‘I Don’t Believe in God, but I Believe in Lithium’
nytimes.com
nytimes.com
When I was in school back in the 60's, I had the chance to see the healing effects of lithium before it was approved here in the US in 1970. I saw a man in a florid manic state dramatically improve in two week's time, kind of magical and it left a lasting impression on me.
A few years later I happened to be walking in town, and a man stopped me. "I know you. You were one of those students there when I was in the hospital." Only then did I know who he was. I asked how he was doing. He said "I'm doing quite well. Lithium saved my life and I'm still taking it."
Since then I've had the responsibility of treating many people with mood disorders, and I didn't forget what I'd learned. Anyway, lithium is still a godsend for many people, but of course it really isn't a magic bullet, nothing is.
Like all medications it can produce bad effects. I've seen that happen too. Renal failure is a risk as the article points out. Careful monitoring can prevent some bad outcomes, though not all. Doing whats best requires utmost dedication by patient and doctor to the cause of stability and quality of life.
In the words of Spinoza, "all things excellent are as difficult as they are rare." Success is possible, we just have to find the courage and strive to get there.
Pleasant surprise indeed, what are the odds? Obviously writing here is motivated by interests in computing as well as brains. Your comment a few weeks ago about SICP strongly resonates.
Scheme has been a productive language for me, I've done useful things with it. Curiously along the way it's taught me subtle lessons applicable in my other work.
That's not every doc's taste to be sure, no doubt an angled view among a quirky subset. Maybe not so strange finding unusual souls in a place known for its weirdness.
Scheme has a certain beauty, and symmetry when well-expressed. Paradoxically, a seemingly simple application can be perplexing on first glance, its meaning not immediately clear. Sure, the formal elegance is there, but how does it work?
The Lispy recursion vital to Scheme won't easily yield to cognitive brute force, when it's obscure to me, it has to sink in over some time.
It's not pure thought, one has to see it or feel it. More than just understanding, it has to make sense to me, that is, achieve a higher level of integration among my internal processes than the term "understanding" implies.
But once I "got it", it seems simple, a mystery whatever made it hard in the first place. Creating a useful program it's necessary to make sense of the tasks in order to translate into compilable expressions. It really is a kind of conversation in a peculiar language.
As I see it, there's a parallel in approaching human illness as a set of algorithmic processes, albeit extremely complex. Here we can apply a lesson, avoiding the temptation to force fit signs and symptoms into some preconceived template vs. what is learned during interaction, a more accurate, nuanced picture of the problems can emerge.
The work of healing is recursive, similar elements occur again and again. But as in a Scheme loop, recursion can end by trapping the right conditions. Wait, there's a clue. What is the condition that ends, at least damps, the troublesome recurring behaviors? Most of the time a "handle" can be found, an opening for intervention.
Programming teaches there's no universal solution to problems, solutions have to vary according to the situation. Each person with an illness has a unique disease, no two diseases are alike. Each person speaks a different language, we have to develop fluency in that language to be able to help. Skilled healers learn to build "macros" that shape the tools to the problem, sort of like evolving a DSL in Lisp/Scheme. Not exactly the same, but an element of the "mental models" that support effective treatment decisions.
Wow, that's pretty long. I don't know how good an answer it is, though a worthy question.
As to comparing programming to the current state of Psychiatry(I'm assuming you're a Psychiatrist?) in 2015; I don't see any similarities?
Personally, I don't find much beauty, symmetry, or even much logic in the practice of Psychiatry these days. What I have witnessed is give a drug the FDA approved, and hope for the best, and this is what the better Psychiatrists do. The lousy ones don't take risks, and just blame the non-responsive patients--on the art of the profession, and "That's all I can do--sorry--and my fee is going up next visit. I can see you in three months from now?"
Don't get me wrong, I glad your are practicing, but this speciality has taken a beating in the last decade. We were all lied to by the drug companies! It took a Psychologist to expose the hidden lies in the excluded meta data in those studies? It seems like lately, another study comes out questioning the use of a particular class of drugs.(The latest study that comes to mind is the one that found Schizophrenic's might have a better quality of life if Not put on medication long term.)
That said, I'm not attacking your profession, but right now it is as much of an art as it was 50 years ago. Because the medical speciality is such an art right now; I don't find any irony in the fact you like programming. If I had to dole out dubious(cure rates, in so many instances, close to placebo) expensive, addictive drugs to alling patients, I would cherish my alone time programming. I have a feeling HN probally has more Psychiatrists interested in Programming than any other medical speciality?
(I am not bashing the Psychiatry profession. I just don't see the beauty/magic in it anymore. I do think it's one of the harder jobs out there--if done right? Doing it right is taking on a few Medi-cal patients, when no one is looking? And, not charging out of pocket patients $300-400 hr.; especially the patients that are just addicted to said dubious psychotropic drugs. I probally sound angry? It's more like disappointment?)
I think it's fine to bash the Psychiatry profession; it doesn't mean you can't appreciate the work of good psychiatrists when you meet them, and there are probably a lot of psychiatrists who would join you.
mdcrawford@gmail.com
s/warplif/warplife/
I Should Not Drink And Post.
He basically said that there was a human soul, but that it wasn't made up of things that couldn't be measured. He thought that the soul was just as profound, or even more profound, if it obeyed laws of physics. My amusement was that a thread on something like the altering of mental state due to artificially introducing lithium into ones diet is amusing, since a philosopher that was very concerned with the philosophy of mind and soul (Spinoza) would have been fascinated by this type of intentional soul alteration.
Notably, there is enough lithium in the groundwater in certain areas of the US that this "study" has been happening for a long time. El Paso, Texas has high naturally occuring lithium in the groundwater, and is widely reputed to have less violence than comparable cities with less lithium in their water. I haven't read the whole thing, but remarkably, a recent paper seems to have shown this to be true, at least for suicide mortality.
Lithium in the public water supply and suicide mortality in Texas (Blüml et al, 2013)
There is increasing evidence from ecological studies that
lithium levels in drinking water are inversely associated
with suicide mortality. Previous studies of this
association were criticized for using inadequate
statistical methods and neglecting socioeconomic
confounders. This study evaluated the association between
lithium levels in the public water supply and county-based
suicide rates in Texas. A state-wide sample of 3123 lithium
measurements in the public water supply was examined
relative to suicide rates in 226 Texas counties. Linear and
Poisson regression models were adjusted for socioeconomic
factors in estimating the association. Lithium levels in
the public water supply were negatively associated with
suicide rates in most statistical analyses. The findings
provide confirmatory evidence that higher lithium levels in
the public drinking water are associated with lower suicide
rates.
Edit: I just realized that the Op Ed linked from the main article mentions the same evidence, although without reference to that particular paper: http://www.nytimes.com/2014/09/14/opinion/sunday/should-we-a...
Much like weed or cocaine.
That's a pretty bold claim.
2 Li + 2 H2O --> 2 LiOH + H2
You can't really find elemental lithium anywhere on Earth, for much the same reasons you can't find elemental sodium or potassium.
From the article: "But opponents of fluoridation and even some scientists maintain the new standard doesn't go nearly far enough. They say there's evidence that overexposure to fluoride might increase the risk for other health issues, including possibly thyroid problems, attention deficit hyperactivity disorder and even lower IQs."
Sort of funny how everyone is on the fluorine wagon, and anyone who says otherwise is a conspiracy nut.
Low = good, high = bad. "Sola dosis facit venenum". The dose makes the poison.
So I provided the source for GP's other statement, "And it is detrimental to brain development."
In contrast you've provided a generic source for an old adage. Anyhow the Harvard study mentions all the levels studied, some of which are comparable to US levels.
"all but one (Chinese) study suggested that high fluoride content in water may negatively affect cognitive development."
The source does not support claims that US levels of flouridation are too high nor that it is detrimental to brain development.
.88, 1.8, 2.97, 1.81-2.69, 4.12, 2.0, 3.15, 2.9, 2.97, .57-4.5, 2.5, 1.24-2.34, 2.47, 2.38
Fortifying food and water supplies helps reduce illness and disease.
(I'm not suggesting that Lithium is suitable for this).
It’s just hard to find causation here, while correlation is simple to prove
Bacteria, genetics, terrain, etc. would be great to study.
Aside: If you are a person who uses the word "bipolar" as a synonym for moody or indecisive, I hope reading this will help you understand what actual bipolar mania looks like.
Depakote, yuck. Gain weight, feel like shit. Or others that remove all desire (except hunger).
It's sad that medicine currently has no attractive offers for strong mental disorders like this.
You are right that many of the medications have serious side effects. There are certainly better choices now than in the past, but there's plenty of room for improvement.
Actual mania (not hypomania) is usually more unpleasant, from what I've seen. (I know quite a few people who've had it.) The stereotype is that the happy mania is the "normal" mania, but the anxious, angry, or psychotic versions are more common. I also think (although phren0logy is going to know a lot more about this than I do) that it's very rare for a person to have only the "happy" mania, unless you're talking about mild hypomania that might not even be classified as bipolar (I tend to think of BP as a spectrum and think that 10-20% of people are "on the spectrum", but that's not the same thing as having BP1 or BP2).
I've only had one actual manic episode (almost a decade ago) and my current doctor's pretty confident that I wouldn't be classified as bipolar based on recent and current state... but the one manic episode that I had was awful and I'll never forget it. There were flashes of the "happy" mania, but it was mostly anger and anxiety, with not a small number of panic attacks.
Impaired judgment. The 'godlike feeling' results in thinking you cannot fail, and therefore in making decisions that are not even remotely prudent. For example, I know someone who, during a manic episode, tried to buy a limo off of ebay.
From what I understand, the deep depression isn't actually all that dangerous -- you don't care enough to do any active harm. The climb out of depression, where the emotional funk is still present and there's sudden volition, is most dangerous from a suicide perspective. The peak of mania, where you're unstoppable and fearless and possibly thrill-seeking, is almost as dangerous.
Borderline Personality Disorder is probably going to change to Emotionally Unstable PD. It's a controversial diagnosis which results in a bunch of stigma. (Not just from the wider population but also MH professionals too.) the document "meeting the challenge, making a difference" from UK NHS describes modern best practice for personality disorder, and the problems the illness, and the diagnosis, cause. The old name borderline comes because it was thought to be sub-threshold psychosis style illness. We know now that's wrong.
The bi in bi polar just means "more than one" - so someone does not have just mania or just depression.
I agree that the jargon being similar to everyday words is problematic. There are very many examples. (Recovery, in England "low secure unit" (which actually have higher levels of security than most MH units) etc etc).
Polar=extreme,
So bipolar means "two extremes", and the question is how does one transition between them-- continuously varying across the gamut, or discretely jumping.
For reference: I've never had a mania or true low since working with it this way, and if I did I would immediately seek a medicated solution knowing the severity of the situation. But, I've managed to hold a full time job, excel my career more than I thought possible, and generally be quite well physically professionally and mentally without it.
The important lesson is that, if a treatment isn't working for you, then you should try something else. My first psychiatrist was extremely hostile to the idea of me switching drugs, so I concluded that all psychiatrists were useless. In retrospect he was wrong, because switching to Seroquel was a good idea for me, and I wouldn't have tried it if I didn't fire him.
I am now on Abilify and it's no worse than slugging back a coffee.
People use "psycho" to mean "violent". Psycho is close to psychotic, and you sometimes see people use psychotic to mean violent. This ignores the fact that people with psychosis are overwhelmingly not a danger to other people. The psycho there refers to psychopath, which is now rolled into the list of different personality disorders.
I think that this is harmful. When people see someone having a psychotic episode in public they'll call the police. If they saw someone having a cardiac arrest or epileptic fit they'd call an ambulance. The police are probably not trained to deal with people who have a mental illness, which results in some police shootings of people with mental illness. (About half the people shot and killed by police each year are people with a mental illness. Since we know that violence is not more prevalent in people with a diagnosis this demonstrates huge over-representation).
I had a bad reaction to it ("zombification," as we call it), but it has clearly helped so many.
Over my lifetime, depression has become something you can talk about without too much stigma (though perhaps not completely), but these other illnesses have a long way to go. "My boss is bipolar." "The weather is bipolar." OCD is similarly treated like a big joke, and not the devastating illness it can be.
I wish I could explain to people what it's like to be bipolar. The biggest problem you have is that the feelings of hopelessness, exhaustion, and despair seem to you to be caused by a lack of hope, laziness, and the fact that everything is dark. The feelings of elation, invincibility, the thought that you've "figured it all out, and all the energy just mean that things are going really well -- maybe that you're not bipolar at all! And if you're experiencing "negative mania" (angry, irritable, etc.), well, then it's whatever in front of you that's causing that, not your brain.
And this is coming from someone who knows they have this illness. You just can't see it while you're having it. It's only when it's over that you finally see how screwed up you were, and for many people, there are jobs, relationships, and finances left in ruins for you to sort through.
What's worst of all is that even the people closest to you can have a lot of trouble understanding it. Why can't you just snap out of it? Get out of bed? Why can't you see that that project is, um, a little nuts? But we just can't.
And then even when the medication works, we live in constant fear that it's going to come around again. A lot of us are deeply traumatized by manic episodes (it only takes one). It's like we're watching and waiting for it to happen again. "I feel fine now (or do I)?"
The end of that article really gets to the heart of that last bit. Totally heartbreaking.
So about eight months ago I started taking a low dosage of lithium, in the form of drops added to my drinking water, in a dosage that amounts to about 2-3mg per day - similar to the amounts in naturally occurring high-lithium drinking water. (In comparison, therapeutic doses are several 100 mgs per day).
Anecdotally, it might just be placebo effect, but I do feel it has had some effect. I have always been a bit anxious, particularly socially, and I feel that has diminished over this period. However, this experiment coincides with a better exercise regimen, and also simply growing older, so it's difficult to 100% attribute the effect (if any) to the added lithium. It would be very interesting to see more studies on this.
If anyone's interested you can buy these drops as 'trace mineral drops' from the Great Salt Lake.
http://psycheducation.org/treatment/bipolar-disorder-light-a...
He was alarmed at my combination of high creatinine levels, damaged kidneys and heart-attack-level blood pressure (185/130). At Mount Sinai Hospital, my doctor’s fears were confirmed in a matter of days: My kidneys were irreparably damaged, an ‘‘uncommon but not rare’’ side effect of long-term lithium use.
And let's be clear about this: you have claimed lithium "will destroy the kidneys, eventually leading to death". This is the claim you made, not some other unrelated claim, and it is wildly implausible.
A plausible but completely unrelated claim is, as reported in this paper: "lithium can be safely prescribed over a protracted period of time, even in elderly populations, but should be monitored closely under specialist supervision, to ensure early identification and management of adverse effects."
This proposition offers no support whatsoever to the claim that lithium "will destroy the kidneys, eventually leading to death". It is not evidence for it, it is contradictory to it.
I'm over-emphasizing this because I've too often seen people make wildly implausible claims like the one you have made and then try to claim that some totally unrelated but plausible claim like the one in this paper somehow supports their position. It does not. Your position is not in any way supported by a paper that directly contradicts it.
And if you bother to do more than cursory research you will find that yes, lithium WILL damage the kidneys, and the damage is irreversible. The only question is how bad will it get, and will you catch it before it causes failure.
Your paper just says the Dr should be on top of things to discontinue treatment before the damage gets too severe. Did you read more than the summary?
"The duration of lithium treatment was found to be positively correlated with mean serum creatinine level"
"We conclude that lithium can be safely prescribed over a protracted period of time, even in elderly populations, but should be monitored closely under specialist supervision, to ensure early identification and management of adverse effects."
So that's exactly in line with what you propose this counters.
After that qualified reassurance we read that "In recent years, large-scale epidemiological studies have convincingly shown that lithium treatment elevates the risk of chronic kidney disease and renal failure."
And further, "Other patients may be able to switch to a different mood stabilizer medication, but kidney function may continue to deteriorate even after lithium cessation. Most, but not all, evidence today recommends using a lower lithium plasma level target for long-term maintenance and thereby reducing risks of severe nephrotoxicity."
The risk of nonreversible kidney damage seems to counter your claim that "lithium can be safely prescribed over a protracted period of time". Even careful monitoring isn't sufficient since detecting these kidney problems does not guarantee they can be corrected ("may continue to deteriorate even after lithium cessation".) Thus a more accurate formulation would be "lithium can be safely prescribed over a protracted period of time... as long as you're lucky enough not to incur this dangerous side effect." Or possibly, "lithium can be safely prescribed over a protracted period of time when it is administered in low doses."
In people with pathological bi-polar disorder, it may be the case that rather than some sort of novel problem, it's just that the amplitude and the frequency can be much larger and higher, where "creativity" and "energy" shoot beyond the realms where either of those words quite properly applies anymore.
But in the end, we don't really know enough about the brain to be sure about this. A proper, correct model of the brain might be able to prove this by showing the drivers of such a long-term oscillation, but we're a long ways away from the requisite level of detail. Even with the suggestive studies it can only be called an interesting theory.
I am guessing lots of people have cycles. I feel I do to some extent, especially when it comes to creativity and insightfulness. Those cycles might actually be a good thing as long as they don't swing wildly.
I was thinking it would be nice to pin the needle slightly on the creative/active side of the equation but it seems lithium doesn't do that. Getting sun and being active probably makes more sense. Time to put the computer away and spend the rest of my day bike riding :-)
Anyway, the combination of lamotrigine, modafinil and caffeine works well for me. Lamotrigine (an antiepileptic like divalproex aka Depakote) helps to stabilize my mood. And it's easy to adjust modafinil and caffeine as needed to keep me happy and productive.
You can also buy straight up lithium tablets which contain a slightly higher dose (5mg) than the recommended dosage of the drops (2-3mg).
The NYT article referenced in the OP and in other comments references 'evidence' in the form of studies of communities with naturally occuring high-lithium drinking water (lower rates of violence in general).
https://en.wikipedia.org/wiki/7_Up
Coke, on the other hand, lost its cocaine content much earlier, in 1903.
I was pleasantly surprised.
Claiming that you don't believe in God is equally annoying as those sect guys knocking at your door. I do believe in God and I find the use of lithium in treating these illnesses a hope (with potential dead serious side effects: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456600/) but not the potential meaning of life (?! how can you compare lithium with the notion of God?!).
If lithium were a deity, it wouldn't exist.
In your opinion perhaps. In my opinion it's a perfectly good example of poor writing as well as a superiority complex.
> If lithium were a deity, it wouldn't exist.
Please.
Well, they kinda are. Theraputic doses of lithium are disturbingly near toxicity levels.
It is not hard to spin anything into a conspiracy.
Please, everyone, let's stop talking such nonsense and missense. There's a framing error at play here, at a very fundamental level, and a whole field has gone down this rabbit hole for far too long. There is no such illness called "manic depression"; there is a symptome called "hope-despair spectra dysregulation disorder". The phrase "manic-depression", like the word "harassment", is a confusing misnomer almost deliberately invoked by a langauge switcheroo, mostly by professionals who are never trained in the original humanisms from which the word originated and is imparted and imported. As with harassment, which is more clearly expressed as "exhaustion", the term "mania" is more clearly expressed as an assessed "unreasonable and/or extreme hope, leading to reckless energy or cognitive chain investments or behavioural drivers". The term "depression" is simply a prolonged despair, wherein a person is seen to be desperate for air. Psychiatrists and psychologists who speak of manic depression as something more than a persistent "hope-despair dysregulation" are usually, in my experience, blowing smoke, and owe a duty to assess whether the hope-despair complex is the result of illogic, illmotion, or both, and whether that illogic, illmotion, or both is exogenous or endogenous. The postulations in the DSM are not credible, as the Director of NIMH, the National Institute of Mental Health, asserts in pointing out that the field of psychiatry is terrible at identifying causes, and dresses up symptom complexes and symptomologies to look like mechanical medical dis-eases. There are very few diagnoses that psychiatrists can do, and calling "hope-despair spectra dysreg disorder" (or, manic depression, as the DSM calls it) a diagnosis is, in my humble opinion, a fraudulent claim. It's not a diagnosis... it's a symptosis, or [symp]tomosis.
It's also completely imprecise and inaccurate, rather like saying, "@phren0logy has a cough", rather than saying "@phrenology has a rhinovirus" .
Hope-Despair Dysregulation Disorder (HD3), from.... Manic = A state of prolonged hope Depression = A state of prolonged despair
It's only natural that We should have evolved, have had revealed, been given, and overwritten and at times, overridden environmental and social expectancies, and that those should altar the pattern of our hope and despair. The persistence of these patterns can, in the eyes of another, be seen as "abnormal" and an "unwanted deviance from socially integrated expectancy patterns". The response pattern from terrapists is to feed a salt pill to the patient as a placebo, in the place of a more obvious sugar pill, so that the patient returns regularly for talk therapy sessions or has a few weeks to stabilize their native sense of the statistics of life, wearing out their own misweighting of cued and observed probabilities. But... this same effect would happen if they were to be fed NaCO3, or NaCl. Lithium, i posit, has no effect other than as an off-grid placebo pill to give terrapists time to try to figure out the root cause and failure modes in cognition. i do not believe the statistical effects of natural experiments yet; i have not come across a convincing study yet, and it's my belief that study non-publication bias for disconfirmations on lithium's environmental effects will explain the rest.
As for what to do with people who are thinking about survival rather than thriving, and considering survival failure, tell them they are on the hope-despair dysregulation spectra, and ask them to consider how many years left they have until they reach 100 years old, and set that as their new age. 22? Your real age is not Your chronological age (cage) of 22; it is Your survivor age (sage) of 78. Reinforce it by teaching them the Periodic Element that their Steam Age corresponds to, in this case, Platinum, or Pt, and ask them to go for physical therapy by going out for a long run with a friend, or, if they have legal woes instead of psychiatric woes, arrange for them to speak with whoever it is that is the cause of their woes in a safe space, rather than aggravating or papering over the lack of ethical calmunity care.
Lastly, read Seligman's Flourish with them, and other works of positive, social, and cognitive bias psychology. The attempt to use diagnostic langauge in a root-cause-agnostic is fraudulent; please stop doing it. It causes far more damage than psychiatrists and other psycholory specialists take responsibility for, particularly as families, calmunities, and institutions abuse the indeterminacy, soft, nearly unfalsifiable nature of psychiatric labels as a means of social control for those they consider inconvenient gadflies suffering from too much institutionally-wrought despair.
Also, the DSM Criteria are foolish to apply against certain classes of the population. For instance, with hope-despair dysreg, one of the symptoms is written up as "Flights of Ideas", with some modifiers. Intellectuals and designers cultivate the capacity to undergo "flights of ideas". That's what these people do. Why would You count that as a bullet point toward psycholore.ical sympagnostics, when it is part of their professional duties? That just weakens the whole meaning of the sympagnostic for that whole sector of the population.
Those are my 2 calming sense on the problem. PERMA, Exercise, Resiliency Training, Socialization, Uninterrupted Purpose, Daily Progress all add up to an end to depression; talking to a blank face of a false friend with no power to convene the social world to determine and test the reality described may help tune, slow, or stop survival fail, but only for a time. Inverted ages (Pb-Ar) and Fundamental, sustained purpose mixed with calming human life stage activities will stabilize most, on a complete review of their ethics, i.e. their character. Lastly, if there's loneliness or a reflective solitude involved, You'll want to review and perhaps fix that as well, as the case requires.
Best wishes, everyone. Let me know if You're ever in need of a call to point out how many Years You'd be sacrificing should You go "Canary" prematurely. Reach out to me; i can help you Flag Sentinal instead of losing Your life to self-organized survival fails.
Since then Ive taken valproate which works well and so far I tolerate well. However there is significant risk to my liver. I take regular blood tests to watch for that.
Lately Ive been feeling physically ill, as if I have been poisoned. I dont know the cause but will request a liver function test this week.
Still, an good read.
In short: Chile, Bolivia, China, United States.
Please, everyone, let's stop talking such nonsense and missense. There's a framing error at play here, at a very fundamental level, and a whole field has gone down this rabbit hole for far too long. There is no such illness called "manic depression"; there is a symptome called "hope-despair spectra dysregulation disorder". The phrase "manic-depression", like the word "harassment", is a confusing misnomer almost deliberately invoked by a langauge switcheroo, mostly by professionals who are never trained in the original humanisms from which the word originated and is imparted and imported. As with harassment, which is more clearly expressed as "exhaustion", the term "mania" is more clearly expressed as an assessed "unreasonable and/or extreme hope, leading to reckless energy or cognitive chain investments or behavioural drivers". The term "depression" is simply a prolonged despair, wherein a person is seen to be desperate for air. Psychiatrists and psychologists who speak of manic depression as something more than a persistent "hope-despair dysregulation" are usually, in my experience, blowing smoke, and owe a duty to assess whether the hope-despair complex is the result of illogic, illmotion, or both, and whether that illogic, illmotion, or both is exogenous or endogenous. The postulations in the DSM are not credible, as the Director of NIMH, the National Institute of Mental Health, asserts in pointing out that the field of psychiatry is terrible at identifying causes, and dresses up symptom complexes and symptomologies to look like mechanical medical dis-eases. There are very few diagnoses that psychiatrists can do, and calling "hope-despair spectra dysreg disorder" (or, manic depression, as the DSM calls it) a diagnosis is, in my humble opinion, a fraudulent claim. It's not a diagnosis... it's a symptosis, or [symp]tomosis.
It's also completely imprecise and inaccurate, rather like saying, "@phren0logy has a cough", rather than saying "@phrenology has a rhinovirus" .
Hope-Despair Dysregulation Disorder (HD3), from.... Manic = A state of prolonged hope Depression = A state of prolonged despair
It's only natural that We should have evolved, have had revealed, been given, and overwritten and at times, overridden environmental and social expectancies, and that those should altar the pattern of our hope and despair. The persistence of these patterns can, in the eyes of another, be seen as "abnormal" and an "unwanted deviance from socially integrated expectancy patterns". The response pattern from terrapists is to feed a salt pill to the patient as a placebo, in the place of a more obvious sugar pill, so that the patient returns regularly for talk therapy sessions or has a few weeks to stabilize their native sense of the statistics of life, wearing out their own misweighting of cued and observed probabilities. But... this same effect would happen if they were to be fed NaCO3, or NaCl. Lithium, i posit, has no effect other than as an off-grid placebo pill to give terrapists time to try to figure out the root cause and failure modes in cognition. i do not believe the statistical effects of natural experiments yet; i have not come across a convincing study yet, and it's my belief that study non-publication bias for disconfirmations on lithium's environmental effects will explain the rest.
As for what to do with people who are thinking about survival rather than thriving, and considering survival failure, tell them they are on the hope-despair dysregulation spectra, and ask them to consider how many years left they have until they reach 100 years old, and set that as their new age. 22? Your real age is not Your chronological age (cage) of 22; it is Your survivor age (sage) of 78. Reinforce it by teaching them the Periodic Element that their Steam Age corresponds to, in this case, Platinum, or Pt, and ask them to go for physical therapy by going out for a long run with a friend, or, if they have legal woes instead of psychiatric woes, arrange for them to speak with whoever it is that is the cause of their woes in a safe space, rather than aggravating or papering over the lack of ethical calmunity care.
Lastly, read Seligman's Flourish with them, and other works of positive, social, and cognitive bias psychology. The attempt to use diagnostic langauge in a root-cause-agnostic is fraudulent; please stop doing it. It causes far more damage than psychiatrists and other psycholory specialists take responsibility for, particularly as families, calmunities, and institutions abuse the indeterminacy, soft, nearly unfalsifiable nature of psychiatric labels as a means of social control for those they consider inconvenient gadflies suffering from too much institutionally-wrought despair.
Also, the DSM Criteria are foolish to apply against certain classes of the population. For instance, with hope-despair dysreg, one of the symptoms is written up as "Flights of Ideas", with some modifiers. Intellectuals and designers cultivate the capacity to undergo "flights of ideas". That's what these people do. Why would You count that as a bullet point toward psycholore.ical sympagnostics, when it is part of their professional duties? That just weakens the whole meaning of the sympagnostic for that whole sector of the population.
Those are my 2 calming sense on the problem. PERMA, Exercise, Resiliency Training, Socialization, Uninterrupted Purpose, Daily Progress all add up to an end to depression; talking to a blank face of a false friend with no power to convene the social world to determine and test the reality described may help tune, slow, or stop survival fail, but only for a time. Inverted ages (Pb-Ar) and Fundamental, sustained purpose mixed with calming human life stage activities will stabilize most, on a complete review of their ethics, i.e. their character. Lastly, if there's loneliness or a reflective solitude involved, You'll want to review and perhaps fix that as well, as the case requires.
Best wishes, everyone. Let me know if You're ever in need of a call to point out how many Years You'd be sacrificing should You go "Canary" prematurely. Reach out to me; i can help you Flag Sentinal instead of losing Your life to self-organized survival fails.
Sent without much editing.