Interesting article about depression as a disease

[Kupek]

It's written by a clinical professor of psychiatry who treats patients with depression, published a book on the subject, and has had subsequent interactions with readers while promoting the book. This is adapted from his next book.

The main gist is that while most people accept that depression is a disease, they don't fully internalize that idea because of the (sometimes perceived, sometimes explicit) role depression has played in our culture through art. I think it's well reasoned and clearly written.

NYT, free registration required: <a href=http://www.nytimes.com/2005/04/17/magaz ... _3>There's Nothing Deep About Depression</a>

[Julius Seeker]

I'll read the article later. I'm in a bit of a rush right now. But my opinion on depression is that from what I have seen the definition is used for too broad of a number of mindstates to be accurately stated as to what the reasoning behind it is. Bi-Polar disorder has been linked to being a cause of depression, as an example; I do not see it as that, though that is a disease. Other examples of depression are mid-life crisis', where a guy feels a huge lack of emotion with the continuation of his everyday life, and wants that void to be filled. Then depression is also used to label teenaged angst. Often depression is seen as synonimous with despair. So it is difficult to label it as a disease when there are so many different forms of it.

"Depression" among teenagers is just a result of teenagers being held down by their parents, when they want to live. I don't meen go and get drunk and high (because believe me, that can fuck you up too). What I mean is to be free, teenagers want to feel the feeling of freedom, and they don't feel it because their parents (most often) have power over them. Cultural and social morals have power over them; everyone has expectations placed on them, everyone wants this teen to behave a certain way.

Anyways, for some people it is a harder bond to break. I myself moved out of home at 16 (most people around here do, once they get an afterschool/weekend job); and I will say, that looking back at those years, no one who was on their own was depressed, those that were always at the guidance councilor and such were those who still lived at home (or if they didn't, they were still in a position in which they were under the thumb of the parent). Is that a disease? No, that is a state of mind.

Yet how do you explain manic depresants that no matter what the situation they are alwasys upset, always "depressed". Well, that is a disease or a very deluded person.

[Shellie]

I think there is hormonal depression and non-hormonal depression.

Non hormonal cannot be cured by drugs, but can be cured with therapy and/or changes within your life.

Unfortunately, doctors are so quick to prescribe drugs instead of actually trying to fix the root of the problem.

[ManaMan]

Seeker: Most of the people around you moved out of their homes when they were 16?

I find that a little hard to believe man... I knew maybe one, two people who moved out of their parents' houses during high school.

I guess minimum wage must be higher in Canada??? Perhaps the freehealthcare makes cost of living less expensive???

I don't know of many apartments around me that would consider renting to anyone so young.



...On the topic of depression, I think that the "hormonal" aspect of it has been overplayed. I think that it is a mostly mental disorder caused by a feeling of powerlessness, fear, and / or loneliness... and a general misconception / disconnect of / from reality.

I would probably agree with Seraphina when she said that it can be *both* mental and hormonal... although, in the end, it's all chemicals in the brain... right?

[SineSwiper]

Unfortunately, doctors are so quick to prescribe drugs instead of actually trying to fix the root of the problem.

Of course. They can either give you drugs for a easy maint fee of whatever the amount it costs for a monthly dose of drugs ($10/15/30, or whatever HMO covers). Or they can recommend that you go to a psychiatrist, which is not covered by most HMOs, and would cost around $100-200 dollars a session.

Which would you pick? Which could you afford?

[Nev]

I think the notion of depression as a disease, as it currently stands, is one of the most pernicious and utterly fucked-up things that this country has ever produced...

While I don't deny that there are certainly chemical changes in peoples' bodies - and brains - that can cause a depressed state, I think that the mental health system in this country relies far too much on medication it neither understands nor uses properly. There are a LOT of ways to get oneself out of the dumps, and most of the ones that I like don't involve medication. I think the "Gee, can I take something for this?" mentality is one that tends to avoid a lot of personal accountability.

I'm not advocating disregarding psychoactive medications as a potential aid in the treatment of serious mental health disorders (bipolar, schizophrenia, borderline, etc.), but I think they're very overused at present.

[Kupek]

So when I posted this article, I hoped people would read it, think about it and comment on what the author said. I wanted to avoid the "My personal opinion which is based solely on my own perception" posts.

I realize that most people here have either personal experience with depression or know someone close to them who has, but that doesn't make you an expert on depression treatment. Whenever subjects like depression and ADD come up, I invariabley see people comment on how medications are over perscribed, yet it's all either personal perception or anecdotes. No one has actually brought up a study to confirm it. We live in a very big country; it takes more than your personal experience or the experiences of those close to you to be able to make generalizations about depression treatment.

Try reading the article. It even might be consistent with your view.

One factual correction: "manic depression" is synonymous with "bi-polar disorder". It does not mean "one who is chronically depressed." It means "one who has manic episodes and depressive episodes." Since those are at the opposite ends of the spectrum, "bi-polar" also fits.

[Nev]

I agree, Kup, but I don't really want to open myself up to the possibility of New York Times spam today as a result of their registration...

*sigh*

I'll use my old hotmail account to register and read it in a bit. I think this is an important enough subject to open myself up to the possibility of getting very angry about something today.

[Nev]

Registration for me is broken right now. I'll read the article if you send it to me via e-mail though...faseidman at comcast dot net.

[ManaMan]

So when I posted this article, I hoped people would read it, think about it and comment on what the author said. I wanted to avoid the "My personal opinion which is based solely on my own perception" posts.

Quit trying to be such a control freak Kupek. You should be glad people responded to you post at all considering how dead this place has been lately.

By the way, didn't we all decide long ago that if you post a NYT article requiring registration thatyou should paste the text of the article in the original post? I vaguely recall something like that... Maybe you could do something like this next time?

My rent was only 100 a month.

Wow Seek, no wonder you were able to do it... and that's $100 Canadian, right? Wow. The least expensive place you can get around here is for $400 US, and that's not much more than a two room piece of crap apartment. An apartment for 2 or more people would cost at least $600 US. Even then, you'd still be paying $300+ just on rent.

St. Louis has a very low cost of living too... In places like California, a single bedroom apartment goes for like $800+ at the cheapest.

[Kupek]

Quit trying to be such a control freak Kupek. You should be glad people responded to you post at all considering how dead this place has been lately.

I don't think hoping that people will actually <i>read</i> an article before talking about it is being a control freak.

By the way, didn't we all decide long ago that if you post a NYT article requiring registration thatyou should paste the text of the article in the original post? I vaguely recall something like that... Maybe you could do something like this next time?

I guess I didn't read my contract.

What I have been doing is posting links from Google News that don't require registration. Since this is a special to the NYT, I doubt there is a Google News link, so I didn't bother looking. I, however, feel that we have not discussed this issue enough, so please, let's talk about it some more.

[SineSwiper]

Registration for me is broken right now. I'll read the article if you send it to me via e-mail though...faseidman at comcast dot net.

Here. BugMeNot also works.

[SineSwiper]

I'd admit that I'm still reading the article, but they are situations and questions that I've ran over and over again myself.

As technology and society progresses, the definition of "socially acceptable" becomes more and more exact, more limited in scope. We can already see the trends towards being politically correct extending to the workplace and home life. It's hard to say if this is a cycle of ebb/flow of freedom within the scope of the socially acceptable. One could argue that the freedoms of the 60/70's expanded the definition from the strict roles of the 40/50's, while today, we seem to be slowly going back to stricter definitions. However, I don't think anybody could really argue that we are less civil than we were 1000 years ago.

Thus, what was considered to be personality traits 1000 years ago are considered social diseases now. As medical knowledge and technology improved, we find better ways to improve these diseases, but at what cost? Who's to say that we'll eventually all be medicated to think like a few select templates? What "Brave New World" would we be entering? But, for now, I'm thinking too long-term.

What about the cure? If one is indeed depressed, would the drug remove traces of "useful depression"? I think the whole argument of the article is whether "useful depression" even exists. Would it be wrong to be depressed and angry at an injustice, and then be motivated to change it? For a un-medicated individual who is truly depressed, the motivation point would probably never come, but for a medicated individual, would the depressed point ever come?

I've thought about finding out ways to change my personality, but I always come up to the question of whether such flaws in my character are considered "socially unacceptable". Are they flaws, or have they passed into the realm of a "disease"? Of course, my personal views do not fall within the scope of human nature, so I cannot say for sure. Maybe I'm trying to find easy ways to correct "socially acceptable" flaws that could be corrected by fixing by changing certain parts of my life.

Would removing such flaws also remove the good-qualities of those flaws? Like the article said, even in somebody who is bi-polar, the manic periods could drive productivity. You try to even out somebody who is bi-polar, and while the work is consistant, the work is not outstanding. Wouldn't that remove periods of inspiration?

Would I be a duller person, if I removed the extremes of my personality? What about my enjoyment of music: is it wrong to feel joy or elation to certain sounds or notes? Would I be less productive because I no longer feel motivated to try challenging tasks or inspired to code?

Honestly, I think the focus of the article was too small. Forget just depression; what about all mental illnesses? After all, with so many people trying to "cure" mental illness, what are we taking away? Taking my example of bi-polarness with his question, should we try to find all sources of bi-polarity and remove the disease like we do with TB or malaria?

The edge between personality and social disease is a very, very thin and ever-changing line. Trying to eraticate a "social disease" could have unpredictable results.

[SineSwiper]

Gee, I have the first real reply and everybody stops talking...

[Kupek]

I want to, actually, and I hope to eventually get to it, but man, crunch time has hit.

[SineSwiper]

Sorry, it's just that after reading it, I was interested in a discussion about it, too.

[Julius Seeker]

Depression causing social change; the first thing that comes to mind is Martin Luther. If it wasn't for his depression due to being helpless in the face of God, I doubt he would have held his revolution. Jow would history change? Erasmus or Zwingly might have been the names most associated with reformation.

[Nev]

I read the first page; the rest I can't get into without registration, and honestly I really didn't feel much like registering to read the rest. I do think that the idea of refusing medicine to someone in great pain is a very bad one, but from my own personal experience I have to state that the corollary of that - refusing to think that someone may ever live a healthy life WITHOUT psychiatric medication - is also a very bad one.

I pretty much agree with Sine. My main problem with the idea of "depression" as expressed in the first page of that article - what the hell is it? There are a lot of reasons why people feel bad/mad/sad and I think the term has become so generalized as to almost lose usefulness. It doesn't really mean much more than someone who feels bad for an extended period of time. I think any useful discussion of depression has to include more specific information than that.

I also agree with that personality and mental illnesses are incredibly linked. I think questions of "morality" and "ethics" - related to the notions of societal acceptability he talked about - are all mixed in with that. My mother, who worked for years in the entertainment industry, said often that Robin Williams is "genuinely crazy" and that people think he's bipolar. But I've listened to some of his stand-up comedy - I just think he's very spontaneous and freewheeling as well as being a true and genuine asshole at times.

As far as bipolar goes, speaking as someone who was considered bipolar for years (my family still considers me bipolar - though by now it's me who thinks they're the crazy ones at times), I can say that there is a LOT that I consider bullshit that goes on with respect to that "illness". I believe a lot of "mania" is creativity or spontenaity that the "bipolar" person in question has not yet found a healthy way to express, often coupled with feelings of desperation with other parts of his/her personality that he/she has not found a way to express. The combination of spontenaity and desperation makes those around the "manic" person feel unsafe and uncomfortable and the bipolar label has evolved to describe this type of behavior. I agree that some people may have a genetic predisposition to this type of behavior; but I also believe that some behaviors and ways of interacting with the world that can contribute to "bipolar" behavior are often learned by children of "bipolar" patients and so genetics may not be as large a factor as some people think.