No Longer Wanting to Die
opinionator.blogs.nytimes.com
opinionator.blogs.nytimes.com
If you break your knee, you will (99.9% chance) go and see a doctor. If the first doctor doesn't fix it, you'll see another. Your knee is broken, unusable, painful and you have a drive to fix it.
A more serious injury will generally result in a friend/family member/passer by getting you to a doctor.
If you suddenly enter a depression... even getting to the stage of seeing a doctor can fail, because suddenly everything is 'pointless' (bad wording. sorry.). And if you see them and they give bad advice, you maybe can't be bothered to see the next one. Or you miss the appointment because getting out of bed was too hard. Etc.
It's more severe than most physical injuries because it affects your ability to seek help.
http://www.cbc.ca/news/canada/toronto/canadian-woman-refused...
That said, I actually have sympathy for the stigmatizers. From their perspective a perfectly healthy person with no overt negative stimuli is profoundly unhappy for no reason. That's got to be frustrating because it's completely and totally opaque, untouchable, alien, and unaddressable. The condition stymies the compassionate person, making a mockery of their good intentions. That is frustrating, even angering, and is probably the cause of the ambient hostility that lingers around depression. Depressives behavior appears stubbornly self-destructive, which essentially and irreducibly thwarts the will of those that care for them.
People going to their GP with a 'I feel depressed' that get told 'well, here's a prescription for some pills, let me know if you feel better with them if not I can give you something else to try' would be the same as if somebody reports a thorny concurrency bug with your embedded multithreaded application and your first response is 'well, let's try to overclock/underclock the CPU to see if it improves things, if not maybe we can try to change the RAM next time'.
It is a lot cheaper for medical services as a whole to have GPs easily prescribe antidepressants and psychoactive drugs in general rather than have psychologists available immediately for anybody who might need them, but it does not make it right.
Others might not share my misgivings but I would only be willing being prescribed a psychoactive drug by a specialist (psychologist/psychiatrist) after a thorough evaluation and non-pharmacological therapy first, and even then very conservatively and after an explanation more objective than "you have a chemical imbalance in your brain" (which chemicals? what imbalance? what should be the normal values?).
There should be much easier and cheaper access to non-pharmacological treatment for mental issues, but maybe to have that one would need it to be destigmatized, which of course is a very slow process and might or might not be possible due to the identification we have with our minds: if our knee hurts we think "my knee hurts, it needs fixing" if our mind hurts we think "I feel bad, I am a worthless person" which is a lot harder to deal with unfortunately.
Everything actually is pointless, since all matter and energy will dissipate from entropy on a long enough time span. Also everyone you know will be dead in 100 years, most likely.
Also most of these people would go see their doctor if there was a million dollars in gold waiting there for them. It's not that 'everything is pointless' is the reason preventing them, but rather that there isn't enough significance in seeing the doctor.
I'll caution you against this thinking, in general. If you have a depression so severe it keeps you from seeking help, you're probably well aware that it's a matter of life and death. Even if you're not acutely suicidal, you live day to day just "running out the clock", hoping it doesn't get any worse before you die. The prospect of wealth or fame in your future is not only not enticing; it may well make you feel worse, as self-awareness of your inability to care reinforces your depression.
The idea that people who are not motivated by death will be motivated by money is, while not categorically false, surely fraught.
Merely anecdotal evidence of course, but I don't think you're on the right path here
Shortly after getting insurance I asked my doctor for a therapist recommendation. The therapist she sent me to was a very nice old man who started suggesting prayer as an answer to my problems in the second session. That was also our last session.
I wish there were a way to do this that eliminated some of the trial and error, because listings tend to be pretty neutral, and reviews are sparse and not particularly trustworthy. You end up picking someone who's close to you and hoping it works out. It's a great way to lose a lot of time, and you know one of the things about depression is failing to find a therapist after a few tries greatly decreases motivation to keep trying.
http://en.wikipedia.org/wiki/High_Frequency_Active_Auroral_R...
In this case, the therapist could have understood that prayer was not a helpful suggestion - but in general, it's a valuable tool.
Keeping faith feels healthier than trying yo regain it.
And doesn't that make sense? We're not merely bodies and brains, a biological machine built to specification, arriving at a particular day exactly like each other and exactly like we were born. Besides differences in brain mechanics and chemistry from each other and from our birth, we are also each the various experiences of our history. We have as much in difference as in common with each other.
Quite apart from the question of whether prayer and what's prayed to is reality or not, people do believe in prayer and what's prayed to. If that's an effective part of their therapy, I see no reason to question it. If it lifts them out of the horror of depression and keeps them alive, I'm very happy for them, and for me if they're in my life.
-- Signed: a non-partisan, small "a" atheist.
The idea of encouraging the hopeless to pray as a method of bootstrapping themselves out of depression may simply be an appeal to a more cognitive self-realisation process. This simply by the act of vocalising what the individual hopes for.
If he thinks that praying in and of itself will be valuable, eg, because the patient is religious and a calm, focussed mental state would be valuable, then it is good therapy.
If the therapist is suggesting that the patient ask God to cure him... well, that's not good therapy.
If it's this bad for ortho it must be unimaginably awful for anything touching mental health. What does one do? Get personal recommendations from trusted friends who've done their own searches? Are online communities any use?
That's where we stand. Infuriating. This is not quality befitting a first world nation.
There are a number of these offices in NYC and I'm sure there are some in other cities as well. I hope you find somebody that works for you.
If therapists have no problem finding clients, word of mouth may actually be the best system for them.
Please correct me if I'm off-base here.
So his rejection may have been ethical and not about your worth as a patient.
If you were already friends with the person, I really don't see them ever wanting to treat you formally. In the worst case they might have to make the almost impossible decision between involuntarily committing you (if they think you are a danger to yourself/others) and losing a valued friendship, or not committing you against their better instincts to preserve their friendship and risking you harming yourself/others. (Not that you are necessarily in that category ever, but if you're making a decision like "Can I ethically provide treatment for this person?" you really have to think about worst cases.)
[0] I don't have any medical/therapy training, but I wound up spending a few months taking care of someone I was dating who was having a pretty severe manic episode. Very irresponsible of her doctor, in retrospect, who later said the reason he hadn't hospitalized her was because she had me to help take care of her/watch her--and we were both college students and he had met me once, briefly.
Psychotherapists and psychiatrists often seem to be utter shit at serving patients as normatively neutral medical professionals, ie: not treating their own lifestyle preferences or ideological frameworks as the One True Way to Live.
Please, keep trying.
As for trial and error, we're far from knowing everything. Among a list of things known to have worked for various people, it is still somewhat trial and error finding out which of those things will work for any individual.
We're big bags of meat, bone and mystery, and solving that mystery is a challenge, for ourselves and for our practitioners.
I find that depression -- at least for me -- has two main causes:
[1] Excessive emotional response to bad situations (similar to what the author of this article is experiencing).
and:
[2] Insufficient motivation/goals/joy.
My solution to [1] is twofold: mindfulness and resolution. Be aware that excessive negative emotional responses are bad (as they lead to depression), so it is better to just observe bad situations and try not to get overly emotional. Secondly, try to resolve the issue (either by actively managing it, or by accepting that the world is just like that and you can't change it), so that the conflict doesn't arise in future.
For [2], the solution is to have a purpose in life, with motivating, goal-oriented activities that you enjoy. I suspect this might be the issue for you. There is more to life than having a well-paid job. I gave up very well paid contract work 15 years ago, as I hated it. Since then I have worked on my own business. I earn a hell of a lot less money now, but I'm much happier.
Having friends (or at least social contact) is also important to mental health, even if that is just saying hello to people you meet on the street, or chatting to like-minded people online.
Please don't wait for something to happen. Take charge of your life and do something about it. Being depressed all the time is an unnatural state, and is your brain's way of telling you that you need to change something in your life. Sometimes you need to make major changes in your life to make things better.
Feel free to email me at cpncrunchhn@gmail.com if you want to chat.
But what are you to do when you have no purpose in life? No motivating, goal-oriented activities that you enjoy? For many depressed people, including myself, everything seems pointless and therefore nothing has purpose and nothing is motivating or truly interesting.
No one really offers any good advice on this part of the solution and yet it's the most important part! Everyone seems to think that everyone must have something that interests them enough to chase a goal for the rest of their lives but I think the reality is that very few people have this. And furthermore motivation ebbs and flows, I have found that it's not very reliable and so a solution that involves it seems oversimplified to me.
There are a bunch of organisations to provide "vocational services" for people with mental health problems. Vocational services doesn't just mean work based activity, it involves social and sports and etc stuff too. This used to be "day services" and was provided in sub-optimal ways. Usually it'd be in a room in a hospital or other mental health building, and there would be strict segregation so no members of the general community would use the room and people with a MH problem wouldn't use rooms in the wider community. There was little concept of progression or push.
The Sainsbury Centre for Mental Health did a great report and so now day services are better - although still no where near good enough.
My local area has "People and Places". They have a large allotment in a normal allotments place. They grow fruit and veg and flowers with other gardening work.
There's also the Independence Trust which run a variety of different groups and sign post to other groups.
Both these groups work with people at most stages of illness (not while they're detained under section in hospital, but pretty much everything else) and they can tailor the work to what the people feel able to do.
a) Yes, everything is indeed pointless / "pointless".
b) Think about what "pointless" means. It requires an agent to assign and remove importance. Who is this agent? Is it you, is it society, is it what you have been told since born? What's his goals / values / pov? Why exactly is something "important" or not?
c) Fck "saving the world". Fck "there is a point in this". See it, start, simpler: Do you enjoy eating some specific food? That's the meaning of life. Do you enjoy taking a dump? That's the meaning of life. Do you enjoy chewing gum? That's the meaning of life. Do you enjoy saying some arcane joke? To yourself or some random person you just met? Even if they dislike it or don't understand it? That's the meaning of life. Do you enjoy scratching your @@? That's the meaning of life.
The "purpose in life", is to eg scratch your @@, and for 2 seconds, say "I liked that, and I currently feel good".
It may sound ridiculous, but everything comes from that. If you eg say, "I was thirsty, it's hot, and I enjoyed this cold glass of water", you are on your way to be happy, and also on your way to save humanity. If you want to do that. ..Don't believe me that everything comes from that. But, pls, do enjoy the one second of today, that you felt well doing whatever.
That's the meaning of life. That's the purpose. And when you internalise that, you will find something that is nice for two seconds, and, eventually, you will find the "purpose".
However, you should also be aware that one of the symptoms of depression is being unable to find enjoyment in activities that you normally find enjoyable. This might be the problem that throwaway3301 is experiencing.
It's not always easy to figure out what is causing depression. It's as if your brain has set off a "master caution" warning light, and you then have to figure out yourself what the problem actually is. I would recommend just asking yourself "is this what I want to do with my life" (in terms of your job, where you live, your relationships, etc.)
Also, depression can feed on itself in a vicious circle. I think this is where CBT comes in, as it teaches you to avoid negative thought patterns (although I never used it myself).
But you do have mind, and so you can choose your purpose, to decide on what you value and then go after it.
Values are arbitrary. Well, the most basic ones are built into you(survival and reproduction, valuing food/safety/sex), but the kind of values humans speak of when they think about a "purpose" are mostly made up by them(making money, raising kids, pleasing god, being a good programmer, whatever).
So if you're looking for "purpose" it's not about finding it somewhere in the world, but more about deciding what you want out of life. I suggest you start by deciding and being clear on what kind of things you value. Once you know what you want out of life on the high/abstract level - you look for the more concrete examples and activities that move you towards achieving these values.
Here's my example. What I want the most in life, in a very abstract sense, is "being clever", so I am very motivated to do everything that moves me in that general direction. More specifically, I want to be great at thinking and creating things, coming up with ideas and understanding the world. This is something I want for the sake of itself, this is what makes life fun, I value these things "just because". After thinking for a while, I figured that the best practical activities that move me in the direction of these values are Computer Science, building a startup, and writing comedy/fiction.
So at this point my abstract desire to "be clever" drives my motivation to "learn programming" or "get good at writing comedy". And from there I can come up with goals and practical projects, which I am motivated to do because they move me further towards fulfilling my values in life.
I went through a period of depression and apathy, and thought a lot about how to figure out what I want. I'm still scared/depressed(for various reasons, mostly related to logistics in life), but now I have figured out how to "find my passion" and come up with goals that make me motivated and driven. So if what I wrote makes any sense or is in any way helpful, I'm happy to talk more on the topic, if you're interested, maybe you could bounce ideas off of me, maybe that will help you out. If you want - feel free to message me to raymestalez@gmail.com
The first idea is wrong, the second idea is right.
But from those concrete things you build up more and more abstract. The more abstract things gain meaning (bring pleasure) from the less abstract things.
As a primitive man, you feel cold and want to be warm, so you build a fire. Then you build a house. Then you kill an animal and make a warm coat. Then you build a better bow. Then you learn how to hunt better. Then you start planning years ahead. You move to better hunting grounds, you start saving up firewood, etc. That is the primitive man's version of a career; the same applies to a modern career.
However, you can't reduce the value of the more abstract things to the less abstract things. Saving up firewood is not reducible to the sum of warm nights you get as a result. It has its own, separate meaning. But that meaning is only possible because of the less abstract things.
Relatedly, people are wrong to say that life is pointless. The point is the pleasure and pain you feel. Meaning is derived from pleasure and pain. Nature gave us a source of meaning---that had to be the case for advanced life to evolve, and it's pleasure and pain.
tl;dr 1) values are built from the ground up, not the top down 2) values are based on pleasure and that is the "point"
A history of extreme emotional swings and hospitalization for attempting suicide.
I was the best man at his wedding. Once he got married and had three sons I thought that was the end of that part of his life.
In my mind, no one with three little boys could ever kill themselves.
I was wrong. As soon as his marriage started to fall apart, he did it.
If anyone reading this knows someone that suffers from depression, never underestimate the power of depression.
An important risk factor for career-oriented married men is total abdication of social efforts and leaving it to the spouse "to manage the social calendar." In the long run, this causes men's own friendships to atrophy. Then, if your spouse divorces you (or pre-deceases you), you find yourself without any functional support structure, which could trigger depression or worse.
I learned this from a book I read a while ago ("Lonely at the Top"), which tries to explain the causes of male suicide, especially among successful men. I vowed then, that if I get married, I'd make a very deliberate effort to maintain those friendships I had before the marriage. It's quite possible that someday, those friendships will be all that you may have left to rely on.
I've since learned that anxiety is often a front for emotions that cannot be adequately expressed or processed. For me, it's all the "unhealthy" emotions - anger, sadness, shame. The tools I've been able to deploy in anxiety fits include mindfulness: simply concentrating on my breathing and realizing how my body is reacting to stimuli. Often just meditating for a few minutes helps lower my anxiety, get my breathing under control and stop my heart from pounding.
There's also journaling my emotions several times a day. I built an app that sends me an SMS asking me how I am feeling and why and logs the response for later analysis.
It's not easy building new skills. It's also not easy re-training your mind after a lifetime of negative thinking. But so far its been working, and I've been able to do it drug free.
Please share if possible! Sounds great.
There has been a focus on CBT. That's great because for most people CBT is effective and short, but as this article says it doesn't work for everyone.
Very recently there is a lot of work to improve access to other talking therapies. Patients now have more choice about where to get their treatment; maximum times for waiting are going to be introduced; "parity of esteem" with physical health is more important. (Although watch out: You may have to wait 18 weeks to have a hip replaced, so you may have to wait 18 weeks to start your psychological therapy.)
One of the problems is that DBT needs experienced (expensive) practitioners, and tends to be used for people who are iller and who need a bit more support. So it's harder for health trusts to implement DBT programmes. Not trying to make excuses for them - I campaign pretty hard to improve treatment for people with a diagnosis of personality disorder and access to therapy is one of the main things.
> And as imperfect as my D.B.T. practice was early on, I found that just taking anxiety down a degree or two gave me a measure of control over my decision making in the presence of intense emotion. The lesson was profound. I couldn’t eliminate anxiety from my life, but I could learn how to tolerate it, and cope without making the situation worse.
This is a really nice point. It's an iterative process. You work at it.
The key is "radical acceptance". The universe is perfect in this moment, even if there are things you don't particularly like. You are a worthy and lovable person in this moment, even as there are certain aspects of yourself that you are currently trying to change. That's the dialectical part of dialectical behavior therapy. The idea of radical acceptance is something that can be applied right now, even before learning the skills.
The author talks about shame. Shame convinces us that we are broken, that we aren't good enough. It tends to get passed through generations due to the way we are raised and the way we raise our children. Treating that shame is very effective for convincing us that we are, in fact, good enough. A book called Taming Your Outer Child [3], accompanied by meditations developed by John Bradshaw meant to get one in touch with one's inner child [4], are both very powerful for healing that shame.
Finally, I can't help but add a TED talk by Brene Brown called the Power of Vulnerability [5]. In it she describes the idea of feeling worthy and "enough," and how it is key to happiness and living a fulfilled life. For me, it was helpful because it gave me a concrete idea to work towards.
[1] http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Wo...
[2] http://www.amazon.co.uk/Mindfulness-Eight-Week-Finding-Peace...
[3] http://www.amazon.com/Taming-Your-Outer-Child-Self-Sabotage-...
[4] http://www.audible.com/pd/Self-Development/Home-Coming-Audio...
[5] https://www.ted.com/talks/brene_brown_on_vulnerability?langu...
THAT was the problem that got fixed as far as I can tell. There was also shame, feeling of inadequacy, etc but the real issue here seems to be that once you can handle a debilitating level of anxiety, you feel empowered to go out and live life and try things.
That's what so many of these depression or suicide articles/ideas seem to be missing - there is usually some debilitating condition that the person is keeping quiet about, that's contributing to the downward spiral and until that gets fixed, nothing is going to work out.
The debilitating problems range from individual to individual, so how can one silver bullet be found for being suicidal or being depressed? It varies.
The issue as I see it in a lot of cases, is one of not being open enough about the root of the problem with yourself and others. Sometimes they don't even really know! (Usually younger people)
I have met a number of people who have depression and it's usually the same story - being very defensive about whatever the root cause might be and if you probe them, they'll clamp up. It's almost like it hurts too much to admit that you are not ok.
That's where there's such enormous amounts of shame - if you've lived with a problem for a dozen years and haven't fixed it, that'll get most people down, no doubt about it.
So yeah, on one hand there's definitely stigma attached to depression and being suicidal but on the other, by treating it as some unicorn of a problem, we are not helping anybody. I think an assumption that there's a root problem that once tackled, will yield massive returns, would go a long way. Coupled with recognizing that most people feel almost insurmountable amounts of pressure at one point or another and find/having people who are understanding and constructively supportive beyond 'everything's gonna be ok' is paramount.
There often isn't a root cause for depression. Asking people why they're depressed can feel like you're judging them - "What have you got to be depressed about?"
"The issue as I see it in a lot of cases, is one of not being open enough about the root of the problem with yourself and others. Sometimes they don't even really know! (Usually younger people)"
If you genuinely don't know, then you need to figure that out, asap. That's what happened to me pretty early on in life, I actually went to my parents one day and musingly said 'I am not happy, I don't know why'. Acknowledging that there genuinely was a problem, was an important step, because then I read all sorts of books and at least did surface level things like 'being more positive' - gleamed from that famous Dale Carnegie book.
It didn't do anything overnight but it got me to open my mind to a wide array of ideas I hadn't considered before - some of them counter-productive, others quite good.
To think that there isn't a root for depression is to basically admit defeat. I recognize that there may be great comfort in going 'well, that's just how I am, not much I can do' but that's the type of mentality that leads down the dark road of despair - if you think you are powerless to change it, then you are quite likely to end up in a place where you are pretty fkd.
Unfortunately psychoanalysis is still quite popular, and as a result too many people remain stuck in endlessly probing their subconscious where CBT or another approach might help them instead.
No. It's to accept that depression happens for a variety of complex reasons and to simplify it to some mythical root cause is not in anyway helpful.
This root cause stuff sounds like traditional psychoanalysis which has been pretty much totally debunked as useless now.
People are much better off ignoring root cause and focussing on treatment. The article mentions two evidence based therapies - CBT and DBT - neither of which ask people to look for a root cause.
By root I mean by changing one aspect of your life - you'll see considerable results. There may be 2-3 root causes, maybe even FIVE!
Point is it's not insurmountable. If you talk to people who were depressed and aren't anymore, they won't claim it was alchemy that fixed it. More likely, they'd attribute it to feeling empowered, rather than helpless and being a victim.
As a personal example - I know a lady who was deeply depressed, food disorder, alcohol problems, a lot of stuff.
Everybody was at a loss for what the fk to do about it. Then comes my friend who happens to really like her. Guess what, they're engaged and she's doing A LOOOOOT better.
Why? Because now instead of feeling like her life is over and that she's worthless, she can see that what she wanted (family and kids and being loved) is not some unattainable dream. She got some professional help for her disorders and while it's a long road ahead, she's in a different place.
So while there's many things left to unroot, ONE root of finding somebody who she can see a future with, is giving her the motivation to get better.
These are the kinds of stories that make a lot of sense - finding something to look forward to AND feeling like you can get there, along with some help in terms of logistics goes a long way.
I went off on a tangent there but I'm all for CBT or whatever other techniques. Point is - if you don't have a conscious break-through of recognizing what the problem was and how you're fixing it and WHY it's working, you are still lost. Just that you're receiving some mythical help at the moment.
While I'm no domain expert, I know a ton about mental health and the process of finding a good provider that you're comfortable with.
I'm a generalist, mostly back-end guy (Ruby/Rails/Postgres) with a good eye for design. I've had a few lucky exits. I think this can be another one.
Email is in profile.
Also the concept of "mindfulness" is so great for those ruminations that never seem to quiet down. Yoga, meditation, running, working out, all seemed to really feed into the idea of being "present".
Rates are similarly high in the US - in 2013 one person died by suicide every 12 minutes.
I'm not sure that entrepreneurs have higher rates of depression or suicidality. I think that depression and suicide are just very very common.
Or, you could read some of the articles that aren't interesting to you, as they'll have ideas and problems that might be outside of your immediate experience and view. Who knows, they might directly or indirectly inspire some entrepreneurial idea that wouldn't have occurred to you otherwise.
Keep your eyes and mind open, you never know what problems you might solve.