I dont know if this is true of everyone but I definitely see this in online communities. People who have access to basic health services still blame themselves for their own conditions and seek individual solutions to collective problems :/
>She told me she welcomed the diagnosis of a neurobiological disorder, which confirmed her problem was ‘real’ – brought on by a physiological force external to her volition – and that it showed she’s not ‘just a slacker’.
That is such an arbitrary distinction. As if being "just a slacker" doesn't have a number of deeper reasons behind it as well. Brains are just machines at the end of the day, every behavior is a result of something material...
Dr. K (a Psychiatrist who is also a Twitch streamer) recently touched on this subject with a very popular streamer (write-up/video linked below). He explains some of what you're saying and I tend to agree with you.
Dr. K suggests the brain is optimized for efficiency. If something is not seen by the brain as being unnecessary, then the brain is unlikely to trigger a response that motivates you to complete the task. The example used was going to the restroom - your bladder fills up and your brain tells you it's time to go. Motivation in areas of life was seen as being similar.
In the case of laziness, the bladder filling up is analogous to, let's say, shame reaching a level to where you're prompted to finally clean your room. Obviously increasing shame would be less than ideal, but there are other means for motivating yourself (e.g., purpose in service to others, duty, dharma, etc). He also draws a distinction between apathy and detachment, which are also part of the problem.
Anyways, I'm not sure I agree with everything he said/says, but it's worth checking out and an interesting perspective nonetheless!
Brains are not machines like your phone is a machine or your car is a machine. They are complex systems and the result of an emergent process rather than designed systems with discrete components.
The analogy that brains are like machines is harmful because it makes it sound like there is some operating manual and simple cause effect relationships that are known. Our knowledge of the brain is in fact very little. It's a false reassurance and reductionist view to see the brain as a machine simply because it is made of material parts that seem to act in a reliable way towards some end.
> The analogy that brains are like machines is harmful because it makes it sound like there is some operating manual and simple cause effect relationships that are known.
Why? We have complex machines and systems as well, where nobody would claim that there are only simple cause effect relationships and you only need a two-page owner's manual.
Drugs work pretty reliably. While you can't predict what exactly is going to happen when you take LSD, you can be pretty sure that something is going to happen. Why, if not because the brain reacting to some chemical?
This idea of "don't say it's a machine, you're oversimplifying it" is what's harmful in my eyes. It leads to anti-scientific positions, mysticism and fatalism. If there's nothing we can do to help, and nothing we can learn because it's so super hyper duper complex and "emergent", why bother. It's not, of course. While we don't know everything, we do know something. And we should extend our knowledge. Pretending that we can't know isn't useful.
I'm not saying we can't know or that our understanding won't improve. I'm saying right now we pretend to know more than we do. LSD has a reliable effect in the short term, just like torching a plot of land in the Amazon has a reliable effect in the short term. It's the long term effects that are subject to the rules of complex systems and not machines.
But the long term effects are observable as well, aren't they?
I understand where you're coming from, and I'm not too excited when people pipe up with things like "the brain is just like X, so you just need to eat more Y to fix your Z", but we're learning plenty of things about how the brain works, and I believe that we do so because we consider it as a complex system that is not unlike a machine. Remove its fuel, and it will stop operating shortly, cut away parts of it and you'll see functionality change or being lost.
I see no harm in reasoning about it as a very complex and very large machine with tons of inputs, outputs and modification systems. A long time ago, we'd consider the heart a mystery full of magic, and now we're regularly transplanting hearts and I believe we're "within reach" (though rather decades than months) of implanting completely artificial hearts. I see no reason why we shouldn't make progress towards a better understanding of the brain in the same way.
In my view its a simple category error, though of a subtle kind. Machines are similar to biological systems in only the most superficial ways: they are non-static systems which exceed a certain complexity and they both follow the laws of physics (see footnote).
There are a lot of ways to think about the differences between machines and people. One very simple one is that machines typically function in only a very limited subset of the space of their available degrees of freedom and small deviations are usually catastrophic. Biological systems don't usually have this property.
Another way to think about it is that machines show evidence of design, which you might characterize as a certain economy of ideas. Two clocks in a computer a much more likely to be identical or to share major conceptual underpinnings than two clocks in a biological system, for example.
I used to have your view of things and then I read Deacon's "Incomplete Nature," a book whose thesis fails to land but is never the less a comprehensive analysis of the properties of living organisms in a unified if rickety system which encompasses the basic laws of physics. It really convinced me that the analogy between brain and machine is poor.
The question of what a mind is and how it relates to the brain is not settled science or philosophy, at any rate. It doesn't do anyone any good to pretend it is.
(footnote): This is a reasonable assumption to make but its hardly widely believed by the general public nor settled scientific fact. Luminaries like Penrose still assert a fundamental disjunction between what brains do and what machines do and he isn't alone among physicists, to say nothing of the broader philosophical community or the lumpen mass of human opinion.
Another thing: to assert that biological systems are just machines is to subscribe to the same error which allows creationists or intelligent design people to put forward the argument that we ought to take the complexity of life as evidence of a designer. It conflates two totally different phenomena by observing a superficial similarity between the two and ignoring all of their manifold and salient differences.
It's just a metaphor. Because the way it works can be viewed as
inputs (sensors, environment, external chemicals) + current state ---> outputs (behavior) + new state
kinda like computers or robots, in a deterministic manner (except it is practically impossible to recreate the exact same inputs, or the exact same state). You don't have to take it too literally, people who read it generally understand what it means.
This is either very specific and thus not all that applicable to biological systems (that is, the current state is typically much much much more dominant a determinant of future time evolution in biological systems than in machines) or so general as to characterize literally any physical phenomenon whatsoever, and thus hardly useful to think about how biological systems work specifically. Indeed, one element emphasized by Deacon is that the notion of "current state" is ambiguous or at least non-trivial for biological systems and exists for machines only because they represent a major simplification of the relations characterized by your metaphor.
Machines are in some sense constituted by an enormous, intentional, simplification of the possible dynamics of a clump of matter and its relations to the outside world. Their design is profoundly impacted by both our own cognitive limitations and the contexts in which they are manufactured and used. Biological systems simply don't have these constraints and they operate in what are often totally different ways from machines.
My point is that there is considerable scientific and philosophical scholarship on this issue which casts this metaphor into doubt at least with regard to base utility.
I see. Do you think a machine that physically alters its own silicon, or software that rewrites its code instead of storing data, would be closer to biological systems? Or is that part irrelevant?
> inputs (sensors, environment, external chemicals) + current state ---> outputs (behavior) + new state
It's just not a very helpful metaphor, because we are nowhere close to having a way to simulate or compute that function.
So treating people as agents with goals, desires, personalities, experiences and histories and traumas, and drawing on our hard wired abilities for empathy, can be a far more useful model for actually helping and healing people than just giving them a pill.
> So treating people as agents with goals, desires, personalities, experiences and histories and traumas, and drawing on our hard wired abilities for empathy, can be a far more useful model for actually helping and healing people than just giving them a pill.
But that's not a dichotomy. Nobody is saying to either disregard biochemistry and believe that God gave us free will by some magical act or just throw random pills at people.
You can see people as all that and still not reject the idea that chemical imbalances can negatively influence their goals, desires and personalities, and that chemicals can also positively influence them,
> This idea of "don't say it's a machine, you're oversimplifying it" is what's harmful in my eyes.
And honestly, there's a lot of complexity to even the smallest thing. A particularly good read, "I, Pencil" goes into how nobody knows how to make even a simple pencil.
I agree, but that seems like a poor example. I could make a pencil out of coal and wood. Wouldn't be as good as a factory one, but good enough. Also, chalk and many other stones/minerals can be used.
Yes and no. The story is more about how that specific (type of) pencil was made, and no single person knows all of it. Even things that we consider simple ... really aren't.
I don't think calling it a machine is implying that we understand how it works internally (to a much greater extent than we actually do). Or even that we fully understand how it tends to behave in practice, out there in the "real world", as part of larger systems. But I guess if many people view it that way, then using slightly different language might be better.
What I was getting at is the fact that there is no fundamental difference between "I did it" and "my illness caused me to do it" (other than maybe probability).
Or in other words, no "free will", in the way that some people view that term.
I agree that there is no fundamental difference between you doing it and your illness causing it. A person can identify with the results of a machine or a complex system.
My issue with the word machine is that in most people's minds that brings up ideas of cross sections, gears, cogs, repairs and so on. People aught to be thinking of a complex system instead like perhaps the ecosystem in the Amazon rainforest.
If a space probe discovered some vast alien structure clearly acting fulfilling some strange purpose by some opaque means... would we not usefully describe it as a machine?
Realistically, if it looked like a bacteria or an animal we would call it life, and it if looked like a printer or a lathe we would call it a machine. That's a more realistic picture of how language works, than expecting everyone to be a philosopher about categories.
I think that statement "ultimately a machine" is hinged upon a philosophical view that existence is simply the result of various material interactions, chemistry, physics and what have you that is pretty common in our culture but also originates from the view of a clockwork universe with divine creator. Nowadays the idea of a creator is often omitted and people suggest that its just everything is just caused by the consequences of the big bang or what have you. I have been suspicious of this kind of reductionist view but also found that a lot of alternatives fly way too quickly into nonsensical dogma without acknowledging that they are just making up something to feel better. The "truth" I like to embrace is kind a panpsychic panspermia pantheism that recognizes that we as humans with limited perception and knowledge are probably part of much larger processes and there are emergent entities created in part through our minds/bodies. These entities can be us as individual humans or something like a family, church, company or government composed of many individuals but acting in concert as a larger entity.
I'm not denying the creationist idea, either (life seeded by some entities sounds plausible to me; just not the almighty bearded guy in the sky, sounds very dumbed-down). And I think consciousness is more of a virtual machine. Could be compared to a "natural AI" of sorts - that arose on top of our primitive animal selves. But that's just my daydream theories. Groups of people can indeed behave as different/new entities.
It's just that the physical composition of our bodies are knwon down to the protons (and even deeper). How they all work is a different question, but there is a specific way they work. Just have to figure it out.
When I say machine, I mean it as "construct" of any kind, not just electromechanical. Imo, it would be really nice if we could grow and reattach whole body parts, or grow bodies for transplant, but obviously those ideas bring a lot of negative connotations and ethical problems, so we're investing in electromechanical alternatives instead.
I think there is some admin access. The problem is it probably isn't a good idea to sudo | grep | awk > overwrite_file.model very often. Brains might just be a jumble of extremely efficient and over-fitted regression models and neural nets with a really shitty training dataset.
Consequentialists often point out that whether things like laziness are moral failings or are physiological problems with no moral bearing, it still makes sense to treat them as a moral failing, because it’s usually more likely to result in incentives and social pressures that lead to the moral failing/physiological problem being fixed, mitigated, or worked around.
There was an SSC article that had some good discussion on this at some point, but thanks to NYT I can no longer link it.
>it still makes sense to treat them as a moral failing, because it’s usually more likely to result in incentives and social pressures that lead to the moral failing/physiological problem being fixed, mitigated, or worked around
When compared to doing nothing and tolerating them, I can definitely see that. But I still think there have to be more effective approaches than either (even if we don't know what some of them are yet).
You might be able to go through archive.is which contains a large part of SSC. I find the argument weird because we tend not to handle moral failings very constructively.
> to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language
This is a pretty big assertion that the piece casually drops without backing. The reasoning as to why "chemical imbalance" is a bad descriptor is apparent* from the study [0] the author cites, but there is nothing that backs up this statement, which seems to be the crux of the whole piece.
*Even the study cited about placebo affects on depression doesn't _really_ prove the author's point that "chemical imbalance" is a bad term, it just proves that we do not yet understand the processes by which drugs treat depression. If we do not understand the processes, how can the author make the assertion that the characterization they are against is wrong? At most, they could claim "we don't know yet" but certainly not that "chemical imbalance" is categorically false.
In fact, isn't the point that the 'ideation' of mental illness as a chemical process seems to further the process somewhat, and therefore some degree of refactoring needs to be done of the language used so that we 'un-know' the details well enough to treat it subjectively?
>This is a pretty big assertion that the piece casually drops without backing
My understanding was that the results of the author's interviews were the backing for this assertion:
>As the interviews made clear, people adopted the biogenetic account because they thought it was based in science. The interviews also show how this account undermines the kinds of introspection and self-examination that can lead to meaningful self-knowledge.
>Mental health treatment needs to re-engage with the language of persons. This means suspending the detached, third-person stance toward patients, and attending to their actual experience and circumstances. And it means encouraging patients themselves to avoid this stance and draw on the normal ways that people make sense of their emotions and actions.
Or do you mean that the conclusion the author reaches, that we should be attending to people's experiences instead of using "biogenetic causal language," isn't justified by the results of the interviews?
I'd like to pull the full quote, which is more nuanced:
>As I argue in my book Chemically Imbalanced (2020), to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language. Psychiatric research doesn’t support the notion of simple cause and effect in mental health, instead uncovering a far more complex and indeterminate picture of vulnerabilities. There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’. Nor does the beneficial use of psychiatric medicines require it. In fact, their precise mechanism of action and relation to troublesome experience remains a mystery. It would be more truthful for mental health professionals and public health campaigns to acknowledge this.
It's helpful to note the flipped the burden of proof here: the author argues there is no evidence for "chemical imbalance" language, not that there is evidence against "chemical imbalance" language. I see it as an admission of uncertainty rather than claim of knowledge; the use of the somewhat tepid phrases "need to move away from", and "complex and indeterminate picture" are a further sign the statements are not categorical.
Though I could have misunderstood their thesis. I'll find out once I've read the book, I suppose. :-)
'Chemical imbalance' as a causal explanation seems to me almost useless because every severe change in behaviour pretty much by definition corresponds to change in the brain. How else is it supposed to be manifest? Is there supposed to be drastic change in psychology without change in the brain?
There can be a company pouring lead into a river, psychological hazard during a civil war, and it will always manifest in the brain, what kind of explanation is this? Of course these things can be found in the brain, it would be crazy if they didn't.
That's not to say there's no diseases that are actual individual pathologies of the brain of course, but to use 'chemical imbalance' as a sort of first order response to what may have actual social or environmental reasons say, is entirely circular reasoning.
>I think a bigger problem is that people are fixated on word definitions and offending others instead of solving problems.
I agree, and this is pretty much unavoidable when the current clinical term is vague enough to be used as a generic insult.
The general pattern I see
1. A vague term is used to describe symptoms of an issue we have a poor understanding of.
2. That term becomes associated with the symptoms, but is vague enough to be used as a generic insult (ex: playground school children yelling it at each other)
3. That term develops a stigma as an insult, and becomes more and more controversial
4. That term is replaced with a new term, rinse and repeat.
We've seen this before
ex: Moron, Imbecile, and Retard all once had vague clinical meanings.
Then we went to mentally challenged, special needs, etc. Now even those are fairly loaded terms.
In all of these cases, the word/phrase describes something that people would rather not have or be, but it does it without clarity.
It will develop a stigma.
I find the folks who constantly advocate for changing these names well-intentioned, but basically a waste of time.
I would say this cycle happens regardless of how vague the term is.
Terms like Black, Dwarf, Gay, etc... were all, at some point, considered insults despite being specific. (note: I'm not saying these are illnesses - just that the same phenomena exists - there are probably much better examples of what I'm trying to say).
How is "distress" not the correct term? It is defined as extreme anxiety, sorrow, or pain which can be caused by any of the factors you described as well as many more you are not even aware of. It is an emotional state that is perceived on the part of the person suffering rather than observers outside of them regardless of the actual physical realities involved.
The term "chemical imbalance" can describe anything from acid reflux to genetic neurological pathologies or even snake bites and can certainly put people "in distress".
The problem is people aren't interested in using correct definitions for anything anymore.
> How else is it supposed to be manifest? Is there supposed to be drastic change in psychology without change in the brain?
There is an implication inherent to "chemical imbalance" that assumes a normative range. Modern medicine is universally based on normative ranges. If you are outside this range, it is considered a problem. Chemical imbalance is a generic and apt descriptor.
It might be a descriptor of a state but it does not explain the cause. The argument here is against the notion that depression is caused by chemical imbalance.
I don't think it is though. For example, one of the things we know is that IBS can cause depression/anxiety (or perhaps more accurately, people with IBS are more likely to have depression/anxiety).
In this case chemical imbalance would be objectively wrong. Their brain is being affected by another part of the body entirely, but you would have doctors selectively treating the symptoms (the 'chemical imbalance') rather than the cause.
> In this case chemical imbalance would be objectively wrong.
I disagree. Chemical imbalance is not necessarily a solitary cause, it's describing a condition regardless. shrug
> you would have doctors selectively treating the symptoms (the 'chemical imbalance') rather than the cause
Typically they treat both or in most cases, the easier problem with less severe treatment consequences (classic House MD - live in constant pain from muscle death vs lose a limb).
There are normative ranges but being outside of such a range alone is usually not enough for a diagnosis. Especially in the arena of mental illness, "abnormal" behavior must also present as interfering with life to earn someone a diagnosis as nearly everyone has some "abnormal" behavior and it would be counter productive to literally diagnose everyone.
That was not my point. Obviously it's a descriptor of a problem, but not an appropriate explanation for a cause. Say you have high blood pressure. That may be because you weigh 400 pounds, or because you have a genetic condition, or because you smoke, or because you are stressed 18 hours a day, but it's not an explanation for anything, and everyone knows that.
Assuming you had an omniscient scientific tool every abnormal change in behaviour by definition has a correspondence to an abnormal state of the brain, that's just saying the same thing at a different level of abstraction.
When everyone is obese and has high blood pressure the correct cause of correction is probably setting different social incentives to fix a systemic problem, not mass producing insulin and betablockers, because you stopped at an overly reductionist level of description and mistook it for insight.
> It's not an apt descriptor at all because there's no test for a normal range of a chemical that depressed people are outside of.
As disconcerting as it may be, subjective feeling is a range (google "pain indicator charts") as well as professional (for some value of that) psychological analysis.
It may be a minority view but only because of people's blind faith in a medical authority's ability to distinguish a patient's mind as 'abnormal'. What Barrin92 said is logically sound, an empirical diagnosis of the behavior coming from an individual is not a very precise measure of any type of chemical imbalance. That's not to say individuals suspected to have of mental illness shouldn't get treated, but that medical professionals shouldn't jump to medications as a primary end-all treatment (which is what I believe is what the linked article was trying to say).
Yes, but you have to see it in the historical context. Not that long ago, mental sickness was caused by various demons, curses and so on. Things change a lot faster now, but it is still taking a while. Hell, being gay was a mental sickness was only 30 years ago.
In other words, it is not useless. It may seem obvious now, but it is not useless.
It's interesting the author argues dropping the term to reduce stigma because many people argue for using the term in order to reduce stigma. That is, if you can explain what is going on with you with some biological case, it seems so much less of a personal indictment than if the case is considered to be psychological.
That said, I completely agree that the explanation should be dropped because we really have little to no evidence for it.
Magnesium is used by the body to cope with stress.
I've noticed in the past, that when I've been under a ton of stress, I drink coffee, soda, ruminate a ton, and things get worse, much worse.
I've started taking magnesium l-threonate the past few months and it's literally made me a better person. Thoughts come and go. The rumination, the "voices" are much less.
One scoop, three times a day during stressful periods (166mg of elemental magnesium).
The only other solution that's had this profound of an affect on me was Lexapro, but it had too many side effects.
I've done years of therapy but nothing ever seemed to stick. But the l-threonate, the diminished anxiety, those affects seem to stick. Better than any therapy session I've had.
I'll give this much more time to see how it plays out. But I have had the thought wondering if my mental anxiousness and depression all of these years was just a mineral deficiency.
Not that I wouldn't have gotten really sad or ruminated, but that it didn't have to be so bad. I was stressed. I needed lots of magnesium. I definitely was not getting it.
Although it is probably not a cure in severe cases as that described in the article, I would also recommend paying attention to one's magnesium intake. However, I found that taking supplements is not necessary. Just find a mineral water that has a high magnesium content (100mg/L +), and it should get you covered as water has a pretty high bioavailability for Mg.
I use to take a large dose of Magnesium Glycinate, which did improve my anxiety. And sleep.
And I've taken epsom salt baths as well. Which helped me relax and sleep better as well.
But none of those have approached the even keeled feeling that the mg l-threonate provides. Maybe it's because l-threonate crosses the blood-brain barrier? Placebo affect? Unsure.
It's easy enough to make your own magnesium water, using magnesium hydroxide (as the laxative Milk of Magnesia) and carbonated water: http://www.afibbers.org/Wallerwater.pdf
Milk of Magnesia is in every grocery store. I buy from Fry's (Kroeger), because their version doesn't have any additives.
I don’t use LaTeX much, so if you would be willing to test with the kinds of documents you write, or even send me a file to test with, that would be greatly appreciated.
If you're drinking lots of caffeine I'd also recommend taking l-theanine. It's a compound found in some teas and has a very calming effect that counteracts the anxiety and jitters of caffeine. It's really amazing at allowing me to have the concentration boost of caffeine while avoiding many of the negative side effects.
You should do your own research on it first of course, but it's been shown to be very safe.
I haven't become acclimated to it yet, but I've only used it for a few months now. Maybe it'll lose its effectiveness for me after awhile? I have read that it generally doesn't build up tolerance though. I take it 2:1 l-theanine:caffeine.
This is a beautifully written article with devastating implications. I have no idea if it’s correct.
My summary: psychiatrists have been orchestrating a campaign of disinformation aimed to remove the stigma of mental illness from our culture, but it appears they may have made the stigma worse.
Anyone who speaks of psychological issues with absolute conviction is wrong. Psychological processes and coping mechanisms are affected by hormones, neurochemicals, and lifestyle. Hormones, neurochemicals, and lifestyle are affected by psychological processes and coping mechanisms.
While drugs aren't a panacea, they can help many with fixing psychological processes that are messed up.
Exactly. What I think people lose sight of is that people with chemical imbalances do, is to create all sorts of behavioral coping mechanisms in their daily lives before they ever see any type of chemical intervention. Once they get that chemical intervention, they then need to deal with the psychological and behavioral issues built up over the years of dealing with a chemical imbalance.
This isn't like a simple infection, where you take a pill and it will go away.
Yes. Psychology must be treated cybernetically, as a historical system of self-environment relationships, which produce state changes within the self.
For anyone interested in "chemical imbalance" theory, I highly recommend reading Carhart-Harris and Friston's paper "REBUS": http://pharmrev.aspetjournals.org/content/71/3/316 -- the basic gist of Friston's model is that the brain functions as a prediction engine, whose "prior probabilities" are "programmed" by past experience (within some environment). This paper addresses the role of serotonin: it reduces the "weighting" of our "prior probabilities" which gives them some malleability, meaning we can allow ourselves to adjust more fully to a new environment (or, if you flood yourself in serotonin, like with psychedelics ... it can nudge your highest-level priors, such as "who am I"?).
So from this perspective, we can see depression as a mis-adjustment between one's self (i.e. adaptation to past environments) and one's current environment (no chemicals involved here), and serotonin can provide a little nudge toward re-adapting.
Came here to make a similar comment. Scientists are not supposed to be activists - focusing on eliminating words that carry stigma from popular (or scientific) use makes me question not just objectivity but qualifications as a scientist.
Is there any space that ideologues haven't infested yet?
There's a difference between ideology and an ideologue. One may believe in something while at least attempting to compartmentalize it's influence over ones work. I feel like that sort of self-restriction is increasingly absent in much of the professional and academic world.
Yeah, sure, everything is political, but that doesn't mean you are obligated to inject your politics into everything.
Can that be avoided? Eventually any term loses its connection with the best available knowledge, and becomes a way to avoid thinking - an euphemism. We then need a new updated term. Eventually that term too will be outdated, but at least it was useful for a while.
If you have been close to a psychotic person who refuses to take antipsychotic medication (a common enough problem that I have faced with multiple people), the "just trying to sell drugs" story gets old very fast. A lot of people really do need the drugs in order to stop harming themselves.
I think this article does a disservice by suggesting that people on such drugs are trying to get over a minor breakup. And actually that does a disservice to very depressed people and somewhat misunderstands them too. (There is also such thing as psychosis in severe depression, btw.)
It might be true that a trauma and stress that appears benign to someone else triggers such a terrible condition. But once the sufferer gets stuck in that loop... The drugs are very often the best idea available. Avoiding them can be harmful to the health of the sufferer.
There’s a difference between antipsychotic medication and medication like SSRIs or anxiety medication. Not only in effects/potentially in necessity, but antipsychotic medication can be very dysphoric and sedating, whereas some people experience SSRIs positively and others negatively, and where anxiety meds are generally well liked (to the point of dependence becoming a real risk). Also whereas antipsychotics and anti anxiolytics are generally quite effective at treating their specific purpose, SSRIs are relatively ineffective, and anti anxiolytics are often not considered long term solutions (at least to GAD) in part because of the tolerance/dependence/addiction effects.
So I don’t think it makes sense to paint all psychiatric medicine with the same brush
Just want to add I have heard people say they avoid antipsychotics due to what you describe as "dysphoria" and "sedating" qualities but one must also recognize that for many, a symptom of their illness is that they do not think they are ill or that anything is wrong.
I get where you're coming from, but we cannot just ignore the obvious incentives at play here. Pharmaceutical companies do want to sell drugs and many have a history of being not-so-ethical about it.
Of course there are people who legitimately have disorders who legitimately benefit from the drugs. But we also need individuals who cast a critical eye on drug prescriptions. The hard part is making sure those critical individuals are sufficiently trained.
If you have a friend who refuses to take drugs prescribed by a medical professional, maybe it would be best to get a second or third opinion from another medical professional.
Please don’t consider my initial statement questioning a metaphor to mean that people that have suffered a psychotic episode or are likely to suffer a psychotic episode in the near future should avoid medication. The threshold for considering medication should be lower than a psychotic episode.
My concern is the metaphor in which many people are viewing mental health, not in the treatments themselves.
Thanks for that. Sorry if my reply was too vicious. I think I was criticizing a variant of the described attitude rather than you or your specific comment.
>"There is some truth to the metaphor, but I wonder if it’s doing more harm than good."
In my experience, whether the metaphor does more harm than good really depends on the individual patient.
When faced with the chemical imbalance metaphor, some people will bristle and say they're not "broken." Or they'll feel disempowered because they feel like they can't do anything but take a pill (or three).
---
For others, it lifts a weight off their shoulders. Most people battling with mental illness have struggled and tried various coping mechanisms to feel "normal." The understanding that the issue chemical, not behavioral, lets some people forgive themselves.
Instead of "not being normal enough", the cause is external; it's something they can't just brute force their way out of. Externalizing the issue lets the person stop feeling guilty that they weren't able to solve their own issue. This clears the slate for the person and leads them to a path toward recovery from mental illness.
NOTE: I'm not a doctor. But everyone in my immediate (and most of my extended family has been diagnosed with a chronic mental health issue. So has my wife, our girlfriend, and many others in my life. So it's well-founded anecdotal evidence. And, for what it's worth, I'm in the second cohort I described above.
It's easy to forget that modern generic SSRIs are dirt cheap.
$4-5/month is typical. These compounds are trivial to produce. Many pharmacies don't even operate as money makers. They just want you to pick up groceries while you're in the store.
Picking up a couple of apples while you wait for a prescription to be filled might cost more than the medicine itself.
It's true that there are more expensive on-patent medications available, but it's reasonable (and encouraged) to start with the cheap generics first.
they struggled against the dehumanising notion that their thoughts, feelings or behaviour were mechanistically caused.
Finally, a thread where I can point out my own experiences.
Around four years ago, it would be fair to call me slightly crazy. It was a harmless sort of crazy, but it was quite self-destructive. I used to wake up wishing to die, genuinely, and not knowing why.
All of that changed after going on Prozac. I don't know why, and I've heard from many others that Prozac was harmful to them. But from my point of view, it was nothing short of a lifechanging miracle. I can't remember the last time I've had suicidal ideation.
Most people keep this sort of thing quiet, and I think silence is part of the problem. When I was younger, I might have looked down on someone for saying what I just said. When you have a broken leg, everyone notices and can relate; when you have a broken mind, no one can see it, and so no one can feel sympathy, let alone empathy.
So what's the takeaway here? One: do not lose hope. I came very close to losing hope, and it would have denied me so much. Two: make a doctor's appointment. There's a chance that you'll wind up on something that makes the situation worse; you need to make a followup appointment ahead of time.
> All of that changed after going on Prozac. I don't know why, and I've heard from many others that Prozac was harmful to them.
SSRIs are some of the most widely-used medications. Tens of millions of people in the United States alone use SSRIs regularly with good results.
No medication is perfect, obviously, and at scale we're bound to see a percentage of people have negative experiences. The problem is that when tens of millions of people have tried SSRIs, even 1% significantly negative reactions adds up to a very large number of people. If 1% of those negative reactions make a point of blasting their negative experience all over the internet, we'll see thousands of negative reports everywhere.
Combine this with the fact that few people are willing to publicly admit that SSRIs helped them, and the bias toward negative reviews online is huge.
SSRIs are a particularly difficult topic, because they have a noticeable treatment lag (can take up to 1-2 months for positive effects, with positive effects increasing up to 6 months out) and can, in some cases, temporarily worsen symptoms during the initial ramp-up period.
Even more difficult, not all SSRIs are the same. It might take 2-3 trials before someone finds the SSRI that works best for them. It might also take several dose adjustments to find the right tradeoff between efficacy and side effects. Unfortunately, many people go online and seek out horror stories before they have a chance to go through a few rounds of medication adjustments to make it work for them.
Thanks for sharing your positive success story online. SSRIs aren't for everyone, but it would be a shame for people to spend years suffering from depression when a few SSRI trials might reveal an easy improvement to their lives. Worst case, they can taper off (tapering helps avoid discontinuation effects) and move on to different treatment avenues.
Great comment, I mostly agree. There are clearly many people who've been helped.
Some of the other contraindications (for the disparate group in that 1% you mentioned) are still important to mention, I think.
If you're not certain you'll always have health insurance. If you may ever want to try MDMA therapy, or just about any type of psychedelic therapy (or use them recreationally). If you're uncomfortable with being on something like this super long term and/or are concerned about withdrawal issues. If you can't stand the thought of risking becoming a happy-ish, functional zombie with no sexual interest in your partner. If you're worried the doctor won't diagnose you correctly. If you're not sure you can emotionally handle going through potentially a year or more of trial & error and having to wait months each time for results. Then think twice.
I am extremely glad for the people SSRIs have saved, especially those who wouldn't have made it otherwise. It is also incredibly clear to me that despite my continuing issues with depression, they are probably the wrong approach for me.
When a patient's symptoms are treated instead of the cause, most people will have subpar results.
The SSRI Lexapro [0] helped my girlfriend relapse on cocaine, before i met her. Cocaine is a much stronger anti-depressant than the SSRI's due to its effects as a Mono-Amine Oxidase Inhibitor [2] (1st generation anti-depressants).
Eventually the professionals figured out she is a poor methylator, and can't convert folic acid into Folate. Folate (Vitamin B9) is important for DNA synthesis. Food companies fortify with folic acid because it's more stable than other forms of Vitamin B9, even though we now know that some people are harmed by this fortification [1]. On the whole, fortification seems to be beneficial (fewer deformed babies), but poor methylators and old people seem to have negative side effects from getting their vitamin B9 from folic acid.
She said adding the L-Methyl-Folate was like flipping a switch between "depressed" and "normal". Her involuntary medical professionals didn't say, "hey sorry we made a mistake, you're not actually broken", and continue to ignore the actual causes of her condition.
I read something that compared cocaine's mood-lifting effects to those of the MAOI's. I remember it further said the MAOI's were generally safe for short-term use, unless you consumed certain types of fine cheese, and that they fell out of favor as their patents expired, not because they didn't work anymore.
I have a hard time keeping track of where I read what; I haven't found a source on a cursory search.
If I could add anything to the SSRI topic it would be that mental health treatment is incomplete without a form a therapy. If a person's treatment plan includes SSRIs, that's great, but it should always include therapy.
There are also other categories of medications which people forget, with the spotlight being on SSRI. Off the top of my head there's also SNRI[0], NRI[1], MAOI[2], RIMA[2], and TCA[3].
Arguably for low to moderate depressive disorders there hasn't been conclusive evidence that psychiatric prescriptions work, however there IS conclusive evidence that for major depression the benefits are at a minimum "small" and up to "substantial" ([4],[5]).
So as soon as we discuss depression, everyone might mean something different. It's a sad state of affairs because now people think they're talking about the same things but they're really not - they just happen to have had different psychiatrists who assessed things and behaved perhaps differently, and where one might have really mostly needed therapy and the other both therapy and antidepressants, in the end everyone went home with a prescription for the fancy SSRI of the year.
Psychiatrists as a whole need to reevaluate the rate of prescriptions, the tools to assess major depressive disorder, and the actual array of treatments that are available to them.
I've had wrong diagnoses. I've had appointments that my doctors missed without rescheduling even though I was there. I've had those 15-minutes-and-you're-out meetings with a psychiatrist, whose prescriptions for what conveniently is the "newest pill" were given along with free samples until one day you have to pay for something you can't afford or switch treatment and deal with weeks of uncertainty, and so on.
I have been saved from death and cycles of immense self-destruction by a healthy relationship with a knowledgeable and experienced psychiatrist willing to take me, when my legal troubles had by then reduced my options and driven me further to the edge.
Some real discussions, a carefully explained switch from SSRI to RIMA, which worked. "Is that what it is to feel somewhat normal? I can't believe people feel like that most of the time!!"
It allowed me to truly know what therapy is, because there was more to the day than being unconscious or wanting to be dead or death-by-proxy. Therapy gave out some tools to live and interact in a healthy way with myself and others, and to seek more tools too.
The struggle still exists entirely and comes back in heavy waves some days. A lot more difficulties are now an inherent part of my life and rebuilding things will take time and struggles.
But psychiatric treatment gave me legs I had lost for nearly all of my life, and therapy taught me to walk again, and I'm well intent on walking out of everything I fell into - regardless of how long and arduous the path is.
And whenever I'm able to, to take others out of the pit too.
I was "lucky" to have been majoring in psychology right before getting diagnosed with major depression. So I went into treatment knowing things like this that helped me stick with it.
Which was a literal lifesaver, because the first SSRI I took gave me severe stomach pains. I spent at least 2 hours every night spitting into the dorm room sink with the lights out.
Instead of quitting, I knew to ask for a different SSRI. I also knew to switch therapists when the first one just talked at me the whole time. I then got one who listened a lot at first, then started challenging things I said after we had some trust.
And one more helpful thing J knew: medication was like a crutch. And, despite that usually being a negative metaphor, I saw it as a positive. If you break your leg, you use a crutch while it heals. Your treatment should be the crutch (meds) and therapy. The therapy works better when you can think better.
I ended up not needing my meds anymore. I still have overall flattened affect and bouts of depression, but I can deal with them. To torture the metaphor, it's like having a slight limp from the broken leg. I'll never be "back to normal" but still find life worth living.
That's fantastic you found the right SSRI for you immediately, that's incredibly rare. I second the sentiment that when you find the one for you and everything clicks, it's a truly life-changing experience.
One thing to watch out for with Prozac is diminishing sensitivity in the nether regions, that's probably the biggest reason I tried a few others and transitioned to another medication.
> That's fantastic you found the right SSRI for you immediately, that's incredibly rare.
It's not accurate to say that it's "incredibly rare". Most people can expect at least some dosage adjustments, if not a few trials of different medications.
However, most people will see some improvements from any antidepressant treatment, even if it's not full remission. Getting to full remission is the challenge that requires fine-tuning.
Practically speaking, antidepressant medication shouldn't be viewed as a one-stop solution to depression treatment. It should be used as a larger treatment regimen involving therapy (ideally professional, but even self-directed with books is helpful) and lifestyle changes to identify and address the source of the problems.
As such, even a minor boost from an antidepressant can help move a person in the right direction, even if it isn't a one-stop cure for the depression. We need to collectively get past this idea that antidepressants are an all-or-nothing cure all and start viewing them as an adjunct to getting back on your feet and staying there.
Thanks for sharing. I've always been firmly grounded and positive person. And then a few years ago riding my bike down the road, I felt a immense wave of anxiety coming over me so intense that I felt like jumping off my bike and running away from myself. As an ex army special forces guy I found this particularly disturbing. And this was just the beginning. My situation continued in that general direction until I started experiencing pain in my liver area. I hoped it would go away but it didn't, so two months ago I decided to face it head on and get full tests done. Xrays, CT scans, ultrasounds, blood work. urinalysis the works. All came back clear. But I just felt it was not me... and searching my symptoms pointed to parasites. So I did a 6 day liver cleans (cant recommend this enough) followed by adjusted diet and two rounds of combantrin I'm please to be back to a very good place.
Depression and anxiety are nasty. I was surprised to learn they are symptoms of parasites.
They've evolved in such a way that they can manipulate the host into craving foods that are beneficial for them (not for the host). Symptoms among others include anxiety, depression and irritability.
I had ups and downs after the first anxiety attack occurred but if normalized it was certainly a gradual decline into depression. Anxiety would come and go and although i never considered suicide I did wonder if I would be better of dead.
The liver flush I did involved a morning celery and lemon juice. 5 light meals. 1L of apple juice spread throughout the day. After dinner a glass of water with epsom salts (tastes like pool water but has epic muscle relaxing effects so amazing sleeps) and psylium husk. On day six involves some more epsom salts, then drinking half a glass of olive oil with lemon juice. There's more to it but you can find this protocol pretty easily. Its quite common to pass a lot of stones in stool the next day which is old bile that has been hardened after being purged from the liver. It's important to check you don't have gall stones before doing the liver flush. An ultrasound will tell.
In terms of parasites I cant say 100% but combantrin works on 4 main types (mostly parasitic worms) [1]. There's also liver flukes which seemed to be explain some symptoms.
"Also, people who try gallbladder cleansing might see what looks like gallstones in their stool the next day. But they're really seeing globs of oil, juice and other materials."
Wow, this is a very interesting story. Another person might have just resigned themselves to their angst-ridden fate, and never gone beyond psych meds. It seems like generalist doctors (I’m sure lot all!) think, or at least act, as if there’s no link or causal relationship between mind and body. I did a three day fast which reduced my anxiety symptoms immensely for months, glad you sorted this out.
> Symptoms among others include anxiety, depression and irritability.
It wasn't until the late 1800s that the miasma theory of disease was overturned in acceptance by germ theory. At some point in the next century, computers will become powerful enough to closely simulate the entire human body. We'll be able to hook up our bodies and compare them to a common model in a sort of "debugging" process. I think what we'll find is a diverse host of viruses and parasites, or other curable abnormalities that are responsible for mental health problems.
I started having disturbing, invasive thoughts a few months before the pandemic hit. I’d be watching a movie with my family after dinner then boom, I’d feel insane. It wasn’t suicidal just things like “soon you will be DEAD!” kind of stuff. Turned out it was me reacting to some of the food we were eating at home.
The GP I saw suggested Lexapro which I’ve taken before and it’s not for me. I told him the problem had a strong correlation to food; if I fasted I didn’t get these thoughts. Doctors look at you weird when you say you think asparagus is driving you mad. He just sort of ignored me, I think the fact I saw him right after the pandemic hit just made him assume I was depressed and anxious because of the lockdown.
The really crazy thing to me is that Nexium has basically made the problem go away (Prilosec worked but wasn’t quite as good) I saw a GI specialist and he showed me the low FODMAP elimination diet and suggested I eat low FODMAP foods and that has helped it the rest of the way. So crazy how much our gut can affect our mood and psychological profile.
Initially I suspected carbon monoxide poisoning, because it correlated to when I’d come home. The symptoms were that bad. Turns out it was the dinner I was cooking every night for the family, I’d sit down to relax and eat and just a few minutes after eating asparagus feel completely bonkers. I went to the emergency room, they gave me a few Xanax; then the GP who wanted to prescribe me Lexapro and referred me to a Gastroenterologist. It wasn’t until I got to the specialist that I felt like he “believed” me.
Have you been allergy tested? I found out last year (midway into my 30s) that I'm actually allergic to half the foods my mom used to prepare for me. Like tomatoes/nightshade fruits. I would always get itchy, confused and generally feel inflamed and terrible and my mom made me tons and tons of spaghetti as a kid. I had constant GI issues in school and did pretty poorly, bad memory, etc.
Prior to allergy testing I got really obsessed and into probiotics, lifehacking etc just to make myself feel better and I feel like nothing really helped my GI problems which always feel like they're sapping the energy out of my entire body. Turns out a huge portion of my problems were food allergies.
I haven't gone full FODMAPS but I eat much more keto/paleo nowadays when I can (I've been loose since quarantine) and feel so much better when I do. Meat and lettuce is my prime meal now.
Aren't there a lot of pseudoscience-based food allergy tests out there? I've seen ones where you drop blood onto paper cards and mail them in. Somehow they test your old dead blood and then they send back a list of foods and tell you if you're allergic to them... Seems fishy to me, and I could not find how it worked or anything that these tests are legit. Every other type of allergy that causes inflammation in the body is done live, on your body with a test where they prick your skin. But I've never heard of this being done with food. Where did you end up getting your food allergy test done?
I went to an Allergy clinic in a hospital and just got the entire test where they prick sample sites into your back (it doesn't hurt at all). I don't have my paper near me but I hit something like 80-85% of the allergens they tested me with which ran the gamut from pollens to bugs, a few common common foods (tomatoes/nightshades for sure, I forget what else) were also on the list although not that many.
IIRC it was either stupid cheap or covered by insurance. I was a little annoyed my parents didn't take me in when I was younger for it.
It was completely hassle-free and maybe 30 minutes.
Now when I eat pizza with tomato sauce and start scratching my arms and my mouth is burnt and my stomach is destroyed and I have wild brain fog for 3 days I finally know why! Not sure how I never equated it before, I always thought it was the bread and never got gluten tested (could still contribute, but I'm not going through that test).
I started taking Prozac a few months ago. It might just be a coincidence but I checked myself into drug addiction treatment a couple months later. I’ve stopped taking almost everything but the Prozac and my life is immeasurably better and my depression is gone. I’m happy for the first time in many years.
This to me hints at the effect of Prozac possibly being far more complex than “chemical imbalance”. I’ve never found that terminology that useful. Fixing my depression required a lot of chemical changes yes, but also major changes in my voluntary behavior. All of it was connected in an intricate tapestry and Prozac only plays one part. If I tapered off Prozac, I suspect I would still be happy, but I don’t know that my depression would have ever resolved properly without Prozac. The side effects are mild so I am in no rush to discontinue.
Hold up. Is the specter of existential angst, rising to outright horror if left unchecked, not just, like, a normal part of life that rises to conscious thought as soon as you’re not distracted, for the entire non-religious population?
Nah, we just ignore this stuff for the most part. People are really good at compartmentalizing things, and pretty much feel they are immortal. A lot of us suffer from stockholm syndrome and think death is somehow good -- just look at a common reaction to many transhumanist notions.
Those who do take it seriously but are not strong enough to bear, end up joining cults.
I've had times in my life when I certainly didn't constantly distract myself, and being of a contemplative type, sometimes also delved into existential thoughts. But I didn't automatically (or generally) feel angst about it.
I'm not religious and haven't been since I was 15 or so. (I don't deny possibly having something of a mildly spiritual side, but I consider that different as it doesn't require belief in anything other than various kinds of feelings and experiences being part of the human experience. It also doesn't provide an externally assigned meaning.)
In times when my mental health and wellbeing have generally been worse, existential questions have also become much more distressing.
So yeah, maybe for some or even many people, existential questions may amount to angst, but in my experience it has depended a lot more on my other emotional and psychological state.
No man, that's just one line of thinking. I'm not religious in the least, and I love spending time alone and unoccupied. I know about existential angst and have indulged in it in the past, but my mind just wanders to other more pleasurable things when it's undistracted.
My wife just started Prozac after years on other medications, and has had a similar “miracle”. Her mood has been the stablest of the last 10 years I’ve known her. It’s been life changing for her and thus myself, as selfish as that feels. Anyway just really glad to hear another’s similar story.
One of the ways that Prozac helps people is by increasing allopregnanolone in the brain [1]. This is a well-known effect of Prozac, and perhaps the other SSRI's. Allopregnanolone "is a neurosteroid and acts as a positive allosteric modulator of the GABA-A receptor, the major biological target of the inhibitory neurotransmitter γ-aminobutyric acid (GABA)" [0]. GABA -> relaxation [2]. GABA supplements don't work very well on account of the blood brain barrier...
An evil pharma company recently got their version of allopregnanolone approved to treat postpartum depression. Cost of treatment: $34,000. It's cheaper to go upstream: progesterone, pregnenolone, or figure out why the body is having trouble making pregnenolone from cholesterol... Vitamin A? Thyroid?
One theory of why women experience postpartum depression is that their progesterone levels "fall off a cliff" after they give birth. In theory supplementing progesterone would help postpartum depression better than allopregnanolone. No one can afford to do that study because there'd be no pay off, as all the important patents have expired.
I've suffered with depression my entire life, or at least as far back as I can remember. Even as a young child I felt that way - despite the fact that my mother was a manic depressive (with multiple suicide attempts and stays in psychiatric hospitals over the years), I didn't recognise it as depression until I was much older; firstly because it was how things had always been, and secondly I guess because I got so good at hiding it that I'd subconsciously convinced myself.
I was always sad, and saw little meaning in my life, or in life at all, really. I cried lot. I frequently fantasised about killing myself, though I never got close to actually doing so.
I never talked about the way I felt. I felt ashamed, and I felt that people wouldn't understand - I've often heard "normal" people talk of how depressed people should "man up" or "get over it". Over the years, I got very good at hiding my true feelings. AFAIK, nobody ever guessed.
Maybe 5 years ago I started taking 5-HTP, which I believe has an SSRI effect (but one that is more short lived than pharmaceutical SSRIs). I actually started taking it for another reason (neuropathic pain, which has of course not helped with depression!), as I'd never considered treating the way I felt with chemicals, but within a few weeks the difference in me was incredible - I realised I hadn't cried in a while, and hadn't felt the immense lows that I felt every couple of weeks or so.
I still take 200mg twice a day, and get immense benefit from it - it's not a cure by a long shot, but after a lifetime of feeling miserable, the change is amazing. I seldom cry for no reason, and I rarely experience extreme lows (and when I do, they are less severe and shorter lived).
More recently I also started taking ketamine for my neuropathic pain, but it's actually further enhanced the anti-depressive actions.
I've tried SNRIs and SSRIs for my neuropathic pain, but am unable to tolerable them. If anyone else is in the same position, I'd very strongly recommend reading about 5-HTP and thinking about trying it. If you've tried SSRIs and they've failed for you, then it might be worth looking into ketamine (though I realise that may not be an option depending on where you live).
I'm the same way with ADD, getting on medicine changed my life. Unfortunately, i waited until my 30s to actually go to a doctor (at my poor wife's demand, i mean suggestion). All my life I had been told i wasn't smart enough nor studious enough to do the things i wanted and so struggled through it all. Getting on a medication changed everything for me. I use the analogy of imagining your day as a good, solid, sprint. You finish tired but you did it and feel good about it. For an unmedicated person with ADD it's a good, solid, sprint but up hill. Everything is just that much harder and exhausting than for a normal person.
ADD drugs obviously get abused and so I think they get a bad reputation and, for sure, can be dangerous and have side effects.
Same goes for pain medication. For real, genuine, chronic pain sufferers Oxycontin and the others are life changing. However, the drugs also get abused and are addicting so the real benefits can get masked.
The last thing i'll say is it takes a disciplined prescriber when dealing with these kinds of drugs. As software engineers, I'm sure we're all guilty of just throwing code at a problem. Many prescribers are guilty of just throwing Adderall at a problem or throwing Oxycontin at a problem without really understanding the root issue.
> When you have a broken leg, everyone notices and can relate; when you have a broken mind, no one can see it, and so no one can feel sympathy, let alone empathy.
This hits home and almost moved me to tears. I went through a trauma about 3 years ago, I was Kidnapped/abducted from a gas station at gun point and was forced to drive my attacker for nearly 30 minutes at gun point under threat of death before opening the door and diving out of my moving vehicle to escape. During that experience I considered purposely crashing my car believing it would kill both me and my attacker, but I wanted to live and ultimately took my chances diving onto the street from the moving car knowing I might get run over.
I can’t explain it other than I know I should have been thankful/grateful/happy I escaped with my life, but I knew immediately the trauma was real and sure enough it has been a downward spiral of cutting off every single relationship in my life and extreme isolation/avoidance. I’ve sought help/treatment (both therapy and meds) to no real benefit.
Even 3 years later I have to relieve the trauma because I’m suing the gas station for negligent security (turns out the guy had been loitering at the gas station for 2 hours prior to targeting me, even hanging out in the store talking to employees without ever making a purchase). The insurance attorneys are victimizing next worse than my kidnapper, they have destroyed the surveillance video, Claimed the kidnapping didn’t happen on their property (when I was literally approached while at the gas pumps), and telling me my damages aren’t real. This goes directly to your point, if I were shot they would have settled the policy limit ($2M) but because it’s not visible damages they are doing everything to claim it didn’t happen on their property, if it did they aren’t liable, and if they are liable the damages aren’t real but self inflicted. They either have no clue what kind of additional trauma they are causing or they actually do and are trying to cause me self harm so this goes away for them.
I humbly admit while I always felt for people who went through traumas (soldiers, child abuse, sexual abuse) I realize now I was incapable of actually empathizing...I won’t say I have suicidal ideations, but I often feel I’d have been better off not surviving.
I’m so sorry to hear that. Keep fighting the good fight. Don’t give up. You survived for a reason. You have a purpose. Only you can figure out what that purpose is.
I'm very sorry to hear about your ordeal, it sounds absolutely horrible. However, it's surprising to me that a commercial outlet in the US is basically responsible for keeping the bandits away. In my country I really doubt such thing claim have any chance in country, as public security is seen as a role of the police. I'm not 100% sure on the law, but I believe that, here in Poland, the security guards are there to protect the company's property and have no legal obligation to protect anyone else.
> as public security is seen as a role of the police
In the US police have no duty to prevent crime, also the gas station is private property not public and police are not considered public security. In short just like slip and fall cases in The US, businesses owe a duty to invitees to remove foreseeable dangers such as a slippery surface (in the case of a slip and fall) or a suspicious person loitering on premises for 2 hours. They also owed a duty to preserve the video evidence but they destroyed that as well.
I have a hard time believing in Poland a business might allow a rapist to just hang out on the property and identify potential victims all while a security guard is standing by that does nothing. That said laws wildly vary from jurisdiction to jurisdiction
Thank you for sharing. I'm glad your still here to relate your story. I think speaking these things is an important part of the healing process. Pax et bonum.
I also got ptsd in a domestic setting. Please remember it gets better with time. I’m sure you already know this, but MDMA has been shown to be effective in treating ptsd. I was personally able to get rid of most of the symptoms with large doses of propranolol. Try both of those before killing yourself.
I had a similar experience with Prozac, albeit less extreme. I was depressed and very anxious about anything and everything. Started Prozac + CBT therapy, it had no side-effects and I was feeling really much better in a matter of weeks.
This plays nicely into the idea that human consciousness is really just our brain meats way of resolving the internal understanding of the world with the outside understanding of the world.
Mental health, and any issues you have with it, are a hitch in that system. But to assume that you can fix is by only affecting one part(the internal understanding of the world) seems flawed for me. Same can be said, like in the article, of only fixing the outside understanding of the world (chemical changes).
So let me add my voice to your message, don't lose hope! We are a ball of walnuty textured jelly that tracks changes between the inside view of the world with the outside input of the world using lightning and chemicals. Its complex, hard, and the fault surface is huge.
Keep going, try new solutions, find someone one who helps you build the solution for you. But please, _try_.
>Most people keep this sort of thing quiet, and I think silence is part of the problem.
For the sake of this, I post about it online on occasion when the topic comes up -- an SNRI, Effexor XR, was life-changing for me, too. I suffered from crippling anxiety; my therapist diagnosed me with generalised anxiety, social anxiety, and major depressive disorders. Cognitive-behavioural therapy helped me live me life instead of letting it be controlled by these issues, but the issues were still there, and quite intense. There were some nights it just totally overwhelmed me. On Effexor XR, that never happens. Anxiety and depression are not only no longer constantly looming over me, but they are completely gone.
However, the first thing I tried was citalopram, an SSRI. It mostly got rid of them too, but I never felt quite like 'myself'. I felt like a zombie and like a bit of my soul had been taken out. Plus it wasn't entirely effective like Effexor.
(For what it's worth -- diet, exercise, and so on were tried too. No benefit to my mental health. I've also given more time than they're worth to various supplements that people report as helping their own issues.)
I’m glad you got help. Sometimes the only thing keeping me going is that suicide is a permanent solution to a temporary problem, and there is something else to try. Medication also helped to prevent me from going too low
I'm glad it helped, and I think offering up stories from all angles is really beneficial, especially when it comes to mental health. The reality is, there is no one size fits all solution, so the more people talk the better off everyone is.
I took one of the offshoots of Prozac for three months and it took my suicidal thoughts to a whole new level. For me it's all about therapy. A lot of what I'm facing is less about hormones and more about emotional trauma, so these pills are trying to fix the wrong thing. It's like fixing your breaks when the engine doesn't start. Sure, they are both parts of a car, but they couldn't be doing more different jobs.
My experience with therapy has been really eye opening. I think everyone can benefit from some form of therapy. I think the world would be a much better place if people were able to feel their emotions, explore them with curiosity, and learn from them.
Lastly, take care of yourself, friends. If you're not feeling well, please talk to a professional. They can help you.
As a counter point, I was on prozac (fluoxetine) for about a year after being diagnosed with major depression. Everything seemed better at first, but my personality changed in a way that, when I looked at it objectively, I did not like and eventually I felt as though the drug was merely masking depression that never actually went away.
My personal opinion having talked to doctors, therapists, and other depression sufferers is that the medical industry's treatment of depression is basically just throwing darts and hoping. They only kinda have a rough idea of how to treat some of the symptoms of depression and care not for any potential underlying causes. The "chemical imbalance" language, in my considered opinion, really does enforce this world view that depression is something you just throw drugs at until you're fixed, and I don't think that's helpful.
As far as I can tell, there isn't a clear consensus on the precise causes underlying depression. It's challenging to treat causes when you lack a mechanistic understanding. So, yes, they've developed treatment protocols that use the tools they have available that sometimes work.
I don't think anybody considers this ideal, but many consider it preferable to no ability to treat at all. A world in which a deeper understanding of fundamentals enabled full treatment would be best for everyone.
It's not like nobody is trying! But setting a bone doesn't require a deep understanding of how bone knitting happens, and therefore comes well before.
The book "Lost Connections" by Johann Hari (which I discovered through HN) has helped me a lot in understanding so much of the context of what makes so many of us feel depression and anxiety at many points in our lives. A big part of the narrative is that we are too quick to diagnose and provide ourselves with medication without really understanding environmental variables that have impacted our overall well-being.
While I do believe our understanding of how the brain functions still has a long way to go, which includes treatments for mental illness, there is something to be said about acknowledging more the external factors of our modern day lives that fill us with so many problems.
Personally, realizing where I have "disconnected" from people, values, and truly human experiences has been a large step forward in improving my mental health. I hope it's something that others who feel so many emotional challenges can try as well to see if they can make progress with their own mental health.
> There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’.
The Lost Connections book, which I read a few years ago, really helped hit this home for me. Totally made me reconsider my view of depression and treatment.
'Chemical imbalance' is an oversimplification used to explain mental disorders to the layman, along with the fact that certain medications that effect neurotransmitters are effective treatments for said disorders.
I agree that, often, these disorders are a product of environment, along with economic, social and material conditions. However, medications can and do improve the quality of life for people who cannot change those conditions due to their station in life.
I'm not technical in this field. But "reductionism" shows up all over.
In solid state physics, where reductionism is definitely a powerful and useful tool, the following article seems to be interesting. It's a possible reminder of what you maybe can and can't get from reductionism.
https://science.sciencemag.org/content/177/4047/393
No clue how much of that (if any) might apply to psychology.
I use chemical imbalance as a convenient terms for friends to explain that there is nothing they can really 'do' at the time in that particular expression of symptoms. "It's Chemical" is something they can understand.
A major issue is that a single cartel controls medical(physicians/AMA). It's not necessarily science backed, so this leaves non science issues filled with tradition and authority.
Are lifetime outcomes really better on all these Drugs? Maybe after you already created drug addictions, a different drug would help.
Prior to drug use, I imagine therapy, monetary support, education, etc... Would all be better than 2020s brand name Adderall.
Many depressed people are very resistant to accepting treatment. In a perfect world, people would have no hangups about scheduling an appointment with a therapist and/or trialing antidepressant medication as an adjunct to their recovery.
However, in the real world many people are resistant to the idea of therapy and/or medication as it feels like admitting defeat. Or perhaps they've read cherry-picked horror stories of bad therapists or medication side effects on the internet.
Giving people the "chemical imbalance" narrative is a way to short-circuit many of those internal objections. It gives people a notion that the depression isn't their fault, but rather they are a victim of a chemical change in their body not unlike getting the flu or having low testosterone levels.
In terms of getting people to accept treatment, it's a win. Getting past the ego can be surprisingly hard, but the idea that we're treating chemicals instead of treating the person is a clever trick to sidestep that obstacle and shortcut to the treatment.
In terms of giving people the tools to address their problems, it's not so clear. The more we reinforce the idea that depression is simply chemicals in the brain, the longer it takes for people to realize that they do have some power to influence their thought processes and voluntarily replace negative thought processes with positive ones.
However, it's important to remember what a typical course of treatment looks like. If someone is suffering from depression, getting them to commit to weekly therapy sessions with another person as well as following up with the therapy homework (that is, actually implementing what was discussed at therapy) can be a difficult proposition. Getting someone to stop by the pharmacy on the their way home and spend 10 seconds taking a pill every morning for the next 30 days is an easier proposition. The medication is often the jolt that gets people into a place where they're receptive to therapy, or they start making life changes to improve their depression. It's a quick and easy way to give people space to solve their problems, which is why the "chemical imbalance" sales pitch has become the entry point to getting people on board with treating their depression. Get them to lower their guard, get them started on the easiest treatment, and then work on scaling the treatment up to a more intensive, longer-term plan after they've seen hints of success.
I don't particularly like the "chemical imbalance" sales pitch either, but it really does function as a decent hook for getting people over their objections to starting treatment.
It seems like anybody familiar with the history of the profession would be wise to not so easily “accept treatment.” But then again, even insiders like Jordan Peterson will “accept treatment” that nearly kills them. The hubris isn’t unique to any one branch of medicine, but consider that not very long ago shock treatment for homosexuals was the accepted treatment. That should give you pause if nothing else.
> It seems like anybody familiar with the history of the profession would be wise to not so easily “accept treatment.”
It's amazing how mainstream the anti-psychiatry movement has become. Please ignore it and focus on the modern science. The attempts to dismiss modern science with questionable historical references is non sequitur.
> But then again, even insiders like Jordan Peterson will “accept treatment” that nearly kills them.
Jordan Peterson is not an insider. He's not even a good representative of the industry. Please don't interpret anything he says or does as representative of the field. He's a social media star, not a recognized expert.
> However, in the real world many people are resistant to the idea of therapy and/or medication as it feels like admitting defeat. Or perhaps they've read cherry-picked horror stories of bad therapists or medication side effects on the internet.
This is hugely compounded by the fact that even when people do decide to go for treatment like therapy, they discover that its painfully inaccessible. As in, if you don't have enough money to afford the 100$+ hour sessions, you feel like you completely run out of options.
There are more services trying to address this cost issue but from my experience (in Canada), they leave a lot to be desired
Often true, but it's also true that many people don't realize how affordable therapy can be under their insurance plans. YMMV, obviously.
Depression is notorious for making people assume the worst. Many depressed people will assume therapy is inaccessible or too costly without even checking. I would encourage everyone to at least take a few minutes to look it up or call their insurance.
For example, I've walked several people through the process of finding a therapist, checking with their insurance, and scheduling appointments to get them started in the past few years (United States, corporate insurance). For most of them, therapy visits were billed with a $20 copay with a limit of 24 visits per year, which is more than accessible.
However, even if it's not, it's important to put the costs in perspective. How much would you pay for a magic pill that improved your problems? Does $1000/year sound worth it? That's 10 x $100 therapy sessions.
If professional therapy is out of reach, self-directed CBT using books or self-help resources have been shown to be effective as well. Not as fast or effective as professionally-guided therapy, but certainly a worthwhile starting point.
The mental health stigma is systemic as well. Did you know that one of the things asked on an application for a CHL in Texas, as an example, is a list of every single time you've received psychiatric treatment and it's a disqualifier. Similarly the Form 4473 has mental health questions required prior to purchasing firearms. If you've ever been admitted for treatment, you're disqualified.
My purpose isn't to re-litigate gun control as an issue, but to point out that our policies and laws reflect our attitudes about mental health directly on access to things which are enshrined as fundamental rights in the US, already. It's a perfectly reasonable supposition to say: "I don't want truly crazy people to have guns.", it's another to say "I think it's acceptable to strip Constitutional rights from millions of Americans because they once had in-patient treatment as a child for their anxiety."
The latter is a matter of policy (regardless of how well it's actually enforced) simply due to the fact we don't understand the human mind or psychology enough to actually draw an objective distinction between those two types of people. Laws and systems work poorly with things which require subjective determination. "I'll know it when I see it" might be an acceptable type of thing to adjudicate, but it's a terrible type of thing to build bureaucratic processes around that are faceless, soulless, with no recourse.
This is just one of many examples where having any history of seeking treatment for mental health can be a disqualifier, or worse strip you of your rights. It's an effective disqualifier for many types of jobs as well in the US, especially government jobs which require a clearance or working at any company which accepts government contracts which would require a clearance.
> However, in the real world many people are resistant to the idea of therapy and/or medication as it feels like admitting defeat. Or perhaps they've read cherry-picked horror stories of bad therapists or medication side effects on the internet.
Or, you know, it's a lot of time and money being spent on something that the medical industry has very little success in dealing with.
Yes, it's like the illness affects the ability to ask for help to treat the illness. Something like expecting people who fall down a cliff to walk to the doctor with broken legs. If there is nobody there to help them it's very hard to do it themselves, and even if there is someone it's harder to help a "broken" brain than a broken leg.
When I had serious depression a while ago trying to find treatment was a seriously depressing experience. I went through several therapists which I didn’t click with and made me just feel worse. When you are already down it‘s very hard to do these attempts because they require a lot of effort and building of trust Every disappointment takes you down even further then . I know people who have had great success with treatment but I also know quite a few people who got more depressed trying to find therapy unsuccessfully.
I've had a similar experience. I think one of the biggest problems with the current approach to mental illness is that practitioners (irrespective of modality) act like unsuccessful treatments are harmless. They're not; they can very credibly reinforce a patient's belief that treatment can't help them. It's easy to say "you just haven't found the right treatment yet, keep trying", but that argument rings pretty hollow after the fifth failure or so.
> In promoting a biogenetic causal theory, anti-stigma campaigners – as well as psychiatrists, the popular media, and others – hoped to convince people that mental illnesses are ‘just like’ other chronic physical ailments, such as ‘heart disease or diabetes’, to quote the APA, and could be medically addressed.
We're very caught up in naturalistic thinking. Speaking of a soul or the mind is frivolous at best, and superstitious at worst. But look where this way of thinking has brought us.
The brain and the heart are two different organs. But while we can use science to gain an understanding of the brain, the mind is understood by philosophy and religion.
Case in point, I once asked a friend of mine if he could prove that he loved his wife. He said if he were able to freeze time, and gain knowledge of every synapse, every chemical reaction, every electrical potential -- he could definitively prove that he loved his wife, and she loved him.
"When you get home," I responded, "remember to duck when you tell your wife you want to go have her brain scanned to prove she loves you."
Not to reduce a complex topic to an aphorism but: if the world is configured in a way thats antagonistic towards you, a negative response is understandable. A lot of this stuff fits neatly into a tradition of blaming people for their conditions that, by and large, they have little control over.
Oh, another aphorism that's always stuck with me is "the difference between 'crazy' and 'eccentric' is a million dollars."
I feel this is particularly apt as depression has grown considerably over the past few decades. Could be the result of destigmatization, or could be the result of society worsening in some way. If you have a poor social life and feel like an underachiever (which describes increasingly more people, IME) it’s no surprise to me that you would experience depression
To start, I hope that if you're talking about yourself you are doing ok.
But yes I think its possible all of the things you're talking about put together. The long term effects of the extreme wealth gap are so broad they're difficult to even take a survey of. But at the same time, we're becoming more open about mental health issues and acknowledging them as legitimate problems so reporting in accepting, progressive communities is going to make it seem like there are more.
If you look at outcomes instead of responsibility, you get the opposite conclusion. If your suffering is a defect, then maybe we can fix it. If your suffering is a correct response to your circumstances, then it's right and proper for you to experience that suffering fully and indefinitely.
I think you might be missing my point: often the conditions are not correctable by the individual. They can only be resolved by collective action, and we can’t really start on that until we stop holding people responsible for things they don’t have meaningful control over.
Whenever I read this, I hear "I need people to stay miserable so that they will be willing to join my revolutionary army."
Something really slimy about pivoting from human suffering to your pet critique of society & insisting that the only worthwhile course of action is your political agenda.
I've had lots of experience with people struggling with various forms of mental illness.
Their stories are not mine to tell. I've managed to squeak by with just a scoche of "on the spectrum," myself, so I am quite grateful, but I have watched (often in horror), as people have spiraled down.
People suffering from mental illness can often be impossible to help; regardless of how much we want to assist. They need to initiate and maintain their treatment.
There's so much societal "baggage," here. Mentally ill folks can often be profoundly unattractive, and it can be difficult to have empathy for them, or get support for them.
I remember once, walking down the street in the Union Square district of SF, on a business trip. As folks know, SF has a big homeless population, that is growing. We stepped around an obviously mentally ill man, and one of my employees shouted "Get a job!".
Would it were that simple, but his attitude is quite common.
But when treatment works, it can be absolutely miraculous, and worth every second of the pain.
Instead, let's end prescription advertising for medication. That's where people get all these stupid ideas in the first place.
We can write and read articles like this all day. But if Rx advertisers can create new, stupid ideas in commercials faster than we can dispel them, then there's no use.
Counter-example: if you’ve ever struggled with OCD or compulsive thoughts then you know the extreme emotional anguish that comes with trying to resist the impulses, that feeling of powerlessness as you feel forced to do something that you know rationally makes zero sense. In this case, recognizing the condition as a “chemical imbalance” may be comforting and a sole source of hope that things can get better.
And this is why I don’t like elitists telling me what I should or shouldn’t say.
> Psychiatric research doesn’t support the notion of simple cause and effect in mental health, instead uncovering a far more complex and indeterminate picture of vulnerabilities. There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’.
I wholeheartedly agree with this, and believe that it's a huge problem with the mental health discourse. However, the author then goes on to say:
> Mental health treatment needs to re-engage with the language of persons. This means suspending the detached, third-person stance toward patients, and attending to their actual experience and circumstances. And it means encouraging patients themselves to avoid this stance and draw on the normal ways that people make sense of their emotions and actions.
A problem I've experienced is that "the normal ways that people make sense of their emotions and actions" do not seem to work for me. I haven't found a good description of it, but something in my sensory and cognitive feedback loop seems to be broken such that I don't get any useful sense of things in the moment and need to reverse-engineer my emotional state after the fact when it seems important to do so (NB: I don't just mean that this disconnect occurs when there's some kind of intense moment; it's pretty much constant). So I don't see how it's possible to both hold that up as the standard and also respect my "actual experience and circumstances". In other words, this sure seems like exactly the sort of one-dimensional theory of mental illness that the author decried earlier.
I completely agree with the fact that the “chemical imbalance” idea is a gross simplification, but it also makes a lot of sense why psychiatrists would be prone to this type of mindset. When all you have is medication with relatively well defined effects on neurotransmitters(mostly GABA, serotonin, norepinephrine, dopamine) everything looks like a problem of getting those in the right ratio.
Personally having experienced depression myself and knowing many others who have experienced it, I’m of the opinion that a lot of mental issues are either symptoms of some other condition (like diarrhea or coughing) or the result of learned behavior / maladaptive coping mechanisms. Or simply us treating emotional states or personalities that aren’t socially acceptable as illnesses (of course this doesn’t include things like psychosis, nor is it meant to diminish how serious depression and anxiety can be). That’s a bit uncomfortable for the existing mental health complex though
I've always been depressive and pessimistic person as far as I can remember.
I've been looking at other people only to see how happy they are and how
content they with their life. They feel motivated, want something from life
and in generally think that being alive is alright, which I just couldn't
internalize no matter how hard I tried.
Essentially, I've come to the conclusion that there _must_ be something wrong
with my neurotransmitters that I just can't be happy as fellow friends around
me.
Many doctor appointments, many different prescriptions.
Antidepressants did their job and I started to care less about what's going on,
but they didn't make me any happier. They just made me less miserable. On the
other side, I've started to see the world through some kind of fog, which
blocked most of my previous perception. My long-term memory started to
degradate.
Now, after many years of taking various SSRIs I'm beginning to realize, that
there's nothing wrong with my brain.
That's perhaps who I am, maybe either percepting more than many people around
or just more sensetive and therefore reacting stronger even on slightest
stimulus in a much stronger ways. I have opinions and thougts on a topics that
many do not even care about.
So instead of supressing thoughts and emotions I must accept them as they are.
Not only MDMA (which is probably not prescribed by anyone yet) like /u/weknowbetter said, but also other stuff that has shown promise in treating depression (and has actually worked for other people). Imipramine (not really good long term), CBD, low dose THC, ketamine, gabapentin, there's some others, too.
Gabapentin works really well for me, though I have to stop taking it for a week every month, so that's 2-3 days of insomnia and nightmares. Technically I'm not supposed to, but then I'd have to increase the dosage to what I consider unacceptable levels. Tapering off also works, though.
CBD/THC (only with a low dose of alcohol) also works well, but I don't like the side effects (lower mental acuity, plus my already bad attention goes rock bottom), so it's more of an occasional thing.
Doctors are really inflexible in what they can give me, so I have to make do. SSRI's just don't work on me, except for imipramine, but that's really temporary.
It’s also like the Facebook effect. For the most part, people post only the best photos, so we only see their best 10%. Yet it’s easy to forget that and compare that to all our photos/experiences even though it’s not apples to apples.
And out of 100 friends, if 5-10 post something cool it’s easy to overlook that the other 90-95 didn’t.
fB is but an example. These effects happen more or less with everything.
The culture in America shames those who post upsetting things or express those feelings. It’s a whole thing where you have to always be happy and “positive”.
I’ve rebelled against this for a long time. I post happy things here and there but since my life isn’t particularly happy, I post the more upsetting things more frequently and express those feelings in real life. I like to think I’m adding balance but I know I’m just being ignored because the culture doesn’t like to hear about suffering.
> The culture in America shames those who post upsetting things or express those feelings.
Yeah, because it’s bloody depressing.
You get what your mind focuses on and if people actively look for depressing topics it’s no wonder they’re all doom and gloom.
That’s why people don’t want to hear it - because it affects your psychology.
I will actively run from people who lead negative lives, that complain about things but never lift a finger to make anything better. I refuse to be sucked into their pits of despair because I know there is good in the world, and I want to be part of that, focus my mind and attention and energy on leaving things slightly better than when I found it.
I will try to help ppl where I can but the truth is a lot of people are lazy and don’t want to change. So I leave them with my thoughts and know that I have done my piece.
I’m not saying this is directly attributable to your experience, simply relaying the way I feel to give you insight into perhaps a different mindset and way of seeing things.
Have you looked into the possibility that you have ADD/ADHD?
I ask because your description sounds spot on for how I have felt throughout life. The 'fog', lack of motivation, and sensitivity to even the slightest stimulus especially ring true. When I first took medication for ADD, I felt like I had been driving through a downpour my whole life and finally discovered the window-wipers - the storm didn't stop, but I could finally look forward and see my goals and desires clearly. Every few weeks I try to do a reset and test how I feel without medication and I definitely still feel that 'fog' that you mention. I would say my fog is more like being in a lightning storm, because I feel the constant 'patter' of thoughts hitting my subconscious (for lack of a better word), but the occasional lightning strike will pull my attention completely away from everything else momentarily.
If you want to learn more, I highly recommend looking through the ADHD subreddit[0] - especially the sidebar material.
There’s a view that ADHD is badly named, because many ADHD people have incredible focus (at times), and many are not hyperactive in the least. It’s more of an issue about emotional dysregulation, which can be exceptionally painful for those who suffer.
I was diagnosed in my mid-20s with inattentive-type ADHD. I had never even considered that I had ADHD until about a year prior to seeing a doctor, because I don't "look" like I have ADHD. There's this stereotype of people with ADHD being unable to sit still, constantly bouncing off the walls, which isn't really me at all.
There's so much more to ADHD than that though. I'm smart enough that I never struggled academically, and wasn't hyperactive enough to cause significant enough disruption in the classroom, so externally it was never picked up that I might have ADHD. But now that I'm aware of it, I've come to realise how significant of an impact it's had in my life, all the self-destructive and self-sabotaging behaviour, the instability of my relationships, the abuse of drugs and alcohol, the lack of internal motivation, emotional hypersensitivity, a lack of emotional and object permanence, and more. I could go on for days (and have) about the less obvious effects and symptoms of ADHD.
> because many ADHD people have incredible focus (at times)
The concept of "hyperfocus" as a symptom of ADHD is relatively recent idea. It didn't appear in any medical literature for a long time. The first appearance I could find was in some author's book about ADHD, which wasn't even targeted at medical professionals.
It might be a symptom for some people, but misinterpreting it as a symptom of ADHD leaves the door wide open for misdiagnosis and over-diagnosis. When we start diagnosis a disorder notorious of lack of attention in people who demonstrate an abundance of attention, there's a problem.
The pop-psychology definition of ADHD is so broad that it's rare to find an HN commenter who hasn't self-diagnosed as maybe having ADHD at some point in their lives.
As you said, pathological ADHD (as diagnosed by a medical professional) can have a severe impact on people's lives. It's best that we leave the diagnosis to professionals and not give people the impression that the regular ups and downs of focus (studying/focus/mental endurance is work for everyone) are indicators of a mental health disorder.
> The concept of "hyperfocus" as a symptom of ADHD is relatively recent idea
Hyperfocus is a symptom of ADHD, ASD, and schizophrenia [1]. So a person who experiences hyperfocus may be experiencing one or more of those conditions. (Although, when I say "symptom", not necessarily a diagnostic one – conditions can have both diagnostic symptoms, which form part of the diagnostic criteria, and non-diagnostic symptoms, which don't, but nonetheless have been commonly observed clinically and/or in research in those formally diagnosed.)
Since it is possible to have subclinical manifestations of psychiatric diagnoses, a person who experiences hyperfocus without meeting the diagnostic criteria for any of these diagnoses may have such a subclinical manifestation of one or more of them. The formal name for subclinical ASD is "Broad Autism Phenotype" (BAP) [2]; I don't think subclinical ADHD [3] or subclinical schizophrenia [4] have distinctive names, but both have been researched. (A lot of people who incorrectly self-diagnose themselves as having X despite not actually meeting the diagnostic criteria, may in fact be correctly identifying the existence of subclinical traits of X in themselves.)
> When we start diagnosis a disorder notorious of lack of attention in people who demonstrate an abundance of attention, there's a problem.
Inattention in ADHD has always been the lack of ability to appropriately direct attention, not the absence of attention to anything.
While “hyperfocus” by name is a fairly recent association, at least as far back as the DSM III-R ADHD has included both tendency to be easily distracted by extraneous stimuli (inability to maintain appropriate attention) and that of not having attention drawn by stimulus that should draw it (appearing not to listen.)
I completely agree that it is poorly named. One of the reasons I never even considered that I had ADD/ADHD was that I was never really exhibited hyperactivity and during certain activities -reading an amazing book or playing my favourite games- I can focus for hours on end. I think it would be great for the scientific/psychiatric community to seriously consider a new name.
It's very common for people on HN to tout the benefits of their ADHD diagnosis and I feel compelled to point out that getting on ADHD meds was one of the worst mistakes of my life. They triggered a manic episode. The psychiatrist solutions to all my problems was always more meds, different meds, etc. I've mentioned this a few times and I'm always accused of abusing them but the truth is I took a small dose as prescribed. Of course I was "pre-disposed" to mania but how was I supposed to learn that without finding out the hard way? I believe that if I just avoided all the psychiatric pill I never would have gone full manic (hypomanic, but not manic).
The article is right that "chemical imbalance" is a myth as there's no sort of blood tests or normative chemical ranges for any of these mental conditions that people get diagnosed because they are outside of. A quick Google search would show there's no scientific support for chemical imbalance theory, just some pills that affect brain chemicals that people report depression improvement on self-reported survey so a huge, unscientific leap is made that depression is some chemical shortage in the brain. All the psychiatrist diagnoses are basically glorified personality tests, and the criteria are based on the DSM-5 which was made closed door and with heavy influence from pharmaceutical company lobbying.
Mental health is probably one of the most complex aspects of health, things like placebo have a huge impact, it's hard to study, and there's huge bias introduced by a for-profit pharmaceutical industry that pushes treatments to pills.
The field of psychiatry is not that scientific, it's not so long ago it was forcing people into lobotomies and I see the unscientific rush to diagnose everyone into these boxes of depression and ADHD as a similar gaffe that will be looked back on poorly.
I am diagnosed with GAD, ADHD, and bipolar type 1 and I'm doing MUCH better since I went against-medical-advice and quit all meds. For bipolar disorder/anxiety, meditation, yoga, exercise, sobriety, journaling are my key treatments. Mindfulness is key, but not the Hacker News McMindfulness variety where you try to emulate a celebrity monk from Tibet so you can reach Zen all so you can write more code for your startup.
For ADHD, meditation, techniques like pomodoro, and most importantly, just accepting that maybe it's better to achieve less peak productivity than take prescription amphetamines.
I just wanted to provide some counter-perspective as someone who's followed advice like yours much to my detriment.
I would like to recommend the book 'crazy like us' it's about how mental health functions differently in different cultures and how we been exporting western conception of mental health and they've actually changed the symptoms people report to their therapist. It also touches on the pharmaceutical industries influence. Really a fascinating reas
Do you (or parent, or GP) have allergies or food allergies by any chance?
I recently did a ~7 day liquid elemental diet [0], followed by a 3 day fast, and at the end of the fast I was more mentally acute and more lucid or "present" than I have ever felt in my life.
The results were far better than any medication or treatment I've ever tried. Unfortunately, re-feeding brought me back to the same state I've known for all of my life.
As a counter point, being diagnosed with ADHD and prescribed medication was one of the best things to have ever happened to me. Everybody is different though, medication is beneficial for some and detrimental for others. It's important to be aware of your mental state and how treatment (whether drugs or other) affects it, and to be able to make informed choices regarding treatment. A good doctor/shrink should take into consideration your feedback and act accordingly. Bad doctors will just push pills on to you. This is why I'm deadset against prescribing stimulant medication to children, it's easy (and common) for doctors and parents to basically force feed their kids amphetamines, often causing them great harm (I also believe that it stops children from learning proper ADHD management strategies, leading to them being completely incapable of functioning without medication or illicit drugs)
Meditation and yoga do nothing for me. Seeing a counsellor has been good though, and I think that its something that everybody should do, regardless of neurotype or how well they appear to be functioning in life.
It seems like you're conflating accurate diagnoses with misdiagnoses here. Nobody thinks being medicated based on a misdiagnosis is a good thing, and especially not as a substitute for parenting.
It's unfortunate that it's often the case that psychiatric help is only sought for "problem children", who negatively impact those around them. These are the kids that get "easily distracted and distracts others" on all their report cards.
Well behaved children with ADHD (generally those with inattentive-type) tend to have their poor academic performance written off as laziness or stupidity. Their report cards tend to say "has great potential, if only he would apply himself"
Unfortunately, it's common just to give kids some pills to settle them down, especially when therapy is expensive or resource limited, without helping them learn healthy coping mechanisms and management strategies.
Often as they grow older, they become less hyperactive, which leads to the belief that they've "grown out" of their ADHD. There's a common misconception (even amongst doctors) that ADHD is a children's disease, when in fact up to 2/3 of children with ADHD carry it through to adulthood. I have friends who went to their GP and were straight up told that they couldn't have ADHD as they're adults.
Therapy should be the first-line strategy for treating children with ADHD, with medication being an alternative or supplemental treatment. Otherwise you end up with adults who never learned healthy management strategies as children, as the medication suppressed the need to learn them. Then as they "grow out" of their ADHD, they're taken off medication and are unable to function as effective members of society.
Medication allows therapy to be effective. And it depends where on the spectrum you are. Just going to therapy and talking won‘t change anything. For me a main symptom is and was the inability to take action on existing knowledge. Therapy can’t fix that.
Treatment of ADHD without medication needs action accommodations from the school, teachers, friends, boy scouts and parents. And it‘s not possible for every parent and every school.
If you feel emotionally numb because of the stimulants your dose is probably too high and it should be adjusted.
But I agree with you. The treatment can‘t be just a pill. It needs at least to be a pill and education for the involved parties. And especially education for the patient. So they can adjust their treatment and lifestyle according to their needs.
I know it's late to respond to this, but I just want to say thank you for offering the opposite perspective. I can only say it was a life-changing improvement in my case and in most of the cases that I have read about. I do want to clarify that I wasn't advising anyone to get medicated immediately; I just offered my perspective and a link to more information.
I agree that we should be focusing more in individualized treatment and not attempting to adjust everyone to some averaged version of 'normal'. Tbh, if I could find a way to live comfortably in a profession that I enjoyed, which didn't also require 'neurotypical' focus, I would drop the medication as well. I do enjoy being able to focus on things which would normally be near impossible for me otherwise, but I certainly feel less creative and mentally adroit when medicated. It's a difficult trade-off at times, but in my current circumstances, it's one I simply have to make, as nothing else works(including meditation, pomodoro, etc.).
In any case, it makes me happy to hear that you have found a solution that works for you.
Hey, I'm a therapist in training and also a developer. I built a side project called Taaalk. It's a platform for people to have public conversations, and I have done a few on mental health:
A psychedelic experience can often offer a profoundly different perspective on things like one's beliefs, perceptions, experiential phenomena, etc - have you ever investigated/considered that avenue? The effects are typically mostly temporary, but one is often left with some convincing fragment of knowledge that what we think/perceive reality to be is wildly off the mark, which can be a useful new base to build upon going forward.
Your comment, "there's nothing wrong with my brain," doesn't clearly define what you mean by "wrong." From a biological standpoint, there is nothing wrong with misery. You can be miserable from birth to death, but as long as you pass on your genes your miserable self is "fit" from an evolutionary perspective.
Personally I would absolutely consider persistent misery, or experiencing extreme sadness over minor things, to be a clear proof that there is something wrong with my brain. Whether I treat that with therapy or medication, I think that is very much worth treating, and definitely not worth simply accepting.
>Personally I would absolutely consider persistent misery, or experiencing extreme sadness over minor things, to be a clear proof that there is something wrong with my brain. Whether I treat that with therapy or medication, I think that is very much worth treating, and definitely not worth simply accepting.
I think you are making the assumption that it is treatable, or that the treatment advantages outweigh the disadvantages, which is not always the case.
I think there is a general over-subscription to the idea that everything can be treated or optimized. Some diseases are incurable and sometimes a personal optimal is still poor compared to average.
Not all cases of depression are effectively treated - some end in suicide - but every single case is worth treating. Resigning oneself to lifelong misery is the worst possible choice.
I think you're on to something really important here.
Some people (normal people if you will) just don't think too much about things. Even when they sometimes go on to make terrible choices for themselves, and others, they might regret it, they might have negative thoughts about it, but they don't become depressed. They are not inclined to ruminating hours on end about their mistakes, so the negative thoughts dissipate over time, they effectively move on.
But if your personality, or brain, or whatever, is made in such a way that you like to think a lot about what could have been, or could be, or how to behave, or what others think of you, any kind of negative thought you might have will stay around, eventually leading to (symptoms of) depression.
So I think you're right when you say that depression is not what's wrong with you. You might just be one of those people that are good at thinking. Perhaps sometimes a little too good at thinking, a little too sensitive. Being sensitive and good at thinking is not be a bad thing at all, but spending too much time having negative thoughts may be what leads to depression.
If this is the case, realizing that you have a choice, in what to think about, is an important step on improving the quality of life, perhaps even learning to life with, or overcome some of the symptoms of anxiety and depression. Accept the negative thoughts, they are just natural thoughts after all, but choose not to dwell on them, let them pass and move on to the next thought, it might be a positive one.
A realization that came to me much later in life was that, although I am in apparently full control of which thoughts I allow to persist in my mind, I do not appear to be in full control of when memories surface. Rather, very similar to my dreaming state, it seems as though there is some process which is constantly comparing my waking events to things that occurred in my past, and trying to form a connection between them.
For the most part this is good, but of course, not all memories are created equal. Sometimes this process of forming connections reminds me of a painful event, something I'd rather not think about.
At first it was frustrating when these memories surfaced repeatedly. I'd dwell on some embarassing thing I'd done, or some painful thing a friend had said to me, which they maybe didn't realize I'd taken so hard. It was tempting to analyze these events to death, and have silent conversations with these figments, as though I could go back and phrase it differently, or change my actions, and perhaps it would have gone better.
Eventually, however, I realized that these mental tasks were not productive. The event, the "danger" had already passed. So now, whenever I realize my mind is about to go down that path, when suddenly I am reminded of a painful event, we pause, my brain and I. "Do we really need to go down this road again? We know where it leads. Let's not."
And so we don't. We reach once again into the stream of thought, allow ourselves to dwell on some happier moment, and in time, that old memory fades and we're off on a different adventure.
This comment assumes people can choose what they think about when most of the time there doesn't seem to be an off-switch to a certain topic or emotion. I've found that it's easier to re-apply one's thought process on something mentally demanding and important (so the mind will find it urgent enough to drop whatever it is currently thinking about) than to direct one's mind to stop thinking about a particular topic. With that being said, I know that I'm also trivializing the difficulty finding a replacement topic that sufficiently demanding and important.
I felt like that for a long time. I can't say that today I am an over-exuberant bundle of joy, but somewhere along the road of fixing my quality of sleep (caffeine, nasal obstruction), eating more fruits & vegetables, and getting regular exercise, the world has become a far more cheery place.
I know it's not an illusion because I very rapidly become dour & flat when I let my diet or exercise slip.
I can relate to much of what you're saying. This seems to be the common trapping of modern society - everyone must be happy and care about the same things. I'm not professionally qualified on the subject, but my vote is embrace it - but also try to understand it.
For instance, find a therapist to talk with. Don't feel like you need to settle for the first one you find, find one that feels right to you. It could be that there are deep rooted thoughts or emotions that actually are unhealthy that you may want to get to the bottom of. The goal here isn't change, it's understanding... and through understanding, determine if there's anything you'd like to change or even embrace. For example, I tend to focus on the negatives and everything wrong with the world. I realized I picked these behaviors up from my mother which not only allows me to be more aware of my behavior, but also helps me gently guide conversations with her away from being so negative and help her find positive things in her life.
Psychedelics often come up in these conversations, as well. I know many people whom see their experiences with psychedelics as turning points for them. There's plenty out research out there on the subject that I won't rehash here. If you choose to go down this route, I'd suggest doing your own research and if it seems like something you'd like to try do so in a safe place with one or more persons you feel safe around. Preferably, have an experienced "guide" there with you.
Lastly, I've been digging into the subject of gratitude for awhile now - both giving and receiving. There's a lot of research indicating it can be quite powerful. I tend to focus on the negative and everything that's wrong with the world (or my job, or my partner). Sometimes, just setting aside time to stop and think about something or someone you're grateful for (and especially communicating that) can do wonders. This isn't about not having or getting rid of pessimistic thoughts - it's about finding conscious space for appreciation, which can help balance things out or just help find some sparks of joy that might otherwise get drowned out by the negativity.
We're all on our own journey. Embrace who you are and try to take in the sights along the way.
But I do very often wonder if and what is the objective purpose of life, and having thought of it for a long time, I came to the conclusion that there are no such objective purpose.
The goal of life is entirely subjective, while the achievement/advancement of the goal is grounded in logic and hard work, the goal itself is not.
I also came to the conclusion that no one has any idea what the purpose of life is. No one. I like listening to various opinions on "how you should live your life", mostly just out of curiosity, but never really take any of them as the answer. There are people (David Goggins) saying that you should work 24/7 and be the best of version of yourself you can be while working your ass off and suffering a lot. There are others who say you shouldn't give a fuck and just enjoy the life in every way you can. Life has no purpose, just enjoy it and do whatever makes you happy and fulfilled (which could mean either slacking or achieving greatness, depending on what you want).
> Now, after many years of taking various SSRIs I'm beginning to realize
So a failure to transmit or receive sufficient chemical stimulus in the brain describes a failure of hardware that may or may not be correctable with drugs. Because we live in a culture of convenience it is common to misrepresent a difference of personality as a defect correctable with a drug, which may explain the drive to consume and abuse stimulants.
Some people, myself, literally enjoy working 80+ hours a weeks with less sleep and without preconditions, like increased compensation. Many people see that as bizarre and wonder where the increased energy and focus come from. It’s not a product of increased energy or focus, but really just a minor difference of personal interest and emotional concerns. Stimulants won’t buy you a necessary change of personal goals or the necessary continuous interest of where you value your time, and certainly won’t buy you enjoyment of working 80+ hours a week. Instead people tend to be most productive where they naturally find increased output due to personal interests whether that’s just from spending time with other people or reading literature.
That’s the difference personal interests (personality) make which is not any indication of defect. There is a famous quote: “Know thyself”. The reflection to that is know what you are not or rather don’t lie to yourself.
I found ssris to be a prison. A profound spiritual stasis. They cut me off from myself. They muted my emotions so instead of learning to deal with them I stayed passive and simply ignored them. When I got off of them I spent quite awhile learning who I was and how to live with myself. I have come a long way as a person and I wonder if that change wouldn't have taken place sooner had I not taken them.
It seems that lots of very smart people take these drugs and I wonder how many are emotionally and spiritually stunted by them.
Due to a video by Dave MacLeod[1], I made some dietary changes that have had a surprising and profound effect on my mental health. The full list of sources for that video are on his blog[2], but the paper I found most helpful was the first on the list[3].
It's hard to come to any conclusions here, but it does seem like for me, the issue was at least partly chemical.
However, I'll say that a lot of why I got to a point where I could even make the dietary changes, was that I had done a lot of emotional and psychological work. The reason I was interested when I saw the vlog, and read the paper, and made the dietary changes, was that I had done a lot of work to learn to even care about myself.
For me, there has been a feedback loop--learning to care about myself has allowed me to discover tools to improve my brain chemistry, which in turn is now allowing me to care about myself better and do more for myself (and others). I don't think that just giving people the right food or medicines to fix their brain chemistry would work if they don't see themselves as worth making the life changes for.
It's hard not to be depressed when you realize how sad society is, and how most of how we're supposed to spend our days (working for an employer, staring at a computer screen all day) has no actual meaning to the world. Yet we're not allowed to talk about it at or you'll get fired, or people will think you're depressing.
For me I've found that my happiness is mostly a function of the community of people I'm surrounded with. This means having a solid group of friends and/or significant other. It's very tough to find this, especially in the U.S. when you're already an "adult" and didn't make many friends in your childhood/university years, but it is possible.
But that's just me, others don't need much social contact. Everyone is different. But for any software engineers like me who find that staring at a computer all day does little for their happiness, you are definitely not alone.
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[ 3.8 ms ] story [ 431 ms ] thread- homeless <=> crazy, bad
- Some anxiety <=> type A hustler, good
- And now: a little depression + access to healthcare <=> "it's just bug", neutral
That is such an arbitrary distinction. As if being "just a slacker" doesn't have a number of deeper reasons behind it as well. Brains are just machines at the end of the day, every behavior is a result of something material...
Dr. K suggests the brain is optimized for efficiency. If something is not seen by the brain as being unnecessary, then the brain is unlikely to trigger a response that motivates you to complete the task. The example used was going to the restroom - your bladder fills up and your brain tells you it's time to go. Motivation in areas of life was seen as being similar.
In the case of laziness, the bladder filling up is analogous to, let's say, shame reaching a level to where you're prompted to finally clean your room. Obviously increasing shame would be less than ideal, but there are other means for motivating yourself (e.g., purpose in service to others, duty, dharma, etc). He also draws a distinction between apathy and detachment, which are also part of the problem.
Anyways, I'm not sure I agree with everything he said/says, but it's worth checking out and an interesting perspective nonetheless!
Source: https://www.healthygamer.gg/asmongold-talks-to-healthygamer-...
The analogy that brains are like machines is harmful because it makes it sound like there is some operating manual and simple cause effect relationships that are known. Our knowledge of the brain is in fact very little. It's a false reassurance and reductionist view to see the brain as a machine simply because it is made of material parts that seem to act in a reliable way towards some end.
Why? We have complex machines and systems as well, where nobody would claim that there are only simple cause effect relationships and you only need a two-page owner's manual.
Drugs work pretty reliably. While you can't predict what exactly is going to happen when you take LSD, you can be pretty sure that something is going to happen. Why, if not because the brain reacting to some chemical?
This idea of "don't say it's a machine, you're oversimplifying it" is what's harmful in my eyes. It leads to anti-scientific positions, mysticism and fatalism. If there's nothing we can do to help, and nothing we can learn because it's so super hyper duper complex and "emergent", why bother. It's not, of course. While we don't know everything, we do know something. And we should extend our knowledge. Pretending that we can't know isn't useful.
I understand where you're coming from, and I'm not too excited when people pipe up with things like "the brain is just like X, so you just need to eat more Y to fix your Z", but we're learning plenty of things about how the brain works, and I believe that we do so because we consider it as a complex system that is not unlike a machine. Remove its fuel, and it will stop operating shortly, cut away parts of it and you'll see functionality change or being lost.
I see no harm in reasoning about it as a very complex and very large machine with tons of inputs, outputs and modification systems. A long time ago, we'd consider the heart a mystery full of magic, and now we're regularly transplanting hearts and I believe we're "within reach" (though rather decades than months) of implanting completely artificial hearts. I see no reason why we shouldn't make progress towards a better understanding of the brain in the same way.
There are a lot of ways to think about the differences between machines and people. One very simple one is that machines typically function in only a very limited subset of the space of their available degrees of freedom and small deviations are usually catastrophic. Biological systems don't usually have this property.
Another way to think about it is that machines show evidence of design, which you might characterize as a certain economy of ideas. Two clocks in a computer a much more likely to be identical or to share major conceptual underpinnings than two clocks in a biological system, for example.
I used to have your view of things and then I read Deacon's "Incomplete Nature," a book whose thesis fails to land but is never the less a comprehensive analysis of the properties of living organisms in a unified if rickety system which encompasses the basic laws of physics. It really convinced me that the analogy between brain and machine is poor.
The question of what a mind is and how it relates to the brain is not settled science or philosophy, at any rate. It doesn't do anyone any good to pretend it is.
(footnote): This is a reasonable assumption to make but its hardly widely believed by the general public nor settled scientific fact. Luminaries like Penrose still assert a fundamental disjunction between what brains do and what machines do and he isn't alone among physicists, to say nothing of the broader philosophical community or the lumpen mass of human opinion.
inputs (sensors, environment, external chemicals) + current state ---> outputs (behavior) + new state
kinda like computers or robots, in a deterministic manner (except it is practically impossible to recreate the exact same inputs, or the exact same state). You don't have to take it too literally, people who read it generally understand what it means.
Machines are in some sense constituted by an enormous, intentional, simplification of the possible dynamics of a clump of matter and its relations to the outside world. Their design is profoundly impacted by both our own cognitive limitations and the contexts in which they are manufactured and used. Biological systems simply don't have these constraints and they operate in what are often totally different ways from machines.
My point is that there is considerable scientific and philosophical scholarship on this issue which casts this metaphor into doubt at least with regard to base utility.
It's just not a very helpful metaphor, because we are nowhere close to having a way to simulate or compute that function.
So treating people as agents with goals, desires, personalities, experiences and histories and traumas, and drawing on our hard wired abilities for empathy, can be a far more useful model for actually helping and healing people than just giving them a pill.
But that's not a dichotomy. Nobody is saying to either disregard biochemistry and believe that God gave us free will by some magical act or just throw random pills at people.
You can see people as all that and still not reject the idea that chemical imbalances can negatively influence their goals, desires and personalities, and that chemicals can also positively influence them,
And honestly, there's a lot of complexity to even the smallest thing. A particularly good read, "I, Pencil" goes into how nobody knows how to make even a simple pencil.
https://en.wikisource.org/wiki/I,_Pencil
What I was getting at is the fact that there is no fundamental difference between "I did it" and "my illness caused me to do it" (other than maybe probability).
Or in other words, no "free will", in the way that some people view that term.
My issue with the word machine is that in most people's minds that brings up ideas of cross sections, gears, cogs, repairs and so on. People aught to be thinking of a complex system instead like perhaps the ecosystem in the Amazon rainforest.
It's kind of like trying to put a rocket into space in the stone/bronze age. Or figuring out the Google codebase if it was handed to you in Assembly.
It's just that the physical composition of our bodies are knwon down to the protons (and even deeper). How they all work is a different question, but there is a specific way they work. Just have to figure it out.
When I say machine, I mean it as "construct" of any kind, not just electromechanical. Imo, it would be really nice if we could grow and reattach whole body parts, or grow bodies for transplant, but obviously those ideas bring a lot of negative connotations and ethical problems, so we're investing in electromechanical alternatives instead.
I think there is some admin access. The problem is it probably isn't a good idea to sudo | grep | awk > overwrite_file.model very often. Brains might just be a jumble of extremely efficient and over-fitted regression models and neural nets with a really shitty training dataset.
There was an SSC article that had some good discussion on this at some point, but thanks to NYT I can no longer link it.
When compared to doing nothing and tolerating them, I can definitely see that. But I still think there have to be more effective approaches than either (even if we don't know what some of them are yet).
This is a pretty big assertion that the piece casually drops without backing. The reasoning as to why "chemical imbalance" is a bad descriptor is apparent* from the study [0] the author cites, but there is nothing that backs up this statement, which seems to be the crux of the whole piece.
*Even the study cited about placebo affects on depression doesn't _really_ prove the author's point that "chemical imbalance" is a bad term, it just proves that we do not yet understand the processes by which drugs treat depression. If we do not understand the processes, how can the author make the assertion that the characterization they are against is wrong? At most, they could claim "we don't know yet" but certainly not that "chemical imbalance" is categorically false.
[0]: https://www.frontiersin.org/articles/10.3389/fpsyt.2019.0040...
Fascinating conundrum.
My understanding was that the results of the author's interviews were the backing for this assertion:
>As the interviews made clear, people adopted the biogenetic account because they thought it was based in science. The interviews also show how this account undermines the kinds of introspection and self-examination that can lead to meaningful self-knowledge. >Mental health treatment needs to re-engage with the language of persons. This means suspending the detached, third-person stance toward patients, and attending to their actual experience and circumstances. And it means encouraging patients themselves to avoid this stance and draw on the normal ways that people make sense of their emotions and actions.
Or do you mean that the conclusion the author reaches, that we should be attending to people's experiences instead of using "biogenetic causal language," isn't justified by the results of the interviews?
>As I argue in my book Chemically Imbalanced (2020), to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language. Psychiatric research doesn’t support the notion of simple cause and effect in mental health, instead uncovering a far more complex and indeterminate picture of vulnerabilities. There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’. Nor does the beneficial use of psychiatric medicines require it. In fact, their precise mechanism of action and relation to troublesome experience remains a mystery. It would be more truthful for mental health professionals and public health campaigns to acknowledge this.
It's helpful to note the flipped the burden of proof here: the author argues there is no evidence for "chemical imbalance" language, not that there is evidence against "chemical imbalance" language. I see it as an admission of uncertainty rather than claim of knowledge; the use of the somewhat tepid phrases "need to move away from", and "complex and indeterminate picture" are a further sign the statements are not categorical.
Though I could have misunderstood their thesis. I'll find out once I've read the book, I suppose. :-)
There can be a company pouring lead into a river, psychological hazard during a civil war, and it will always manifest in the brain, what kind of explanation is this? Of course these things can be found in the brain, it would be crazy if they didn't.
That's not to say there's no diseases that are actual individual pathologies of the brain of course, but to use 'chemical imbalance' as a sort of first order response to what may have actual social or environmental reasons say, is entirely circular reasoning.
I don't mind changing language, as long as we're become more precise, not less.
If "chemical imbalance" is bad, suggest something better.
I think a bigger problem is that people are fixated on word definitions and offending others instead of solving problems.
I agree, and this is pretty much unavoidable when the current clinical term is vague enough to be used as a generic insult.
The general pattern I see
1. A vague term is used to describe symptoms of an issue we have a poor understanding of.
2. That term becomes associated with the symptoms, but is vague enough to be used as a generic insult (ex: playground school children yelling it at each other)
3. That term develops a stigma as an insult, and becomes more and more controversial
4. That term is replaced with a new term, rinse and repeat.
We've seen this before ex: Moron, Imbecile, and Retard all once had vague clinical meanings.
Then we went to mentally challenged, special needs, etc. Now even those are fairly loaded terms.
In all of these cases, the word/phrase describes something that people would rather not have or be, but it does it without clarity.
It will develop a stigma.
I find the folks who constantly advocate for changing these names well-intentioned, but basically a waste of time.
Terms like Black, Dwarf, Gay, etc... were all, at some point, considered insults despite being specific. (note: I'm not saying these are illnesses - just that the same phenomena exists - there are probably much better examples of what I'm trying to say).
The term "chemical imbalance" can describe anything from acid reflux to genetic neurological pathologies or even snake bites and can certainly put people "in distress".
The problem is people aren't interested in using correct definitions for anything anymore.
Really? That's the problem? Not the mental disorder itself?
These semantic debates are less than worthless.
There is an implication inherent to "chemical imbalance" that assumes a normative range. Modern medicine is universally based on normative ranges. If you are outside this range, it is considered a problem. Chemical imbalance is a generic and apt descriptor.
In this case chemical imbalance would be objectively wrong. Their brain is being affected by another part of the body entirely, but you would have doctors selectively treating the symptoms (the 'chemical imbalance') rather than the cause.
I disagree. Chemical imbalance is not necessarily a solitary cause, it's describing a condition regardless. shrug
> you would have doctors selectively treating the symptoms (the 'chemical imbalance') rather than the cause
Typically they treat both or in most cases, the easier problem with less severe treatment consequences (classic House MD - live in constant pain from muscle death vs lose a limb).
Assuming you had an omniscient scientific tool every abnormal change in behaviour by definition has a correspondence to an abnormal state of the brain, that's just saying the same thing at a different level of abstraction.
When everyone is obese and has high blood pressure the correct cause of correction is probably setting different social incentives to fix a systemic problem, not mass producing insulin and betablockers, because you stopped at an overly reductionist level of description and mistook it for insight.
As disconcerting as it may be, subjective feeling is a range (google "pain indicator charts") as well as professional (for some value of that) psychological analysis.
I think your view is minority view.
It may be a minority view but only because of people's blind faith in a medical authority's ability to distinguish a patient's mind as 'abnormal'. What Barrin92 said is logically sound, an empirical diagnosis of the behavior coming from an individual is not a very precise measure of any type of chemical imbalance. That's not to say individuals suspected to have of mental illness shouldn't get treated, but that medical professionals shouldn't jump to medications as a primary end-all treatment (which is what I believe is what the linked article was trying to say).
In other words, it is not useless. It may seem obvious now, but it is not useless.
That said, I completely agree that the explanation should be dropped because we really have little to no evidence for it.
Generally, in a scientific context, characterizations are wrong if they lack any scientific basis.
I've noticed in the past, that when I've been under a ton of stress, I drink coffee, soda, ruminate a ton, and things get worse, much worse.
I've started taking magnesium l-threonate the past few months and it's literally made me a better person. Thoughts come and go. The rumination, the "voices" are much less.
One scoop, three times a day during stressful periods (166mg of elemental magnesium).
The only other solution that's had this profound of an affect on me was Lexapro, but it had too many side effects.
I've done years of therapy but nothing ever seemed to stick. But the l-threonate, the diminished anxiety, those affects seem to stick. Better than any therapy session I've had.
I'll give this much more time to see how it plays out. But I have had the thought wondering if my mental anxiousness and depression all of these years was just a mineral deficiency.
Not that I wouldn't have gotten really sad or ruminated, but that it didn't have to be so bad. I was stressed. I needed lots of magnesium. I definitely was not getting it.
I use to take a large dose of Magnesium Glycinate, which did improve my anxiety. And sleep.
And I've taken epsom salt baths as well. Which helped me relax and sleep better as well.
But none of those have approached the even keeled feeling that the mg l-threonate provides. Maybe it's because l-threonate crosses the blood-brain barrier? Placebo affect? Unsure.
Milk of Magnesia is in every grocery store. I buy from Fry's (Kroeger), because their version doesn't have any additives.
I’m about to release an update to Orgro with LaTeX support powered by KaTeX. More info here: https://reddit.com/r/emacs/comments/hsa3ik/orgro_update_inli...
I don’t use LaTeX much, so if you would be willing to test with the kinds of documents you write, or even send me a file to test with, that would be greatly appreciated.
You should do your own research on it first of course, but it's been shown to be very safe.
But it felt like I became acclimated to it quickly - did you experience this?
Same for CBD - I felt very calm, like my normal self, but also became acclimated after a while.
My summary: psychiatrists have been orchestrating a campaign of disinformation aimed to remove the stigma of mental illness from our culture, but it appears they may have made the stigma worse.
While drugs aren't a panacea, they can help many with fixing psychological processes that are messed up.
This isn't like a simple infection, where you take a pill and it will go away.
For anyone interested in "chemical imbalance" theory, I highly recommend reading Carhart-Harris and Friston's paper "REBUS": http://pharmrev.aspetjournals.org/content/71/3/316 -- the basic gist of Friston's model is that the brain functions as a prediction engine, whose "prior probabilities" are "programmed" by past experience (within some environment). This paper addresses the role of serotonin: it reduces the "weighting" of our "prior probabilities" which gives them some malleability, meaning we can allow ourselves to adjust more fully to a new environment (or, if you flood yourself in serotonin, like with psychedelics ... it can nudge your highest-level priors, such as "who am I"?).
So from this perspective, we can see depression as a mis-adjustment between one's self (i.e. adaptation to past environments) and one's current environment (no chemicals involved here), and serotonin can provide a little nudge toward re-adapting.
Is there any space that ideologues haven't infested yet?
Yeah, sure, everything is political, but that doesn't mean you are obligated to inject your politics into everything.
There is some truth to the metaphor, but I wonder if it’s doing more harm than good.
I think this article does a disservice by suggesting that people on such drugs are trying to get over a minor breakup. And actually that does a disservice to very depressed people and somewhat misunderstands them too. (There is also such thing as psychosis in severe depression, btw.)
It might be true that a trauma and stress that appears benign to someone else triggers such a terrible condition. But once the sufferer gets stuck in that loop... The drugs are very often the best idea available. Avoiding them can be harmful to the health of the sufferer.
So I don’t think it makes sense to paint all psychiatric medicine with the same brush
Just want to add I have heard people say they avoid antipsychotics due to what you describe as "dysphoria" and "sedating" qualities but one must also recognize that for many, a symptom of their illness is that they do not think they are ill or that anything is wrong.
Of course there are people who legitimately have disorders who legitimately benefit from the drugs. But we also need individuals who cast a critical eye on drug prescriptions. The hard part is making sure those critical individuals are sufficiently trained.
If you have a friend who refuses to take drugs prescribed by a medical professional, maybe it would be best to get a second or third opinion from another medical professional.
My concern is the metaphor in which many people are viewing mental health, not in the treatments themselves.
In my experience, whether the metaphor does more harm than good really depends on the individual patient.
When faced with the chemical imbalance metaphor, some people will bristle and say they're not "broken." Or they'll feel disempowered because they feel like they can't do anything but take a pill (or three).
---
For others, it lifts a weight off their shoulders. Most people battling with mental illness have struggled and tried various coping mechanisms to feel "normal." The understanding that the issue chemical, not behavioral, lets some people forgive themselves.
Instead of "not being normal enough", the cause is external; it's something they can't just brute force their way out of. Externalizing the issue lets the person stop feeling guilty that they weren't able to solve their own issue. This clears the slate for the person and leads them to a path toward recovery from mental illness.
NOTE: I'm not a doctor. But everyone in my immediate (and most of my extended family has been diagnosed with a chronic mental health issue. So has my wife, our girlfriend, and many others in my life. So it's well-founded anecdotal evidence. And, for what it's worth, I'm in the second cohort I described above.
It's easy to forget that modern generic SSRIs are dirt cheap.
$4-5/month is typical. These compounds are trivial to produce. Many pharmacies don't even operate as money makers. They just want you to pick up groceries while you're in the store.
Picking up a couple of apples while you wait for a prescription to be filled might cost more than the medicine itself.
It's true that there are more expensive on-patent medications available, but it's reasonable (and encouraged) to start with the cheap generics first.
Finally, a thread where I can point out my own experiences.
Around four years ago, it would be fair to call me slightly crazy. It was a harmless sort of crazy, but it was quite self-destructive. I used to wake up wishing to die, genuinely, and not knowing why.
All of that changed after going on Prozac. I don't know why, and I've heard from many others that Prozac was harmful to them. But from my point of view, it was nothing short of a lifechanging miracle. I can't remember the last time I've had suicidal ideation.
Most people keep this sort of thing quiet, and I think silence is part of the problem. When I was younger, I might have looked down on someone for saying what I just said. When you have a broken leg, everyone notices and can relate; when you have a broken mind, no one can see it, and so no one can feel sympathy, let alone empathy.
So what's the takeaway here? One: do not lose hope. I came very close to losing hope, and it would have denied me so much. Two: make a doctor's appointment. There's a chance that you'll wind up on something that makes the situation worse; you need to make a followup appointment ahead of time.
Support networks only got me so far.
SSRIs are some of the most widely-used medications. Tens of millions of people in the United States alone use SSRIs regularly with good results.
No medication is perfect, obviously, and at scale we're bound to see a percentage of people have negative experiences. The problem is that when tens of millions of people have tried SSRIs, even 1% significantly negative reactions adds up to a very large number of people. If 1% of those negative reactions make a point of blasting their negative experience all over the internet, we'll see thousands of negative reports everywhere.
Combine this with the fact that few people are willing to publicly admit that SSRIs helped them, and the bias toward negative reviews online is huge.
SSRIs are a particularly difficult topic, because they have a noticeable treatment lag (can take up to 1-2 months for positive effects, with positive effects increasing up to 6 months out) and can, in some cases, temporarily worsen symptoms during the initial ramp-up period.
Even more difficult, not all SSRIs are the same. It might take 2-3 trials before someone finds the SSRI that works best for them. It might also take several dose adjustments to find the right tradeoff between efficacy and side effects. Unfortunately, many people go online and seek out horror stories before they have a chance to go through a few rounds of medication adjustments to make it work for them.
Thanks for sharing your positive success story online. SSRIs aren't for everyone, but it would be a shame for people to spend years suffering from depression when a few SSRI trials might reveal an easy improvement to their lives. Worst case, they can taper off (tapering helps avoid discontinuation effects) and move on to different treatment avenues.
Some of the other contraindications (for the disparate group in that 1% you mentioned) are still important to mention, I think.
If you're not certain you'll always have health insurance. If you may ever want to try MDMA therapy, or just about any type of psychedelic therapy (or use them recreationally). If you're uncomfortable with being on something like this super long term and/or are concerned about withdrawal issues. If you can't stand the thought of risking becoming a happy-ish, functional zombie with no sexual interest in your partner. If you're worried the doctor won't diagnose you correctly. If you're not sure you can emotionally handle going through potentially a year or more of trial & error and having to wait months each time for results. Then think twice.
I am extremely glad for the people SSRIs have saved, especially those who wouldn't have made it otherwise. It is also incredibly clear to me that despite my continuing issues with depression, they are probably the wrong approach for me.
The SSRI Lexapro [0] helped my girlfriend relapse on cocaine, before i met her. Cocaine is a much stronger anti-depressant than the SSRI's due to its effects as a Mono-Amine Oxidase Inhibitor [2] (1st generation anti-depressants).
Eventually the professionals figured out she is a poor methylator, and can't convert folic acid into Folate. Folate (Vitamin B9) is important for DNA synthesis. Food companies fortify with folic acid because it's more stable than other forms of Vitamin B9, even though we now know that some people are harmed by this fortification [1]. On the whole, fortification seems to be beneficial (fewer deformed babies), but poor methylators and old people seem to have negative side effects from getting their vitamin B9 from folic acid.
She said adding the L-Methyl-Folate was like flipping a switch between "depressed" and "normal". Her involuntary medical professionals didn't say, "hey sorry we made a mistake, you're not actually broken", and continue to ignore the actual causes of her condition.
[0] https://en.wikipedia.org/wiki/Escitalopram
[1] https://now.tufts.edu/articles/folic-acid-too-much-good-thin... / https://www.futurity.org/folic-acid-too-much-of-a-good-thing...
[2] https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor
(edit - added bit about cocaine being an MAOI)
I have a hard time keeping track of where I read what; I haven't found a source on a cursory search.
If I could add anything to the SSRI topic it would be that mental health treatment is incomplete without a form a therapy. If a person's treatment plan includes SSRIs, that's great, but it should always include therapy.
Arguably for low to moderate depressive disorders there hasn't been conclusive evidence that psychiatric prescriptions work, however there IS conclusive evidence that for major depression the benefits are at a minimum "small" and up to "substantial" ([4],[5]).
So as soon as we discuss depression, everyone might mean something different. It's a sad state of affairs because now people think they're talking about the same things but they're really not - they just happen to have had different psychiatrists who assessed things and behaved perhaps differently, and where one might have really mostly needed therapy and the other both therapy and antidepressants, in the end everyone went home with a prescription for the fancy SSRI of the year. Psychiatrists as a whole need to reevaluate the rate of prescriptions, the tools to assess major depressive disorder, and the actual array of treatments that are available to them.
I've had wrong diagnoses. I've had appointments that my doctors missed without rescheduling even though I was there. I've had those 15-minutes-and-you're-out meetings with a psychiatrist, whose prescriptions for what conveniently is the "newest pill" were given along with free samples until one day you have to pay for something you can't afford or switch treatment and deal with weeks of uncertainty, and so on.
I have been saved from death and cycles of immense self-destruction by a healthy relationship with a knowledgeable and experienced psychiatrist willing to take me, when my legal troubles had by then reduced my options and driven me further to the edge. Some real discussions, a carefully explained switch from SSRI to RIMA, which worked. "Is that what it is to feel somewhat normal? I can't believe people feel like that most of the time!!"
It allowed me to truly know what therapy is, because there was more to the day than being unconscious or wanting to be dead or death-by-proxy. Therapy gave out some tools to live and interact in a healthy way with myself and others, and to seek more tools too.
The struggle still exists entirely and comes back in heavy waves some days. A lot more difficulties are now an inherent part of my life and rebuilding things will take time and struggles. But psychiatric treatment gave me legs I had lost for nearly all of my life, and therapy taught me to walk again, and I'm well intent on walking out of everything I fell into - regardless of how long and arduous the path is. And whenever I'm able to, to take others out of the pit too.
[0] https://en.wikipedia.org/wiki/Serotonin%E2%80%93norepinephri...
[1] https://en.wikipedia.org/wiki/Norepinephrine_reuptake_inhibi...
[2] https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor
[3] https://en.wikipedia.org/wiki/Tricyclic_antidepressant
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712503/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253608/
Which was a literal lifesaver, because the first SSRI I took gave me severe stomach pains. I spent at least 2 hours every night spitting into the dorm room sink with the lights out.
Instead of quitting, I knew to ask for a different SSRI. I also knew to switch therapists when the first one just talked at me the whole time. I then got one who listened a lot at first, then started challenging things I said after we had some trust.
And one more helpful thing J knew: medication was like a crutch. And, despite that usually being a negative metaphor, I saw it as a positive. If you break your leg, you use a crutch while it heals. Your treatment should be the crutch (meds) and therapy. The therapy works better when you can think better.
I ended up not needing my meds anymore. I still have overall flattened affect and bouts of depression, but I can deal with them. To torture the metaphor, it's like having a slight limp from the broken leg. I'll never be "back to normal" but still find life worth living.
One thing to watch out for with Prozac is diminishing sensitivity in the nether regions, that's probably the biggest reason I tried a few others and transitioned to another medication.
It's not accurate to say that it's "incredibly rare". Most people can expect at least some dosage adjustments, if not a few trials of different medications.
However, most people will see some improvements from any antidepressant treatment, even if it's not full remission. Getting to full remission is the challenge that requires fine-tuning.
Practically speaking, antidepressant medication shouldn't be viewed as a one-stop solution to depression treatment. It should be used as a larger treatment regimen involving therapy (ideally professional, but even self-directed with books is helpful) and lifestyle changes to identify and address the source of the problems.
As such, even a minor boost from an antidepressant can help move a person in the right direction, even if it isn't a one-stop cure for the depression. We need to collectively get past this idea that antidepressants are an all-or-nothing cure all and start viewing them as an adjunct to getting back on your feet and staying there.
¯\_(ツ)_/¯
Both my psych and GP said it generally takes at least three different medications to find one that's effective for someone.
Depression and anxiety are nasty. I was surprised to learn they are symptoms of parasites. They've evolved in such a way that they can manipulate the host into craving foods that are beneficial for them (not for the host). Symptoms among others include anxiety, depression and irritability.
Do you mean to say you had depression for a few months (with anxiety on top) ?
The liver flush I did involved a morning celery and lemon juice. 5 light meals. 1L of apple juice spread throughout the day. After dinner a glass of water with epsom salts (tastes like pool water but has epic muscle relaxing effects so amazing sleeps) and psylium husk. On day six involves some more epsom salts, then drinking half a glass of olive oil with lemon juice. There's more to it but you can find this protocol pretty easily. Its quite common to pass a lot of stones in stool the next day which is old bile that has been hardened after being purged from the liver. It's important to check you don't have gall stones before doing the liver flush. An ultrasound will tell.
In terms of parasites I cant say 100% but combantrin works on 4 main types (mostly parasitic worms) [1]. There's also liver flukes which seemed to be explain some symptoms.
[1] https://en.wikipedia.org/wiki/Pyrantel
https://www.mayoclinic.org/diseases-conditions/gallstones/ex...
It wasn't until the late 1800s that the miasma theory of disease was overturned in acceptance by germ theory. At some point in the next century, computers will become powerful enough to closely simulate the entire human body. We'll be able to hook up our bodies and compare them to a common model in a sort of "debugging" process. I think what we'll find is a diverse host of viruses and parasites, or other curable abnormalities that are responsible for mental health problems.
The GP I saw suggested Lexapro which I’ve taken before and it’s not for me. I told him the problem had a strong correlation to food; if I fasted I didn’t get these thoughts. Doctors look at you weird when you say you think asparagus is driving you mad. He just sort of ignored me, I think the fact I saw him right after the pandemic hit just made him assume I was depressed and anxious because of the lockdown.
The really crazy thing to me is that Nexium has basically made the problem go away (Prilosec worked but wasn’t quite as good) I saw a GI specialist and he showed me the low FODMAP elimination diet and suggested I eat low FODMAP foods and that has helped it the rest of the way. So crazy how much our gut can affect our mood and psychological profile.
https://www.sciencemag.org/news/2019/05/gut-bacteria-may-con...
https://www.psychologytoday.com/us/blog/balanced/201903/schi...
Sounds like you have some enzyme defect. Do you know any specifics?
Prior to allergy testing I got really obsessed and into probiotics, lifehacking etc just to make myself feel better and I feel like nothing really helped my GI problems which always feel like they're sapping the energy out of my entire body. Turns out a huge portion of my problems were food allergies.
I haven't gone full FODMAPS but I eat much more keto/paleo nowadays when I can (I've been loose since quarantine) and feel so much better when I do. Meat and lettuce is my prime meal now.
IIRC it was either stupid cheap or covered by insurance. I was a little annoyed my parents didn't take me in when I was younger for it.
It was completely hassle-free and maybe 30 minutes.
Now when I eat pizza with tomato sauce and start scratching my arms and my mouth is burnt and my stomach is destroyed and I have wild brain fog for 3 days I finally know why! Not sure how I never equated it before, I always thought it was the bread and never got gluten tested (could still contribute, but I'm not going through that test).
This is a dogs results but my results looked similar, I just had a food section; https://i.servimg.com/u/f11/18/49/47/07/kyeall11.jpg
https://www.kallyope.com/
This is anything but crazy. It has been well known for a very long time and is very well supported.
This to me hints at the effect of Prozac possibly being far more complex than “chemical imbalance”. I’ve never found that terminology that useful. Fixing my depression required a lot of chemical changes yes, but also major changes in my voluntary behavior. All of it was connected in an intricate tapestry and Prozac only plays one part. If I tapered off Prozac, I suspect I would still be happy, but I don’t know that my depression would have ever resolved properly without Prozac. The side effects are mild so I am in no rush to discontinue.
Those who do take it seriously but are not strong enough to bear, end up joining cults.
I've had times in my life when I certainly didn't constantly distract myself, and being of a contemplative type, sometimes also delved into existential thoughts. But I didn't automatically (or generally) feel angst about it.
I'm not religious and haven't been since I was 15 or so. (I don't deny possibly having something of a mildly spiritual side, but I consider that different as it doesn't require belief in anything other than various kinds of feelings and experiences being part of the human experience. It also doesn't provide an externally assigned meaning.)
In times when my mental health and wellbeing have generally been worse, existential questions have also become much more distressing.
So yeah, maybe for some or even many people, existential questions may amount to angst, but in my experience it has depended a lot more on my other emotional and psychological state.
The realization that thoughts think themselves was one of the most profound moments of my life.
Identification with your thoughts is a recipe for unhappiness.
An evil pharma company recently got their version of allopregnanolone approved to treat postpartum depression. Cost of treatment: $34,000. It's cheaper to go upstream: progesterone, pregnenolone, or figure out why the body is having trouble making pregnenolone from cholesterol... Vitamin A? Thyroid?
One theory of why women experience postpartum depression is that their progesterone levels "fall off a cliff" after they give birth. In theory supplementing progesterone would help postpartum depression better than allopregnanolone. No one can afford to do that study because there'd be no pay off, as all the important patents have expired.
[0] https://en.wikipedia.org/wiki/Allopregnanolone
[1] https://scholar.google.com/scholar?q=allopregnanolone+fluoxe...
[2] https://en.wikipedia.org/wiki/Gamma-Aminobutyric_acid
I was always sad, and saw little meaning in my life, or in life at all, really. I cried lot. I frequently fantasised about killing myself, though I never got close to actually doing so.
I never talked about the way I felt. I felt ashamed, and I felt that people wouldn't understand - I've often heard "normal" people talk of how depressed people should "man up" or "get over it". Over the years, I got very good at hiding my true feelings. AFAIK, nobody ever guessed.
Maybe 5 years ago I started taking 5-HTP, which I believe has an SSRI effect (but one that is more short lived than pharmaceutical SSRIs). I actually started taking it for another reason (neuropathic pain, which has of course not helped with depression!), as I'd never considered treating the way I felt with chemicals, but within a few weeks the difference in me was incredible - I realised I hadn't cried in a while, and hadn't felt the immense lows that I felt every couple of weeks or so.
I still take 200mg twice a day, and get immense benefit from it - it's not a cure by a long shot, but after a lifetime of feeling miserable, the change is amazing. I seldom cry for no reason, and I rarely experience extreme lows (and when I do, they are less severe and shorter lived).
More recently I also started taking ketamine for my neuropathic pain, but it's actually further enhanced the anti-depressive actions.
I've tried SNRIs and SSRIs for my neuropathic pain, but am unable to tolerable them. If anyone else is in the same position, I'd very strongly recommend reading about 5-HTP and thinking about trying it. If you've tried SSRIs and they've failed for you, then it might be worth looking into ketamine (though I realise that may not be an option depending on where you live).
ADD drugs obviously get abused and so I think they get a bad reputation and, for sure, can be dangerous and have side effects.
Same goes for pain medication. For real, genuine, chronic pain sufferers Oxycontin and the others are life changing. However, the drugs also get abused and are addicting so the real benefits can get masked.
The last thing i'll say is it takes a disciplined prescriber when dealing with these kinds of drugs. As software engineers, I'm sure we're all guilty of just throwing code at a problem. Many prescribers are guilty of just throwing Adderall at a problem or throwing Oxycontin at a problem without really understanding the root issue.
This hits home and almost moved me to tears. I went through a trauma about 3 years ago, I was Kidnapped/abducted from a gas station at gun point and was forced to drive my attacker for nearly 30 minutes at gun point under threat of death before opening the door and diving out of my moving vehicle to escape. During that experience I considered purposely crashing my car believing it would kill both me and my attacker, but I wanted to live and ultimately took my chances diving onto the street from the moving car knowing I might get run over.
I can’t explain it other than I know I should have been thankful/grateful/happy I escaped with my life, but I knew immediately the trauma was real and sure enough it has been a downward spiral of cutting off every single relationship in my life and extreme isolation/avoidance. I’ve sought help/treatment (both therapy and meds) to no real benefit.
Even 3 years later I have to relieve the trauma because I’m suing the gas station for negligent security (turns out the guy had been loitering at the gas station for 2 hours prior to targeting me, even hanging out in the store talking to employees without ever making a purchase). The insurance attorneys are victimizing next worse than my kidnapper, they have destroyed the surveillance video, Claimed the kidnapping didn’t happen on their property (when I was literally approached while at the gas pumps), and telling me my damages aren’t real. This goes directly to your point, if I were shot they would have settled the policy limit ($2M) but because it’s not visible damages they are doing everything to claim it didn’t happen on their property, if it did they aren’t liable, and if they are liable the damages aren’t real but self inflicted. They either have no clue what kind of additional trauma they are causing or they actually do and are trying to cause me self harm so this goes away for them.
I humbly admit while I always felt for people who went through traumas (soldiers, child abuse, sexual abuse) I realize now I was incapable of actually empathizing...I won’t say I have suicidal ideations, but I often feel I’d have been better off not surviving.
In the US police have no duty to prevent crime, also the gas station is private property not public and police are not considered public security. In short just like slip and fall cases in The US, businesses owe a duty to invitees to remove foreseeable dangers such as a slippery surface (in the case of a slip and fall) or a suspicious person loitering on premises for 2 hours. They also owed a duty to preserve the video evidence but they destroyed that as well.
I have a hard time believing in Poland a business might allow a rapist to just hang out on the property and identify potential victims all while a security guard is standing by that does nothing. That said laws wildly vary from jurisdiction to jurisdiction
Mental health, and any issues you have with it, are a hitch in that system. But to assume that you can fix is by only affecting one part(the internal understanding of the world) seems flawed for me. Same can be said, like in the article, of only fixing the outside understanding of the world (chemical changes).
So let me add my voice to your message, don't lose hope! We are a ball of walnuty textured jelly that tracks changes between the inside view of the world with the outside input of the world using lightning and chemicals. Its complex, hard, and the fault surface is huge.
Keep going, try new solutions, find someone one who helps you build the solution for you. But please, _try_.
For the sake of this, I post about it online on occasion when the topic comes up -- an SNRI, Effexor XR, was life-changing for me, too. I suffered from crippling anxiety; my therapist diagnosed me with generalised anxiety, social anxiety, and major depressive disorders. Cognitive-behavioural therapy helped me live me life instead of letting it be controlled by these issues, but the issues were still there, and quite intense. There were some nights it just totally overwhelmed me. On Effexor XR, that never happens. Anxiety and depression are not only no longer constantly looming over me, but they are completely gone.
However, the first thing I tried was citalopram, an SSRI. It mostly got rid of them too, but I never felt quite like 'myself'. I felt like a zombie and like a bit of my soul had been taken out. Plus it wasn't entirely effective like Effexor.
(For what it's worth -- diet, exercise, and so on were tried too. No benefit to my mental health. I've also given more time than they're worth to various supplements that people report as helping their own issues.)
I took one of the offshoots of Prozac for three months and it took my suicidal thoughts to a whole new level. For me it's all about therapy. A lot of what I'm facing is less about hormones and more about emotional trauma, so these pills are trying to fix the wrong thing. It's like fixing your breaks when the engine doesn't start. Sure, they are both parts of a car, but they couldn't be doing more different jobs.
My experience with therapy has been really eye opening. I think everyone can benefit from some form of therapy. I think the world would be a much better place if people were able to feel their emotions, explore them with curiosity, and learn from them.
Lastly, take care of yourself, friends. If you're not feeling well, please talk to a professional. They can help you.
My personal opinion having talked to doctors, therapists, and other depression sufferers is that the medical industry's treatment of depression is basically just throwing darts and hoping. They only kinda have a rough idea of how to treat some of the symptoms of depression and care not for any potential underlying causes. The "chemical imbalance" language, in my considered opinion, really does enforce this world view that depression is something you just throw drugs at until you're fixed, and I don't think that's helpful.
I don't think anybody considers this ideal, but many consider it preferable to no ability to treat at all. A world in which a deeper understanding of fundamentals enabled full treatment would be best for everyone.
It's not like nobody is trying! But setting a bone doesn't require a deep understanding of how bone knitting happens, and therefore comes well before.
While I do believe our understanding of how the brain functions still has a long way to go, which includes treatments for mental illness, there is something to be said about acknowledging more the external factors of our modern day lives that fill us with so many problems.
Personally, realizing where I have "disconnected" from people, values, and truly human experiences has been a large step forward in improving my mental health. I hope it's something that others who feel so many emotional challenges can try as well to see if they can make progress with their own mental health.
> There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’.
The Lost Connections book, which I read a few years ago, really helped hit this home for me. Totally made me reconsider my view of depression and treatment.
I agree that, often, these disorders are a product of environment, along with economic, social and material conditions. However, medications can and do improve the quality of life for people who cannot change those conditions due to their station in life.
In solid state physics, where reductionism is definitely a powerful and useful tool, the following article seems to be interesting. It's a possible reminder of what you maybe can and can't get from reductionism. https://science.sciencemag.org/content/177/4047/393
No clue how much of that (if any) might apply to psychology.
Are lifetime outcomes really better on all these Drugs? Maybe after you already created drug addictions, a different drug would help.
Prior to drug use, I imagine therapy, monetary support, education, etc... Would all be better than 2020s brand name Adderall.
However, in the real world many people are resistant to the idea of therapy and/or medication as it feels like admitting defeat. Or perhaps they've read cherry-picked horror stories of bad therapists or medication side effects on the internet.
Giving people the "chemical imbalance" narrative is a way to short-circuit many of those internal objections. It gives people a notion that the depression isn't their fault, but rather they are a victim of a chemical change in their body not unlike getting the flu or having low testosterone levels.
In terms of getting people to accept treatment, it's a win. Getting past the ego can be surprisingly hard, but the idea that we're treating chemicals instead of treating the person is a clever trick to sidestep that obstacle and shortcut to the treatment.
In terms of giving people the tools to address their problems, it's not so clear. The more we reinforce the idea that depression is simply chemicals in the brain, the longer it takes for people to realize that they do have some power to influence their thought processes and voluntarily replace negative thought processes with positive ones.
However, it's important to remember what a typical course of treatment looks like. If someone is suffering from depression, getting them to commit to weekly therapy sessions with another person as well as following up with the therapy homework (that is, actually implementing what was discussed at therapy) can be a difficult proposition. Getting someone to stop by the pharmacy on the their way home and spend 10 seconds taking a pill every morning for the next 30 days is an easier proposition. The medication is often the jolt that gets people into a place where they're receptive to therapy, or they start making life changes to improve their depression. It's a quick and easy way to give people space to solve their problems, which is why the "chemical imbalance" sales pitch has become the entry point to getting people on board with treating their depression. Get them to lower their guard, get them started on the easiest treatment, and then work on scaling the treatment up to a more intensive, longer-term plan after they've seen hints of success.
I don't particularly like the "chemical imbalance" sales pitch either, but it really does function as a decent hook for getting people over their objections to starting treatment.
It's amazing how mainstream the anti-psychiatry movement has become. Please ignore it and focus on the modern science. The attempts to dismiss modern science with questionable historical references is non sequitur.
> But then again, even insiders like Jordan Peterson will “accept treatment” that nearly kills them.
Jordan Peterson is not an insider. He's not even a good representative of the industry. Please don't interpret anything he says or does as representative of the field. He's a social media star, not a recognized expert.
This is hugely compounded by the fact that even when people do decide to go for treatment like therapy, they discover that its painfully inaccessible. As in, if you don't have enough money to afford the 100$+ hour sessions, you feel like you completely run out of options.
There are more services trying to address this cost issue but from my experience (in Canada), they leave a lot to be desired
Depression is notorious for making people assume the worst. Many depressed people will assume therapy is inaccessible or too costly without even checking. I would encourage everyone to at least take a few minutes to look it up or call their insurance.
For example, I've walked several people through the process of finding a therapist, checking with their insurance, and scheduling appointments to get them started in the past few years (United States, corporate insurance). For most of them, therapy visits were billed with a $20 copay with a limit of 24 visits per year, which is more than accessible.
However, even if it's not, it's important to put the costs in perspective. How much would you pay for a magic pill that improved your problems? Does $1000/year sound worth it? That's 10 x $100 therapy sessions.
If professional therapy is out of reach, self-directed CBT using books or self-help resources have been shown to be effective as well. Not as fast or effective as professionally-guided therapy, but certainly a worthwhile starting point.
My purpose isn't to re-litigate gun control as an issue, but to point out that our policies and laws reflect our attitudes about mental health directly on access to things which are enshrined as fundamental rights in the US, already. It's a perfectly reasonable supposition to say: "I don't want truly crazy people to have guns.", it's another to say "I think it's acceptable to strip Constitutional rights from millions of Americans because they once had in-patient treatment as a child for their anxiety."
The latter is a matter of policy (regardless of how well it's actually enforced) simply due to the fact we don't understand the human mind or psychology enough to actually draw an objective distinction between those two types of people. Laws and systems work poorly with things which require subjective determination. "I'll know it when I see it" might be an acceptable type of thing to adjudicate, but it's a terrible type of thing to build bureaucratic processes around that are faceless, soulless, with no recourse.
This is just one of many examples where having any history of seeking treatment for mental health can be a disqualifier, or worse strip you of your rights. It's an effective disqualifier for many types of jobs as well in the US, especially government jobs which require a clearance or working at any company which accepts government contracts which would require a clearance.
Or, you know, it's a lot of time and money being spent on something that the medical industry has very little success in dealing with.
We're very caught up in naturalistic thinking. Speaking of a soul or the mind is frivolous at best, and superstitious at worst. But look where this way of thinking has brought us.
The brain and the heart are two different organs. But while we can use science to gain an understanding of the brain, the mind is understood by philosophy and religion.
Case in point, I once asked a friend of mine if he could prove that he loved his wife. He said if he were able to freeze time, and gain knowledge of every synapse, every chemical reaction, every electrical potential -- he could definitively prove that he loved his wife, and she loved him.
"When you get home," I responded, "remember to duck when you tell your wife you want to go have her brain scanned to prove she loves you."
Oh, another aphorism that's always stuck with me is "the difference between 'crazy' and 'eccentric' is a million dollars."
But yes I think its possible all of the things you're talking about put together. The long term effects of the extreme wealth gap are so broad they're difficult to even take a survey of. But at the same time, we're becoming more open about mental health issues and acknowledging them as legitimate problems so reporting in accepting, progressive communities is going to make it seem like there are more.
Something really slimy about pivoting from human suffering to your pet critique of society & insisting that the only worthwhile course of action is your political agenda.
Their stories are not mine to tell. I've managed to squeak by with just a scoche of "on the spectrum," myself, so I am quite grateful, but I have watched (often in horror), as people have spiraled down.
People suffering from mental illness can often be impossible to help; regardless of how much we want to assist. They need to initiate and maintain their treatment.
There's so much societal "baggage," here. Mentally ill folks can often be profoundly unattractive, and it can be difficult to have empathy for them, or get support for them.
I remember once, walking down the street in the Union Square district of SF, on a business trip. As folks know, SF has a big homeless population, that is growing. We stepped around an obviously mentally ill man, and one of my employees shouted "Get a job!".
Would it were that simple, but his attitude is quite common.
But when treatment works, it can be absolutely miraculous, and worth every second of the pain.
We can write and read articles like this all day. But if Rx advertisers can create new, stupid ideas in commercials faster than we can dispel them, then there's no use.
And this is why I don’t like elitists telling me what I should or shouldn’t say.
> Psychiatric research doesn’t support the notion of simple cause and effect in mental health, instead uncovering a far more complex and indeterminate picture of vulnerabilities. There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’.
I wholeheartedly agree with this, and believe that it's a huge problem with the mental health discourse. However, the author then goes on to say:
> Mental health treatment needs to re-engage with the language of persons. This means suspending the detached, third-person stance toward patients, and attending to their actual experience and circumstances. And it means encouraging patients themselves to avoid this stance and draw on the normal ways that people make sense of their emotions and actions.
A problem I've experienced is that "the normal ways that people make sense of their emotions and actions" do not seem to work for me. I haven't found a good description of it, but something in my sensory and cognitive feedback loop seems to be broken such that I don't get any useful sense of things in the moment and need to reverse-engineer my emotional state after the fact when it seems important to do so (NB: I don't just mean that this disconnect occurs when there's some kind of intense moment; it's pretty much constant). So I don't see how it's possible to both hold that up as the standard and also respect my "actual experience and circumstances". In other words, this sure seems like exactly the sort of one-dimensional theory of mental illness that the author decried earlier.
Personally having experienced depression myself and knowing many others who have experienced it, I’m of the opinion that a lot of mental issues are either symptoms of some other condition (like diarrhea or coughing) or the result of learned behavior / maladaptive coping mechanisms. Or simply us treating emotional states or personalities that aren’t socially acceptable as illnesses (of course this doesn’t include things like psychosis, nor is it meant to diminish how serious depression and anxiety can be). That’s a bit uncomfortable for the existing mental health complex though
I've been looking at other people only to see how happy they are and how content they with their life. They feel motivated, want something from life and in generally think that being alive is alright, which I just couldn't internalize no matter how hard I tried.
Essentially, I've come to the conclusion that there _must_ be something wrong with my neurotransmitters that I just can't be happy as fellow friends around me.
Many doctor appointments, many different prescriptions.
Antidepressants did their job and I started to care less about what's going on, but they didn't make me any happier. They just made me less miserable. On the other side, I've started to see the world through some kind of fog, which blocked most of my previous perception. My long-term memory started to degradate.
Now, after many years of taking various SSRIs I'm beginning to realize, that there's nothing wrong with my brain.
That's perhaps who I am, maybe either percepting more than many people around or just more sensetive and therefore reacting stronger even on slightest stimulus in a much stronger ways. I have opinions and thougts on a topics that many do not even care about.
So instead of supressing thoughts and emotions I must accept them as they are.
I am depressive and pessimistic by nature, too. I have accepted that. But I have to fix the extremes because otherwise I simply can't function.
Different drugs can literally make you feel and think like a different person.
The only problem is side effects and tolerance, you can't go on on drugs for very long. They can be invaluable for building different habits, though.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4502590/
Gabapentin works really well for me, though I have to stop taking it for a week every month, so that's 2-3 days of insomnia and nightmares. Technically I'm not supposed to, but then I'd have to increase the dosage to what I consider unacceptable levels. Tapering off also works, though.
CBD/THC (only with a low dose of alcohol) also works well, but I don't like the side effects (lower mental acuity, plus my already bad attention goes rock bottom), so it's more of an occasional thing.
Doctors are really inflexible in what they can give me, so I have to make do. SSRI's just don't work on me, except for imipramine, but that's really temporary.
And out of 100 friends, if 5-10 post something cool it’s easy to overlook that the other 90-95 didn’t.
fB is but an example. These effects happen more or less with everything.
I’ve rebelled against this for a long time. I post happy things here and there but since my life isn’t particularly happy, I post the more upsetting things more frequently and express those feelings in real life. I like to think I’m adding balance but I know I’m just being ignored because the culture doesn’t like to hear about suffering.
Yeah, because it’s bloody depressing.
You get what your mind focuses on and if people actively look for depressing topics it’s no wonder they’re all doom and gloom.
That’s why people don’t want to hear it - because it affects your psychology.
I will actively run from people who lead negative lives, that complain about things but never lift a finger to make anything better. I refuse to be sucked into their pits of despair because I know there is good in the world, and I want to be part of that, focus my mind and attention and energy on leaving things slightly better than when I found it.
I will try to help ppl where I can but the truth is a lot of people are lazy and don’t want to change. So I leave them with my thoughts and know that I have done my piece.
I’m not saying this is directly attributable to your experience, simply relaying the way I feel to give you insight into perhaps a different mindset and way of seeing things.
And being a pessimist is not a problem that should be medicated. The world needs us!!
I ask because your description sounds spot on for how I have felt throughout life. The 'fog', lack of motivation, and sensitivity to even the slightest stimulus especially ring true. When I first took medication for ADD, I felt like I had been driving through a downpour my whole life and finally discovered the window-wipers - the storm didn't stop, but I could finally look forward and see my goals and desires clearly. Every few weeks I try to do a reset and test how I feel without medication and I definitely still feel that 'fog' that you mention. I would say my fog is more like being in a lightning storm, because I feel the constant 'patter' of thoughts hitting my subconscious (for lack of a better word), but the occasional lightning strike will pull my attention completely away from everything else momentarily.
If you want to learn more, I highly recommend looking through the ADHD subreddit[0] - especially the sidebar material.
[0] https://old.reddit.com/r/ADHD/
There's so much more to ADHD than that though. I'm smart enough that I never struggled academically, and wasn't hyperactive enough to cause significant enough disruption in the classroom, so externally it was never picked up that I might have ADHD. But now that I'm aware of it, I've come to realise how significant of an impact it's had in my life, all the self-destructive and self-sabotaging behaviour, the instability of my relationships, the abuse of drugs and alcohol, the lack of internal motivation, emotional hypersensitivity, a lack of emotional and object permanence, and more. I could go on for days (and have) about the less obvious effects and symptoms of ADHD.
The concept of "hyperfocus" as a symptom of ADHD is relatively recent idea. It didn't appear in any medical literature for a long time. The first appearance I could find was in some author's book about ADHD, which wasn't even targeted at medical professionals.
It might be a symptom for some people, but misinterpreting it as a symptom of ADHD leaves the door wide open for misdiagnosis and over-diagnosis. When we start diagnosis a disorder notorious of lack of attention in people who demonstrate an abundance of attention, there's a problem.
The pop-psychology definition of ADHD is so broad that it's rare to find an HN commenter who hasn't self-diagnosed as maybe having ADHD at some point in their lives.
As you said, pathological ADHD (as diagnosed by a medical professional) can have a severe impact on people's lives. It's best that we leave the diagnosis to professionals and not give people the impression that the regular ups and downs of focus (studying/focus/mental endurance is work for everyone) are indicators of a mental health disorder.
https://news.ycombinator.com/item?id=23821855
Hyperfocus is a symptom of ADHD, ASD, and schizophrenia [1]. So a person who experiences hyperfocus may be experiencing one or more of those conditions. (Although, when I say "symptom", not necessarily a diagnostic one – conditions can have both diagnostic symptoms, which form part of the diagnostic criteria, and non-diagnostic symptoms, which don't, but nonetheless have been commonly observed clinically and/or in research in those formally diagnosed.)
Since it is possible to have subclinical manifestations of psychiatric diagnoses, a person who experiences hyperfocus without meeting the diagnostic criteria for any of these diagnoses may have such a subclinical manifestation of one or more of them. The formal name for subclinical ASD is "Broad Autism Phenotype" (BAP) [2]; I don't think subclinical ADHD [3] or subclinical schizophrenia [4] have distinctive names, but both have been researched. (A lot of people who incorrectly self-diagnose themselves as having X despite not actually meeting the diagnostic criteria, may in fact be correctly identifying the existence of subclinical traits of X in themselves.)
[1] https://pubmed.ncbi.nlm.nih.gov/31541305/
[2] e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949081/
[3] https://www.sciencedirect.com/science/article/abs/pii/S01918...
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2547346/
Inattention in ADHD has always been the lack of ability to appropriately direct attention, not the absence of attention to anything.
While “hyperfocus” by name is a fairly recent association, at least as far back as the DSM III-R ADHD has included both tendency to be easily distracted by extraneous stimuli (inability to maintain appropriate attention) and that of not having attention drawn by stimulus that should draw it (appearing not to listen.)
Hyperfocus is simply the latter.
The article is right that "chemical imbalance" is a myth as there's no sort of blood tests or normative chemical ranges for any of these mental conditions that people get diagnosed because they are outside of. A quick Google search would show there's no scientific support for chemical imbalance theory, just some pills that affect brain chemicals that people report depression improvement on self-reported survey so a huge, unscientific leap is made that depression is some chemical shortage in the brain. All the psychiatrist diagnoses are basically glorified personality tests, and the criteria are based on the DSM-5 which was made closed door and with heavy influence from pharmaceutical company lobbying.
Mental health is probably one of the most complex aspects of health, things like placebo have a huge impact, it's hard to study, and there's huge bias introduced by a for-profit pharmaceutical industry that pushes treatments to pills.
The field of psychiatry is not that scientific, it's not so long ago it was forcing people into lobotomies and I see the unscientific rush to diagnose everyone into these boxes of depression and ADHD as a similar gaffe that will be looked back on poorly.
I am diagnosed with GAD, ADHD, and bipolar type 1 and I'm doing MUCH better since I went against-medical-advice and quit all meds. For bipolar disorder/anxiety, meditation, yoga, exercise, sobriety, journaling are my key treatments. Mindfulness is key, but not the Hacker News McMindfulness variety where you try to emulate a celebrity monk from Tibet so you can reach Zen all so you can write more code for your startup.
For ADHD, meditation, techniques like pomodoro, and most importantly, just accepting that maybe it's better to achieve less peak productivity than take prescription amphetamines.
I just wanted to provide some counter-perspective as someone who's followed advice like yours much to my detriment.
I recently did a ~7 day liquid elemental diet [0], followed by a 3 day fast, and at the end of the fast I was more mentally acute and more lucid or "present" than I have ever felt in my life.
The results were far better than any medication or treatment I've ever tried. Unfortunately, re-feeding brought me back to the same state I've known for all of my life.
[0] - https://www.siboinfo.com/uploads/5/4/8/4/5484269/homemade_el...
Meditation and yoga do nothing for me. Seeing a counsellor has been good though, and I think that its something that everybody should do, regardless of neurotype or how well they appear to be functioning in life.
I've seen it first hand. Child is beautiful and active and happy and sad and angry and living and the Mother just can't handle it and BAM - drugs.
Child grows up, becomes a teenager. Prescription drugs stop. Teenage moves to Methamphetamine, start cooking. Eventually is busted and jailed.
The connection, for me, is clear.
I feel very very lucky that I grew up before the ADHD diagnosis was a thing as I could have easily been that child.
It's unfortunate that it's often the case that psychiatric help is only sought for "problem children", who negatively impact those around them. These are the kids that get "easily distracted and distracts others" on all their report cards.
Well behaved children with ADHD (generally those with inattentive-type) tend to have their poor academic performance written off as laziness or stupidity. Their report cards tend to say "has great potential, if only he would apply himself"
Unfortunately, it's common just to give kids some pills to settle them down, especially when therapy is expensive or resource limited, without helping them learn healthy coping mechanisms and management strategies.
Often as they grow older, they become less hyperactive, which leads to the belief that they've "grown out" of their ADHD. There's a common misconception (even amongst doctors) that ADHD is a children's disease, when in fact up to 2/3 of children with ADHD carry it through to adulthood. I have friends who went to their GP and were straight up told that they couldn't have ADHD as they're adults.
Therapy should be the first-line strategy for treating children with ADHD, with medication being an alternative or supplemental treatment. Otherwise you end up with adults who never learned healthy management strategies as children, as the medication suppressed the need to learn them. Then as they "grow out" of their ADHD, they're taken off medication and are unable to function as effective members of society.
Treatment of ADHD without medication needs action accommodations from the school, teachers, friends, boy scouts and parents. And it‘s not possible for every parent and every school.
If you feel emotionally numb because of the stimulants your dose is probably too high and it should be adjusted.
But I agree with you. The treatment can‘t be just a pill. It needs at least to be a pill and education for the involved parties. And especially education for the patient. So they can adjust their treatment and lifestyle according to their needs.
I agree that we should be focusing more in individualized treatment and not attempting to adjust everyone to some averaged version of 'normal'. Tbh, if I could find a way to live comfortably in a profession that I enjoyed, which didn't also require 'neurotypical' focus, I would drop the medication as well. I do enjoy being able to focus on things which would normally be near impossible for me otherwise, but I certainly feel less creative and mentally adroit when medicated. It's a difficult trade-off at times, but in my current circumstances, it's one I simply have to make, as nothing else works(including meditation, pomodoro, etc.).
In any case, it makes me happy to hear that you have found a solution that works for you.
Have you read about sensory processing sensitivity/highly sensitive people?
https://taaalk.co/t/discussing-eating-disorders
https://taaalk.co/t/exploring-obsessive-compulsive-disorder
Would you like to do one to see if anything comes up? Kind of a public anonymous therapy session...
https://taaalk.co/t/invite/what-s-going-on-with-dukha, invite code: 314798825
(If anyone else is interested my email is in my profile)
-Fred Rogers
Personally I would absolutely consider persistent misery, or experiencing extreme sadness over minor things, to be a clear proof that there is something wrong with my brain. Whether I treat that with therapy or medication, I think that is very much worth treating, and definitely not worth simply accepting.
I think you are making the assumption that it is treatable, or that the treatment advantages outweigh the disadvantages, which is not always the case.
I think there is a general over-subscription to the idea that everything can be treated or optimized. Some diseases are incurable and sometimes a personal optimal is still poor compared to average.
Some people (normal people if you will) just don't think too much about things. Even when they sometimes go on to make terrible choices for themselves, and others, they might regret it, they might have negative thoughts about it, but they don't become depressed. They are not inclined to ruminating hours on end about their mistakes, so the negative thoughts dissipate over time, they effectively move on.
But if your personality, or brain, or whatever, is made in such a way that you like to think a lot about what could have been, or could be, or how to behave, or what others think of you, any kind of negative thought you might have will stay around, eventually leading to (symptoms of) depression.
So I think you're right when you say that depression is not what's wrong with you. You might just be one of those people that are good at thinking. Perhaps sometimes a little too good at thinking, a little too sensitive. Being sensitive and good at thinking is not be a bad thing at all, but spending too much time having negative thoughts may be what leads to depression.
If this is the case, realizing that you have a choice, in what to think about, is an important step on improving the quality of life, perhaps even learning to life with, or overcome some of the symptoms of anxiety and depression. Accept the negative thoughts, they are just natural thoughts after all, but choose not to dwell on them, let them pass and move on to the next thought, it might be a positive one.
You may also find some inspiration in metacognitive therapy (https://en.wikipedia.org/wiki/Metacognitive_therapy).
For the most part this is good, but of course, not all memories are created equal. Sometimes this process of forming connections reminds me of a painful event, something I'd rather not think about.
At first it was frustrating when these memories surfaced repeatedly. I'd dwell on some embarassing thing I'd done, or some painful thing a friend had said to me, which they maybe didn't realize I'd taken so hard. It was tempting to analyze these events to death, and have silent conversations with these figments, as though I could go back and phrase it differently, or change my actions, and perhaps it would have gone better.
Eventually, however, I realized that these mental tasks were not productive. The event, the "danger" had already passed. So now, whenever I realize my mind is about to go down that path, when suddenly I am reminded of a painful event, we pause, my brain and I. "Do we really need to go down this road again? We know where it leads. Let's not."
And so we don't. We reach once again into the stream of thought, allow ourselves to dwell on some happier moment, and in time, that old memory fades and we're off on a different adventure.
I know it's not an illusion because I very rapidly become dour & flat when I let my diet or exercise slip.
For instance, find a therapist to talk with. Don't feel like you need to settle for the first one you find, find one that feels right to you. It could be that there are deep rooted thoughts or emotions that actually are unhealthy that you may want to get to the bottom of. The goal here isn't change, it's understanding... and through understanding, determine if there's anything you'd like to change or even embrace. For example, I tend to focus on the negatives and everything wrong with the world. I realized I picked these behaviors up from my mother which not only allows me to be more aware of my behavior, but also helps me gently guide conversations with her away from being so negative and help her find positive things in her life.
Psychedelics often come up in these conversations, as well. I know many people whom see their experiences with psychedelics as turning points for them. There's plenty out research out there on the subject that I won't rehash here. If you choose to go down this route, I'd suggest doing your own research and if it seems like something you'd like to try do so in a safe place with one or more persons you feel safe around. Preferably, have an experienced "guide" there with you.
Lastly, I've been digging into the subject of gratitude for awhile now - both giving and receiving. There's a lot of research indicating it can be quite powerful. I tend to focus on the negative and everything that's wrong with the world (or my job, or my partner). Sometimes, just setting aside time to stop and think about something or someone you're grateful for (and especially communicating that) can do wonders. This isn't about not having or getting rid of pessimistic thoughts - it's about finding conscious space for appreciation, which can help balance things out or just help find some sparks of joy that might otherwise get drowned out by the negativity.
We're all on our own journey. Embrace who you are and try to take in the sights along the way.
But I do very often wonder if and what is the objective purpose of life, and having thought of it for a long time, I came to the conclusion that there are no such objective purpose.
The goal of life is entirely subjective, while the achievement/advancement of the goal is grounded in logic and hard work, the goal itself is not.
So a failure to transmit or receive sufficient chemical stimulus in the brain describes a failure of hardware that may or may not be correctable with drugs. Because we live in a culture of convenience it is common to misrepresent a difference of personality as a defect correctable with a drug, which may explain the drive to consume and abuse stimulants.
Some people, myself, literally enjoy working 80+ hours a weeks with less sleep and without preconditions, like increased compensation. Many people see that as bizarre and wonder where the increased energy and focus come from. It’s not a product of increased energy or focus, but really just a minor difference of personal interest and emotional concerns. Stimulants won’t buy you a necessary change of personal goals or the necessary continuous interest of where you value your time, and certainly won’t buy you enjoyment of working 80+ hours a week. Instead people tend to be most productive where they naturally find increased output due to personal interests whether that’s just from spending time with other people or reading literature.
That’s the difference personal interests (personality) make which is not any indication of defect. There is a famous quote: “Know thyself”. The reflection to that is know what you are not or rather don’t lie to yourself.
It seems that lots of very smart people take these drugs and I wonder how many are emotionally and spiritually stunted by them.
It's hard to come to any conclusions here, but it does seem like for me, the issue was at least partly chemical.
However, I'll say that a lot of why I got to a point where I could even make the dietary changes, was that I had done a lot of emotional and psychological work. The reason I was interested when I saw the vlog, and read the paper, and made the dietary changes, was that I had done a lot of work to learn to even care about myself.
For me, there has been a feedback loop--learning to care about myself has allowed me to discover tools to improve my brain chemistry, which in turn is now allowing me to care about myself better and do more for myself (and others). I don't think that just giving people the right food or medicines to fix their brain chemistry would work if they don't see themselves as worth making the life changes for.
[1] https://www.youtube.com/watch?v=UPi41bSrFdI
[2] https://www.davemacleod.com/blog/vlog15
[3] https://pubmed.ncbi.nlm.nih.gov/30254980/
For me I've found that my happiness is mostly a function of the community of people I'm surrounded with. This means having a solid group of friends and/or significant other. It's very tough to find this, especially in the U.S. when you're already an "adult" and didn't make many friends in your childhood/university years, but it is possible.
But that's just me, others don't need much social contact. Everyone is different. But for any software engineers like me who find that staring at a computer all day does little for their happiness, you are definitely not alone.