The Endlessly Examined Life: A most chronic depression | Hacker News Reader

The Endlessly Examined Life: A most chronic depression

thebaffler.com

61 pointspepys18 comments

The unfortunate reality is that in 2014 we don’t have a good treatment for depression, let alone a solid science-based definition of what we are trying to fix. There are many ways of contextualizing human unease and cognitive discomfort. “Depression” is the current label in a medical context for pervasive unhappiness, yet it’s not one with a clear biological underpinning. To this, I think it can be advantageous to avoid self-identifying as “depressed”, as I suspect it’s not uncommon for many venturing down the psycho-therapudic/pharmalogical wormhole in search of Help to end up endlessly suspended in a search for a ‘cure’ like this author. Another similar account which comes to mind is Daphne Merkins’ “My life in Therapy” which was published in the NYT a few years back: http://www.nytimes.com/2010/08/08/magazine/08Psychoanalysis-...

I spent many years myself searching for a magic pill or something to cure me of my "depression", which of course I didn't find, and all that did was reinforce my belief in my own inability to deal with life.

Some people claim that there is indeed such a pill:

http://www.reddit.com/r/Ibogaine/comments/2kb3s9/i_have_done...

Sad story. I wonder whether he might have benefitted from a mindfulness based therapy. Unfortunately, some depressions are more difficult to treat than others. Very qualified doctors that I know would disagree with the notion that "it’s still not clear that [antidepressants] are better than placebos." They would argue that antidepressants are overprescribed to people that do not in fact have biological depression, lowering the effectiveness rate. Lastly, it should be noted that ECT (electroconvulsive therapy), is actually one of the most effective treatments for depression, and one that carries minimal harmful side effects (although short-term memory loss is one such side effect).

As someone with depression, it's clear to me that our knowledge of mental health is where medicine was in the late 1700s. We know that certain treatments work for certain people, in certain situations, but we don't have the theoretical frameworks to figure out where to experiment further. Reading the psych. literature, it really feels like a lot of the science in that field is just random shots in the dark. When certain therapies or substances work well, we don't why they work and in what circumstances they won't.

IMHO, psychology is still waiting for its "germ theory" moment.

I'm so tired I'm not even sure why I'm posting. I have spent so many days thinking about the treatment of psychiatric disorders; it literally gives me a headache. I agree that Psychiatry is still in the Dark Ages(not figuratively, but in some ways so close to the right period in time it's humorous.) I won't state what I was diagnosed with, but what I will disclose is it came on one Christmas Eve and went on for Years. I tried all the tri, and heterocyclic drugs. They all failed spectacularly. The only reprieve I have gotten over the years are highly addictive drugs. I now just try to keep the dosage low because I know if my current doctor retires; I'll have a hard time getting these drugs, or run out of money paying out of pocket for unnesarry office visits. I don't blame the Psychiatrists--that is the Psychiatrists who don't call themselfs "Specialist in Psychotropic Drugs", or a dude who charged $400.00/hr for dubious advice and medication. Who I do blame are the Drug companies and their oh so carefully designed Double Blind Placebo Controlled studies. Studies which were pimped out to the cheapest Ho(country). Studies that were cherry picked in order to show the FDA their dubious drug worked slightly over Placebo. Studies that didn't exclude early Placebo responders. Studies that didn't account for subjects who felt the side effects and attributed to the Placebo Cure. And--my last gripe; Studies that didn't really use subjects who were clinically ill. Yes--they were poor, and many times Homeless, but they really didn't have a malfunction in their brain.(Yes--they might have had symptoms out of DSM-5, but because of their predicament many of their symptoms could be accounted for.) While I'm on the soap box, I'll pass this along. I'm not sure this s the truth, but it came from a good source. It is this; I was told that Fluoxetine(Prosac) showed so little promise it was "shelved" for years until some MBA in Business decided to he could market a cureall drug--that is if the researchers played along?

ECT offers a very poor trade-off -- potentially irreversible brain damage and mental dysfunction in exchange for the docility and temporary emotional blunting or euphoria that result from the damage.

Yep. It's "effective" in that it's not suicide.

No, it's effective in that it cures completely some people's depression, leadig to a transformed life.

Not everyone, and it's reserved for long term untreatable severe depression, but it's important to note that it's very effective for some people.

Well sure, sometimes, but you yourself describe it as a last-ditch effort.

Having wrestled with severe depression for many years, I've learned a few things.

1) There is hope! Don't give up.

2) Many people will not understand. That's okay.

3) Cognitive Behavioral Therapy (CBT) works. It's hard work, but it's easier than having depression and anxiety. It's really about renewing your mind. Best book on the subject is an old one: http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808...

4) You have to find help from others. You will likely run into quacks, and well-meaning but unhelpful advisers. Don't give up.

I've read Feeling Good, and found many of its basic premises to be flawed. Conscious thoughts aren't, as Burns claims, always a leading cause of bad feelings. Biological, hereditary, and environmental factors can have a large effect on mood. Burns believes negative thinking patterns are 'distorted', and we can ameliorate depression by 'correcting' them. Several studies have shown that the depressed people are actually more, not less, likely to appraise situations accurately. http://nuweb9.neu.edu/personalitylab/wp-content/uploads/Tayl...

Out of curiosity, who did you find that was able to help you?

CBT is used to help cancer patients deal with pain. It's not about "correcting" thoughts. Have you said something similar on HN before, under a different account?

I'm sure CBT has been used with cancer patients, but pain management is not the heart of what CBT is about: http://www.beckinstitute.org/cognitive-behavioral-therapy/#q...

CBT is however about fixing negative thought patterns. Start of chapter 3 of Feeling Good (I just pulled open the pdf) Burns says 'Illogical pessimistic attitudes play the central role in the development and continuation of all your symptoms'

I don't think I myself have posted about this before, and just did a search. Hacker news does seem to be often dismissive of the psych field though, as there is not a lot of good science that would appease a critical thinker.

You said that emotions can be caused by a wide range of stuff and suggested that CBT might be less effective in those situations.

But it doesn't matter what causes the emotions - CBT helps people deal with negative emotion no matter how they're caused. Pain management in cancer patients is a good example where emotions are caused by something external but where CBT is still effective.

You might want to have a look through some better books or websites to get an idea of what modern CBT involves.

https://moodgym.anu.edu.au/welcome

The author makes the best point. That from his work environment and its union he was supported. Depression may be a fairly normal thing, which some people go through from time to time. It becomes a whole different problem when the individual is not supported and starts a spiral out of available support. Because of his degree, even though he didn't apply it directly, he gained access to a job he wasn't motivated by and substantial benefits. Some may say the answer is to get that degree, regardless of its applicability, to gain access to the club, but others will see the real problem this indirect solution creates for the vast majority of people.

It bemuses me that on HN, people push for CBT, positive thinking, more time spent on exercises, relationships, basically all of the outward signals of American professional and social-media "well-being."

What needs to be mentioned is that the author despite his professed history of severe clinical depression, is a published author of somewhat notability, whose last book was vouched by James Wood, the literary critic of New Yorker. And despite whatever professed outward collective-mentality present in IT, I know that many of my friends and co-workers suffer from existential doubts, personal isolation and obsessive-compulsive behaviors in private, if not more so. If anything, the fact that the author chooses to share his personal history so openly makes me more comfortable about his handling of personal issues than others who lead double of lives and "#winning on facebook" and "suffering alone."

As another perspective on depression and anxiety counter to the HN's mainstream answer, I highly recommend "Happiness and Its Discontent" essay here (http://chronicle.com/article/HappinessIts-Discontents/144019...)

"But we are mistaken when we interpret anxiety and other forms of existential disorientation as being at odds with a well-lived life. It may well be that they are an essential part of such a life."

>"But we are mistaken when we interpret anxiety and other forms of existential disorientation as being at odds with a well-lived life. It may well be that they are an essential part of such a life."

If existential anxiety is part of a well-lived life, then by definition, why does everyone seem to prefer not to have existential anxiety?

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