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Here's a possible hot take: when will we start treating this as a systemic and structural issue? When will we stop privatizing the issue of mental health, treat

Here's a possible hot take: when will we start treating this as a systemic and structural issue? When will we stop privatizing the issue of mental health, treating it exclusively as basically chemical imbalances within individual bodies, and start recognizing that there must be something deeper, something perhaps cultural or political, at work here?

retube 8y ago
Not to trivialize people with genuine issues, but experiencing "stress, anxiety and low mood" is completely normal and natural. In fact not experiencing these kinds of emotions from time to time would indicate an issue! I do wonder whether the scope of what's deemed "mental illness" is being widened
- spiritcat 8y ago
  na internet done made us all crazy
  - deleted 8y ago
    [deleted]
- kneel 8y ago
  Pretty sure this study took normal mood fluctuations into consideration. Poor mental health probably means poor mental health.
- frabcus 8y ago
  Mental illnesses have psychological (eg issues from childhood), chemical (eg neurotransmitter balance) and yes social (communication and meaning) aspects. It's easy to pay attention to only one (a definition shift would be social/communication), but all three matter. These illnesses are failure modes at a mid level in the most complex information processing device in the universe. There's a lot going on - it's not so much definition shift, as this is complex, and yes it is a communal cry for help in part.
  - aszantu 8y ago
    I want to add allergies to your list :) Personal experience: Ketogenic died made my depression go away almost over night
    - djsumdog 8y ago
      Diet plays a huge role in mood; and we normalize "comfort eating" way too much. You cut out sugar from your diet and you will feel better. We consume an insane amount in western societies and it's not good physically or mentally. You can't just focus on mental health without the physical health because they are so dependent. I feel like we're deeply missing that point today.
      - dvdhnt 8y ago
        > Diet plays a huge role in mood. I've seen many articles lately on the relationship between what's in our gut and our mental health. Their source escapes me at the moment, but here's a paper on the relationship between diet and mental health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167107/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167107/
- TheSmiddy 8y ago
  This argument is the equivalent of a climate change denier stating "the climate is always changing". Anecdotally the percentage of my friends who I would describe as unhappy has been increasing over time. In my early 20's at most 10% of my friends would be unhappy at any given moment, now in my 30's I feel like a solid 25% of my friends are noticeably unhappy and god knows how many are good at putting on a brave face. I don't know how much of this is just due to getting older or something specific to how our society is operating at this current point in history. When I talk to people from my parents generation I get the feeling that on average every year of their life was better than the last up until about 40, whereas it feels like the opposite is true for people today. I too am worried about the increasing scope of what determines a mental illness, but at the same time if your environment can cause you to get Pneumonia, it makes sense that your environment can cause you to experience clinical depression.
  - cs02rm0 8y ago
    Being more stressed in your 30s than your early 20s is probably normal too. You've got less time on the planet, I've got a wife and three kids to support now, career options are vastly more limited, incurred massive debt to buy a house. But hey, things are going comparatively well for me relative to many of my peers. It seems really hard to compare between generations. Things are so different, but if mental health is towards the top of the pile of concerns now we should probably address it regardless of whether it's really a bigger issue than today than it was previously.
    - iovrthoughtthis 8y ago
      But is normal ok?
    - skohan 8y ago
      Normal in the context of how our society is structured, but far from ideal or unavoidable. For instance, I can compare the experience of my cousin raising two young kids on the east coast of the US with my girlfriend's sister in the same situation in Italy. In my cousin's case, she had to go back to work almost immediately in order to pay the high rents where she lives, and money's a constant stress because of the price of a decent daycare/preschool. Family's far away, so essentially all the childcare responsibilities fall on her and her husband. In contrast, my girlfriend's sister had 9 months of paid maternity leave with which she could stay home with the baby without undue financial stress. When she returned to work part time, she didn't have to rely on commercial childcare because her large extended family is close by to share the burden. In general that makes her and her husband's life more relaxed, because if they want to go away for the odd weekend they can leave the kids with grandma. If you ask me, the work culture is deeply pathological in places like the US and UK. With the rise in technology and automation there's no reason we couldn't live in societies which prioritize our human needs more highly.
- stronglikedan 8y ago
  I think this article is eluding to the problem of sustained stress, anxiety and low mood, which lead to abnormal chemical imbalances that cannot easily be overcome. Once the imbalance becomes impossible to overcome without external support, it becomes a legitimate illness (mental, in this context) that requires treatment.
  - megous 8y ago
    Chemical imbalance (as a cause of depression or anxiety) is just a hypothesis (one of many). It's heavily used for marketing, because people can easily imagine something behind it, that's easily corrected by what companies sell (more chemicals), but it's most probably nonsense. Though your underlying point is observably valid. People can get into a state where it's hard for them to improve their well being without outside intervention.
    - stronglikedan 8y ago
      As someone who had such a chemical imbalance that was corrected by medication, I can assure you it's definitely not nonsense (although I thought the same as you until I went through it myself).
      - megous 8y ago
        I appreciate that you took pills and felt change. It, by itself, doesn't prove that there's a specific chemical imbalance in the brain, or that it causes depression or anxiety.
        stronglikedan 8y ago
        It doesn't, but all the science behind the pills does. They weren't created for no reason.
        megous 8y ago
        What science? Most of it is focused on whether the drug has effect compared to placebo/other pills, what unintended effects it has, and not on trying to understand how brain works. Pill may have effect, yet the hypothesis may still be nonsense. Chemical imbalance hypothesis is really old, and doesn't account for a lot of new information since last 50-60 years. It's in principle the same problem as when psychotherapists/clinicians try to develop a theory of mind. The result is that we have several major contradictory theories of mind/schools of psychotherapy, and all of them work/are helpful. Yet the usefulness can not be used to validate the underlying theories of mind the methods are based on, because that would mean that all of those theories are valid.
- DanBC 8y ago
  Notice the submitted article doesn't talk about "mental illness" but about "poor mental health". I can have poor physical health without having a specific disease. I can have poor mental health without having a specific mental illness.
- projektir 8y ago
  I mean human misery is also completely normal and natural, that doesn't mean we're not going to notice it and point it out when we get better tools for identifying it...
- mywacaday 8y ago
  Anecdotal evidence of one person close to me, saw the benefits in the use of anti depressants but what I didn't expect was that when the person came off them they laughed more, the anti-depressants might reduce the lows but they also dimmed the highs.
- amelius 8y ago
  The lines of what is a mental illness are blurry. That doesn't mean we should stop paying attention when the "blurry blob" moves left or right on the chart.
- m_fayer 8y ago
  For a long time in many places, living in grinding poverty was and is "normal" and "natural" for most people. Living with all sorts of insecurity - food, physical safety, shelter - all normal. Evolution only selected for those of us who manage to reproduce individually and societally, not for those who tend to live to a ripe old age with a minimum of misery. I really don't get this formulation of "x miserable condition is perfectly natural!" when "natural" so often == "miserable".
  - YinglingLight 8y ago
    Yes, but this is specifically about mental health. I believe the increased level of physical activity, combined with greater in-person socialization/community of our forefathers allowed them greater mental health (and with it, greater resiliency) than people of today.
    - emodendroket 8y ago
      Perhaps, but what is the evidence that that was the case or that the causes you cite are the ones to credit?
  - danharaj 8y ago
    Hardship and misery aren't the same thing.
  - 2bitmachine 8y ago
    >Evolution only selected for those of us who manage to reproduce individually and societally, not for those who tend to live to a ripe old age with a minimum of misery. Once humans developed complex societal structures, any such discussion of "evolutionary selection" borders on the ludicrous. Who reproduced and survived was (and is) far more dependent on you're relative power and status within these systems than anything even closely resembling natural selection.
- eli_gottlieb 8y ago
  The point where negative emotions become homeostatic dysfunction is the point where they've become a legitimate health issue. Yeah, sometimes life hurts, but if you're getting hypertension because of work stress, fuck your job.
- Bartweiss 8y ago
  > I do wonder whether the scope of what's deemed "mental illness" is being widened There are two questions here, I think. One is whether we're confusing regular moods with larger conditions, and the answer is generally no. Conditions like anxiety have time thresholds of persistent symptoms to avoid this issue, and other conditions like panic disorders describe things that many people never experience. The second is whether the scope of what's diagnosable is broadening on any axis. And there, we can say: yes, consciously so. The US standards for diagnosing mental illness (the DSM definitions) have been steadily moving away from attempts to determine who has a 'real' mental illness in favor of symptoms-based diagnoses. The standard for e.g. anxiety excludes anxiety from drugs (legal or not) and physical health problems, but says nothing about whether the long-term anxiety is 'justified' or a reasonable reaction to circumstances. It's partly an acknowledgement that lots of appraisals are made quickly and on circumstantial evidence, so we might as well issue circumstantial decisions instead of assigning grand theories that might not apply. And it's partly about the fact that many treatments are circumstance-agnostic; absent other options, someone who's constantly anxious because they have high debt and a stressful job will see basically the same benefits from CBT or medications as someone without circumstantial issues. But it's also a concession to just how little we understand a lot of mental illnesses. There's no particular sign that anxiety-the-disorder is anything but high activity from the system everyone has, and we're not sure why it seems to be so much more active in certain people, so there's no objective test to run. Which means either relying on a clinician's judgement about what's 'justified' anxiety, with all the cultural biases and doctor-shopping that invites, or admitting that it's an unclear question and bypassing it. (This looks a bit different when we do understand the biological mechanisms of a disorder, or at least know that certain treatments are conditional. As an example, nicotine helps decrease the symptom intensity of schizophrenia, but doesn't for most other hallucinatory or delusional disorders. And other conditions like ASPD or ADHD have foggy partial understandings that leave them in the middle.) One way of framing this is that we're pathologizing normal reactions. But another is that we have a system built to treat certain unpleasant conditions, and we're recognizing that it can operate on more pain than we'd previously realized. A lot of historical support mechanisms have ceased to support most people, both formal (priests running confessionals and doing relationship mediation) and informal (the death of the 'third place', fraternal organization membership, etc.) If the problem is "many people are sad and stressed by their work", assigning the care of those feelings to our sadness-and-stress support framework makes sense. Ideally we might change people's work circumstances instead, but this looks like at worst a return to the historical approach.
kzrdude 8y ago
The biggest issue is I think lack of sleep, and sometimes you need professional help to fix it or even realize you should
Kiro 8y ago
Because your whole premise may not necessarily be true. First step is to evaluate it, not the other way around as you suggest.
- elvinyung 8y ago
  Just curious -- what did you interpret my premise to be? To clarify, I think that this issue is so obviously overdetermined that we need to tackle all of the causes, not just any one.
50 8y ago
I'm pretty certain cultural and social conditioning is a large, if not the entire, part of the problem with poor mental health (and not just poor mental health!). Take this line from Andrei Tarkovsky's Sculpting in Time: "Modern mass culture, aimed at the 'consumer', the civilisation of prosthetics, is crippling people's souls, setting up barriers between man and the crucial questions of his existence, his consciousness of himself as a spiritual being." This is not something new. The severity of the problem has just heightened because of the information age. But otherwise, since this topic interests me greatly, I would definitely love to hear why you might think poor mental health may be due to something like culture and politics? Possible solutions?
- elvinyung 8y ago
  I am not an original thinker. My main reference for this topic has been the cultural theorist Mark Fisher. In Capitalist Realism he not only describes the privatization I mentioned previously, but also introduces two ideas that he ascribes to the neoliberal condition (based on anecdata of young people from his experiences as a professor): * reflexive impotence, in which people know that things are bad and that they can't do anything about it, leading to a kind of self-fulfilling prophecy en masse * depressive hedonia, in which people are depressed, but instead of being unable to seek pleasure, they basically can't do anything except seek pleasure (to consume more, faster, etc.) He also has another book, Ghosts of My Life, in which he talks about how we're essentially collectively "haunted" by the possible futures that failed to materialize. I've yet to read it, but I've heard it's fascinating.
  - ak39 8y ago
    Ah, thank you for these two points and the book suggestions! I too am not an original thinker and I often synthesize ideas on this matter incoherently. But how is it that it is not universally accepted that the structure of employment, even in its most compassionate incarnation, is a structure that is designed to humiliate and strip the dignity of the employee? And then we have the modern employment contract that explicitly forbids talent to be shared with other employers, or for allegiance to be enunciated in corporate culture slogans drummed to death as though attempting to wash away the employee's identity. Maybe things are different in different cultures vis-a-vis the structure of employment. Japan for example where Salary Man choose to willingly marry his corporation for a lifetime.
DanBC 8y ago
> treating it exclusively as basically chemical imbalances within individual bodies Dunno where you live but over here we stopped doing that fucking years ago. This is why things like IAPT (Improved access to psychotherapy, a short course of normally cognitive behavioural therapy) has been the recommended frontline treatment for many mild to moderate mental ill health problems for years. In the UK psychologists are important members of multidisciplinary teams, and psychological therapies are strongly recommended in NICE guidance for a wide range of problems.
- FrojoS 8y ago
  I think the parent was hinting at a culture that leads to depression, e.g. due to high pressure to show economic success.
- deleted 8y ago
  [deleted]
odiroot 8y ago
I think you're trivializing it a bit in here. For many people it is indeed a chemical imbalance and no amount of wishful thinking would change anything, but regulating with chemicals (obviously) does.
StudyAnimal 8y ago
People have been trying for years to undo this damage, Deming, Ohno etc. nowadays it’s probably mostly the agile community leading the way but I feel the curve is trending downwards. Most people here hate agile especially the fluffy cultural bits, and crave the pressure of a Silicon Valley startup.
- acdha 8y ago
  > Most people here hate agile especially the fluffy cultural bits, and crave the pressure of a Silicon Valley startup. That last bit seems like you may be extrapolating from a very small sample size. Hating on some of the Agile culture, sure, but are there really that many people wanting more stress? Most of the Agile reaction I’ve seen seems like the opposite direction with people wanting to improve work-life balance, or drop the parts of consultant-driven Agile which are just adding ceremony without benefit.
  - itronitron 8y ago
    A lot of the complaints on Agile are on its use as a system to micromanage. My experiences with Agile involve it being applied to a subset of the organization and in a limited fashion, for example only having standups and no planning meetings.
    - acdha 8y ago
      I think there’s also a good argument that much of what’s termed Agile, especially the annoying parts, really isn’t. For example, the importance of teams choosing how to work rather than having dogma forced on them: https://martinfowler.com/articles/agile-aus-2018.html https://martinfowler.com/articles/agile-aus-2018.html
WalterSear 8y ago
When our corporate oligarchs consider a path to greater ownership and control over society.
bluntfang 8y ago
I like the perspective that the DSM-* is a collection of behaviors that don't fit the current societal norms and is the attempt to correct people who don't/can't subscribe/adhere to these norms through medicine.
- modoc 8y ago
  That's an... interesting.. take.. There's a slice of that which is probably accurate, or at least something we could have a legitimate discussion about. However there's a lot of very REAL mental illness that is extremely detrimental to the people suffering from it, and from those around them, that has nothing to do with societal norms (in the way you mean). I'd also point out that the DSM isn't just used by psychiatrists (who give medicine) but is used by courts, psychologists, therapists, etc... who are dealing with treatment and therapy outside of prescribing drugs...
- shubb 8y ago
  Some people who don't fit in are labeled for sure, but other people are definitely ill. A middle class teenager expected to focus on math and prepare for a desk job is inappropriately diagnosed with something, when they might have been a tallented athlete. A clever, responsible man with a comfortable life suddenly hears voices that tell him his lifelong friends are poisoning him, and is incapable of seeing that this is a delusion, so he kills them. The first doesn't preclude the other, and I don't think the second one is merely 'behaviors that don't fit the current societal norms'. Sometimes brains go wrong. If you don't believe me, take a bunch of acid.
dalbasal 8y ago
The question in my mind is "who is we." Where we is "we the people," or somesuch acting through our medical establishments.. we get what we have. Medicalizing & treating as we do other ailments. The reason we use drugs instead of talk or behavioural therapies is because they are cheap or rather that recurring 1-on-1 therapy is very expensive. What does treating this systemically mean? We are increasingly treating mental health as systemic/epidemic problems via the medical systems. However, this generally means doing more diagnosing and treating of mental health in the same way. There isn't really an embodied "we" that makes decisions and takes actions at a cultural level. That is, no way of changing how people interact with eachother individuals doing it. A religious society might have a church that could do this. A local cleric could (for example) try and relieve loneliness in her community. I don't know of any body that could really affect how work culture works. Some things just develop in societies and "we" just don't act as a non-metaphorical "we." Cultural change works this way, mostly. If we're talking about a "we" that's me, you and a few other people, then we could definitely do a lot about mental health for some people.
Maybestring 8y ago
This is basically the left take. https://jacobinmag.com/2018/08/mental-health-psychiatry-class-struggle/ https://jacobinmag.com/2018/08/mental-health-psychiatry-clas... 'The rise of psychiatry was funded by America’s Gilded Age industrialists. Their aim: to cast society’s ills as problems of individual "mental health."'

retube 8y ago

Not to trivialize people with genuine issues, but experiencing "stress, anxiety and low mood" is completely normal and natural. In fact not experiencing these kinds of emotions from time to time would indicate an issue! I do wonder whether the scope of what's deemed "mental illness" is being widened

spiritcat 8y ago
na internet done made us all crazy
- deleted 8y ago
  [deleted]
kneel 8y ago
Pretty sure this study took normal mood fluctuations into consideration. Poor mental health probably means poor mental health.
frabcus 8y ago
Mental illnesses have psychological (eg issues from childhood), chemical (eg neurotransmitter balance) and yes social (communication and meaning) aspects. It's easy to pay attention to only one (a definition shift would be social/communication), but all three matter. These illnesses are failure modes at a mid level in the most complex information processing device in the universe. There's a lot going on - it's not so much definition shift, as this is complex, and yes it is a communal cry for help in part.
- aszantu 8y ago
  I want to add allergies to your list :) Personal experience: Ketogenic died made my depression go away almost over night
  - djsumdog 8y ago
    Diet plays a huge role in mood; and we normalize "comfort eating" way too much. You cut out sugar from your diet and you will feel better. We consume an insane amount in western societies and it's not good physically or mentally. You can't just focus on mental health without the physical health because they are so dependent. I feel like we're deeply missing that point today.
    - dvdhnt 8y ago
      > Diet plays a huge role in mood. I've seen many articles lately on the relationship between what's in our gut and our mental health. Their source escapes me at the moment, but here's a paper on the relationship between diet and mental health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167107/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167107/
TheSmiddy 8y ago
This argument is the equivalent of a climate change denier stating "the climate is always changing". Anecdotally the percentage of my friends who I would describe as unhappy has been increasing over time. In my early 20's at most 10% of my friends would be unhappy at any given moment, now in my 30's I feel like a solid 25% of my friends are noticeably unhappy and god knows how many are good at putting on a brave face. I don't know how much of this is just due to getting older or something specific to how our society is operating at this current point in history. When I talk to people from my parents generation I get the feeling that on average every year of their life was better than the last up until about 40, whereas it feels like the opposite is true for people today. I too am worried about the increasing scope of what determines a mental illness, but at the same time if your environment can cause you to get Pneumonia, it makes sense that your environment can cause you to experience clinical depression.
- cs02rm0 8y ago
  Being more stressed in your 30s than your early 20s is probably normal too. You've got less time on the planet, I've got a wife and three kids to support now, career options are vastly more limited, incurred massive debt to buy a house. But hey, things are going comparatively well for me relative to many of my peers. It seems really hard to compare between generations. Things are so different, but if mental health is towards the top of the pile of concerns now we should probably address it regardless of whether it's really a bigger issue than today than it was previously.
  - iovrthoughtthis 8y ago
    But is normal ok?
  - skohan 8y ago
    Normal in the context of how our society is structured, but far from ideal or unavoidable. For instance, I can compare the experience of my cousin raising two young kids on the east coast of the US with my girlfriend's sister in the same situation in Italy. In my cousin's case, she had to go back to work almost immediately in order to pay the high rents where she lives, and money's a constant stress because of the price of a decent daycare/preschool. Family's far away, so essentially all the childcare responsibilities fall on her and her husband. In contrast, my girlfriend's sister had 9 months of paid maternity leave with which she could stay home with the baby without undue financial stress. When she returned to work part time, she didn't have to rely on commercial childcare because her large extended family is close by to share the burden. In general that makes her and her husband's life more relaxed, because if they want to go away for the odd weekend they can leave the kids with grandma. If you ask me, the work culture is deeply pathological in places like the US and UK. With the rise in technology and automation there's no reason we couldn't live in societies which prioritize our human needs more highly.
stronglikedan 8y ago
I think this article is eluding to the problem of sustained stress, anxiety and low mood, which lead to abnormal chemical imbalances that cannot easily be overcome. Once the imbalance becomes impossible to overcome without external support, it becomes a legitimate illness (mental, in this context) that requires treatment.
- megous 8y ago
  Chemical imbalance (as a cause of depression or anxiety) is just a hypothesis (one of many). It's heavily used for marketing, because people can easily imagine something behind it, that's easily corrected by what companies sell (more chemicals), but it's most probably nonsense. Though your underlying point is observably valid. People can get into a state where it's hard for them to improve their well being without outside intervention.
  - stronglikedan 8y ago
    As someone who had such a chemical imbalance that was corrected by medication, I can assure you it's definitely not nonsense (although I thought the same as you until I went through it myself).
    - megous 8y ago
      I appreciate that you took pills and felt change. It, by itself, doesn't prove that there's a specific chemical imbalance in the brain, or that it causes depression or anxiety.
      - stronglikedan 8y ago
        It doesn't, but all the science behind the pills does. They weren't created for no reason.
        megous 8y ago
        What science? Most of it is focused on whether the drug has effect compared to placebo/other pills, what unintended effects it has, and not on trying to understand how brain works. Pill may have effect, yet the hypothesis may still be nonsense. Chemical imbalance hypothesis is really old, and doesn't account for a lot of new information since last 50-60 years. It's in principle the same problem as when psychotherapists/clinicians try to develop a theory of mind. The result is that we have several major contradictory theories of mind/schools of psychotherapy, and all of them work/are helpful. Yet the usefulness can not be used to validate the underlying theories of mind the methods are based on, because that would mean that all of those theories are valid.
DanBC 8y ago
Notice the submitted article doesn't talk about "mental illness" but about "poor mental health". I can have poor physical health without having a specific disease. I can have poor mental health without having a specific mental illness.
projektir 8y ago
I mean human misery is also completely normal and natural, that doesn't mean we're not going to notice it and point it out when we get better tools for identifying it...
mywacaday 8y ago
Anecdotal evidence of one person close to me, saw the benefits in the use of anti depressants but what I didn't expect was that when the person came off them they laughed more, the anti-depressants might reduce the lows but they also dimmed the highs.
amelius 8y ago
The lines of what is a mental illness are blurry. That doesn't mean we should stop paying attention when the "blurry blob" moves left or right on the chart.
m_fayer 8y ago
For a long time in many places, living in grinding poverty was and is "normal" and "natural" for most people. Living with all sorts of insecurity - food, physical safety, shelter - all normal. Evolution only selected for those of us who manage to reproduce individually and societally, not for those who tend to live to a ripe old age with a minimum of misery. I really don't get this formulation of "x miserable condition is perfectly natural!" when "natural" so often == "miserable".
- YinglingLight 8y ago
  Yes, but this is specifically about mental health. I believe the increased level of physical activity, combined with greater in-person socialization/community of our forefathers allowed them greater mental health (and with it, greater resiliency) than people of today.
  - emodendroket 8y ago
    Perhaps, but what is the evidence that that was the case or that the causes you cite are the ones to credit?
- danharaj 8y ago
  Hardship and misery aren't the same thing.
- 2bitmachine 8y ago
  >Evolution only selected for those of us who manage to reproduce individually and societally, not for those who tend to live to a ripe old age with a minimum of misery. Once humans developed complex societal structures, any such discussion of "evolutionary selection" borders on the ludicrous. Who reproduced and survived was (and is) far more dependent on you're relative power and status within these systems than anything even closely resembling natural selection.
eli_gottlieb 8y ago
The point where negative emotions become homeostatic dysfunction is the point where they've become a legitimate health issue. Yeah, sometimes life hurts, but if you're getting hypertension because of work stress, fuck your job.
Bartweiss 8y ago
> I do wonder whether the scope of what's deemed "mental illness" is being widened There are two questions here, I think. One is whether we're confusing regular moods with larger conditions, and the answer is generally no. Conditions like anxiety have time thresholds of persistent symptoms to avoid this issue, and other conditions like panic disorders describe things that many people never experience. The second is whether the scope of what's diagnosable is broadening on any axis. And there, we can say: yes, consciously so. The US standards for diagnosing mental illness (the DSM definitions) have been steadily moving away from attempts to determine who has a 'real' mental illness in favor of symptoms-based diagnoses. The standard for e.g. anxiety excludes anxiety from drugs (legal or not) and physical health problems, but says nothing about whether the long-term anxiety is 'justified' or a reasonable reaction to circumstances. It's partly an acknowledgement that lots of appraisals are made quickly and on circumstantial evidence, so we might as well issue circumstantial decisions instead of assigning grand theories that might not apply. And it's partly about the fact that many treatments are circumstance-agnostic; absent other options, someone who's constantly anxious because they have high debt and a stressful job will see basically the same benefits from CBT or medications as someone without circumstantial issues. But it's also a concession to just how little we understand a lot of mental illnesses. There's no particular sign that anxiety-the-disorder is anything but high activity from the system everyone has, and we're not sure why it seems to be so much more active in certain people, so there's no objective test to run. Which means either relying on a clinician's judgement about what's 'justified' anxiety, with all the cultural biases and doctor-shopping that invites, or admitting that it's an unclear question and bypassing it. (This looks a bit different when we do understand the biological mechanisms of a disorder, or at least know that certain treatments are conditional. As an example, nicotine helps decrease the symptom intensity of schizophrenia, but doesn't for most other hallucinatory or delusional disorders. And other conditions like ASPD or ADHD have foggy partial understandings that leave them in the middle.) One way of framing this is that we're pathologizing normal reactions. But another is that we have a system built to treat certain unpleasant conditions, and we're recognizing that it can operate on more pain than we'd previously realized. A lot of historical support mechanisms have ceased to support most people, both formal (priests running confessionals and doing relationship mediation) and informal (the death of the 'third place', fraternal organization membership, etc.) If the problem is "many people are sad and stressed by their work", assigning the care of those feelings to our sadness-and-stress support framework makes sense. Ideally we might change people's work circumstances instead, but this looks like at worst a return to the historical approach.

kzrdude 8y ago

The biggest issue is I think lack of sleep, and sometimes you need professional help to fix it or even realize you should

Kiro 8y ago

Because your whole premise may not necessarily be true. First step is to evaluate it, not the other way around as you suggest.

elvinyung 8y ago
Just curious -- what did you interpret my premise to be? To clarify, I think that this issue is so obviously overdetermined that we need to tackle all of the causes, not just any one.

50 8y ago

I'm pretty certain cultural and social conditioning is a large, if not the entire, part of the problem with poor mental health (and not just poor mental health!). Take this line from Andrei Tarkovsky's Sculpting in Time: "Modern mass culture, aimed at the 'consumer', the civilisation of prosthetics, is crippling people's souls, setting up barriers between man and the crucial questions of his existence, his consciousness of himself as a spiritual being." This is not something new. The severity of the problem has just heightened because of the information age. But otherwise, since this topic interests me greatly, I would definitely love to hear why you might think poor mental health may be due to something like culture and politics? Possible solutions?

elvinyung 8y ago
I am not an original thinker. My main reference for this topic has been the cultural theorist Mark Fisher. In Capitalist Realism he not only describes the privatization I mentioned previously, but also introduces two ideas that he ascribes to the neoliberal condition (based on anecdata of young people from his experiences as a professor): * reflexive impotence, in which people know that things are bad and that they can't do anything about it, leading to a kind of self-fulfilling prophecy en masse * depressive hedonia, in which people are depressed, but instead of being unable to seek pleasure, they basically can't do anything except seek pleasure (to consume more, faster, etc.) He also has another book, Ghosts of My Life, in which he talks about how we're essentially collectively "haunted" by the possible futures that failed to materialize. I've yet to read it, but I've heard it's fascinating.
- ak39 8y ago
  Ah, thank you for these two points and the book suggestions! I too am not an original thinker and I often synthesize ideas on this matter incoherently. But how is it that it is not universally accepted that the structure of employment, even in its most compassionate incarnation, is a structure that is designed to humiliate and strip the dignity of the employee? And then we have the modern employment contract that explicitly forbids talent to be shared with other employers, or for allegiance to be enunciated in corporate culture slogans drummed to death as though attempting to wash away the employee's identity. Maybe things are different in different cultures vis-a-vis the structure of employment. Japan for example where Salary Man choose to willingly marry his corporation for a lifetime.

DanBC 8y ago

> treating it exclusively as basically chemical imbalances within individual bodies Dunno where you live but over here we stopped doing that fucking years ago. This is why things like IAPT (Improved access to psychotherapy, a short course of normally cognitive behavioural therapy) has been the recommended frontline treatment for many mild to moderate mental ill health problems for years. In the UK psychologists are important members of multidisciplinary teams, and psychological therapies are strongly recommended in NICE guidance for a wide range of problems.

FrojoS 8y ago
I think the parent was hinting at a culture that leads to depression, e.g. due to high pressure to show economic success.
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odiroot 8y ago

I think you're trivializing it a bit in here. For many people it is indeed a chemical imbalance and no amount of wishful thinking would change anything, but regulating with chemicals (obviously) does.

StudyAnimal 8y ago

People have been trying for years to undo this damage, Deming, Ohno etc. nowadays it’s probably mostly the agile community leading the way but I feel the curve is trending downwards. Most people here hate agile especially the fluffy cultural bits, and crave the pressure of a Silicon Valley startup.

acdha 8y ago
> Most people here hate agile especially the fluffy cultural bits, and crave the pressure of a Silicon Valley startup. That last bit seems like you may be extrapolating from a very small sample size. Hating on some of the Agile culture, sure, but are there really that many people wanting more stress? Most of the Agile reaction I’ve seen seems like the opposite direction with people wanting to improve work-life balance, or drop the parts of consultant-driven Agile which are just adding ceremony without benefit.
- itronitron 8y ago
  A lot of the complaints on Agile are on its use as a system to micromanage. My experiences with Agile involve it being applied to a subset of the organization and in a limited fashion, for example only having standups and no planning meetings.
  - acdha 8y ago
    I think there’s also a good argument that much of what’s termed Agile, especially the annoying parts, really isn’t. For example, the importance of teams choosing how to work rather than having dogma forced on them: https://martinfowler.com/articles/agile-aus-2018.html https://martinfowler.com/articles/agile-aus-2018.html

WalterSear 8y ago

When our corporate oligarchs consider a path to greater ownership and control over society.

bluntfang 8y ago

I like the perspective that the DSM-* is a collection of behaviors that don't fit the current societal norms and is the attempt to correct people who don't/can't subscribe/adhere to these norms through medicine.

modoc 8y ago
That's an... interesting.. take.. There's a slice of that which is probably accurate, or at least something we could have a legitimate discussion about. However there's a lot of very REAL mental illness that is extremely detrimental to the people suffering from it, and from those around them, that has nothing to do with societal norms (in the way you mean). I'd also point out that the DSM isn't just used by psychiatrists (who give medicine) but is used by courts, psychologists, therapists, etc... who are dealing with treatment and therapy outside of prescribing drugs...
shubb 8y ago
Some people who don't fit in are labeled for sure, but other people are definitely ill. A middle class teenager expected to focus on math and prepare for a desk job is inappropriately diagnosed with something, when they might have been a tallented athlete. A clever, responsible man with a comfortable life suddenly hears voices that tell him his lifelong friends are poisoning him, and is incapable of seeing that this is a delusion, so he kills them. The first doesn't preclude the other, and I don't think the second one is merely 'behaviors that don't fit the current societal norms'. Sometimes brains go wrong. If you don't believe me, take a bunch of acid.

dalbasal 8y ago

The question in my mind is "who is we." Where we is "we the people," or somesuch acting through our medical establishments.. we get what we have. Medicalizing & treating as we do other ailments. The reason we use drugs instead of talk or behavioural therapies is because they are cheap or rather that recurring 1-on-1 therapy is very expensive. What does treating this systemically mean? We are increasingly treating mental health as systemic/epidemic problems via the medical systems. However, this generally means doing more diagnosing and treating of mental health in the same way. There isn't really an embodied "we" that makes decisions and takes actions at a cultural level. That is, no way of changing how people interact with eachother individuals doing it. A religious society might have a church that could do this. A local cleric could (for example) try and relieve loneliness in her community. I don't know of any body that could really affect how work culture works. Some things just develop in societies and "we" just don't act as a non-metaphorical "we." Cultural change works this way, mostly. If we're talking about a "we" that's me, you and a few other people, then we could definitely do a lot about mental health for some people.

Maybestring 8y ago

This is basically the left take. https://jacobinmag.com/2018/08/mental-health-psychiatry-class-struggle/ https://jacobinmag.com/2018/08/mental-health-psychiatry-clas... 'The rise of psychiatry was funded by America’s Gilded Age industrialists. Their aim: to cast society’s ills as problems of individual "mental health."'