Depression lies because Depression is a dick.
February 18, 2016 4:14 PM   Subscribe

 
This is always a good reminder for me. Thank you, Wil Wheaton, and thank you klausman for sharing it.
posted by Joey Michaels at 4:32 PM on February 18, 2016


This sort of thing? This is why The Traveller chose him.
posted by justsomebodythatyouusedtoknow at 4:43 PM on February 18, 2016 [16 favorites]


I think a good analogy, also, is that your brain needs sustenance, and you give it what it needs to produce what you need to function well (like serotonin). We don't feel like we're broken when we give what our bodies food to function well, and we sure feel the pain of that when we don't. Sailors who got scurvy and were losing their teeth weren't broken for needing to eat fruit.

And depression is a big fat liar. If you can find a medication that works for you, you look back on it like a dysfunctional relationship that had you blind due to the ongoing drama of not knowing there were other ways to actually feel.
posted by SpacemanStix at 4:52 PM on February 18, 2016 [4 favorites]


I want to push back on the comparison of mental illness to physical ailments because the analogy has recently run rampant (yet is simultaneously always stated as though it's a revelation). I can appreciate the analogy as a way of beginning a conversation about medication, but as someone who was adamant about not using medication and has, only after years of exhausting every other option, begun antidepressants, I've always found the analogy lacking.

The difference between depression and a fever is that depression is nebulous. One knows with near certainty if they have a fever, but depression can often seem like a feeling that will pass or, for those who have dealt with it their entire life, so utterly omnipresent that it becomes normal. The diagnostic signs of depression are also broader and more prone to subjectivity than those of a fever, so that when I was initially diagnosed, I dismissed the therapist as melodramatic, and with that, the idea of seeking psychiatric help. I have a general idea of how fever medication operates, but the antidepressants I currently have come with the note that "it is not known how the drug works," which is terrifying to me and makes me worry what consequences the medication might have, and the process of ramping up medications and switching to different drugs altogether can exacerbate that anxiety. I'm fortunate enough that I have the ability to even undergo medication. The difference between medication for depression and medication for a fever is that not everyone's insurance covers the former.

My decision to begin medication has been the correct choice for me, but it wasn't necessarily obvious or inevitable. The great problem with mental illness is how shapeless it often feels, how ubiquitous yet invisible it is, and discussions of depression that speak as though mental illness and medication and the availability of resources are all straight-forward overlook much of what makes mental illness so insidious and difficult. The decision to begin medication is difficult, especially for people who don't live in areas where psychiatrists are readily available or whose insurance doesn't cover mental health. As someone who is still knee deep in his struggle with depression, I wish our language around mental health advocacy could appreciate the incredible disparities and nuances to the issue, because our failure to recognize these subtleties can feel trivializing, and ultimately does people with mental illness a disservice.
posted by lunch at 4:58 PM on February 18, 2016 [39 favorites]


I don't think it's meant to be a 1:1 perfect analogy. For me, coming from a family where mental illness is often rhetorically linked with demonic activity (oh, how I wish I were kidding) being able to position depression as similar to any other physical ailment has been a huge help, both in discussing my own troubles as well as the far more significant issues my sibling struggles with. I am not speaking for everyone, obviously, but the brain health = physical health connection has gone a long, long way towards destigmatizing MH issues in my family, recasting it as little different from other chronic medical conditions for which they wouldn't hesitate to seek out professional help and pharmaceutical therapy.
posted by shiu mai baby at 5:15 PM on February 18, 2016 [34 favorites]


Mental illness is exactly the same as a physical illness. Your body has something that’s out of whack – in our case, it’s how our brains handle neurochemicals and stuff – and there’s medication that can help us help ourselves feel better.

Lord help me. More chemical imbalance nonsense. Another comparison to diabetes. More of the same old disease model. None of what he's saying is well supported by science. I'm going to have to put together a critical psychiatry FPP together one of these days.
posted by Wemmick at 5:24 PM on February 18, 2016 [21 favorites]


More chemical imbalance nonsense

Is it your belief that depression is not caused by a chemical imbalance or that the chemical imbalance is just one part of a larger, more complicated issue?
posted by Myca at 5:44 PM on February 18, 2016 [4 favorites]


Hey Wemmick, I will be happy to read that FPP when you put it together. In the meantime, any better analogies you can think of, analogies that do not equate mental illness with imaginary illness or do not make me feel hopeless, defective, and willfully screwed up, are most welcome. If you've got an evidence-based, more nuanced replacement, have at it. If all you've got is "Wil Wheaton is wrongity, wrongity, wrong," that's not especially helpful.
posted by Bella Donna at 5:46 PM on February 18, 2016 [48 favorites]


Depression isn't much like fever, but it is kind of like chronic pain. Some pain some of the time, like after exercising a lot more than usual, is normal. Being in constant, severe pain isn't. It's hard to objectively measure pain, just like it's hard to objectively measure mood. But that doesn't mean that pain or depression are not real, or that they're some sort of character flaw.
posted by Anne Neville at 5:51 PM on February 18, 2016 [6 favorites]


Correct or incorrect, Wil Wheaton is a great example of what's right with the world. Dude is double plus awesome in my book. Thanks for posting this.
posted by Mooski at 6:09 PM on February 18, 2016 [7 favorites]


Depressed people resist trying antidepressants for many reasons, but one of them is that they fear losing or changing particular aspects of their personality from which they derive value as well as pain, or that by affecting one part of their minds they will disrupt the whole. Pretending loudly that these concerns emanate solely from the mouth of a disease personified as an evil liar is not helpful. If we must ridicule as unrealistic the idea that antidepressants have real risks and are not universally effective as a class of treatment, we can at least admit that we are belittling the fears of depressed people, not bravely engaging this imaginary independent dragon Depression like so many tiny St. Georges riding around on our high horses.

This feared loss and change, sometimes it happens and sometimes it doesn't; sometimes it happens but it's worth it and sometimes it's not; sometimes you can stop treatment if you don't like it and go back to how you were with no lasting ill effects and sometimes you can't. And you don't know until you try. That truth is not useful for creating strong social pressure on mentally ill people to take particular drugs, [1] but I don't think that frantic repetition of slogans is as useful for that purpose as it might appear, either.

(Let alone flat-out not-true things. Diabetes is a pretty good comparison because some people have a kind that gives you a choice between drugs and death, as simple as that, while others have a kind that can be hindered and held back without any drugs at all, and still others can only delay it for a time without drugs and perhaps only by extraordinary effort. And most people don't, actually, have unmixed emotions at the prospect of a lifetime drug regimen to control that purely physical ailment. And this is a value that they are permitted to hold and express without being told that's just the voice of mean old Diabetes trying to stay alive at any cost. It's not wrong to say that we should feel about mental illness the way we do about physical illness, but the assertions about how we feel about physical illness aren't true at all.)

[1] Which, for the record, I support. I have argued to depressed people that antidepressants are a good idea before and I expect I will do so again. Most mentally ill people should give drugs a shot, is what I think. I also think that Wil Wheaton seems like a great guy, and his post-script helps, but wrong is wrong.
posted by queenofbithynia at 6:25 PM on February 18, 2016 [13 favorites]


"None of what he's saying is well supported by science"?

Bullshit.

Much of what he's saying is at least partially supported by science and, given the stakes (real live human beings are suffering and need help) and that THERE ARE ZERO OTHER ALTERNATIVES SUPPORTED AT ALL BY SCIENCE, what do you propose?
posted by soylent00FF00 at 6:33 PM on February 18, 2016 [2 favorites]


THERE ARE ZERO OTHER ALTERNATIVES SUPPORTED AT ALL BY SCIENCE

"SCIENCE" shows that talk therapy works at least as well as medication in the short term and probably works better in the long term.
posted by callmejay at 6:44 PM on February 18, 2016 [5 favorites]


I'd give anything to be able to experience depression as an invasive disease, or as an "other" outside myself. Alas, speaking as a lifelong sufferer, it simply isn't that easy. Depression, for many, is as much a part of you as your skin color. You definitely get angry with depression, but it leads to being angry with yourself, because the two aren't easily separable.
posted by Thorzdad at 6:47 PM on February 18, 2016 [5 favorites]


"SCIENCE" shows that talk therapy works at least as well as medication in the short term and probably works better in the long term.

In the linked piece, if one had read it, one would have realized that this was Wil Wheaton's point: Medication + Therapy is his elixir.

I teach this for a living and I think the data is inconclusive: most studies show meds + therapy are best, a few are in favor of meds only, and some in favor of therapy only.

To use that indecision to counsel someone to say "Don't take meds, we don't know precisely how they work" (which is one of the thought processes involved in depression) is, I think what the original article is trying to talk about.

(typos due to autocorrect)
posted by soylent00FF00 at 6:49 PM on February 18, 2016 [4 favorites]


"I'd give anything to be able to experience depression as an invasive disease, or as an "other" outside myself. Alas, speaking as a lifelong sufferer, it simply isn't that easy. Depression, for many, is as much a part of you as your skin color. You definitely get angry with depression, but it leads to being angry with yourself, because the two aren't easily separable."

In my experience (as researcher, suffer, and clinician) : it's complicated. One of the "nice" things about Depression (and Mania) is that compared to, say, Schizophrenia and other disorders, there remains for most many people a "normal" to get back to, and the illness can be thought of as a foreign invader(*) and quite a few first-person accounts of it relay this (c.f. Vonnegut, Jameson, etc.)

* the catch being that, during an episode, this realization is often lost.

(Edit: tone)
posted by soylent00FF00 at 6:54 PM on February 18, 2016 [3 favorites]


"The diagnostic signs of depression are also broader and more prone to subjectivity than those of a fever, so that when I was initially diagnosed, I dismissed the therapist as melodramatic, and with that, the idea of seeking psychiatric help."

There is clinical lore that says "The person with depression is often the last to know they are getting worse, and also the last to know they are getting better". Whether through meds or therapy or just the natural healing process, there are countless stories that go like this "I still felt like shit but my doctor|nurse|spouse|coworkers thought I was getting better, well before I could see it".

This is in fact PERFECTLY consistent with the "depression lies" theme.
posted by soylent00FF00 at 7:00 PM on February 18, 2016 [7 favorites]


This is in fact PERFECTLY consistent with the "depression lies" theme.

My comment is neither about that theme nor intended as a refutation of it, and I wouldn't have used the word dismissed if I was trying to lend credence to that original thought. I don't know why you felt the need for such an emphatic response to a comment you didn't fully read.
posted by lunch at 7:32 PM on February 18, 2016


Wow. During my first experience with therapy, after teenaged me begged my parents to let me go*, I was literally told, verbatim, that "you're a well-off white girl from the suburbs. What problems could you possibly have?" Well, for starters, when I learned how to read at write, at four, I left notes around the house saying "I hate myself and want to die." My actual childhood was idyllic beyond belief. Except for the fact that my brain kept saying I was an awful person who should be dead. No biggie. Now, I take a pill every day, and that pill gives me the greatest gift I have ever received, which is the ability to be a functional human being. I still get sad, but, appropriately so. That's the thing. I feel things now, all sorts of beautiful, messy emotions. It's the best.

*My parents' views toward mental healthcare have improved considerably since the days of stoic resolve that everything is always fine.
posted by Ruki at 7:38 PM on February 18, 2016 [26 favorites]


"You're a well-off white girl from the suburbs. How could you possibly have cancer?"
posted by straight at 7:43 PM on February 18, 2016 [13 favorites]


I eagerly await a FPP that says why chemical imbalance is the wrong way to phrase it. That talk therapy works makes no comment on whether it is a chemical imbalance or not.

The notion that we don't know how antidepressants work is another part of the narrative I'd like to address. We don't really understand how the underlying neurochemistry is connected to depression, but we understand a significant amount of the actual neurochemistry involved. We have know far more than the basic high-school model that simplistically states dopamine and serotonin make you feel good. Those two neurotransmitters are the very tip of a far larger body of work.

Unfortunately, we don't currently have better method than "try this, see if it works" for finding medication that works for a particular individual, but that's largely because cutting someone's brain apart to measure everything is rather invasive, and not currently a reversible procedure.
posted by fragmede at 7:52 PM on February 18, 2016 [10 favorites]


I want to push back on the comparison of mental illness to physical ailments because the analogy has recently run rampant (yet is simultaneously always stated as though it's a revelation).

Well then here we goddamn go again. Mental Illness is a physical ailment, as your brain is a part of your body.

You can put things into your mouth to make you think you're talking to neon-monkey-jesus, but you can't put things into your mouth to make you stop feeling like a worthless failure when you are, in actuality, not a worthless failure? SOUNDS LEGIT!

Med school students saw brains out of skulls all the time to dissect them to pass a class. We don't know everything about those head-meats of ours, but we do know a lot. One of the things we know is that Cartesian Dualism is shit.
posted by Slap*Happy at 8:08 PM on February 18, 2016 [22 favorites]


"SCIENCE" shows that talk therapy works at least as well as medication in the short term and probably works better in the long term.

Science also shows that meditation provides as much relief from certain forms of anxiety and depression as antidepressants. Citation.

I would never rely on meditation in place of either therapy or medication, but my experience does back up the assertion that it's a powerful adjunct to the traditional approaches. Problem is, it takes intention and effort, things that are in short supply when you're deeply depressed.
posted by neon meat dream of an octofish at 8:19 PM on February 18, 2016 [4 favorites]


My parents put me in counselling after a suicide attempt at 15 and the psychologist tried to convince me that I was just feeling abandoned because my parents were favoring my six year old brother. Years of major depression and suicidal thoughts later I put myself on anti-depressants in college and that was a hell of a lot more useful.
posted by the agents of KAOS at 8:33 PM on February 18, 2016 [2 favorites]


To say that there's a major distinction between talk therapy and chemical therapy is to ignore the fact that all brain functions are chemical. So in a fundamental sense talk therapy is chemical therapy.

I'm someone who's neurochemistry is different enough* that I could never be sure of the effect of meds. Cognitive therapy, and major job change helped my depression.

My wife on the other hand is happy because she's been using the right meds for ten years, and she still goes to therapy.

The thing is, use whatever works. Therapy, meds, keep trying different combinations until something clicks.

*(seriously? Pot's supposed to have a different effect than alcohol? Weird.)
posted by happyroach at 8:47 PM on February 18, 2016 [14 favorites]


Ugh, yes, whatever works! I hate hate hate "meds only!" as much as I hate "therapy only!" There are multiple paths to treatment, and people who have mental health problems should really band together. Honestly, it reminds me of the mommy wars. Breast vs bottle, attachment vs cry it out... In both cases, the divisiveness prevents opportunity to come together for change. If the mentally ill can't agree among ourselves, how can we possibly reverse the stigma? Talk therapy didn't work for me. It has worked for others, and vice versa. But we're so busy squabbling about which way is best that we are literally incapable of working together. Fuck that noise. A problem is a problem.
posted by Ruki at 8:56 PM on February 18, 2016 [5 favorites]


To say that there's a major distinction between talk therapy and chemical therapy is to ignore the fact that all brain functions are chemical. So in a fundamental sense talk therapy is chemical therapy.

this a million times. we're all walking talking chemical reactions affected by all manner of stimuli (external, internal, whatever). So whether it's talk or medication or meditation (or combinations thereof) that ultimately work for you, the "cure" will manifest in your walking talking chemical reaction being more agreeable.
posted by philip-random at 8:57 PM on February 18, 2016 [1 favorite]


Pills are a hell of a lot more accessible for most people than lots of therapy. That's a real god damn factor and let's not pretend it isn't. I'd love to talk to a therapist, but I can't afford 100+ dollar per session fees. Brain pills are 8 bucks a month.
posted by Ferreous at 9:11 PM on February 18, 2016 [20 favorites]


Well, I had no diagnosed problems when I married my wife, who had serious ones that certainly required medication that was changed several times in our 16 years together, and my relationship with her put me in contact with therapists (as a couple AND alone myself) who were really helpful until things really fell apart. But the combination of stressors of her worsening problems (ultimately leading to her rejecting me), my long-time job disappearing out from under me, my own health problems (including a heart condition), and financial crises (not even gold-level employer insurance kept us from owing a LOT) sent me into a catatonic state. And the first time I was given an antidepressant (the 'old reliable' Prozac), I was almost shocked at how quickly my spirits were lifted and I could face (or in some cases, just let go of) my problems. Continued therapy also helped and allowed me to make my 'big move' out of Los Angeles (although where I now live, therapy is hard to come by). I HAVE to declare with great emphasis MY RESULTS ARE NOT TYPICAL, but a mix of the right meds, the right therapist, creative activity (yes, blogging was therapeutic) and community (I'm giving MetaFilter some credit, especially after losing access to a therapist) have brought me from severely depressed to just quirky and cranky but fully capable of dealing with more purely-physical health issues. But my advice to anyone dealing with Depression is "try everything... even the things you don't think could possibly help... in fact, especially the things you don't think could possibly help..." because I solidly agree with Wil Wheaton*: Depression is a liar.
*even though I still resent him for being a more famous "WW the Blogger" than Wendell Wittler
posted by oneswellfoop at 9:32 PM on February 18, 2016 [20 favorites]


Wait, hold on. Is this thread actually, for reals, going to Wendell? Because that's a damn near perfect post.
posted by Ruki at 9:47 PM on February 18, 2016 [2 favorites]


(Apologies, but I literally teared up at the truth of your comment, and I had to say it.)
posted by Ruki at 9:49 PM on February 18, 2016


As a life-long sufferer of depression and anxiety, I have, um, many feelings and opinions about this topic.

It is true that science (if I may generalize in that way when speaking about a few specific trials that a few specific members of the scientific community conducted) has validated a connection between improved well-being in both meditation and talk therapy. I am not arguing that at all. What I would like to point out is that people suffering from severe depression may not be in a place where they are able to work in those modalities consistently enough to obtain a desired result.

I would also like to caution people from touting that which has worked for them (or someone they know) as the only, or obvious, solution to the problem. Each person is different and needs different approaches to treatment. I think it's like people who have had highly positive experiences with diet changes, and assume that everyone else would feel better if they made the same change. While an improved diet is inarguably a good thing, what constitutes ideal nutrition varies wildly from person to person.

Depression is far more than simply 'brain chemistry imbalances'. It can be tied to imbalances in gut bacteria, adrenal and hormonal issues, vitamin deficiencies, learned coping skills (or lack thereof), and many other things. And sometimes, as they say, simply being surrounded by jerks.

...I'm getting off my soap box now. Please continue :)
posted by ananci at 9:52 PM on February 18, 2016 [6 favorites]


Back when I started meds, thinking of them as brain vitamins made excellent sense.

Kudos to Wheaton for being so open about this, too.
posted by mikurski at 1:41 AM on February 19, 2016 [1 favorite]


This sort of feels like the type of thread that, if you haven't ever experienced chronic depression, you should probably be very mindful and careful about how your express your "opinions" about this issue, it's a difficult topic to discuss if you've not personally been there. (I feel the same way about reviewing a movie you haven't seen or a restaurant you haven't eaten at.)
posted by HuronBob at 4:51 AM on February 19, 2016 [2 favorites]


To me the analogy of depression to physical to illness is a distraction from the intent of the article. Wheaton says as much in the post script.

I think a better frame would be "your emotions and state of mind can influence your beliefs and cognitive process." The point being a depressed person thinks that it is fully rational and objective to see themselves as worthless. This belief is in fact heavily driven by the depressive mood itself. If their mood was better they may not hold the same belief.

One analogy might be of a court. A depressed and suicidal person might judge themselves to be so "worthless" that the appropriate sentence is death. There's a part of their mind which believes and argues for this. Furthermore feels this belief is objective and rationally grounded.

Say it's a US supreme court. In this analogy depression is like Scalia. Of course the constitution doesn't protect lgbt individuals from discrimination. Of course this is a completely objective, originalist reading of the text. It has absolutely nothing to do with my Catholicism or homophobia.

The tricky thing is this kind of irrationality is very slippery. The depressed person might be very rational in other ways. For example if you presented them with the statement "homeless, unemployed people are not contributing to society so should be rounded up and gassed" they would reject it as blatantly horrible. But this is precisely the way they think about themselves.

I think sometimes coming out of a low mood period feels like waking up from a strange dream. Suddenly your opinion of yourself swings and the world seems very different. But the reverse feels the same - as if you've chanced upon the sacred truth of your own worthlessness that you've been hiding from.
posted by Erberus at 4:55 AM on February 19, 2016 [2 favorites]


Pills are a hell of a lot more accessible for most people than lots of therapy. That's a real god damn factor and let's not pretend it isn't. I'd love to talk to a therapist, but I can't afford 100+ dollar per session fees. Brain pills are 8 bucks a month.

I'm still working my way out of debt that I gained because of therapy bills the last time I went into a major depressive episode five years ago. I was suicidal and needed help -- so I'm happy to have racked up the debt on the whole. But the cost something that I feel gets dismissed a lot in conversations about therapy. It's always "find a sliding scale therapist!" Even those who do use a sliding scale are not cheap and that also doesn't take into account that all therapists are not created equal. Sometimes a therapist can be a good therapist and still not be the right therapist for you. Finding the right therapist can be an additional cost burden. I'm a big fan of therapy, but it isn't nearly as accessible to those of us who live on a lower middle class or working class income as it should be.
posted by JustKeepSwimming at 5:22 AM on February 19, 2016 [9 favorites]


I disagree a bit with the contrast between physical illness as clear cut and mental illness as ambiguous. I've been struggling for years with a digestive problem that, as of this week, crossed the threshold from, "maybe, let's try the diet of the year" to "definitely, and you should consider surgery soon." Fever does not unambiguously point to influenza, or strep, or initial onset HIV, and a doctor may skip expensive diagnostics if you present the same symptoms as the local seasonal crud. I have a wheelchair using colleague who struggled absent a firm diagnosis for years because her symptoms did not exactly fit any known disorder. My mother may or may not have COPD depending on which doctor she sees because she's never been a miner, industrial worker, or smoker and she doesn't have the most common marker for genetic lung disease. Physical medicine is very much a heuristic affair unless diagnostic procedures end up in an unambiguous range. And even then there is wiggle room regarding the bayesian costs and risks medicating everyone whose blood work falls in a certain range.

Not to mention that women and PoC get different diagnoses and treatment for reporting the same symptoms.

The physicality of my panic attacks have, as of late, become just as real as headaches and gall bladder cramps.
posted by CBrachyrhynchos at 6:30 AM on February 19, 2016 [4 favorites]


"SCIENCE" shows that talk therapy works at least as well as medication in the short term and probably works better in the long term.

There's also increasing scientific and anecdotal evidence that mindfulness meditation and exercise work pretty well.

Increasingly, the conclusion seems to be that there's no silver bullet; the good news is that we can fight this war on multiple fronts, and we have a wide variety of weapons in the arsenal: SSRIs, talk therapy, diet, exercise, meditation, personal homework (journaling, therapeutic exercises), and many more.
posted by theorique at 9:30 AM on February 19, 2016 [1 favorite]


Washington Post article on brain hacking:
"The leading drugs for depression — the selective serotonin reuptake inhibitors, or SSRIs — are designed to ease symptoms by boosting serotonin, one of the brain’s pleasure chemicals. But it’s not known whether that corrects an imbalance, because there’s no way to directly measure a person’s neurochemical levels. Experts also can’t explain why antidepressants work only 40 percent of the time or why, when they do, it takes weeks for most patients to feel the effects since the levels are boosted almost immediately.

The chief complaint about today’s psychiatric medications is the same one cited by those frustrated by the lack of progress on Alzheimer’s: They don’t treat the disease, just the symptoms, and they don’t even do that very well."
When it comes to me, I'd rather wait until they can come up with some better solutions than putting me on a bunch of drugs that they have no idea what they will do to me or not, if they will make me better or mess me up worse temporarily or even permanently and it's a total crap shoot. The "who knows? Not us! We have NO IDEA! But this is your only option!" attitude about depression meds scares the bejeezus out of me and frankly, is a lot scarier than any issues I have. Also, frankly, I'd probably get my ass canned from work if I was all messed up on side effects and anything less than 100% perky and happy. I literally can't afford to "give it a try!" if everything is this iffy.
posted by jenfullmoon at 10:35 AM on February 19, 2016 [3 favorites]


Yesterday someone rang the doorbell and I panicked. No one else was home. There wasn't anyone around to ask to get the door for me.

It had me worried. I wasn't sure who it might be. Religious people with tracts? That guy who came by last year to sell magazines? The police? Bill collectors? UPS? My neighbor?

Worse still, there's a doorbell button on two doors, so I couldn't be sure if the person was at the side door or the front door. And I couldn't remember if the shades on the window on the side door were open or not. If they were open, and someone was at the side door, then I was in serious trouble, because if I peeked out of my office, they would see me. And the angle was all wrong to try to use the camera on my phone to see the door.

So I peeked, and felt a bit of relief that no one was at the side door. That meant I could slip through the back of the house to come up front another way, where I could peer out of the curtains and not be seen. But I had to be quiet, because footsteps are really loud in my house. It's okay, usually; I always tiptoe anyway. But I had to be extra careful, because someone was at the door, and if they heard me...they'd probably knock or ring the bell again, something like that. It would be foolish to let that happen, when basic safety steps like tiptoeing can be followed.

Well, it took me about five minutes to work my way through the house and get to a good enough vantage point that I could see the porch. What a relief, whoever it was, had left! Once I was sure the coast was clear, I opened the front door, and there was no evidence anyone had been there, no flyers left in the door or anything like that. So, just to be safe, I checked the side door...and panicked. There was a stack of mail left on the step. Mail that could have had notices in it. Emergencies. I steeled my resolve, and opened the door and picked up the mail. Fortunately it was just a book and some more Rubio advertisements. I closed the door, relieved that it had all worked out okay.

Then today I drove my kids to school and nodded hello to strangers and smiled at people I didn't know, and did not panic once.

I am actually okay with seeing my depression and anxiety as a weakness. I am okay with calling it a brokenness. Strong and well-put-together people do not creep around their houses in a panic that they might have to have a conversation with a stranger. And someone with a chronic, serious illness doesn't simply have the symptoms of that illness one day, then cease to have them the next morning. These are all metaphors anyway; it's hard to call these things an illness when we don't even know what they are, exactly. Everything we say about the mind is vague and analogical. Might as well go with the analogies that suggest an emotional truth. Brokenness, for example, suggests being fixed, or at least patched. Tinkered with, worked on. Comparisons with diabetes or other physical ailments seem...stretched. Although I appreciate that they work well for other people. The idea of this being an illness for which medicine can be prescribed seems disproved by none of the medicine working (for me, for long). The idea of this being a thought-illness for which therapy can be prescribed seems similarly unfounded.

I am--today, at least--less okay with using person-metaphors. This changes from time to time. But "depression lies" does not seem to me to be particularly true. My deep melancholy and sense of dread don't seem to be making many declarative statements that could be said to be true or false. I may certainly be noticing more of the sad, scary, harrowing things life presents right now, but it's not exactly untrue that life can be terrifying, full of hidden dangers, ultimately ending in death and the wiping away of any memory of you and all the things you cared about. And then some days I don't notice them as much.

It's all very confusing.
posted by mittens at 11:45 AM on February 19, 2016 [3 favorites]


queenofbithynia: "Pretending loudly that these concerns emanate solely from the mouth of a disease personified as an evil liar is not helpful."

This. So very much this. I know other people experience depression differently to me, and I'm glad that they find articles like this helpful, but I don't. To me it feels trivialising and condescending. My experience of depression is not at all similar to having an evil homunculus in my head whispering bad lies. It's not a jerk, a dick, or a liar. It is a persistent, pervasive bias to interpret every ambiguous situation in a more negative light than it deserves. This bias is part of how I reason, how I feel, and how I talk. It's no more separate from who I am than my vulnerability to cognitive illusions like hindsight bias, the illusion of control and so on. Saying things like "oh, that's just your depression talking" feels as silly to me as saying "oh, that's just your conjunction fallacy talking". Disentangling depressive biases from "me" doesn't seem helpful, and I'm not at all keen on being pushed towards addressing them via SSRIs any more than I would feel keen on having any other aspect of my personality fixed with drugs. That doesn't mean I shouldn't address them (and I've used medication as a last resort when other methods have failed), but I don't feel that I'm neglecting my depression by preferring to rely on exercise, diet and mindfulness. I don't feel that it is helpful to characterise my situation as one in which "your brain needs some help to get healthy" and I am tired of clicking on a supposedly great article about depression only to read yet another analogy that equates the decision not to take SSRIs with the refusal to put a cast on a broken leg. For some of us at least, those situations are not analogous.
posted by langtonsant at 11:52 AM on February 19, 2016 [5 favorites]


major distinction between talk therapy and chemical therapy is to ignore the fact that all brain functions are chemical

This. I honestly wasn't aware that there was a dissenting view to this proposition that was either testable or supported by reproducible evidence. Assuming a person decides that scientific evidence and logical reasoning provide a more consistent and reliable framework of understanding the universe than spiritual experiences do (and I'm aware that not everyone does, nothing against them at all), EVERY illness is physical, whether it falls under the category of 'mental illness' or not.

If we attempt to create a fundamental distinction of causative category between depression and diabetes, or for that matter schistosomiasis and schizophrenia, bipolar disorder and brucellosis, etc., we risk committing a grave misstep in logical reasoning. I'm not even sure what to call it- a reverse fallacy-of-division? Erroneous creation of categorisation? Whatever a human being may understand to be their 'mind' or 'thoughts' is an emergent, complex, absolutely amazing manifestation of individually-simpler electrical/chemical signalling within the CNS/PNS (and to a lesser extent, information sent to/from other bodily systems). It has no fundamental differences in causation than a perceived 'fault' in any other biological system.

Perhaps there's a general perception of conditions like guinea-worm infections or a shattered tibia as absolute 'wrongs' which can be righted, whereas depression and anxiety are more likely to be seen as manifestations of thought that are only unhelpful or 'bad' insofar as they prevent us functioning as effective members of an integrated society. Or changes in mood/personality are much likelier to be thought of as part of a person's soul and identity (as products of their CNS chemistry), whereas a fungal growth between the feet wouldn't at all.

Each of us decides for ourselves what we consider to be a disease, a syndrome or a disorder. It happens there's broad agreement on about 95% of it, but it's the 5% where we trip each other up and make each other unhappy.

(If you can't tell yet, I have driven the physicians/professors that teach me on a daily basis to the very brink of homicidal psychosis).
posted by The Zeroth Law at 12:04 PM on February 19, 2016 [2 favorites]


My first eye-opener about depression: I realised that I lived in an inverse Dr. Jekyll and Mr. Hyde universe. If I was depressed, I was under the impression that everyone and everything was evil and was kicking me in the head. ...while when I was less depressed, people and the world were kind of normal and people can actually care. Clearly, they contradict with one another and only one of those realities might be actually true. A surprisingly easy thing to be confused about.

My second eye-opener was that, no, despite of the fact that reality is actually pretty nice, some people just are actually terrible. But that's basically an entirely separate discussion from the first one, so hey.

(And thanks for the article, really bad shit happened this week and that got me so depressed I'm actually feeling physically ill. Or something.)
posted by wwwwolf at 12:31 PM on February 19, 2016 [2 favorites]


Finding the right therapist can be an additional cost burden. I'm a big fan of therapy, but it isn't nearly as accessible to those of us who live on a lower middle class or working class income as it should be.

Finding the right therapist is also a lot of work, which can be prohibitive if you're already so depressed you're having trouble coping with minimal daily activities. Or if you have social anxiety and are rejected by a therapist (which happened to me once I finally got up enough energy and courage to talk to a professional/stranger about my problems and I haven't tried it again in the years since).
posted by Mavri at 12:46 PM on February 19, 2016 [2 favorites]


I understand the easy jump to the physical illness comparison. I am bipolar. It's hard, in different ways at different times. On the very rare occasion I discuss it with someone who doesn't know much about it, the comparison to a physical illness is easiest. I sometimes say I wish that a person's skin could turn a different shade of blue based on how they were feeling - whether that be a physical or mental ill-feeling.

Mental illness/skillness (heh) is a hard thing to deal with on a daily basis. A big part of it ends up wanting to just be SEEN as being on a similar spectrum to everyone else who tries to manage a condition daily. There are days when I wish my coping strategies, or moods, could be seen the same way a cast can be seen on someone with a broken leg.

I wonder how many people could begin to feel better more quickly if they felt like they could be "seen" in some sort of objective way - apart from any particular treatment strategy or stigma.
posted by nickjadlowe at 1:24 PM on February 19, 2016


I think the reason I dislike the depression is a liar framing so much is that it robs me of agency in the eyes of people who buy into it. The depression is a weakness folks are pretty awful to deal with, but at least they do me the respect of attributing my beliefs to me. If they disagree with me, they'll disagree with me, and they'll allow me to hold a proper conversation with them.

My experience has been that the depression is a liar folks won't even accord me that bare minimum of respect. If I express a negative thought - no matter whether it has factual basis and no matter what my current mood is like - my words are explained away as "the depression talking". And because depression is a liar there is no value in holding a discussion with depression, and by extension there is no value in holding a serious conversation to me. In practice, I have found that subscribers to the depression is a liar worldview treat me with even less respect and even less kindness than the depression is a weakness folks.

Somewhat amusingly, my experience has been that the best way to get a depression is a liar believer to listen to me is to lie. If I hide my depression or tell them that I'm taking SSRIs or in therapy, a magic wand of legitimacy is suddenly waved over my words, rendering me a fully-formed human being in their eyes. I don't know why it works this way, but the end result is that I simply do not trust the depression is a liar folks enough to be honest with them. Just as much as the depression is a weakness worldview, the depression is a liar framing plays a very strong part in my decision not to tell people - even well meaning folks - that I'm managing a chronic depressive condition.
posted by langtonsant at 2:09 PM on February 19, 2016 [5 favorites]


Somewhat amusingly, my experience has been that the best way to get a depression is a liar believer to listen to me is to lie

I don't know if this is the inverse or the converse of that or what, but I recently discovered the only way to make me think maybe I should take antidepressants (or therapy) is to tell me I don't need them. I saw a psychiatrist (who is also a therapist) for (different) drug acquisition purposes recently and prefaced my whole spiel with the stipulation that I am depressed and anxious by nature, sure -- never give a doctor a chance to tell me I'm in denial, is my thinking; they enjoy so much to discern things wrong with you that you never suspected, so I take care to suspect everything and deny them the pleasure -- but never in crisis, & I do not want to either try SSRIs or therapy, for good and numerous Reasons that I will enumerate if pressed. Sure! he says. You don't have to! he says, with every sign of not really caring. so now I really want to. he was skillful, that one.

but I do not take this as a sign that I need treatment any more than I ever did, only that it is supremely important to my self-respect to never be seen to be doing what I am told is good for me.
posted by queenofbithynia at 2:22 PM on February 19, 2016 [3 favorites]


queenofbithynia: "tell me I don't need them"

Oh yes, that works on me too. For me, "I'm a grown up: don't you tell me what to do" is such a big part of my identity that I arc up when someone gives me orders (I'm a terrible employee sometimes). But if someone lays out their reasoning, shrugs their shoulders and says the choice is yours, well... then I'll listen. The best doctor I ever had did that: he gave a pretty disinterested overview of my situation as he saw it, said that I seemed to have the situation in hand, listed a few warning signs that he thought might be worth paying attention to, and that was it. He said he'd write a prescription "just to save me another trip to his office" and sent me off. That was the single most effective intervention any medical professional ever made in my condition. I never filled that prescription, but his deliberate refusal to try to control the situation had exactly the effect I think he was aiming for: I got a lot more serious about managing the condition behaviourally. Bloody genius that bloke.
posted by langtonsant at 3:05 PM on February 19, 2016


If you have a worldview that everyone is disrespecting you and don't view you as a person it's real easy to justify contrarianism and stoic suffering.
posted by Ferreous at 3:33 PM on February 19, 2016 [1 favorite]


I dare say. I have never met a really dedicated contrarian who was also a stoic in her suffering but there must be one somewhere, it's a big world. Then again, I am surprised by the notion that such a basic friendly human reflex as contrarianism needs justification, let alone a whole worldview to back it up.

I do think it is weird to post a non-sequitur about perceptions of universal disrespect right after two different people posted appreciative anecdotes about being respected but maybe the comment had nothing to do with them?
posted by queenofbithynia at 4:00 PM on February 19, 2016


Yes, it's a little odd.

So there was this pair of comments in which we described concrete examples of being respected, which were offered as an explicit contrast to the frustrating and somewhat common situation in which people attribute every non-cheerful opinion expressed by a depressed person to the depression itself, and then use that attribution as an excuse to refuse to engage with the substance of the depressed person's comment ... and these are followed immediately by a comment that mischaracterises the concern as "a worldview that everyone is disrespecting you" and does not engage with the content of our comments?

I'm very interested to hear how that isn't an excellent illustration of the problem.
posted by langtonsant at 6:25 PM on February 19, 2016


My interpretation of depression is a liar isn't that I'm wrong about everything, but that I'm wrong about some things. To be fully specific, the train of thought that interprets current events according to abusive mindfucks from 25-30 years ago is probably wrong. Often it's half wrong and I really am reacting to a situation that's a problem. But I need reality checks and sometimes, I need to be walked through the analysis to distinguish my beliefs from ghosts of L., F., or G..
posted by CBrachyrhynchos at 9:45 AM on February 20, 2016


My interpretation of depression is a liar isn't that I'm wrong about everything, but that I'm wrong about some things. To be fully specific, the train of thought that interprets current events according to abusive mindfucks from 25-30 years ago is probably wrong. Often it's half wrong and I really am reacting to a situation that's a problem. But I need reality checks and sometimes, I need to be walked through the analysis to distinguish my beliefs from ghosts of L., F., or G..

Regarding my depression, thinking of it as a "liar" is a good metaphor, and it helped me considerably; but mostly in retrospect, such that it's easier to not regress to bad habits now than it was to make initial progress then. In retrospect, depression created a grungy filter that encouraged incorrect information into my belief system and gave it higher epistemic privilege than accurate information. One of the benefits for me in medication, and supplemental talk therapy, is that it allowed the filter to lift a bit and encourage accurate information in about myself and the way that others interacted with me.

The really tricky part for me is that feelings and truth propositions don't always go hand in hand, so I could be aware of true things but not be emotionally persuaded. But those two pieces function better together with 1) better biochemical interactions (thanks, wellbutrin), and 2) a neutral third party person who cared about me to help process what was going on. So,I wouldn't consider it "lying" in a nefarious sense (as that word seems to imply neglect or moral culpability in our agency), but in terms of my processes (whatever they are) having resisted true information, and often not allowing my affect to match up accurately with that information once I'm presented with the evidence.

This is just my story and the metaphor that has helped me, and it may not apply to everyone.
posted by SpacemanStix at 1:41 PM on February 20, 2016 [4 favorites]


I'm one of the people who chose "suffering" (and other alternatives) over the diabetes meds. Because guess what? Phyiscal illnesses can also be ambiguous and their treatment dependent on individual physiologies!

But I took the meds the psychiatrists offered, even with the illness fighting it pretty much the way Wil Wheaton decsribed.

"SCIENCE" shows that talk therapy works at least as well as medication in the short term and probably works better in the long term.

Therapy was helpful and I was in a position to have several sessions a month, which was great, but without the meds I would assuredly have failed out of SCIENCE grad school. And would have lost years of work. And my medical insurance. And access to that $10/session therapy that was helping. And the rest of my savings. And my school-centered social life. And any hope of finding a job, as this was at the beginning of the recession.

There are no black and white answers.
posted by zennie at 11:32 PM on February 23, 2016


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