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Comment by lolo_ | Hacker News Reader

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.

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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.)

> 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.

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.

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.

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

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.

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...

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.

>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.

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).

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