4 ms·

I hear the "depression is an illness" trope repeated over and over but I still fail to understand what it means. I'm sure for some definition of the word illne

by anm89 7y ago

I hear the "depression is an illness" trope repeated over and over but I still fail to understand what it means. I'm sure for some definition of the word illness it's true. But it's certainly not an illness in the way a cold or malaria or shingles or cystic fibrosis are illnesses. Those things can be objectively diagnosed. They entail physical measurable changes to a person's body. Depression is a set of guidelines in a book that ask vague subjective questions about how someone perceives the world. And then if the person decides you have it you have it. If they don't you dont. This has very little to do with the first scenario. I'm not trying to trivialize depression. I think it is very real and very serious. But I think the "illness" rehtoric is at best innacurate and at worst seriously misleading and distracting to people who have serious issues to deal with.

syndacks 7y ago
Just because you can't measure something doesn't mean it's not there. Perhaps we don't have the tools or knowledge yet to measure depression, like countless other human ailments of the past that are now treatable.
ncmncm 7y ago
Once all fevers were "ague". Now we have flu (dozens of strains), malaria, encephalitis, toxemia, etc., with a different treatment for each. Depression is still at the "ague" stage. For certain varieties, certain medications completely resolve them. For some, a treatment hasn't been identified. Approval of treatments is crippled by lack of diagnostic tools, so to test one, it has to be used on people who have all kinds, and then it only helps the small minority of them who have what it's good for. Statistically, one that works 100% for the actual illness it treats looks like it helps only 10-15% of the sample.
tim333 7y ago
There are different types of depression. It can be an illness caused by some brain imbalance, or it can be a normal human reaction to things being a bit depressing. For the first maybe seek medical help and for the second maybe try to improve your situation eg. go somewhere sunny, get a better job, make more friends etc. Also things like gratitude journals, DIY CBT and so on can help with the second. It the US there seems a tendency to overmedicalize and put people on antidepressant pills for life although they have no more effect than taking up exercise for example.
currymj 7y ago
this is equally true of, say, schizophrenia — there’s no physical test for it as far as I know, just questionnaires about how someone perceives the world. but i don’t think anyone would argue it’s not a biological disease at this point, even if we don’t yet know what biological parameters to measure.
brudgers 7y ago
Diagnosis of depression is clinical. Self reporting via standardized questions is an ordinary medical method. "Where does it hurt?" "When did it start?" "Is there a history of heart disease in your family?." "When did your baby start crying?" 'Illness' provides a framework for recognition and treatment. The book with the guidelines is medical not religious. The guidelines are guided by empiricism not revelation. Treatments are selected based on statistics rather than authority. There's general agreement that the book's content might be wrong. There's a process for changing it and the expectation that it will be rewritten. Criteria for diagnosing depression in the DSM include behavioral "thinking of suicide," physically measurable "weight loss," and general well being "fatigue." The suicide criterion is more conducive to empirical confirmation than "headache" or "joint pain."
ExtremePopcorn 7y ago
> I'm not trying to trivialize depression. As someone who has been catatonically depressed for a couple years now, I'm not so sure about this! People with chronic pain also often can't identify any physical source, but obviously you would never start posting "is this really an illness though?" or "aren't we distracting and misleading people??" in a thread about that. The undercurrent of your post is that depressed people need to snap out of it, and falling back on the "illness" label reduces personal responsibility. Trust me, many people feel like imposters claiming they have depression, despite being completely non-functional. Thanks but no thanks to this proposed contribution to the discourse. Are you really here to understand, or is it just to judge? Want some MRIs and EKGs of depressed brains?
- anm89 7y ago
  > undercurrent of your post is that depressed people need to snap out of it, Please point to where I say that. I explicitly do not say that. That's not an undercurrent because I don't believe it. I do also believe that people don't have zero agency in this problem. There is SOME ability and necessity for people to work on these types of problems. That's what therapy with a therapist is right? And that does differentiate depression from tuberculosis which cannot ever be improved by sitting down and talking about it.
  - ncmncm 7y ago
    Visiting a professional is generally a necessary step in recovering from tuberculosis. In that way it is not different from depression. In most forms of depression, talking with someone and doing nothing else is guaranteed to do no good. In that way they do not differ from tuberculosis.
  - ExtremePopcorn 7y ago
    Okay, my mistake for getting dragged into the archetypal HN argument. It's clear you cannot be convinced. Your original point - that depression has no biomarkers and is extremely subjective - has been proven wrong by a couple others and you've shown no gratitude or interest in this information. Only replying where you think there's an argument to be won. Maybe you, some random person on Hacker News, are not in fact smarter than the medical consensus? https://www.youtube.com/watch?v=NOAgplgTxfc https://www.youtube.com/watch?v=NOAgplgTxfc
belltaco 7y ago
Science is getting there. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436791/table/t1-ndt-13-1245/?report=objectonly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436791/table/t...
psv1 7y ago
You write this: > I'm not trying to trivialize depression. And then: > at worst seriously misleading and distracting to people who have serious issues to deal with. Implying that it isn't a serious issue.
- anm89 7y ago
  I literally used the phrase "serious issue" in the proceeding sentence to describe the situation. ??? I'd be very curious to hear this one explained. I'm totally baffled.
  - dmos62 7y ago
    You are mistaken about depression not having observable effect on the body. I wrote a post about that; it's a direct sibling to your original post. Your point is a bit conflicted. Like this person pointed out, it seems that you're saying that it's serious and not that serious at the same time. However, I think that the observation you wanted to convey wasn't about the comparative seriousness of depression, but rather that it's in some sense in a different realm than for example AIDS or shingles, even if the realm of some of its effects are similar (which you argued against, but you're wrong). And, I sympathize with that. Depression does seem to be made of a different cloth, but it's quite hard to elaborate further, and I won't get into it here.
    - ncmncm 7y ago
      It is odd to mention shingles in this context, as depression is a very common symptom of herpes infection, actually fixed by antiviral medication. So, even on its own terms, the argument is incoherent and, not to put too fine a point on it, wrong.

by anm89 7y ago

syndacks 7y ago

Just because you can't measure something doesn't mean it's not there. Perhaps we don't have the tools or knowledge yet to measure depression, like countless other human ailments of the past that are now treatable.

ncmncm 7y ago

Once all fevers were "ague". Now we have flu (dozens of strains), malaria, encephalitis, toxemia, etc., with a different treatment for each. Depression is still at the "ague" stage. For certain varieties, certain medications completely resolve them. For some, a treatment hasn't been identified. Approval of treatments is crippled by lack of diagnostic tools, so to test one, it has to be used on people who have all kinds, and then it only helps the small minority of them who have what it's good for. Statistically, one that works 100% for the actual illness it treats looks like it helps only 10-15% of the sample.

tim333 7y ago

There are different types of depression. It can be an illness caused by some brain imbalance, or it can be a normal human reaction to things being a bit depressing. For the first maybe seek medical help and for the second maybe try to improve your situation eg. go somewhere sunny, get a better job, make more friends etc. Also things like gratitude journals, DIY CBT and so on can help with the second. It the US there seems a tendency to overmedicalize and put people on antidepressant pills for life although they have no more effect than taking up exercise for example.

currymj 7y ago

this is equally true of, say, schizophrenia — there’s no physical test for it as far as I know, just questionnaires about how someone perceives the world. but i don’t think anyone would argue it’s not a biological disease at this point, even if we don’t yet know what biological parameters to measure.

brudgers 7y ago

Diagnosis of depression is clinical. Self reporting via standardized questions is an ordinary medical method. "Where does it hurt?" "When did it start?" "Is there a history of heart disease in your family?." "When did your baby start crying?" 'Illness' provides a framework for recognition and treatment. The book with the guidelines is medical not religious. The guidelines are guided by empiricism not revelation. Treatments are selected based on statistics rather than authority. There's general agreement that the book's content might be wrong. There's a process for changing it and the expectation that it will be rewritten. Criteria for diagnosing depression in the DSM include behavioral "thinking of suicide," physically measurable "weight loss," and general well being "fatigue." The suicide criterion is more conducive to empirical confirmation than "headache" or "joint pain."

ExtremePopcorn 7y ago

> I'm not trying to trivialize depression. As someone who has been catatonically depressed for a couple years now, I'm not so sure about this! People with chronic pain also often can't identify any physical source, but obviously you would never start posting "is this really an illness though?" or "aren't we distracting and misleading people??" in a thread about that. The undercurrent of your post is that depressed people need to snap out of it, and falling back on the "illness" label reduces personal responsibility. Trust me, many people feel like imposters claiming they have depression, despite being completely non-functional. Thanks but no thanks to this proposed contribution to the discourse. Are you really here to understand, or is it just to judge? Want some MRIs and EKGs of depressed brains?

anm89 7y ago
> undercurrent of your post is that depressed people need to snap out of it, Please point to where I say that. I explicitly do not say that. That's not an undercurrent because I don't believe it. I do also believe that people don't have zero agency in this problem. There is SOME ability and necessity for people to work on these types of problems. That's what therapy with a therapist is right? And that does differentiate depression from tuberculosis which cannot ever be improved by sitting down and talking about it.
- ncmncm 7y ago
  Visiting a professional is generally a necessary step in recovering from tuberculosis. In that way it is not different from depression. In most forms of depression, talking with someone and doing nothing else is guaranteed to do no good. In that way they do not differ from tuberculosis.
- ExtremePopcorn 7y ago
  Okay, my mistake for getting dragged into the archetypal HN argument. It's clear you cannot be convinced. Your original point - that depression has no biomarkers and is extremely subjective - has been proven wrong by a couple others and you've shown no gratitude or interest in this information. Only replying where you think there's an argument to be won. Maybe you, some random person on Hacker News, are not in fact smarter than the medical consensus? https://www.youtube.com/watch?v=NOAgplgTxfc https://www.youtube.com/watch?v=NOAgplgTxfc

belltaco 7y ago

Science is getting there. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436791/table/t1-ndt-13-1245/?report=objectonly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436791/table/t...

psv1 7y ago

You write this: > I'm not trying to trivialize depression. And then: > at worst seriously misleading and distracting to people who have serious issues to deal with. Implying that it isn't a serious issue.

anm89 7y ago
I literally used the phrase "serious issue" in the proceeding sentence to describe the situation. ??? I'd be very curious to hear this one explained. I'm totally baffled.
- dmos62 7y ago
  You are mistaken about depression not having observable effect on the body. I wrote a post about that; it's a direct sibling to your original post. Your point is a bit conflicted. Like this person pointed out, it seems that you're saying that it's serious and not that serious at the same time. However, I think that the observation you wanted to convey wasn't about the comparative seriousness of depression, but rather that it's in some sense in a different realm than for example AIDS or shingles, even if the realm of some of its effects are similar (which you argued against, but you're wrong). And, I sympathize with that. Depression does seem to be made of a different cloth, but it's quite hard to elaborate further, and I won't get into it here.
  - ncmncm 7y ago
    It is odd to mention shingles in this context, as depression is a very common symptom of herpes infection, actually fixed by antiviral medication. So, even on its own terms, the argument is incoherent and, not to put too fine a point on it, wrong.