I periodically experience bouts of (what I call) depression, which I'd summarize as an intense anger that's oriented towards one's self. Paradoxically, it's very intense and at the same time it shuts me down. An analogy would be shoveling sand and cement into a drive train.
I won't get into the typical "how to fix it" part of this discourse, but I think it can be useful for people who have trouble sympathizing with people who experience depressive episodes to know what are some of the things that one experiences. I think it's also good for one experiencing these things to be able to reflect on what's happening, to, at the very least, get some distance.
So the episodes, in my case, have very clear "clinical" symptoms. Blood flow to the limbs is reduced severely, I'll often be on the verge of shivering with cold, similarly to what happens when you have a fever; motoric ability is severely reduced: you'll be tripping on things, dropping things; reaction time is severely reduced: for example, you're likely to not catch something that's thrown at you; appetite loss; glaring morbidity; difficulty sleeping; a strong, general feeling of discomfort in the body, a bit like recovering from a physical shock, like an automotive accident. For me, the thing lasts for 2 to 5 days, and happens every few weeks, rarely more than twice a month.
That's not to say medication doesn't have its place. It's that suggesting we eschew all other measures in favor of medication is ridiculous.
That's misleading. Lifestyle changes can have a significant positive effect, but that's also misleading, because you have to account for the often insurmountable inertia that old behaviors have.
Furthermore, the most reliable predictor of manic depression in later life is more than 2 traumatic experiences before age 7. I might be misquoting the figures slightly: it might be 3, not 2, or 10, not 7. However, the point I'm making is that in many cases saying that depression is caused by erroneous lifestyle is plain wrong.
I agree with you on medication, it has it's place, but it's hardly the end of the story. I personally don't take it, because I feel that my case is more suited to a different therapy, though I feel a bit silly about never having tried it. I think that one of the best things you can do is try a lot of things, to see what works for you.
It must be nice to know so much about everyone around you, without needing to actually obtain any facts at all.
Is it possible that changes to exercise, diet, time outdoors, or latitude of residence could help in some cases? Maybe.
Is there anywhere near enough data to attribute a "vast majority of cases" to these causes?
No.
I'm sure for some definition of the word illness it's true. But it's certainly not an illness in the way a cold or malaria or shingles or cystic fibrosis are illnesses. Those things can be objectively diagnosed. They entail physical measurable changes to a person's body.
Depression is a set of guidelines in a book that ask vague subjective questions about how someone perceives the world. And then if the person decides you have it you have it. If they don't you dont. This has very little to do with the first scenario.
I'm not trying to trivialize depression. I think it is very real and very serious. But I think the "illness" rehtoric is at best innacurate and at worst seriously misleading and distracting to people who have serious issues to deal with.
As someone who has been catatonically depressed for a couple years now, I'm not so sure about this! People with chronic pain also often can't identify any physical source, but obviously you would never start posting "is this really an illness though?" or "aren't we distracting and misleading people??" in a thread about that.
The undercurrent of your post is that depressed people need to snap out of it, and falling back on the "illness" label reduces personal responsibility. Trust me, many people feel like imposters claiming they have depression, despite being completely non-functional. Thanks but no thanks to this proposed contribution to the discourse.
Are you really here to understand, or is it just to judge? Want some MRIs and EKGs of depressed brains?
Please point to where I say that. I explicitly do not say that. That's not an undercurrent because I don't believe it.
I do also believe that people don't have zero agency in this problem. There is SOME ability and necessity for people to work on these types of problems. That's what therapy with a therapist is right?
And that does differentiate depression from tuberculosis which cannot ever be improved by sitting down and talking about it.
Maybe you, some random person on Hacker News, are not in fact smarter than the medical consensus?
The idea that I'm not coddling your victimhood/ helpless mentality is offensive to you, not any specific argument I'm making.
But sure, let me actually respond to you:
* At no point have you acknowledged or shown any awareness that depression is not "one thing". Like how people discuss "curing cancer" as if that's any sort of meaningful statement. How complex do you think depression is? What point of complexity does something need to reach before you defer to experts? Depression is still more or less a black box (watch the Sapolsky video I linked or look up some starslatecodex articles on ketamine.) Again, no sign of awareness of this on your part, which suggests you haven't done the most basic research.
* Yep, you never said there are no biomarkers. You said:
> Depression is a set of guidelines in a book that ask vague subjective questions about how someone perceives the world. And then if the person decides you have it you have it. If they don't you dont. This has very little to do with the first scenario."
This was your reason for stating that depression wasn't an illness. That it was based on a list of subjective questions. Sadly you didn't respond to the person saying that this was equally true for schizophrenia. Is schizophrenia an illness?
* I said it was an undercurrent, meaning subtext. Do you understand why subtext can't be quoted, and why that's work that you need to do for yourself? (If you somehow can quote subtext, though, immediately switch careers to political journalism, you'll be a wonder.)
* The only really offensive part was when you said "I do also believe that people don't have zero agency in this problem." Like, cool, a few sentences in and you've also added in a complete strawman to make yourself look reasonable. So this was just debate club to you.
The last point, combined with the fact that you're only responding when it might let you feel superior, leads me to believe you're not here in any sort of attempt to learn. How's your own mental health? You're clearly get some need fulfilled by arguing on the internet, which generally isn't the best sign. Watch that video, it's good, and absolutely full of things you do not know.
'Illness' provides a framework for recognition and treatment. The book with the guidelines is medical not religious. The guidelines are guided by empiricism not revelation. Treatments are selected based on statistics rather than authority. There's general agreement that the book's content might be wrong. There's a process for changing it and the expectation that it will be rewritten.
Criteria for diagnosing depression in the DSM include behavioral "thinking of suicide," physically measurable "weight loss," and general well being "fatigue." The suicide criterion is more conducive to empirical confirmation than "headache" or "joint pain."
Depression is still at the "ague" stage. For certain varieties, certain medications completely resolve them. For some, a treatment hasn't been identified. Approval of treatments is crippled by lack of diagnostic tools, so to test one, it has to be used on people who have all kinds, and then it only helps the small minority of them who have what it's good for. Statistically, one that works 100% for the actual illness it treats looks like it helps only 10-15% of the sample.
> I'm not trying to trivialize depression.
And then:
> at worst seriously misleading and distracting to people who have serious issues to deal with.
Implying that it isn't a serious issue.
??? I'd be very curious to hear this one explained. I'm totally baffled.
Your point is a bit conflicted. Like this person pointed out, it seems that you're saying that it's serious and not that serious at the same time.
However, I think that the observation you wanted to convey wasn't about the comparative seriousness of depression, but rather that it's in some sense in a different realm than for example AIDS or shingles, even if the realm of some of its effects are similar (which you argued against, but you're wrong). And, I sympathize with that. Depression does seem to be made of a different cloth, but it's quite hard to elaborate further, and I won't get into it here.
So, even on its own terms, the argument is incoherent and, not to put too fine a point on it, wrong.
but i don’t think anyone would argue it’s not a biological disease at this point, even if we don’t yet know what biological parameters to measure.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436791/table/t...
The second most important thing to know is that "depression" is a label for at least a half-dozen, probably more, unrelated illnesses. What helps with one does nothing for another.
The third is that no matter what else you do, getting enough (but not too much) sleep, and enough exercise, are essential. Lack of either makes all varieties worse. But if you can't, do whatever you can. Sometimes just getting up is a triumph. Savor each.
Psychiatrists have no other way to determine which kind you have than to try various meds and see if any work. For some varieties no med works. Often a med does no good below a certain dosage level, or until you have been taking it for a month. Some work immediately. Most have annoying side effects that may gradually fade.
Many people have more than one kind, and need to treat both or all. It may be combined with other problems like anxiety.
Exercising, sleeping, and eating right can be hard, even prohibitively hard, when you are ill. Don't beat yourself up over being ill. Do whatever you can, now, and plan to do more when you can.