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Comment by sigkill | Hacker News Reader

[begin rant]

Your post sparked a thought. We've been hearing about 'cure' for depression. From the point of depression, isn't the baseline a 'high'? Yet, we're told right from childhood that drugs that put you on a high are not acceptable. Is our brain not on a high naturally then, and could you classify depression as the wearing out of the hormonal high? Just as one is able to make better judgement at the base line if compared to being high, (as you say ->) people are able to make better judgement at 'depressed' than normal. I don't even know what I'm talking anymore, but I think we should stop seeing the depression as a problem and start accepting it as a state of not high/not baseline, just as the baseline is accepted as a state of not high.

[end rant]

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The problem with what we call depression is not the depressive mode of thought, per se. The problem is that this mode of thought gets out of control.

The depressive mode of thought is a tool, and an important one. The brutal honesty of this way of thinking allows you to analyze situations more clearly, and in so doing, it allows you to make better decisions. Being able to enter this mode of thought was likely an important step in human evolution, and we all do it from time to time, even those of us who are not "depressed".

But like most tools, the depressive mode of thought can be dangerous. That same brutal honesty, applied to one's self, does not end well: our human imperfections basically guarantee that such analysis will tear at the psyche in ways that little else can.

It is said that we should not judge others because "you weren't there; you don't know." But that doesn't work when you apply it to yourself, because you were there; you do know. And so you analyze yourself, and your judgment inevitably comes out wanting. The next question is obvious: what should you do about that? Only there's usually not enough data to answer that question, so an obvious intermediate step emerges: more analysis. And so the spiral continues.

This makes the ability to leave the depressive mode of thought just as important, from an evolutionary and health standpoint, as the ability to enter it. Pick up the tool, use it as needed, and put it down again. What we call "depression" is essentially what happens when you can't put it down.

You can probably see where I'm going with this. I think we're going about treating depression the wrong way. We try to take the edge off the mode of thought, when we should really be targeting the mechanisms that let people go into and out of it. Those mechanisms, unfortunately, are poorly-understood today.

There's also very likely to be an extremely delicate balance: you have to let people out while also allowing them back in, lest some kind of "antidepression" take hold where they can no longer pick up the tool. I don't know what such a thing would be like; it's possible that we already know it, but under another name that might or might not be linked to what we currently call depression.

It took a bit of courage to write this down so please bear with me.

Your post, I don't know why, has me in figurative tears. This feels like someone 'gets' what's happening... and to think that I had no idea what I was feeling for all this time was categorized as depression. I hate to say this because it sounds fake and silly, but you know when people say it 'clicks' and they feel like there's a sudden "light"? That's exactly how I felt after reading your post. Don't ask me why, because I don't know.

Totally agree. This was one of the most insightful things I've read on this site in years.

EDIT: Hey, what if it's a natural cycle, like tons of other stuff? Normally, it comes and goes, and the sickness is when it doesn't go. Not really a big leap from your point, but something to think about.

While going through a down cycle one time, I decided to watch some of the psychotherapy presentations on youtube. Not the ones designed to be uplifting and helpful, but the ones with actual research or for psychotherapy students.

> I think we're going about treating depression the wrong way.

The main thing I took away from the presentations was that psychotherapists know they aren't getting it all right. I was surprised when they talked about the client dropout rates, client satisfaction rates and measurement techniques, and the treatment success, and reoccurrence, rates. It reminded me of discussions about the realities of software project management.

> targeting the mechanisms that let people go into and out of it

Mindfulness is the term used currently to describe the ability to regulate your own "mode", and the automatic thoughts that go along with them. Usually the term gets lumped into the act of meditation, but the result, being able to manage your mode yourself, is the same. MBCT, DBT, ACT, CBT and other modern forms of psychotherapy, seem to be designed around this idea of teaching people how to recognize the mode they are in and manage the cycle between them in different ways.

The anti-depression is called mania.

By currently prevailing definitions, yes, but the dysregulated-adaptation hypothesis is relatively new. If we assume this new definition instead, then would an impaired ability to enter the depressive mode still produce something we would call mania nowadays? Or might the effect be different?

I think mania sounds right.

> I think we should stop seeing the depression as a problem

This Grey depression rarely comes without the Black depression described above, which really is a bad disease.

I've only recently been diagnosed with depression, and one of the reasons I went in to see a doctor about it is because of the self-doubt. Right now at work, I've been told to convert an existing synchronous system into an asynchronous workflow engine, and I don't know two shits about workflow engines. So, even with a "normalized" view of what I know and what I can do, I get anxious about the responsibilities I've been assigned, which leads to physical manifestations of anxiety, which leads to physical ailments, which leads to sick days. I know I can sit down and within a week, learn exactly what I need to do, but my mind keeps telling me I'm stupid and I should just quit my job.

Your rant reminds me of the people that claim autism spectrum disorders are just a rung on the evolutionary ladder. It might have one little part that sounds good on paper when you completely ignore the disease as a whole, but it's still a fucking disease.

edit: if you want to try and pretend to know what it's like to have a "baseline" like mine, take a week and instead of saying yes or no, just say "I don't care". Coworker asks you where you want to go to lunch, you don't care because it's all food at the end. Significant other asks if you want to go out to a movie, you don't care because it's all the same action packed or slapstick comedy crap. You no longer care about anything, because it's all stupid crap. You go through the motions of waking up, showering and go to work every morning, not because you like your job (even if you do), but it's because that's what you've been told to do. This is the brink of suicide, and it's a very real thing for people with depression. Nothing excites you, so there's no point in living. </endrant>

edit2: If anyone else is thinking they might have depression, please go see someone. It really does help. Greg Baugues, a developer out of Chicago, recently gave a talk about developers and depression at Mountain West RubyConf, and I would suggest watching it (http://www.confreaks.com/videos/2341-mwrc2013-devs-and-depre...). It gave me the courage to go seek help, hopefully it can do the same for others.

Replying to your first edit. Trust me I don't care. I'm relatively sure I'm not going to apply to YC so I can tell here. I know what it feels like. The hyperbole and half post resonated with me. Things are happening, I know they are happening, but I don't know that these are symptoms for something. If you've been through depression, I think you know what I'm talking about. You can just see, nothing matters. Why am I getting up? Why am I poking a fork on a grape and eating it? I'm washing a plate... what's going on. The water is running from the tap and hitting the sink and making a sound. What's the point of that? What's life anyway? Just a bunch of random chemical reactions. Basically I'm ending up think (paraphrased) "What the fuck is actually going on in this world?"

I didn't know that was called depression until I read that post...

Note that there is an important part of the definition being left out: "... significant impairment in social, work, or other important areas of functioning".

"please go see someone. It really does help"

Sorry for your circumstances. I wonder though if it could actually be more helpful to have a close friend that can provide unconditional support and guidance if possible of course. Reason being is I've always found (from relationship counseling) the therapist caring but then "ok our appointment is over that will be $x" to contradict somewhat the caring part even recognizing that it's a job. Wondering about your thoughts on this?

For example when someone calls me for help (which is actually pretty often and I separately dated for some time a very depressed woman and oddly find it interesting) I gave all the time that they needed anytime anyplace and the conversation didn't end "just like that". I would imagine things like that provoke feelings that aren't exactly positive.

You're basically asking a friend to be an untrained therapist for free. Even the most caring and generous of people know in their hearts that they can't take on that kind of responsibility and still be able to manage their own life. It's not fair to ask - most people will feel guilty about saying no to someone asking for their help, even knowing it's help they cannot feasibly give.

It's truly a full-time job. I don't mind paying my therapist, because while it could be interpreted as paying someone to care, I see it as paying for their expertise in helping me get better. The right therapist will care about you regardless of payment; it's both a professional and a profoundly personal relationship. It's why many therapists, particularly ones treating personality disorders, have to go into therapy themselves to stay grounded.

I struggle with depression and anxiety pretty severely at times, and while my boyfriend is tremendously supportive to an almost saintly degree, he absolutely insists on me having professional help. There is only so much he can do and asking more of him would be counterproductive for both of us. I wouldn't get better and he'd be taking on a problem that is ultimately not his.

>"You're basically asking a friend to be an untrained therapist for free."

On the flip side, going to a therapist is just paying someone to pretend to be your friend for a while. My insurance (Kaiser; about $600 per month) covers something like 80% of 6 therapist visits, and after that it's all on me. This is probably the worst part of trying to seek help; the sickness basically prevents you from taking all the steps necessary to start getting better. I've thought long and hard about how to solve this (maybe have a service that just handles all the idiotic HMO stuff for you to make it as low-effort as possible), but I still don't have a good solution, and "hacking the medical industry" has traditionally been a non-starter.

No. That's not what modern evidence based therapy is.

If you're talking about 'counselling' then yes, a friend can do it about as well as a trained counsellor. But remember that the evidence base for counselling is weak; that people often feel worse with counselling; and that counselling is sometimes actively harmful.

> covers something like 80% of 6 therapist visits, and after that it's all on me.

That's a shame. If they covered 100% of 8 visits they'd cover most people who need CBT.

> I've thought long and hard about how to solve this (maybe have a service that just handles all the idiotic HMO stuff for you to make it as low-effort as possible),

Maybe just "buddying" - someone visits or calls you and talks to you and watches you while you do all the stuff you need to do. This builds self-reliance.

But yes, anything medical is really tricky.

Therapist is not pretending to be your friend. Because the uninformed opinions like yours are getting spread, people who need help do not seek it, making the problem worse.

That's a lot of responsibility to put on somebody, for one - and for the other, that somebody may not have either the distance from you or the skills to assess your situation correctly. (Of course, a therapist might not, either, but you can't easily fire a significant other for failure to meet your therapy needs, and what you're describing is much more intensive than mere friendship.)

If this bothers you, you might want to consider a religiously affiliated counselor. Many religious institutions offer different forms of counseling as part of their ministry. Sometimes it is just for members, but other times it is open to all.

For instance, it is quite common for pastors to have some psychological training so that they can assist their parishioners. Of course, the quality of counseling can vary quite widely depending on their natural talents and how well they were trained.

If you're non-religious, I've heard that Jesuit and Benedictine counselors tend to be quite good about taking you on your own terms.

You wouldn't tend to look at anything from the point of depression though.

This is tantamount to saying "from the point of view of a disease, healthy people just live too long"

I've come to the same conclusion. Hackers (and smart people in general) have an inclination to use drugs like marijuana and ecstasy that actually do something, as opposed to pharmaceuticals which, well, do something else. I've never understood why feeling good is deemphasized over not feeling bad. I can't help but wonder if there is some ulterior motive. If there is, then somebody profits from depression. That's pretty messed up..

we're told right from childhood that drugs that put you on a high are not acceptable

Drug education has progressed decades since I've had it, but it was never in terms of a "high." The distinction was that drugs given to you by someone other than a doctor are bad.

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