnoses. The other are normal emotions everyone can, should, and does experience.

Why? In what sense are they "normal"? They're unpleasant and they leave you worse off than you were before you experienced them. It's also becoming clearer that frequently experiencing them has harmful physical effects from stress responses. Over-diagnosis with depression and anxiety is bad because the treatments have such a wide array of potential side effects and limited evidence for efficacy, but it makes no sense to not categorize something as a disease just because we can't treat it.

I think most doctors aren't eager to prescribe the pills, but they have to treat the parents like any other drug-seeking population. It's impossible to get medication to people who need it while denying it to people who don't need it but are determined to get it and know all the right things to say, so you accept there will be some abuse.

> You're a guy and play with a barbie... trans. Less horny, asexual.

Setting aside, for now, the fact that these are things that people realize about themselves and not things people are diagnosed with by others... Why are you bringing them up in response to a comment about mental illness?

Because boys are allowed to play with dolls. And shouldn't think it indicates they are trans or have gender dysphoria. It's not a sign of anything.

Please don't misinterpret the comment.

*Edit: removed the word diagnosed as wasn't in the original comment.*

> Because boys are allowed to play with dolls. And shouldn't be diagnosed as being trans or having gender dysphoria. It's not a sign of anything.

Yep, I meant exactly this.

I mean... take the clothes away, and Action Man and (barbie's) Ken are practically the same doll.

What you actually implied is trans skepticism, which is a form of transphobia, questioning its legitimacy, implying that a lot of trans kids aren't actually trans, that they're being labeled that because they "play with dolls" - and this shouldn't be the case.

No kid is diagnosed with gender dysphoria for playing with dolls.

Another weird trend of this is that these self-diagnoses are brought up as if they're personality traits. From what I've seen, Gen Z is much more likely to introduce themselves to others by saying things like "My name is [xyz] and I'm bipolar transfluid asexual with depression" or similar

Nobody has ever said this to you in your entire life

They actually have. Meeting my significant other's family, her niece came up to me and specifically introduced herself as her father's son

That's kinda different, bud.

No it isn't

> parents give their kids pills,because it's easier than actually parenting that kid.

And then you have threads like this, where people call for mass censorship because some believe it's easier to ban "bad" topics than to actively parent their kids.

Your generalization OCD is very, very wrong. I can sadly speak from all-too-close experience that OCD is an absolutely crippling mental illness our society still does not take seriously enough. It’s still largely used as a punchline in popular culture and in social interactions.

Edit: I’m being told I misunderstood the parent comment but it appears to be claiming the bar is much lower now than in the past. Certainly skipping over sidewalk cracks isn’t OCD. The point of my comment is that when someone is diagnosed with OCD in 2022 by a professional, it’s generally for very serious reasons.

I think you may have misread the comment you replied to.

The claim being made, is that in times past, the bar for being diagnosed with something like OCD was much lower than today, causing people to consider mundane things as symptoms.

“The bar also got a lot lower than back then.”

It appears GP is saying the bar for being diagnosed with a mental illness is lower today (“got a lot lower”). I am pushing back, at least where OCD is concerned.

I'm not talking about official diagnosis by trained professionals, i'm talking about tiktok and self diagnosis.

Kids today think they have OCD because they jump over the gaps in tiles, and promote that on social networks. Other kids claim they have it too, because they jump over the gaps too. And in the end... social vmedia (tiktok videos) leave teens thinking they have rare mental disorders (like 'real' OCD)... as the title of this post says.

from the same GP: “ we have professionals (doctors, etc.) reinforcing this”.

If you’re talking about merely kids self-mis-diagnosing, then sure I’ll grant that, it’s unclear to me that GP was solely talking about that though.

You are replying directly to GP.

Whoops. You're right. I thought you had misread the comment, but instead, I had misread the comment.

I had read "The bar also got a lot lower back then." and missed a critical word. Sorry!

I heard that Obamacare changed the way insurers are paid to more of a cost plus model. So they actually have an incentive to not push back against anything.

Don't know if that's true. But if it is, who is pushing back against treatments? Doctors? Insurance companies? Government? Parents?

> You're a guy and play with a barbie... trans.

This literally does not happen.

Depends on which bubble you live in.

Simple objective reality. Nobody is diagnosing boys as trans or having gender dysphoria simply because they play with Barbies. People in a certain bubble may believe it's happening, but in the real world it takes a lot more than "plays with barbies" to get that diagnosis.

What makes you think you have more access to objective reality than others ?

What makes you think anyone can have access to objective reality? What makes you think a first assertion holds more weight than a second? What makes you think bubbles are not a thing? What makes you think certain phrases don't immediately betray how little someone knows about people outside of their bubble?

I know enough people outside of the heteronormative experience to know that nothing about playing with Barbies pushes people toward being trans. It's reminiscent of the classic "violent games make kids violent" line. That's not the case at all -- rather violent kids are attracted more to violent games. The causality is completely incorrect and displays an obvious naivete paired with a pre-existing ideological bias.

>What makes you think anyone can have access to objective reality?

Because independent people agree, when independent sources of data agree on something, that means the thing they are agreeing on is (plausibly) larger than them, and that's what we call 'reality'.

>What makes you think a first assertion holds more weight than a second?

I don't.

>What makes you think bubbles are not a thing?

That's literally the opposite of what I said.

>I know enough people outside of the heteronormative experience to know that nothing about playing with Barbies pushes people toward being trans.

Cool, but you're missing the point that nobody claims that playing with Barbies, by itself, makes people trans. But rather what's being claimed is that certain people push the people who play Barbies into being trans, which is an entirely different thing.

>obvious naivete paired with a pre-existing ideological bias

You say this as if you don't have an obviously ample supply of those yourself.

Your right. Obviously we can't be sure birds are real, because some people say (without evidence) bird's aren't real and how can we say we have a better grasp of objective reality than them? Obviously, based on their absurd and evidence-less claims, we should forever question if birds are actually flying creatures and not government drones, regardless of our own experiences with birds and information provided by people who study birds for a living.

But by all means, provide me one documented case of a biological male being diagnosed with gender dysphoria by an actual medical professional based on nothing but the fact he plays with Barbies and burst my "bubble".

The comparison to birds is bizarre because they are a public phenomena that anyone can see and study, gender transitions aren't.

>our own experiences with birds

Which is none in the case of gender transitions, or very little for some people. But certainly nowhere near the experience of an average person with birds.

>information provided by people who study birds for a living

Which is not reliable in the case of gender transitions, because those who "study them for a living" have proven themselves to be unreliable and value-laden communicators who either has an ideology to push or are too timid to challenge those who do have an ideology to push. Don't forget the substantial material incentive for diagnosing people with gender dysphoria (months and possibly years of consultation and medical appointments, services and products), if ornithologists were similarly ideological and have reasons to benefit from denying that birds are drones, I would be skeptical of their claims too, until I see lots of birds and study them myself at any rate.

>provide me one documented case of a biological male being diagnosed with gender dysphoria

Diagnosis is medical data that is mostly non-public, so this is an impossible demand for rigor. And yet, here's[1] the next best thing, a celebrated psychologist with a long career in sex and gender research, editor for several journals, slandered and fired because activists are outraged he tries to encourage gender-non-conforming kids to be comfortable in their assigned gender instead of transitioning them immediately. So anybody who doesn't diagnose a barbie-playing boy with dysphoria and transition them is at risk of being slandered and fired no matter what their contribution or position is. I consider this pretty solid evidence for the original claim.

[1] https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-r...

> I consider this pretty solid evidence for the original claim.

Which is odd, because neither the physiologist nor the activists decided anyone was trans for "just playing with Barbies".

It's hilarious that the first "answer" to the Quora question "How do you stop a boy from playing with dolls?" is a targeted ad saying "Ad by Amazon Web Services (AWS): AWS is how. AWS removes the complexity of building, training, and deploying machine learning models at any scale." ;)

They're "Action Servers", not "Doll Models"!

https://www.quora.com/How-do-you-stop-a-boy-from-playing-wit...

> You're a guy and play with a barbie... trans.

That's...not how anyone realizes they're trans or is diagnosed as having gender dysphoria. Your comment is very moral-panicky and transphobic.

There are lots of money to be made from more diagnoses,

This and the parent’s statement is almost entirely wrong.

Given 2 statements: 1) Americans don’t seek/receive enough mental healthcare 2) Americans seek/receive too much mental health care

no one (other than the old school types who think mental health is simply something for weak people) would pick (2) as true.

You can have mental health care without over prescribing pills. Some people can really benefit from being asked "how does that make you feel" in a place where they can be honest and not have to provide an answer they think is being sought.

Americans don’t receive enough HEALTH care. Period. When they do it’s a yearly 10 minute appointment with a primary care physician.

The physician breezes in, looks at some lab work, asks a few questions, writes a prescription or two (hey they have to “treat” something), and heads to the next patient because they do not have time.

80% of anti-depressants are prescribed by general practitioners, not psychiatrists:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473964/#Sec1ti...

I know many, many people who were going through something in their life and mentioned being “a little down” to their primary care doctor. They were handed a prescription for an SSRI on the spot. So now they have depression.

General practitioners do not have the time or the training to be diagnosing and treating mental health disorders. This isn’t a case of “look at a rash for 2 seconds and prescribe a topical steroid”. Psychiatrists schedule hour long appointments and many of them will want to see you a few times before they attempt to diagnose or treat anything.

You can receive not enough health care and too much at the same time. It’s a matter of the right quality and appropriate type of health care.

Healthcare costs are equal to the amount of healthcare used multiplied by the cost per use.

Big picture, Americans use a bit less healthcare and an other parts of the world, but they tend to spend about five times as much which is where the costs come in.

This is a counterargument to something I didn't say.

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