This is psychiatry. Psychiatry certainly respects its sister field but takes an independent look at the brain. We could always go back to the wild wild west with no psychologists or psychiatrists.
I mean, does depression even exist, or is it a psychiatric scam?
Oh, depression definitely exists. It tends to be over-simplified and is too stigmatized, but it most definitely exists. Keep in mind that "depression" is a very general spectrum disorder with many different forms. Saying someone has depression is a bit like saying "they're sick"; but they could have the common cold, flu, COVID-19, ect.
It's worth noting that there are people out there with what I'll call "inexplicable depression". In other words, everything could be going right for them. You could look at their life and find no flaws. Loving parents, deep, rich friendships, good profession, success, loving relationship with a partner, and comfortable financial situation. They seem to have it all, but just want to die.
More often there's at least some trauma and adverse experiences. On the flip side, you can find people whose lives have been and continue to be just awful; yet they're fine (or at least no depression). It's not always predictable whether someone will have problems, just like how some smokers never get cancer.
There's a scale of severity and even some people with it can't relate to everyone who has it. Someone who grew up in squalor and abuse isn't going to relate to a wealthy person with body image issues.
I've had some amount of depression myself, but I've still been unable to relate to my friends. For example, one that flunked out of college, because he wouldn't get out of bed. I've felt bad, but never to the point of letting my life completely wither away. I guess the guy just couldn't do it. He was abused growing up, experienced some relationship problems, and starting having severe issues. I have absolutely zero doubt that the person was sick. Healthy people aren't bedridden.
Posts like this concern me. You don't have to accept everything psychiatry as a field says. You can be skeptical. However, there's too much backlash to the slightest amount of acceptance and de-stigmatization of depression. Yes, it exists, you really don't want to get it, and it's a serious problem we need to keep addressing.
Maybe this just isn't a problem like doctors make it out to be. Maybe life isn't worth living. It seems like if you try to take up this position, you get shouted out of the room because no one wants to accept the fact that life is utterly meaningless and futile for a subset of people, and it's not a condition -- it's just an objective analysis of the situation.
Slaving away for 60 years and having to spend the vast majority of your healthy, waking hours making someone else rich isn't rewarding. It's pointless.
The good things in life -- family, friends, hobbies -- are sidelined and you're only allowed to focus on them 2/7 days of the week. Yeah, life really doesn't seem like it's worth living.
And that, my friend, is exactly how this mental sickness is diagnosed as a sickness: because for the majority of human beings, life is worth in and for itself, despite its suffering, nonsense and stupidity.
A healthy person wants to live. Not wanting to is one of the ways of "being ill".
And I am not shouting you out of the room: at all. Being objective requires acknowledging that most people want to go on living despite the difficulties. The inability of understanding that outlook is exactly why depression is defined as a sickness.
And being depressed has nothing to do with "slaving it" and "sidelining the good things". It has to do with BEING INFINITELY TIRED and UNABLE to COPE with ANYTHING (even those "good things" feel bad, unworthy and unappealing when you are depressed).
> because for the majority of human beings, life is worth in and for itself
Do we really know this is true? What percentage of people are just going through the motions because they don't want to cause pain to their family/friends, and what percentage of people actually just don't see the point? If suicide was culturally acceptable, or even normal, how many people would participate? Can you say with certainty that number is less than 10%? Because if 1/10 people don't see the point in living, then it doesn't sound like a disease to me.
We live in a culture that promotes "positivity" and despises "negativity," so naturally we classify the lack of will to live as a disease, but I'm not so sure that it's that far outside of the norm.
> It has to do with BEING INFINITELY TIRED and UNABLE to COPE with ANYTHING
I'm no expert, but I'd imagine at some point you just get sick of putting on the act that stocking shelves at Walmart for 60 years is your life's true calling, or that writing code to track people around the internet to sell them more useless shit is really a valuable use of your life.
Eventually you realize you're going to spend more of your life doing pointless shit than actually doing the stuff you enjoy, and that there's no escape from the system, that you're just a nameless, faceless cog in the machine, and that you actually have no real agency. So the only difference between being depressed and being healthy is how much energy you have to put up with that bullshit.
Treating depression as a disease, and not as a rational reaction to the world we live in really feels like it serves only to benefit rich corporations, VCs, private equity, etc. because if the cogs stop turning, they stop making money. Then they would have to work a dayjob, and they would understand why depression is totally fucking normal.
I have known some very intelligent homeless people who have made the same argument as you. Abandoning social expectations was their attempt at a solution. I think it mostly worked for those who dedicated their lives to chess, reading, casual volunteerism. It did not work out for those who took to drugs.
Something should be done, but trying to fix it on an individual level won't work -- you have to fix the way the system operates so agency isn't something that's reserved for a small subset of the wealthiest individuals in society. UBI would go a long way towards this, I think.
I just want to be in charge of my own life, but as long as I have to show up at the same place from 9-5, five days a week, I really don't have that ability. My life exists solely to serve my masters. Yes, I can choose which master to serve, but ultimately I am not free to do with my life what I please.
We have no agency against death, nor ability to ignore the survival needs of the body. We have little agency against many forms of suffering intrinsic to being human.
The economic requirements you mention seem small, to me, compared to the larger tragedies of life, the real limitations to our agency.
If the time sucking effect of economic needs are your primary focus, you are lucky not to be born in a prior era. I've worked minimum wage, rented the smallest room I could find, counted every penny when buying my needs. The agency granting economic power I had was objectively superior to most humans throughout history.
What have we done with this power? For the most part, we trade it for safety, comfort, security, not freedom. We trade it for entertainment, sometimes addiction. We give up our agency for more. Which is fine, my point is that the problem is not economic power, the problem is what we, both individually and collectively, choose to do with it.
You say we have the more agency than the people who preceded us, but you fail to realize the only reason that is the case is because those people reached out and took it for us. You're a bit of a hypocrite if you lavish in benefit from their actions, but fail to pick up their torch.
> We have no agency against death, nor ability to ignore the survival needs of the body.
When death becomes escapable, I can guarantee you that the escape won't be affordable for us. There are 2,000 billionaires on this planet, and every single one of them will have access to it decades before you or I can dream of it.
Their achievements don't warrant the power or privileges they enjoy as a result of their wealth, and everyone deserves a shot at that kind of success. If the game is rigged from the beginning, the winners get to run the world, and they want you to work 48+ weeks every healthy year of your life for them, what's the point of playing?
I'm not even asking for their power or wealth, I'm just asking for the same ability to pursue my own ideas with my time instead of being forced to trade my time for money through employment. We live in an era where the vast majority of "essential" jobs are beginning to be automated, and this is achievable within our lifetimes.
> What have we done with this power? For the most part, we trade it for safety, comfort, security, not freedom.
This wasn't ever our choice. As long as fields need to be plowed, and factory lines staffed, you weren't allowed freedom. The people who are in charge want you to work, so they can be rich, so they made sure you had to do something for them in order to feed yourself. Now? With automation the need for human laborers is dropping, so we can feed and house ourselves with less effort than ever before. Let's use this to free everyone from the shackles of wage-labor, and allow them to pursue their own desires with their lives, like the billionaires get to do.
> A healthy person wants to live. Not wanting to is one of the ways of "being ill".
This is the medical model of disability fallacy: someone can't function in society so there must be something wrong with them that we should try to fix--but society itself is just the same neutral backdrop for everyone. The alternative is to acknowledge that society/environment plays a big role in mental health and that because society isn't primarily structured to keep people healthy, some people will expectedly have poor mental health.
Does diabetes even exist? At some point these labels are more a matter of semantics than clear binary clinical determinations. For example, the current guideline is to diagnose a patient as diabetic if their uncontrolled hemoglobin A1c is over 6.5%. But the reality is that it's a spectrum with no clear dividing lines, significant fluctuations from day to day, individual genetic variations, etc.
Likewise depression is just a convenient label for a bundle of loosely correlated symptoms. Some patients are clearly having a rough time and need treatment. Because it's impractical to deal with subtle differences between patients at scale, psychiatrists have defined some subjective criteria to decide who should be treated as depressed.
The issue is that there is a measurement problem with many depression symptoms. You can have multiple people independently measure the blood glucose level of a patient and get the same result. And this result compares with other patients. With depression, you almost always have to rely on self-reporting or subjective evaluation by a health professional. One person saying they are depression might mean a whole lot more than another person saying it. It's not that you can't make measurements that are useful, its just that the error bars are so much larger.
> For example, the current guideline is to diagnose a patient as diabetic if their uncontrolled hemoglobin A1c is over 6.5%.
Several other objective tests can be used to diagnose diabetes. The disease could present with characteristic symptoms which match diabetes. The presence of comorbidities such as obesity also help with diagnosis.
> But the reality is that it's a spectrum with no clear dividing lines, significant fluctuations from day to day, individual genetic variations, etc.
This spectrum is called pre-diabetes. At some point, the risk becomes unacceptably high for the patient and treatment is indicated. This point has been determined through research.
Yes, blood glucose does vary during the day depending on the person's metabolic state. This variability is well understood. Normal and abnormal is well-defined. Fasting blood glucose > 126 mg/dl is evidence of diabetes mellitus. Blood glucose 2 hours after ingesting 75 g of glucose > 200 mg/dl is evidence of diabetes mellitus.
I'm aware of those clinical issues but I didn't want to obfuscate my original comment with a lot of irrelevant details. The point is that the decision about whether a particular disease is "real" or not is at some level a matter of semantics and arbitrary definitions. It's real because we all agree that it's real, and it seems to have some negative impact on the patient's life. And that's only partially correlated with what's actually going on inside the patient's body and mind. Quantitative blood tests are somewhat more reliable and consistent than subjective reports of psychological symptoms, but nothing is 100%. What level of certainty do we expect?
Depression exists. It is the most thoroughly researched psychiatric disorder. If left untreated, depression can lead to physical changes in the brain. It has enormous impact on the individual and society.
> DALYs represent the total number of years lost to illness, disability, or premature death within a given population.
> DALYs are calculated by adding the number of years of life lost to the number of years lived with disability (YLDs) for a certain disease or disorder.
There's a very interesting post Slate Star Codex about internal perception of wellbeing vs external behavior. TL;DR: there is a paper about people who claim to have experienced enlightenment, but often there's no changes in their behavior (that people around them, e.g. their friends and relatives, would notice). Scott warns against dismissing these experiences as "fake", arguing that we similarly don't dismiss claims of depression in people who are still "functional" and living their lives as usual.
The pathophysiology of depression is not fully understood. It is possible that what we understand as depression today could become several distinct diseases in the future.
In any case, the impact of depression is known and it can't be ignored. Doctors must at least try to help depressed patients. There are models which guide pharmacological and behavorial treatments employed in current practice. They are proven to be superior to placebo.
That's my point. You haven't even come up with a basic taxonomy of depression and you're already applying your theory. In physics this would be blasphemous.
> Doctors must at least try to help depressed patients.
All the help I've received has been useless or actively harmful. No one even told me to exercise or diet, in fact, some suggested I take it easy, stop blaming myself.
That was all wrong. I was to blame. Every morning, by blaming myself, I made better choices w.r.t health. Now I am no longer to blame, I have no depression.
I used to be arthritic and asthmatic, now I am biking for hours straight, doing pull-ups every day.
> You haven't even come up with a basic taxonomy of depression and you're already applying your theory.
We have no choice but to apply these theories. The alternative would be to do nothing until they are perfected. That would be negligence.
Antidepressants do not have a 100% success rate. Nothing in medicine has. That doesn't mean they shouldn't be used.
> In physics this would be blasphemous.
Not really. Plenty of theories ended up being revised when humanity's understanding of the world improved. They still had real world applications: even though they were imperfect, they were good enough for a wide variety of uses.
We don't fully understand depression. We don't even fully understand how some medications work. However, we have studies showing that by taking these medications patients improve and mortality decreases. That's enough to justify their use.
> Not really. Plenty of theories ended up being revised when humanity's understanding of the world improved. They still had real world applications: even though they were imperfect, they were good enough for a wide variety of uses.
Those imperfect theories are applied today, and still work in lots of contexts. They are complete, but subsets. We can make predictions, given certain initial conditions, with accuracy as close to 100% as you require, the only issue is measurement. Comparing psychology to physics in this manner is pretty embarrassing, and shows a lack of understanding of physics.
Applying imperfect physical theories causes bombs to explode where they shouldn't, nuclear plants to react when they shouldn't. We don't build fusion reactors today because we still need to determine the safety of isolating the plasma.
> We have no choice but to apply these theories. The alternative would be to do nothing until they are perfected. That would be negligence. Antidepressants do not have a 100% success rate. Nothing in medicine has. That doesn't mean they shouldn't be used.
I didn't say they needed to have a 100% success rate. You just need to find the mechanism. I'd be happy with a 0.1% success rate if our determination of the mechanism implies that there is no cure once it reaches that stage.
Let's do a study--I think drinking alcohol has cured my depression. It doesn't have a 100% success rate, but it would be negligent to tell people that they shouldn't get plastered if they're depressed.
edit: Don't drink alcohol to cure your depression. I suspect the mechanism is related to the gut flora. Alcohol kills the gut flora.
> Applying imperfect physical theories causes bombs to explode where they shouldn't, nuclear plants to react when they shouldn't. We don't build fusion reactors today because we still need to determine the safety of isolating the plasma.
Failures in nuclear reactors can have disastrous outcomes for a huge number of people. Is this comparable to the use of prescription drugs under medical supervision? A failure in these cases means the patient may experience adverse effects for no benefit, a risk inherent in any treatment.
> You just need to find the mechanism.
People are working on it. Meanwhile, we have make the best of what we know right now.
> Let's do a study--I think drinking alcohol has cured my depression. It doesn't have a 100% success rate, but it would be negligent to tell people that they shouldn't get plastered if they're depressed.
Again my point, obviously I don't believe this to be true, but since it does have a positive success rate (there's no study which quantifies this, strangely enough, your studies are purely epidemiological, you'd have to take someone without ASD and then prescribe them ethanol at about 20% to actually study this) it would be negligent, as per your theory/ethics, to not prescribe this, and in fact it was prescribed in the past during prohibition [1]. Now, looking back this is obviously false.
> People are working on it. Meanwhile, we have make the best of what we know right now.
Great! The best of what we know right now is simply diet & exercise, no pill can prevent the onset of depression.
I think you'll find the taxonomy of depression to be a subset of existing disease categories. The brain, gut, and nervous system are connected in a chaotic manner.
PS. I don't drink at all, zero alcohol. I agree that it's probably very much related to all existing depression categories, correlated positively.
> The best of what we know right now is simply diet & exercise, no pill can prevent the onset of depression.
Absolutely. Healthy life style decreases the risk of depression and can help depressed patients. It's standard advice.
Prevention and treatment are different though. A patient who is already severely depressed and anhedonic and struggling to leave the bed is unlikely to suddenly start dieting an exercising. It makes sense to try and improve the symptoms prior to trying this.
There are different, but they are not mutually exclusive.
> A patient who is already severely depressed and anhedonic and struggling to leave the bed is unlikely to suddenly start dieting an exercising.
I had the same symptoms, I found that exercising and dieting was the only thing that gave me pleasure (other than alcohol or cannabis). During the thick of it I would do pull-ups by walking to the bar, knocking some out (if I had a RA flare-up then I would do planks), and then collapsing after my heart-rate went back down. The issue was that people kept telling me to keep eating carbohydrate, which was causing lots of inflammation (I had tons of visceral fat). I also found that direct sun exposure improved my symptoms a ton (I was talking a D3 supplement prior).
Maybe if we told people "We have no idea how to cure this--the only proven method is diet & exercise, and this often lead to an early death if you don't start now" it would work? Once I realized that myself, it was a huge kick in the ass. I was figuratively paralyzed because no one seemed to give me this most basic advice, and the only way to get to a psychologist where I live is to self-harm.
I know a cancer survivor who was told that, and she did it, at 65, and she was obese by a large margin with severe trauma from the chemo.
I'd agree in so far as it makes pulling scams (or innocently giving useless advice) far too easy:
"I had depression, and I tried X, and it worked. You've got depression, so you should try X." Extremely unlikely to be helpful, and often can be harmful.
Hi! Lifelong experiencer of depression and several mental disorders. Am I mentally ill, or is the world really actually a horrible and callous place where most humans spend their time being negligent and abusive towards each other? At very best, psychiatrists might claim to be able to open up a wider perspective, which is why they used to be called "head-shrinkers", for their ability to humble and to remove egoist barriers, but a bit of meditation will do that too. So, is psychiatry's ability to give perspective worth the pathologizing effect that it has on people?
Why isn’t it both? There are earthy cultures around the world that don’t have a concept of ownership or the strict boundaries of western life, living in different places and cultures is easier for some and you can easily make the critical case against the western world, ill or not.
The trouble with a social intervention like therapy is the fundamental attribution error in sociology. Which character is the problem and which is the solution played out in a battle of the minds in an enclosed space. The government employed brainwashing therapist seeking to downplay any eccentricity that destabilises a social norm, or the poorly functioning client who blames others for their problems.
Therapists have a habit of dumping the responsibility for generally unsolved philosophical questions about social interaction onto the client. Where is the line between internal and external social stimuli? Who do you attribute your problems to? What is the value in a diagnosis label? Answer these questions for yourself and you’ll cure many different ailments. Fail to find the answer and remain pathologized?
Therapists routinely underserve the amount of education and philosophy required to heal. The diagnostic categories are a descriptive mess that are used as tools, yet people use them as definitions far too often.
I recommend anyone interested in therapy and ideas to see Jordan peterson’s YouTube video Self-Deception in Psychopathology (from before his fame) where he gives a quick rundown of a view above the current running mill of therapy. It tackles briefly some philosophical problems with therapy.
I like how you worded that. I definitely have my moments when cynicism takes hold and I lose most desire to do anything creative or productive. I normally power through it and double down on walking and running. It’s not a 100% fix but it certainly prevents the feeling from being my overwhelming mind state. While I guess the definition fits, mental illness seems a hard word for depression. It does seem that the tide is turning and the stigma around mental health has steadily lifted with most people.
I have mixed feelings around Psychology and Psychiatry. I still feel like there are too many doctors offering pills to cure your ailments without getting to the root of the problem. But that isn’t every doctor and I have seen things like CBT improve people’s lives. Ultimately I think that some of the “cure” must come from within and you have to want to change. I think a good doctor and therapist will help someone unload and frame things in such a way as to encourage that.
Broadly, the world is indeed arguably a horrible place. Within that context, one might hope that psychiatrists can help some with their immediate suffering.
The myopic view of treating everyone with antidepressives seems to be the result of capitalism exporting lifestyle problems and solutions to those problems, solutions that can be monetised and which create new problems. But, a big but, there is a segment of population which does need to be at some point in their life on antidepressants, clinical depression is real. These people have no reason to be depressed and yet they can’t get out of bed. We have to make sure we make this distinction though. Clinical depression cannot be denied unless one is ignorant or didn’t have first hand experience themselves or or someone close.
Where exactly is the line between the two drawn. I always got the impression that Psychiatry needed a medical degree while Psychology was similar but without one.
I'm not so sure. It depends what you mean by "depression". If you mean exactly what's written in the DSM then you should be sceptical. See "Crazy like us" by Ethan Watters: a great book, only part of it about depression.
Remember that when Freud was active the main psychiatric ailment was "hysteria". Did hysteria exist? Does it still exist? To what extent is mental illness socially determined?
It's a model. There are plenty of other models for the symptoms classified under clinical depression, human suffering is not a new thing that people just started trying to solve in the last century. Depression has some stigma attached to it, and big pharma profits a lot from it. The model and its treatments do help a lot of people, but there are an equal or greater number that they don't help. As a model it's pretty meh in my opinion but it's the best thing that modern science has come up with.
Nobody is questioning or invalidating their experiences. As I understand it, the issue is partly semantic. Is our system of labeling helping or hurting our understanding of reality?
There's an entire "field of study" that seems designed to prove that through the age-old mechanism of twisting logic into absurd pretzel knots that don't hold up to scrutiny from any but the most casual observer. It's called antipsychiatry.
The concept of a major depressive disorder exists. There are common symptoms and likely causes such as childhood trauma. Can we be certain it is a unanimous mental disorder? No, it might as well be several different disorders we haven't understood yet. But isn't that similar for most mental disorders?
It is a bad analogy. We do not know even if dark matter exists as it is one of many possible explanations of a particular phenomenon. So the depression is like a galaxy rotation speed anomaly.
Fulton Sheen has spilled a significant amount of ink against psychiatry, and against many forms of psychology, because they all reject the existence of the soul. And if the soul does exist, but we make all sorts of assumptions based on the idea that it doesn't, then all our conclusions will be tainted if not completely wrong. He talked quite a bit on depression, psychosis, neurosis, anxiety, and other mental conditions.
Incidentally, the stereotype that religion is only for the ignorant and that talking about it always devolves into an emotional and irrational argument, is only true for certain emasculated forms of Christianity, but not Catholicism, where Fulton Sheen proved that (high) intelligence is in no way contrary to religious belief, but actually religious concepts are better explained by those with higher intelligence.
Anecdotally, one of the biggest reasons I bring up religion so much, especially in threads like this, is because Catholicism was the only form of psychology that actually helped me overcome my many great mental disorders, and I am confident that it will be able to help others through their lesser and fewer forms than I had. But because of the extreme prejudice that intellectual people have against religion in general and Catholicism specifically, there has been almost no public progress in this field.
"Catholic counselors" have generally in my opinion been non-Catholic in their foundational principles and have in no way been able to help me, for example. And priests, although they should especially be educated about psychology from a Catholic foundation, especially in these days where it's more prevalent than ever (Fulton Sheen expands quit a bit on the reasoning), they have not seemed to recognize the serious need for this yet and have not caught up.
So almost all of my improvements have been from independent research on and application of these things. I really wish that the intelligentsia in general and here especially would catch up, especially when I see so many people struggling in many of the same ways I did and have overcome in the past few years. That's why I try so hard on here to convince them it's actually for them. If they only read Thomas Aquinas and Fulton Sheen they might see that it's actually more of an intellectual position than agnosticism or atheism are.
But sometimes it takes a person hitting rock bottom to realize that all their enlightened philosophy is useless to help them live a truly happy and fulfilling life. Sometimes only when we have the most pressure do we consider alternatives that may be a bit unpalatable to our preferences.
I was skeptical about depression until I saw it in my son. This is a terrible condition with bad side-effects even in a mild form. And the only effective treatment is time.
I beleive it is a scam. Every single person I've met who suffered from "depression" had a troubled past, and often a troubled present.
Not saying the symptoms are mild. It's a nasty state to be in. Inability to sleep and concentrate, leading to all sort of physical issues and impossibility to learn and keep a job.
All that being said, the causes are rather clear. Hard to fix. All these pshyco active treatments are judge bandades, anything to keep the brain quiet which in my opinion often aggregates the issue. Dependence, side effects... A person is not depressed but doesn't have its full brain capacity.
It would be valuable if clinical consultants converted to social workers to help patients address the root causes instead of prescribing medications and whatnot. Thing is, it doesn't sell that well and isn't covered by your insurance. Medics and therapy sessions are.
Have met lots of people who are depressed and don't have a troubled past or present. Your descriptions of etiologies, how medications function and help, etc. are simplistic and ignorant at best. My opinion of your opinion is not high, but luckily that's not a good basis for judgment.
See, I don't like calling it a "scam" because that implies malice. Hanlon's razor may apply here. "Depression" is our modern analogue of "hysteria" in the past; a blanket term for a wide variety of poorly understood diseases.
The medical establishment's strange resistance to exploring gut flora and inflammation as a cause of these kinds of diseases, on the other hand, is something I might call a scam.
I mean, does depression even exist, or is it a psychiatric scam?