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I'm glad that someone is challenging what the author calls the 'medical "physical" theory of depression/anxiety', although it's unfortunate that the only way to do this is to use another progressive narrative (alienation caused by capitalism).

To me, the biggest gap in the mainstream theory is that it claims that depression is qualitatively different from sadness, and yet I have never seen any scientific article that provides evidence of this. The usual argument that is given for this distinction is that, unlike merely being sad, depression produces extreme feelings of helplessness, pessimism and inability to act. And yet what if these were actually just extreme versions of things that already go along with what we call sadness? That is, what if mild sadness and mild depression were the same thing, and severe depression was categorically different from mild sadness only because it was more extreme?

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As you yourself said, the claim is "qualitatively" different, not "quantitatively" different. If you think about what qualitatively means, I really have no idea what you're trying to say. "Just" being "more extreme" is sufficient for something to be qualitatively different. Different symptoms start manifesting, especially as compensatory systems start to fail. As far as I can tell your point is vacuous; please clarify, otherwise.

If you're instead trying to say that they're biologically / mechanically similar phenomena, well, that's a different discussion we could have.

Have you ever experienced severe depression (i.e., the type that prevents you from getting out of bed for months or causes you to be hospitalized)? Because it's absolutely fucking awful. I'd love some clarification of where you're going with this hypothetical, because right now it sounds like you're denying the experience of a whole lot of people in a whole lot of pain, without having much of a point.

The main point is that there are a number of different axes along which "severe", "major" or "clinical" depression is said to differ from ordinary sadness, and that the qualitative distinction is used to justify all of these.

The main ones are

1) Depression (unlike sadness) is not caused by circumstances that cause a person to be unhappy.

2) Depression (unlike sadness) can only be cured by addressing to root (medical) cause of unbalanced brain chemistry.

3) Depression (unlike sadness) either is not curable, only the symptoms can be cured, or people who recover are prone to relapse.

>Have you ever experienced severe depression (i.e., the type that prevents you from getting out of bed for months or causes you to be hospitalized)? Because it's absolutely fucking awful.

No, but maybe I've experienced things just as bad? I don't really know, but I also don't know how you claim to be able to compare your experience to mine.

I'd love some clarification of where you're going with this hypothetical, because right now it sounds like you're denying the experience of a whole lot of people in a whole lot of pain, without having much of a point.

It's a logical fallacy to think that people do/should only make arguments with some end goal. My goal is to express my opinion on the nature of mental illness. Another fallacy is that arguing that "X is true" can be immoral, because of X were true, then some immoral consequence would follow. If I am right, we should still be just as compassionate towards other people's problems.

You can be compassionate and understanding towards someone's problems without categorizing those problems as a medical illness. Similarly, you can use this categorization as an excuse not to be compassionate, e.g. treating a person as irrational or untrustworthy because they have had a mental illness in the past.

> and that the qualitative distinction is used to justify all of these.

Yes - does it pose a risk of harm to yourself or other people; does it interfere with your day to day life? These quality statements are used as part of the process of assessing whether someone needs or wants a treatment, and they should be common across all forms of mental illness. (EG people with auditory hallucinations often go unmedicated because they can live with their voices.)

> You can be compassionate and understanding towards someone's problems without categorizing those problems as a medical illness.

Compassion does not treat depression, although it's important part of preventing depression. Talking therapies like CBT are pretty structured, and the evidence says they seem to work. We know the counseling generally doesn't, and can be harmful. And also, if a person needs treatment then they might need money to pay for that treatment and protected time off work to get treatment. Calling dysfunctional forms of sadness "depression" is partly a bureaucratic measure we take to fund treatment and protect people from losing a job.

Strongly agree with your last sentence. A few people on HN equate mental illness with violence but mental illness does not predict violent behaviour (drug addiction; or previous violence are much better predictors, and if you have a combination of either / both of those and a mental illness that's a better predictor, but merely mental illness itself isn't predictive).

Having suffered from severe depression I sincerely doubt your analysis. There are times where you feel deeply numb and no sense of sadness whatsoever. You'd have to bend over backwards to call that an extended version of sadness, where it somehow eliminates its own emotional experience.

Also I think you should be very careful down this road, even if you don't intend it, it's very very easy to paint it like it's less serious than it is even if you don't intend to. This is something to look at the _evidence_ for.

I disagree that because depression has these qualities that it cannot be thought of as extreme sadness. I think that human experience and emotions are complex, and that for various reasons, extremes of unhappiness may result in these symptoms.

>Also I think you should be very careful down this road, even if you don't intend it, it's very very easy to paint it like it's less serious than it is even if you don't intend to. This is something to look at the _evidence_ for.

On the contrary, I don't see why we need to put things into special categories in order to respect people's problems and properly judge their seriousness. I don't see any logical connection between the views that(1) severe depression is a serious problem, and (2) severe depression is on a spectrum where the milder versions are not distinguishable from being unhappy or "in a rut".

[0] http://www.nimh.nih.gov/health/statistics/prevalence/major-d...

I think the author of this article's point, and the point that is most likely accurate is that depression is sometimes a manifestation of a physical malady and sometimes not (of course the lines between physiology and psychology are becoming increasingly blurry).

The take-away here is not really whether the condition is or is not physical, but rather, what the labeling of it as physical does to the perspective of its sufferers and its effect on their prognosis.

Pyschological issues of this nature are a curious form of disease, in that the mental models of their sufferers form a feedback loop with the condition itself. Whether or not depression is physical, thinking that depression is physical has a tangible effect on the condition itself, one that this author and I would argue is sometimes (though not always!) negative.

However, it is in the interest of pharmaceutical companies that it be thought of as purely physical, with purely physical treatments. And it can be argued that this mode of treatment, and this mental model in the minds of the sufferers is self-reinforcing. Because it is presented as a physiological ill, depressed persons see it as such, and eschew or don't fully invest themselves in alternative solutions, which make them not work.

The sum of all of this is that depression is one of the few diseases that is actually itself shaped by the marketing of its treatments. Which is both interesting and troubling, given the relative inability of the current regulatory framework to cope with this systemic condition.

See also chronic fatigue, where people reject entirely any psychological help. And if someone's CFS is treated, cured, by a psychological treatment, well, they were faking it.

(This has pretty much been said on HN before.)

>I disagree that because depression has these qualities that it cannot be thought of as extreme sadness. I think that human experience and emotions are complex, and that for various reasons, extremes of unhappiness may result in these symptoms.

Is this even meaningful? What you're saying is 'emotions are complex so feeling X might just be a more extreme version of Y even though it sometimes shares no properties with Y whatsoever' - doesn't that mean I can now say any experience is just an extreme version of any other?

Schizophrenia is really a lot like extreme happiness! You have any problem with that?

>On the contrary, I don't see why we need to put things into special categories in order to respect people's problems and properly judge their seriousness.

I didn't say put them in 'special categories' (most of the 'mainstream' attitude I experience is that I'm full of shit and should pull myself together, by the way), I said be careful and don't just speculate as if it were a folly in a public place like this, since you risk coming off like you're downplaying it. You can categorise however you like, but _back it up_ and have a little compassion. This isn't a programming language pissing match.

Saying severe depression is a more extreme sadness potentially implies you should do some lovely happy nice things to fix it like you can with milder sadness - much like the usual bullshit I hear about how if only I did more exercise it'd all be fixed and really you can fix it if you just put some effort in! Never mind that the lead PT of the biggest fitness brand in the UK jumped off a cliff, or that many people with seemingly great lives have committed suicide...

Saying something is just more of something else, implies that usual fixes apply, just you need to do more.

I'm not saying you think any of this, but that you need to tread carefully - these are actually I think (and experience) most people's views anyway, even if they don't want to say it, so both for depressives and those who might interact with them, you're potentially doing harm - is you waxing philosophical of more value than that potential harm?

In my experience, if there is something that is troubling or upsetting for me, I can tend to engage in distracting activities or thoughts so I don't have to think about it. This seems like a less extreme version of becoming emotionally numb in response to very negative feelings.

I think this gets to the core of our disagreement. You are implying that people without mental illness experience life in a way that is simple and intuitive. If you are unhappy, do more exercise. If you have a "seemingly" good life then you won't want to commit suicide.

There is a lot of discussion on introversion on HN, and one interesting post I read was saying how the advice to "put yourself out there" was not good because shallow interactions with other people could be just as unsatisfying a no interactions. The advice was to find ways to connect with people at a deeper level.

Similarly "do more exercise" might be simplistic and bad advice for many people, not just the severely depressed. And people with seemingly great lives might commit suicide because they are deeply unhappy or dissatisfied about their lives. Do you honestly think that just because a person has the appearance of a great life, that they must be happy?

It might seem like that to you, but the two don't seem that similar to me. Differences include the fact that you may be able to will your way out of your (somewhat healthy) distraction - or think clearly about it, care about it, or register it happening at all - while this is largely not the case regarding emotional numbness (pathology).

I don't think that's what he's implying at all. Rather, I think he is implying that those that have not had to struggle with depression has another perspective entirely, and thus have a very hard time intuiting what dealing with mental illness is like. That's why you get that kind of simplistic "solutions": those that suggest them usually have no experience with or knowledge of the pathology in question, and are basically thinking of how they would attempt to remedy the situation (unknowingly basing their whole plan on how a healthy mind works).

Apropos of introversion; there seems to be a great deal of confusion surrounding the term, particularly in relation to insecurity and social anxiety (as with terms that have their meaning muddied by colloquial misuse.)

Again, lolo_ is talking about why "do more exercise" is bad advice in the context of attempting to cure the perceived "sadness" of an individual suffering with depression. Healthy subjects, on the other hand, will generally see a rise in mood (short term). Depressed subjects will subsequently return to their baseline of "shitty" - if they ever experience an effect in mood at all. And regarding people with seemingly great lives committing suicide: Most of these would likely be diagnosed with some sort of psychopathology (although suicide itself might be debatable on a more philosophical level.)

I'm curious as to whether or not people here have actually experienced severe depression. From my own experience it does seem obvious that depression is extreme sadness. The experience is a more extreme version of what you feel during grief. That doesn't mean that depression is always caused by an obvious trigger such as a death of a loved one, or that it is easy to fix. (In fact, sometimes grief can turn into depression that feeds on itself).

IMO most cases of depression are caused by life events. That opinion is based on seeing a number of people close to me suffer from it, and recover. Generally it is not entirely obvious to the person what is causing the depression, but looking closely at their life usually pins down a cause. Generally it is something along the lines of working in a job that you don't like, being in a relationship that isn't working, excessive stress/burnout, or not having a purpose in life, or some combination of these factors.

Your depression may well have felt like extreme sadness or grief. Why do you think your individual experience transfers to all other people with depression?

> IMO most cases of depression are caused by life events.

This is called "reactive depression". Do you have any real numbers, or are you just going by the people who you know? Some people mask their depression.

>Your depression may well have felt like extreme sadness or grief. Why do you think your individual experience transfers to all other people with depression?

I'm not necessarily saying it does. There may be different types of depression. However I'm saying that this particular type of depression that I experienced definitely was extreme sadness, and it's pretty obvious that that is the case if you have experienced it. It's like saying that a colour is a slightly darker shade of blue.

>This is called "reactive depression". Do you have any real numbers, or are you just going by the people who you know

No, it is just an observation of people I know who have had depression.

Other people in this thread have claimed, based on their own experience, that severe depression is nothing like sadness. So for me it's useful to see both sides (I'm not discounting either). It seems a bit one sided for you to criticize this post on this ground, and not the others.

You claim that depression is just a form of sadness. Other people prove you wrong by describing some episodes of depression that are not just extreme forms of sadness.

When someone says "all swans are white" someone saying "my swan was black" is useful because it makes you realise that maybe you're wrong and need to rethink. someone saying "my swan is white and I've seen some swans my friends own that are white" is less useful because it doesn't provide much on top of what you've already said.

Also I find it interesting -- and sad -- that I got a downvote for sharing my experience.

I think different people often experience different aspects. I've felt that extreme sadness, as well as feelings totally unrelated, i.e. the numbness I talked about.

The point I was making was to contradict the idea that it can _only_ be described as extreme sadness, but in no way discounts that as an experience.

Sorry you got downvoted for that, I for one found our different experiences of this disease quite interesting! Though I'd much rather nobody experienced it...

So do I. I supplied a corrective upvote.

I realise that my post does sound critical. Sorry for that -- I didn't intend that harshness.

AFIK most cases of depression are triggered by life events. Causative factors are usually not quite that simple (except maybe in the case of adjustment disorder?)

But then again this kind of discussion frequently gets muddied by colloquial use of the term "depression".

I guess that's the problem with trying to discuss something complex in a sentence. In many cases the life event appears to be a major causal factor, although there are obviously other perpetuating factors.

Sure.

Well, that's just it though; They appear to be a major causal factor. They might be. But is there any reason for us to believe so, other than the observed correlation of some stressor with the onset of an episode? And even then: do they cause or trigger the illness?

Or maybe that's what you mean - that a life event triggers the episode, not that the traumatic event is the genesis of the illness?

I guess you can never definitively prove it. However, given what we know about how the stress system works, how long-term high cortisol affects the brain, etc., it's pretty well established that long-term stress has certain measurable effects on structure of the brain. Also, there have been studies showing similar changes in brain chemistry in animals to that seen in depressed patients, when put into socially stressful situations.

I'm not entirely sure what your differentiation is between "trigger" and "genesis" in this case. Can you explain?

I'm sorry, I don't think I made myself very clear:P

My point, summed up, is one regarding definition.

Maybe it's just pedantry, but I find that your use of cause (what I also describe as genesis) sort of implies that it is a progenitor - that it is a starting point of sorts.

And what I'm suggesting is that there are other factors at play (biopsychosocial model) long before the culmination of the disease in a major depressive episode - provided we are still talking about the term "depression" as in "major depressive disorder."

In the cases I have witnessed, life events have been the progenitor. There are obviously other factors, such as personality, genetics, etc. However, life events seem to have been the main "cause" of these depressive episodes (and not just the trigger).

> much like the usual bullshit I hear about how if only I did more exercise it'd all be fixed

You could try pointing them to this, which shows that evidence is unclear whether exercise works or not to treat depression.

http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depre...

> When only high-quality trials were included, exercise had only a small effect on mood that was not statistically significant.

Even if a scientist can legitimately prove depression is different from sadness, you will not believe it, because it requires a degree of subjectivity you will not tolerate. You expect a kind of purity, an objective, emotionless vocabulary with it's associated numeric data; data that has been wiped clean of the people and the lives of those people it describes, to describe that which is fundamentally indescribable to someone who has never experienced it.

Sometimes compassion means saying 'okay, I understand, that sucks?'.

I've been reading through your responses and agree generally with your perspective on this issue (I say this as someone who has dealt with varying levels of depression behaviorally and chemically, both on my own and with professional assistance). But I'm curious about your fundamental position on the "physical theory", which seems to imply there's a real distinction between physical processes and emotional processes, and that sadness, extreme or not, is non-physical. Sadness is not some ephemeral phantasm that floats beyond the body. It's a cognitive/neurological response to external stimuli. It's a biological event. My personal opinion is that controlling your brain with chemicals should be a last resort, because in many cases you can achieve similar results with relative consistency by addressing underlying social problems. While more labor-intensive, achieving satisfaction without drugs is liberating.

But I don't think normal emotions are categorically distinct from medicalized emotional states: both are chemical or electrical processes. It seems you disagree. Am I misinterpreting your position?

I used the term physical as a quote from the author, who also used in quotes (hence the python style quotes in my post).

But "physical" somewhat captures the medical view on depression, as something distinct from the ordinary spectrum of "healthy" emotions, and with causes that are primarily internal not external (although, as you say, all thoughts and emotions are ultimately mediated through physical processes in the brain).

So my point wasn't that sadness is non-physical, but rather all experiences are physical, and most experiences belong to the spectrum of human emotions, which are influenced by external and social events, thought not always in the most obvious way (hence my opposition to the "just get over it" strawman, since "just get over it" might be a bad response to mere sadness too).

I also don't have a strong opinion on chemical intervention, except that I would hold them to a higher standard of evidence since I have a stronger prior on the root cause being social and emotional, rather than a congenital inbalance in brain chemistry. It's plausible that they work, and if they work, they should be used.

> I'm glad that someone is challenging what the author calls the 'medical "physical" theory of depression/anxiety',

What? Mainstream firstline treatment for depression is a talking therapy. This rejection of the physical basis is written into government provided guidance (see eg UK NHS guidance for depression and anxiety).

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