Stephen Fry reveals he attempted suicide in 2012
bbc.co.uk
bbc.co.uk
http://www.imdb.com/title/tt0808482/
http://en.wikipedia.org/wiki/Stephen_Fry:_The_Secret_Life_of...
http://www.amazon.co.uk/Stephen-Frys-Secret-Manic-Depressive...
Depression, for example, in my experience, and from what I've seen -- often has a cause; a rational, explainable cause (that the sufferer often isn't aware of). When you treat someone's depression as a "medical disease" like the cold or the flu, you are completely ignoring the human factor.
Many cases of depression can actually be solved without drugs -- by addressing the problem at the root of it. "Feeling Good: The New Mood Therapy" by David D. Burns, goes into this. (http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808...)
I don't know why people ignore the real human factor when it comes to depression. Instead they resort to a bunch of drugs that do not address the root (psychological) cause of the depression, but rather just give some temporary fleeting relief.
Addressing the root cause typically requires working with others over a period of time... and that work is oftentimes what people with depression want to avoid.
When the only reason you haven't killed yourself is that you don't have the strength to do so, the last thing you want to do is have the people you love going down with you.
(Note, before people get worried: I'm on the way up again now, and getting the help I need to ensure I don't get bad again.)
Am I doing the right thing?
If they've not experienced something similar to the mental health problems I'm suffering from it's usually best if they treat me as normal. The effort required to try and explain aspects of what I'm going through, usually with little success, is often far more detrimental than any benefit they could hope to provide. Being distracted from the problems, even if only for a short while, can be blissful and hugely appreciated.
On the other hand, I'm usually happy to be treated differently by people that have had similar experiences to me. I can often communicate to them in a sentence things which would take hours of conversation with somebody who'd not been there before.
It's a difficult situation for both the supporter and the supported, particularly in the early days.
> On the other hand, I'm usually happy to be treated differently by people that have had similar experiences to me. I can often communicate to them in a sentence things which would take hours of conversation with somebody who'd not been there before.
I very much agree with both parts of what you've said here. I'm curious if & how you tend to balance between the two?
Generally when I'm having a bad time just having some casual distraction works fine, especially from someone who doesn't know what's wrong.
When I'm stuck in a rut, just having a few friends who can stop me bullshitting and keep me talking works wonders.
The result of this seems to be that when I become unwell people in this group provide me with the best kind of support that they're equipped to give while others help me talk it out.
Unfortunately this hasn't been so easy to achieve with family members as it has with friends since they're so desperate to see me well, although things are improving. Fortunately (or unfortunately) my wife is also bipolar so I don't have that problem with her.
As to balancing talking it out vs. distraction? I rapid cycle so distraction can be very effective for dealing with short-term mood swings. If I notice that I'm distracting myself a lot then that's a sign that bigger trouble is just around the corner and is when I start to seek help. My wife and I discuss the state of our mental health very frequently so there's always a certain amount of discussion going on as well.
Extensive HN thread: https://news.ycombinator.com/item?id=5684773
Or so a 21st century corrupt medical establishment, that abuses and neglects science in favour of greed (from inventing mental issues out of thin air to over-prescribing medication, to even advocating unnecessary operations) likes to tell people.
Depression sure is a true medical condition for some (relatively few) people -- but in the quantities and degrees it affects the general population though, it's anything but.
thats the reason why people with bipolar usually don't want to be medicated - the highs bring genius.. the problem are the lows which follow it.
average people don't make the big breakthroughs.
http://en.wikipedia.org/wiki/List_of_people_with_bipolar_dis...
I also struggle to believe that there is any evidence to support your claim that depression as experienced by somebody who is bipolar is worse than somebody who is unipolar which is again worse than depression caused by life events.
Saying that the highs bring genius is a gross simplification.
Yes, manic episodes can provide productivity boosts and huge amounts of energy but it doesn't have to go much further before it becomes impossible to complete a thought let alone a sentence, where you cannot sit still, where your judgement is severely impaired or you're suffering psychoses.
None of these symptoms (and there are many more) are particularly conducive to productive work, let alone breakthroughs.
(PhysOrg.com) -- The Greek philosopher Aristotle once said "there is no great genius without a mixture of madness," and now there is some scientific evidence that there is a link between mania and high IQ and creativity, since a study of over 700,000 subjects showed those who scored the highest grades were almost four times more likely to develop bipolar disorder in their adult lives than those scoring average grades.
I've been on meds for bipolar for five years, and I see a therapist every week. The meds get me stable - like healing a broken broken leg - and the therapy is my personal trainer building me up to run the marathon. Neither would be as effective without the other, but in my case, if I could only have one, it'd be the meds.
This is a very different illness to depression. And depression has different forms.
Yes, talking therapies are powerful. But you seem to be making the mistake that a talking therapy isn't affecting brain chemistry, or that drugs are inherently bad.
Comments like yours are very frustrating. Do you talk about people ignoring the real human factor when we put a broken bone in a cast?
The belief that mental illness is biological ("chemical imbalance in the brain" and so on) is very widespread and very emphatic. But the gap between that and what we actually know is drastic. What explains that gap? Most likely, it's that (a) people very much want to believe it, and (b) the belief has been heavily marketed.
No. Biological theories of mental health and mental illness are very much established.
And yours is a complete mischaracterization of the work of Kirsch et al.
Their meta-analysis found that in ALL cases of depression, there is statistically significant improvement in quantitative measures of depression treated with SSRI. In moderate to severe cases of depression, the improvement was clinically significant (ie a clinician and patient clearly note the improvement). The meta-analysis done on clinical trials were overwhelmingly trials of 6 weeks of SSRI or less. Suicidal patients are almost all excluded from such trials. Treatment groups were treated with SSRIs via research protocols, and not usual clinical practice: there were no attempts made to match patients to an SSRI that would be most likely to help, to wait on a response, to use SSRIs that were helpful based on a family history; dose adjustments were typically prescribed by study protocol and not by patient response, patients were not switched to another SSRI when there was no response or if intolerable side effects developed, often no attempt to treat side effects with other agents were done, etc. In other words, none of the things any physician routinely does to optimize treatment were done in those trials, and yet there were STILL improvements in measures of depression across the board.
No reputable psychiatrist or physician will fail to recommend an SSRI in cases of moderate to severe depression. Therapy can also be helpful, but the evidence is overwhelming that SSRIs help in clinically significant ways in moderate to severe depression. There is no credible doubt about it.
Despite your assertions about what "people very much want to believe" - in my experience, people very much want to believe that the brain is somehow different - that something beyond biology is at work. Believing that somehow depressed or otherwise mentally ill people can just "snap out of it" or "pull themselves up by their bootstraps" is erroneous, unhelpful, but fits nicely into really completely shitty and cruel narratives about human beings.
But please. Perhaps you'd like to advance a theory on how an organ like the brain differs from every other organ and does its work in ways not explainable by biology, chemistry, physics, etc.
It isn't my characterization so much as a paraphrase of various sources I've read/heard on this, including Kirsch himself. My understanding is that Kirsch and Sapirstein's findings are two: (a) for all but severe depression, the improvement of SSRIs over placebo is measurable but too small to be clinically significant; (b) even that small measurable difference is questionable, because the studies were not really double-blind. (Patients could figure out which group they were in because of the SSRIs' side effects.) Is either of those descriptions of their findings wrong?
I haven't kept a list of sources, but one I remember is [1]. Is Kirsch mischaracterizing his own work?
I noticed that you didn't use the word 'placebo' in what you wrote. My understanding is that Kirsch et. al.'s findings were specifically about lack of clinical significance beyond placebo. Could that explain the discrepancy between your description and mine?
Perhaps you'd like to advance a theory
I would not. Do you think that lack of a better theory has anything to do with whether this one is substantiated or not?
[1] http://www.huffingtonpost.com/irving-kirsch-phd/antidepressa...
No that's a common misunderstanding. Science is the search for the best model/theory as such it's hard to rank something as better or worse than we don't know. Thus the default theory is "There is no relationship between X and Y". Even if not clinically useful there does appear to be a connection and as such you can replace the default theory.
After even more research the current theory is something like. "They appear to beat placebo's which have no side effects." Which again is far more useful than "We don't know." As it suggests comparing them to placebos that have side effects. Again not because they are going to help you treat patents directly, but because it tells you more about the disease and possible what research could be useful.
For the purposes of this discussion, that's a distinction without a difference. (BTW I edited my comment before your reply showed up, and had deleted the bit you quoted.)
More significantly, your suggestion of comparing SSRIs to placebos with side effects strikes me as an excellent idea; it is what Kirsch's study would naturally seem to suggest. I wonder if such studies will ever be undertaken.
Edit: I did find at least one such study:
http://psychrights.org/research/Digest/CriticalThinkRxCites/...
Authors' conclusions:
The more conservative estimates from the present analysis found that differences between antidepressants and active placebos were small. This suggests that unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos. Further research into unblinding is warranted.
A great example of this is Heroin addiction and alcohol addiction are vary different biochemically. There is even a wide range of Alcholhol addictions, but you will see them treated side by side. The simple truth is we can't really understand why someone has issues but we do have treatments that help people lead productive lives and that's enough to be useful. Just as your dentist does not need to know how pain killers work to use them effectively.
The comment I replied to had some worrying flags.
It made blanket statements about meds; it suggested that depression has a "root cause". I took that to be a reference to classical psychotherapy -- some event happened a long time in the patient's past and that event must be uncovered by the therapist for the patient to address it and recover. Re-reading the post I see that I might be wrong! Perhaps the post is just talking about regular evidence based cognitive model.
> The belief that mental illness is biological
Well, for something like bipolar disorder this feels like it's true. I don't know much about BPD, and I don't know many people in real life who have it. But it seems that people need the meds.
When talking about depression I recognise that there are various types. I'm not a doctor and have no special knowledge. When people ask I suggest they investigate talking therapies (and probably CBT) first. But I know that people might get benefit from meds, especially if they're on the more severe end. I know that meds can have unpleasant side effects.
> Well, for something like bipolar disorder this feels like it's true.
I agree. The open question is on what level these things are best to be understood. In some sense everything about us is biology, just as in some sense everything is physics. But we don't think of, say, heart disease as best addressed by physics. Similarly, that there is a biological stratum to our actions and feelings does not automatically mean that chronic emotional suffering is best understood as biology. One might as well conclude from the tongue and larynx that language is biology too. And indeed it is, sort of—yet its meaning lies elsewhere. Or you might as well conclude from the importance of neurons to learning that education is brain biology. Why bother with teachers or schools? We should just 'learn' the neurons directly. Such examples are obviously silly, at least given our current knowledge.
To know that chronic emotional suffering is a biological disorder requires more than the involvement of biological phenomena in it; it requires an experimentally verified model. My understanding is that we don't have anything close to that. The one that entered the public imagination, the serotonin-deficiency theory, is widely dismissed by experts [1,2,3,4]. The only argument seems to be whether they knew it was false from the beginning or discovered that it was false decades ago.
Yet we insist that modern science has discovered that mental illness is biological just the way that cancer is and so on. What do you call a conclusion like that which goes far beyond what we actually know?
It's worth realizing that psychiatry has always made this claim. The grounds for it shift every 20 years or so, and the previous grounds are always dismissed as ludicrous if not harmful (think lobotomies etc.). Nevertheless we're perpetually certain that we're beyond all that now.
> But I know that people might get benefit from meds
I don't think anyone questions that; the question is whether the benefit is that of a placebo or not. My understanding is that SSRIs are no more effective a treatment for depression than tricyclics were a generation earlier; their advantage is rather that they have fewer side effects [5]. So whatever explanation there is for their efficacy must plausibly explain how both of those (presumably very different?) biochemical mechanisms could do it. Given that even inert placebos produce most of the same effect (Kirsch's finding), the placebo explanation is pretty clearly a major candidate. If there's another, I'd like to know about it.
(I realize you were talking primarily about bipolar disorder, but I haven't read about that, so I've continued to talk about depression instead. That may lessen the relevance of the above.)
[1] http://www.npr.org/blogs/health/2012/01/23/145525853/when-it...
[2] http://www.plosmedicine.org/article/info:doi/10.1371/journal..., via http://www.plosmedicine.org/article/info:doi/10.1371/journal...
[3] http://www.psychiatrictimes.com/blogs/couch-crisis/psychiatr..., paywall bypassable by clicking link at http://goo.gl/3LxUW
[4] http://www.madinamerica.com/2012/01/revising-the-history-of-...
[5] http://www.ncbi.nlm.nih.gov/pubmed/17636689. This looks like it was withdrawn because it was to be superseded by a larger study, but I couldn't find that one.
I think that might be why people cling to a biological model for mental health problems.
Obviously, we're not saying any of that. I say that there are powerful talking therapies; that these are evidence based and effective for many people; that medication may help although it's probably over-prescribed and it can have unpleasant side-effects; and that some people won't respond to any of that and may need electro-convulsive therapy or other severe interventions.
I agree that people tend to overstate the biological model, and that is a problem. It's a problem because, as you say, we don't know if it's true, and it's a problem because it steers people away from talking therapies.
It is effectively treatable for most sufferers, of which a combination lithium-lamotrigine therapy is currently considered the treatment of choice. See http://archpsyc.jamanetwork.com/article.aspx?articleid=20732...
Talking therapies do not stop these kinds of mood swings, but they may be able to help people cope with the effects of mood swings. As importantly, they can help people follow their prescription, failure to do so being the #1 reason for these pharamceutical treatments to fail.
Any psychiatrist worth his salt, will primarly prescribe drugs as a means to help people cope, while working on the actual underlying causes. Indeed, in many cases, using drugs in the treatment may be the only option to make the patient's day-to-day life bearable. Drugs may also be essential for allowing the treatment team to examine, possibly very problematic, underlying issues.
Also, a SSRI, for instance, can of course not "treat" someone of a clinical depression; you will virtually always need professional cause-oriented therapy to get better. Most patients know this, or will realize it as they experience how their meds work.
Finally, there are some mental disorders, and many individual cases, that require constant medication, despite of the quality of the other treatment given. For example, full-fleged bi-polar disorder, where a manic or a depressive episode may have very severe consequences.
Dr. Burns stated that the methods often work best when used in conjunction with medication. Some people may be so far down the rabbit hole that medication is necessary to restore improper brain chemistry.
Did you know they can surgically put a pacemaker in your brain to "treat" you?
I thought it was common knowledge.
Your anecdotal observations shouldn't drive your understanding. Go read up on it. Suffering from mental illness myself I find your post quite offensive.
We need to destigmatize mental illness so that our friends and coworkers aren't ashamed to ask for help. There are a lot more people going through this than you think. If you're struggling, and don't have anyone to talk to, check out devpressed, or contact me.
[1] http://confreaks.com/videos/2341-mwrc2013-devs-and-depressio...
Until last December I'd been stable for around 5 years. Now I'm putting together an account of my health over the last 6 months for the benefit of my department's special circumstances committee. With any luck I'll make it through to the next year of my degree.
Thank you for your efforts, I hope to be able to contribute similarly when I'm stable again.
I'll forward this to my wife[1] as I expect she'll find them of interest too (she's also bipolar).
[1] http://www.time-to-change.org.uk/blog/academic-life-mental-i...
In theory we have anti-discrimination laws here, but it's hard to prove that someone hasn't employed you because of your mental health problems. And actors usually need to be insured when they're doing a film. It's hard for some actors to get that insurance, expensive, because of past mental illness.
Stephen Fry (among others in some UK media) is doing good work at destigmatizing mental illness.
I've been getting better lately, but for a few months I was the worst I've ever been in my life; not being able to talk publicly about it for fear of discrimination and the general mental health stigma makes the loneliness... crushing. I'm hoping this will help others take the first step to helping themselves and others.
The insidiousness of this disease is in how well it hides itself in plain sight in many cases. And how terrifyingly easy it is to fall to it.
He said there is "no reason" for someone wanting to take their own life.
"There is no 'why', it's not the right question. There's no reason. If there were a reason for it, you could reason someone out of it, and you could tell them why they shouldn't take their own life," he said.Life is not infinitely valuable. Its goods can be outweighed by bads. People who really just want to go should be respected and we should help them get out of here.
You seem to have missed context here. The context being him talking about his depression. He's not talking about suicide in general, he's talking about suicide of the clinically depressed.
My roommate suffers from bipolar disorder (and a lot of other stuff to boot), and honestly, it is as much a disease with as much rationale behind it as any physiological one. His comment about "arguing" with suicidals hit the right note.
It is strange to think that someone who is 'always so happy' gets depressed. Not that they are hiding that depression under their cheer but that the cheer and depression are genuine states that manifest very powerfully. It just isn't something that most people go through.
After having understood the actual title, I'm now unsure which of the two is more confusing or unsettling. I suppose equally so. This world would miss an incredible human being.
There was a deeply insightful interview with him where he spoke about self pity and how destructive it is[0]. I hope to some day meet him and thank him for that. As I would love to just thank him for openly being himself, in public.
I admire his ability to explain a concept that is dear to him. He will lay the scene in your head by touching of various points (which is exquisitely exploited in his host capacity on QI) and then, with sudden, stern force drill the most amazing and brutal observation into your skull that makes a lightbulb explode right above your head.
He will start speaking and briefly mention what he is talking about. Then he will turn all chitty-chattery as you are accustomed to, cause it's Stephen. And then he just ravages you with this piece of gold and while you're still recovering from the blow to your brain, he will return to Stephen mode, picking up the pieces, holding your hand, asking whether you're OK and making everything good again.
I would walk right up to him, wherever I can get a hold of him, tell him how much I admire him and weep in public, right then and there, without hesitation. Then I will tell him that I haven't done anything close to that in years. I should really find out whether he will be close to where I live anytime soon.
I was diagnosed bipolar as a kid and spent over three years in a locked disciplinary boarding school. At first I was reluctant to take medication because of the stigma associated with it, but taking lithium changed my life.
I've been completely stable for 9 years, taking the same low dose.
It's really hard to find the right mix of medication and / or behavioral changes because every person is different. But it is possible for people with bipolar to find balance, stability and happiness. I think that speaking up about our personal experiences helps shatter the stigma while supporting families who are still considering different treatment options.
Bravo to Stephen Fry for going public.
He also attempted suicide as a teenager (I think 16/17 but don't quite recall), although in his (first) autobiography he describes it as a childish rebellion to upset his parents. Therefore I wonder if it's happened 3 times or potentially many more.
Incidentally, both his autobiographies are well worth reading. As are his novels.
So glad that Stephen Fry is still with us, and is continuing to speak out about mental illness so well.
Waiting lists[1] for some forms of talking therapy (for people in secondary care, with severe and enduring MH problems) can be very long. In Gloucestershire there's[2] a max 6 week wait for assessment and then 18 week wait for treatment to start. This is for people being treated in the community, as an alternative to hospitalisation. And Glos is pretty good at this. Some places there's waits of over a year.
Luckily there's something called "IAPT" (Improved Access to Psychological Therapies) which is ring-fenced[3] funding to provide evidence based (usually cognitive behavioural therapy) in short courses (12 weeks) to people coming from primary care, but not in secondary care. Usually you can self refer for assessment. You might need to ask your GPs surgery for "IAPT" or "PCAT" (primary care and assessment team), because some of them don't appear to know it exists.
[1] be careful with terminology here. I'm using it wrong. Waiting list is a defined term with a specific meaning. If you're asking a local health board about the length of time people have before they start treatment you want to avoid use of the words "waiting list".
[2] These times were accurate last time I asked, about 2 years ago. These times are significantly better than they were 5 years ago, and the local trust is still working to reduce those maximum times.
[3] Maybe I'm wrong about the ring-fencing of the funding?
Grrr: door-stepped by the press this morning. Said all there was to be said in the podcast with [Richard K Herring] - intrusion makes 1 withdraw
to be expected, perhaps, but not really helpful.
But its easier to think about it than to do it, that's for sure. Something changed in my mind about the time I had 30. Never had those feelings again. But I always will remember the times I contemplated death as moments of hope in between desperation.