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Some more food for thought - occasionally doctors will privately admit that many of their patients aren't really depressed, they're in fact suffering from "shit

Some more food for thought - occasionally doctors will privately admit that many of their patients aren't really depressed, they're in fact suffering from "shit life syndrome" - in other words, their mood is the normal and natural response to the circumstances they are in. Here's an FT article about Blackpool, a deprived seaside town in the north of England. It has the highest unemployment rate, some of the lowest life expectancy, highest rate of prescription of antidepressants, and highest rate of hard drug abuse (heroin and spice) in the country: https://www.ft.com/blackpool https://www.ft.com/blackpool

yomly 6y ago
Anecdotally a doctor friend confirmed this same observation to me after doing a psychiatry rotation - they suggested that most people with depression were just sad but wanted a magic pill to cure the unpleasant emotion.
- ip26 6y ago
  It's hard to know if you are clinically depressed. I've asked myself the question many times, and can never really say for sure.
  - Johnjonjoan 6y ago
    Usually if everyone around you would say you're one of the happiest people and you think you're also one of the saddest you are depressed. "Happiness has nothing on the overcompensations for misery" - Huxley If you're sad for a good/known reason you probably won't feel the need to overcompensate. Edit: I do not mean to say people who don't meet this criteria aren't depressed in any way shape or form.
  - jac241 6y ago
    https://www.mdcalc.com/phq-9-patient-health-questionnaire-9 https://www.mdcalc.com/phq-9-patient-health-questionnaire-9 . You deserve to feel happy and enjoy life. Don't let a stigma about mental illness prevent you from getting treatment (therapy and/or antidepressants) if you feel like you could benefit.
  - 6nf 6y ago
    Clinical depression is diagnosed when 1) its ongoing over 6 months or more and 2) it's having a detrimental effect on your life or the lives of those around you Roughly speaking of course
    - logfish 6y ago
      You are correct for point 2, but as far as 1 goes: major depressive disorder (what most people mean when they say "clinical depression") requires only two weeks of anhedonia/decreased mood plus a few more symptoms to be diagnosed: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/ https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/. Which is interesting, because a significant number of mental health conditions do require 6 months of ongoing symptoms e.g. generalized anxiety disorder and schizophrenia. First line treatment is cognitive behavioral therapy and an SSRI.
    - kzrdude 6y ago
      Cool. I had some annoying friends ask me if when I was referring to a depressed period, I was clinically depressed. (It sounded so dismissive to me, to ask if it was clinically or not.) Never really knew what it would mean (to be open about it, it affected me for years.. and I consider it over nowadays :).
  - ghostbrainalpha 6y ago
    I never thought of myself as depressed. Then I tried to sign up to be part of a Stanford Study, and the person reviewing my answers to a questionnaire rejected me for depression and said I should get help. It was absolutely shocked at the time. But in hindsight the frequency with which I considered ending my life should have been a clue.
    - kirsebaer 6y ago
      Most people never ever think about suicide. You might consider if you fit with "complex PTSD" or "childhood emotional neglect". This seems common among high-achieving tech people.
      - ghostbrainalpha 6y ago
        "Most people never ever think about suicide" That was such a huge insight to me that I still struggle with it almost 15 years later. It's like a Fish out of the fishbowl moment, discovering that other peoples inner dialogue can be so much more positive.
- mrkurt 6y ago
  Depression isn't "sad". Depression _can_ be a function of the environment, but it's still not "sad". Sad is a healthy, appropriate emotion. Depression is a numbness that makes it difficult to even feel sadness.
  - jac241 6y ago
    Amen. Depression is a a feeling of worthless or loss of interest in things that is significant enough to negatively impact your life.
  - garbagetime 6y ago
    Depression as you mean it is a proper state for a person to be be in when his life and the world about him seem to be very wrong. To delete depression rather than addressing the root causes seems strange and inhuman.
    - BurningFrog 6y ago
      The root causes are often unfixable. So you try to fix the other side of the equation. Often it means adjusting unrealistic expectations. Like if I'm sad because I'm not a famous movie star. You could either make me a movie star, or make me accept that this is very likely not going to happen, and that's OK. Nothing inhuman about that.
      - squiggleblaz 6y ago
        The root cause of that isn't that you're not a famous movie star. It's that you have so ordered your life that all happiness depends on being a famous movie star. There's parts of that equation that can be changed: teaching you how to have reasonable goals might be one of them. Ignoring the fact that you're sad because you're not a famous movie star and giving you a happy pill is the inhuman step. It's the old adage in spades: "Give someone a fish and they'll eat for a day; teach them to fish and they'll eat for the rest of their life." Happiness in pill form is not happiness.
  - jjeaff 6y ago
jkhdigital 6y ago
This is a gross oversimplification, but crude measures of self-reported well being can be correlated to three factors: genetics 50%, controllable life circumstances (e.g. habits, hobbies, voluntary social engagement) 40%, uncontrollable life circumstances 10% [source: The How of Happiness by Sonja Lyubomirsky]. In other words... a “shit life” for someone who hit the genetic lottery for happiness could look quite similar to a “golden life” for someone with terrible happiness genetics. The same objective life situation can result in profoundly different levels of self-reported well-being.
- taneq 6y ago
  I guarantee you that if you're trapped working 50+ hours a week in a minimum wage job without the necessary talents, connections or life skills to ever better your lot in life, your 'controllable life circumstances' control a lot less than 40% of your wellbeing.
  - rrrrrrrrrrrryan 6y ago
    There are people who live happily with minimum wage jobs though. I have to assume that this is at least partially due to genetics.
  - deleted 6y ago
    [deleted]
ogurechny 6y ago
Your article is better than the one on the top, which is a bit undecided about questioning the status quo. It advocates for some changes, but tries to remain inside the same world view. From outside US, it is quiiite noticeable that a lot of age-old philosophical and societal problems have been converted into personal problems that are supposedly solved by “pills” or “therapy” (that is as uniform and easily applicable as taking pills). Despite the pace of scientific and technological progress, people don't change so fast and evolve so quickly to have those “solved”. It is also doubtful that the rates of popular “mental health issues” have grown in recent decades the way the headlines routinely tell us. If some observer told you he had been seeing more and more people with four hands and two heads, you'd suppose that he had actually been getting more and more drunk. It is possible that the system that categorizes those issues is not up to the task. Partially, it's because everything is a nail if you have a hammer. Drugs exist, patients know that and want them, doctors know that and prescribe them, the wheels are rolling, and it's sure hard to swim up the current. Whether they do work is not that important, people have always had talismans, and strong feelings about them (just look at the global mask wearing hassle). Partially, it's because modern education is still based on positivism, scientism, and mechanicism of XIX century, but it is very rarely stated clearly. Even “critical” disciplines take a lot of things for granted. On this very page, people write about DNA this and DNA that, neurotransmitters this and neurotransmitters that, and it's implied that they'd tend to explain the world that way. Despite the origins of these terms, it is easy to see that they are used in the same way celestial signs were used to describe the initial state of a person, and imbalance of humors was used to reason about the immediate state of a person. The physical effects of, say, a bullet flying into someone's body can be studied and understood, and surgeons do treat these wounds, but it would be stupid to only describe the problem at that level without asking how and why bullets are actually shot. Partially, it's because the image of the world presented to a person — not just by media, but also by familiar, decent, like-minded people — is skewed, and many have to over-correct into the opposite direction to balance it. Some ever-important matters are suppressed and rarely discussed in societies that consider themselves free and well organized, and the assumed path to “success” in life won't admit everyone even in theory. Not so long ago, only nobles had an option to care about having the biggest rubies in their jewelry, but now, thanks to progress, everyone can be a small noble and worry about countless new trifles. The generated noise hinders the uncovering of what lies beneath. All in all, the “depression” might not be the term that needs a more precise or extensive definition. It might be a swept heap of everything that is not defined.

yomly 6y ago

Anecdotally a doctor friend confirmed this same observation to me after doing a psychiatry rotation - they suggested that most people with depression were just sad but wanted a magic pill to cure the unpleasant emotion.

ip26 6y ago
It's hard to know if you are clinically depressed. I've asked myself the question many times, and can never really say for sure.
- Johnjonjoan 6y ago
  Usually if everyone around you would say you're one of the happiest people and you think you're also one of the saddest you are depressed. "Happiness has nothing on the overcompensations for misery" - Huxley If you're sad for a good/known reason you probably won't feel the need to overcompensate. Edit: I do not mean to say people who don't meet this criteria aren't depressed in any way shape or form.
- jac241 6y ago
  https://www.mdcalc.com/phq-9-patient-health-questionnaire-9 https://www.mdcalc.com/phq-9-patient-health-questionnaire-9 . You deserve to feel happy and enjoy life. Don't let a stigma about mental illness prevent you from getting treatment (therapy and/or antidepressants) if you feel like you could benefit.
- 6nf 6y ago
  Clinical depression is diagnosed when 1) its ongoing over 6 months or more and 2) it's having a detrimental effect on your life or the lives of those around you Roughly speaking of course
  - logfish 6y ago
    You are correct for point 2, but as far as 1 goes: major depressive disorder (what most people mean when they say "clinical depression") requires only two weeks of anhedonia/decreased mood plus a few more symptoms to be diagnosed: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/ https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/. Which is interesting, because a significant number of mental health conditions do require 6 months of ongoing symptoms e.g. generalized anxiety disorder and schizophrenia. First line treatment is cognitive behavioral therapy and an SSRI.
  - kzrdude 6y ago
    Cool. I had some annoying friends ask me if when I was referring to a depressed period, I was clinically depressed. (It sounded so dismissive to me, to ask if it was clinically or not.) Never really knew what it would mean (to be open about it, it affected me for years.. and I consider it over nowadays :).
- ghostbrainalpha 6y ago
  I never thought of myself as depressed. Then I tried to sign up to be part of a Stanford Study, and the person reviewing my answers to a questionnaire rejected me for depression and said I should get help. It was absolutely shocked at the time. But in hindsight the frequency with which I considered ending my life should have been a clue.
  - kirsebaer 6y ago
    Most people never ever think about suicide. You might consider if you fit with "complex PTSD" or "childhood emotional neglect". This seems common among high-achieving tech people.
    - ghostbrainalpha 6y ago
      "Most people never ever think about suicide" That was such a huge insight to me that I still struggle with it almost 15 years later. It's like a Fish out of the fishbowl moment, discovering that other peoples inner dialogue can be so much more positive.
mrkurt 6y ago
Depression isn't "sad". Depression _can_ be a function of the environment, but it's still not "sad". Sad is a healthy, appropriate emotion. Depression is a numbness that makes it difficult to even feel sadness.
- jac241 6y ago
  Amen. Depression is a a feeling of worthless or loss of interest in things that is significant enough to negatively impact your life.
- garbagetime 6y ago
  Depression as you mean it is a proper state for a person to be be in when his life and the world about him seem to be very wrong. To delete depression rather than addressing the root causes seems strange and inhuman.
  - BurningFrog 6y ago
    The root causes are often unfixable. So you try to fix the other side of the equation. Often it means adjusting unrealistic expectations. Like if I'm sad because I'm not a famous movie star. You could either make me a movie star, or make me accept that this is very likely not going to happen, and that's OK. Nothing inhuman about that.
    - squiggleblaz 6y ago
      The root cause of that isn't that you're not a famous movie star. It's that you have so ordered your life that all happiness depends on being a famous movie star. There's parts of that equation that can be changed: teaching you how to have reasonable goals might be one of them. Ignoring the fact that you're sad because you're not a famous movie star and giving you a happy pill is the inhuman step. It's the old adage in spades: "Give someone a fish and they'll eat for a day; teach them to fish and they'll eat for the rest of their life." Happiness in pill form is not happiness.
- jjeaff 6y ago

jkhdigital 6y ago

This is a gross oversimplification, but crude measures of self-reported well being can be correlated to three factors: genetics 50%, controllable life circumstances (e.g. habits, hobbies, voluntary social engagement) 40%, uncontrollable life circumstances 10% [source: The How of Happiness by Sonja Lyubomirsky]. In other words... a “shit life” for someone who hit the genetic lottery for happiness could look quite similar to a “golden life” for someone with terrible happiness genetics. The same objective life situation can result in profoundly different levels of self-reported well-being.

taneq 6y ago
I guarantee you that if you're trapped working 50+ hours a week in a minimum wage job without the necessary talents, connections or life skills to ever better your lot in life, your 'controllable life circumstances' control a lot less than 40% of your wellbeing.
- rrrrrrrrrrrryan 6y ago
  There are people who live happily with minimum wage jobs though. I have to assume that this is at least partially due to genetics.
- deleted 6y ago
  [deleted]

ogurechny 6y ago

Your article is better than the one on the top, which is a bit undecided about questioning the status quo. It advocates for some changes, but tries to remain inside the same world view. From outside US, it is quiiite noticeable that a lot of age-old philosophical and societal problems have been converted into personal problems that are supposedly solved by “pills” or “therapy” (that is as uniform and easily applicable as taking pills). Despite the pace of scientific and technological progress, people don't change so fast and evolve so quickly to have those “solved”. It is also doubtful that the rates of popular “mental health issues” have grown in recent decades the way the headlines routinely tell us. If some observer told you he had been seeing more and more people with four hands and two heads, you'd suppose that he had actually been getting more and more drunk. It is possible that the system that categorizes those issues is not up to the task. Partially, it's because everything is a nail if you have a hammer. Drugs exist, patients know that and want them, doctors know that and prescribe them, the wheels are rolling, and it's sure hard to swim up the current. Whether they do work is not that important, people have always had talismans, and strong feelings about them (just look at the global mask wearing hassle). Partially, it's because modern education is still based on positivism, scientism, and mechanicism of XIX century, but it is very rarely stated clearly. Even “critical” disciplines take a lot of things for granted. On this very page, people write about DNA this and DNA that, neurotransmitters this and neurotransmitters that, and it's implied that they'd tend to explain the world that way. Despite the origins of these terms, it is easy to see that they are used in the same way celestial signs were used to describe the initial state of a person, and imbalance of humors was used to reason about the immediate state of a person. The physical effects of, say, a bullet flying into someone's body can be studied and understood, and surgeons do treat these wounds, but it would be stupid to only describe the problem at that level without asking how and why bullets are actually shot. Partially, it's because the image of the world presented to a person — not just by media, but also by familiar, decent, like-minded people — is skewed, and many have to over-correct into the opposite direction to balance it. Some ever-important matters are suppressed and rarely discussed in societies that consider themselves free and well organized, and the assumed path to “success” in life won't admit everyone even in theory. Not so long ago, only nobles had an option to care about having the biggest rubies in their jewelry, but now, thanks to progress, everyone can be a small noble and worry about countless new trifles. The generated noise hinders the uncovering of what lies beneath. All in all, the “depression” might not be the term that needs a more precise or extensive definition. It might be a swept heap of everything that is not defined.