10 ms·

No Longer Wanting to Die

181 points by hudibras 11y ago

la6470 11y ago
Sorry but I am still not going to subscribe to NYT just to RTFA.
rquantz 11y ago
As someone who has suffered from moderate but not debilitating depression for much of my adulthood, one thing that has always stood in the way of getting treatment has been finding a damn therapist. Back when I was a broke, insurance-less musician, I went to inexpensive sessions with a student therapist who listened to me talk for a semester but offered very little in the way of help. Shortly after getting insurance I asked my doctor for a therapist recommendation. The therapist she sent me to was a very nice old man who started suggesting prayer as an answer to my problems in the second session. That was also our last session. I wish there were a way to do this that eliminated some of the trial and error, because listings tend to be pretty neutral, and reviews are sparse and not particularly trustworthy. You end up picking someone who's close to you and hoping it works out. It's a great way to lose a lot of time, and you know one of the things about depression is failing to find a therapist after a few tries greatly decreases motivation to keep trying.
- furyofantares 11y ago
  I've felt the same way. I randomly found a therapist who has been very helpful to me and who I think is quite talented, but I only found her long after I'd given up on searching (many years later). It was essentially random happenstance. Though it also required me to become more open minded about the value someone could provide despite what I consider a less than ideal scientific literacy (in this case Myers-Briggs).
- zkhalique 11y ago
  Was your second session your last because the prayer suggestion made you not want to go again?
  - rquantz 11y ago
    It was a little more than that - he was talking about the HAARP conspiracy theory as well. It just became clear he didn't approach the world rationally. I'm sure for some people he would be a great therapist, but not a good match for me.
    - AnkhMorporkian 11y ago
      Wow, that's and extremely weird thing to come up from the therapist in a therapy session.
      - a3n 11y ago
        That, and the bit about prayer, sounds like the therapist was focusing on his own needs rather than the needs of the client.
    - eropple 11y ago
      So I'm a sucker for conspiracy theories, and this one's a new one on me: http://en.wikipedia.org/wiki/High_Frequency_Active_Auroral_Research_Program#Conspiracy_theories http://en.wikipedia.org/wiki/High_Frequency_Active_Auroral_R...
      - rquantz 11y ago
        Yeah, I hadn't heard of it either. He started talking about it and I said, "that sounds like a conspiracy theory," and then ended up looking it up in the session because he wouldn't let it go.
  - japhyr 11y ago
    Being told to pray is pretty much the antithesis of good therapy.
    - Dylan16807 11y ago
      How so? Seriously praying is an involved, focused mental state. It's not flippantly wishing.
- shanusmagnus 11y ago
  I think this is a general problem with the health care system. Finding somebody that's worth a shit is basically impossible to do in any sensible way, even for something as straightforward as orthopedics -- my journey towards shoulder surgery has been ridiculous to the point of farce. If it's this bad for ortho it must be unimaginably awful for anything touching mental health. What does one do? Get personal recommendations from trusted friends who've done their own searches? Are online communities any use?
  - sopooneo 11y ago
    I can testify to the mental health search difficulty. A close family member is searching for a therapist for emotional help dealing with an occasionally debilitating physical health issue. The first group we found through online searches ended up being a front for a multi-level-marketing group schilling essential oils. The second group, recommended by the overseeing physician at one of the most prestigious hospitals in the United States, was actually a "new age" center, whose main advise was to try homeopathic remedies. The third group, recommended glowingly on its web page, and organized by the hospital itself for sufferers of my family member's very condition, seemed to have vanished without a trace. No one had heard of it. Turns out it went defunct years ago, but no one bothered to update or remove its associated page. That's where we stand. Infuriating. This is not quality befitting a first world nation.
    - a3n 11y ago
      I've begun to wonder if the US is really and second and a half world nation. We have so much potential, and we keep it from ourselves. Maddening.
- grrrando 11y ago
  If you can, I suggest finding a Psychotherapy institute (this is not the "institute" of "institutionalized"). They have many therapists on "staff", and you begin your treatment with an interview that's designed to match you to a therapist that works well for you. The interview asks about why you're seeking therapy and if you have any preferences for your therapist (male, female, young, old, religious, non-religious, etc.). And if you wind up not liking the therapist they recommend, you can ask for another without any fuss. There are a number of these offices in NYC and I'm sure there are some in other cities as well. I hope you find somebody that works for you.
- msutherl 11y ago
  Totally speculative, but I think this might have something to do with a high demand for good therapists. For instance, I spoke recently with a friend who was studying to practice psychoanalysis and when I asked him if he was looking for clients, he turned me down in such a way as to suggest 'you're not on the level of my clientele' or at least 'I have all the clients I need.' This was in New York where I'm sure there's a huge base of wealthy potential clients willing to pay a premium. If therapists have no problem finding clients, word of mouth may actually be the best system for them. Please correct me if I'm off-base here.
  - judk 11y ago
    It's a classic NY/Jewish joke that the only doctor worth seeing is a doctor whose schedule is fully booked.
  - jmnicolas 11y ago
    Or maybe he didn't want a friend as a patient. You're not supposed to bond with your therapist but if you're already a friend it's too late. So his rejection may have been ethical and not about your worth as a patient.
    - electronvolt 11y ago
      I know as someone who was a caretaker[0] for a partner, it's incredibly hard to separate making responsible choices for someone who can't always make them from your regular actual friendship or relationship with them. If you were already friends with the person, I really don't see them ever wanting to treat you formally. In the worst case they might have to make the almost impossible decision between involuntarily committing you (if they think you are a danger to yourself/others) and losing a valued friendship, or not committing you against their better instincts to preserve their friendship and risking you harming yourself/others. (Not that you are necessarily in that category ever, but if you're making a decision like "Can I ethically provide treatment for this person?" you really have to think about worst cases.) [0] I don't have any medical/therapy training, but I wound up spending a few months taking care of someone I was dating who was having a pretty severe manic episode. Very irresponsible of her doctor, in retrospect, who later said the reason he hadn't hospitalized her was because she had me to help take care of her/watch her--and we were both college students and he had met me once, briefly.
- eli_gottlieb 11y ago
  Oh wow. That's even worse than the therapist I tried to see after getting out of undergrad and finding myself depressed with adulthood. I said that I was depressed with the thought that life after graduation consisted exclusively of work and materialism. He said I was being immature and should grow up. Psychotherapists and psychiatrists often seem to be utter shit at serving patients as normatively neutral medical professionals, ie: not treating their own lifestyle preferences or ideological frameworks as the One True Way to Live.
  - rquantz 11y ago
    Interesting, I'm not sure it's worse than your experience. I was pretty well equipped to discount the advice of a therapist pushing prayer and weird conspiracy theories. On the other hand, your therapist was an authority on mental health who was actually confirming some of the negative thoughts that depressed people often have. That would be a lot harder to defend against.
- identityhiden 11y ago
  I highly recommend the book "Feeling Good" (by David Burns) as an alternative to talk therapy. I (and several of my friends) have found it instrumental in overcoming depression. More importantly, it has been clinically studied and IIRC evidence suggests that it's on par with talk therapy or medication for mild to moderate depression.
DanBC 11y ago
In England DBT is patchily available. You'd usually have to be very ill, or persistant, to get it, and wait times can be too long. There has been a focus on CBT. That's great because for most people CBT is effective and short, but as this article says it doesn't work for everyone. Very recently there is a lot of work to improve access to other talking therapies. Patients now have more choice about where to get their treatment; maximum times for waiting are going to be introduced; "parity of esteem" with physical health is more important. (Although watch out: You may have to wait 18 weeks to have a hip replaced, so you may have to wait 18 weeks to start your psychological therapy.) One of the problems is that DBT needs experienced (expensive) practitioners, and tends to be used for people who are iller and who need a bit more support. So it's harder for health trusts to implement DBT programmes. Not trying to make excuses for them - I campaign pretty hard to improve treatment for people with a diagnosis of personality disorder and access to therapy is one of the main things. > And as imperfect as my D.B.T. practice was early on, I found that just taking anxiety down a degree or two gave me a measure of control over my decision making in the presence of intense emotion. The lesson was profound. I couldn’t eliminate anxiety from my life, but I could learn how to tolerate it, and cope without making the situation worse. This is a really nice point. It's an iterative process. You work at it.
- wcummings 11y ago
  Having done CBT, I found the complaints in the article really puzzling. Glad the author found something that worked for him, though.
  - mattmanser 11y ago
    Especially as what he describes sounds like CBT anyway.
  - NPMaxwell 11y ago
    What jumps out at me is that, as far as I know, CBT training focuses on having the therapist provide cognitive tools to reduce awful automatic thoughts and emotions. The therapist empowers the client. Some therapists bring from their own prior experience the ability to manage anxiety, shame, and guilt by leading the conversation, but others approach their work like computer programmers -- for them the task is to get the code in there. If you have ever seen a talented salesperson alternate pushing and withdrawal as they manage the prospect's anxiety and vanity while bringing them to a purchase, you have seen the element that is present in some CBT, but not part of the official training. Without that management by the therapist, the client may feel worse in sessions, and might come away with the sense that CBT is belittling. An irony here is that the greater respect of empowering the client may feel like less respect.
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Chinmayh 11y ago
I am not surprised that a treatment that is so effective to the author has remained unknown to him for so long. I have had feelings of suicide for the last 14 years. I personally hate meeting psychologists, because they can be so unpredictable. Some of the better ones prescribed me medicine, some of the worse ones, told me I had to stop crying and find solutions to my problems, that I was lazy. I was also told because I could do my job and earn a good living, I had nothing wrong. Few acknowledge that having no friends for 14 years can be disruptive. I am in a state where every moment is sad, but over the years at least I have learnt to keep a happy face on the outside and wait for something to happen. I just wished psychologists be more scientific and stop considering everything trial and error!
- a3n 11y ago
  > I am in a state where every moment is sad Please, keep trying. As for trial and error, we're far from knowing everything. Among a list of things known to have worked for various people, it is still somewhat trial and error finding out which of those things will work for any individual. We're big bags of meat, bone and mystery, and solving that mystery is a challenge, for ourselves and for our practitioners.
- cpncrunch 11y ago
  Here are some suggestions that worked for me, and may (or may not) help. I find that depression -- at least for me -- has two main causes: [1] Excessive emotional response to bad situations (similar to what the author of this article is experiencing). and: [2] Insufficient motivation/goals/joy. My solution to [1] is twofold: mindfulness and resolution. Be aware that excessive negative emotional responses are bad (as they lead to depression), so it is better to just observe bad situations and try not to get overly emotional. Secondly, try to resolve the issue (either by actively managing it, or by accepting that the world is just like that and you can't change it), so that the conflict doesn't arise in future. For [2], the solution is to have a purpose in life, with motivating, goal-oriented activities that you enjoy. I suspect this might be the issue for you. There is more to life than having a well-paid job. I gave up very well paid contract work 15 years ago, as I hated it. Since then I have worked on my own business. I earn a hell of a lot less money now, but I'm much happier. Having friends (or at least social contact) is also important to mental health, even if that is just saying hello to people you meet on the street, or chatting to like-minded people online. Please don't wait for something to happen. Take charge of your life and do something about it. Being depressed all the time is an unnatural state, and is your brain's way of telling you that you need to change something in your life. Sometimes you need to make major changes in your life to make things better. Feel free to email me at cpncrunchhn@gmail.com if you want to chat.
stegosaurus 11y ago
Treatment for depression is badly handled almost universally... It seems as if people still don't generally understand that it's more than 'feeling a bit sad'. If you break your knee, you will (99.9% chance) go and see a doctor. If the first doctor doesn't fix it, you'll see another. Your knee is broken, unusable, painful and you have a drive to fix it. A more serious injury will generally result in a friend/family member/passer by getting you to a doctor. If you suddenly enter a depression... even getting to the stage of seeing a doctor can fail, because suddenly everything is 'pointless' (bad wording. sorry.). And if you see them and they give bad advice, you maybe can't be bothered to see the next one. Or you miss the appointment because getting out of bed was too hard. Etc. It's more severe than most physical injuries because it affects your ability to seek help.
- abandonliberty 11y ago
  This is further compounded by the stigma & blame that surrounds mental illness, which can be quite severe in certain cultures/countries e.g. China
  - Chinmayh 11y ago
    Add India to the list
    - tim333 11y ago
      Plus you can get banned from entering the US http://www.cbc.ca/news/canada/toronto/canadian-woman-refused-u-s-entry-because-of-depression-1.2444960 http://www.cbc.ca/news/canada/toronto/canadian-woman-refused...
      - khnd 11y ago
        wow is this forreal?
- javajosh 11y ago
  Not to mention the social stigma that still(!) haunts depression (and virtually all psychological injuries). Few physical injuries have any sort of stigma - and the ones that do are usually associated with depression. Certainly it would be better if that stopped entirely (and, as with homosexuality in general, and gay marriage, it seems to be happening). That said, I actually have sympathy for the stigmatizers. From their perspective a perfectly healthy person with no overt negative stimuli is profoundly unhappy for no reason. That's got to be frustrating because it's completely and totally opaque, untouchable, alien, and unaddressable. The condition stymies the compassionate person, making a mockery of their good intentions. That is frustrating, even angering, and is probably the cause of the ambient hostility that lingers around depression. Depressives behavior appears stubbornly self-destructive, which essentially and irreducibly thwarts the will of those that care for them.
colund 11y ago
Hacker News unfortunately seems to be more and more about depression/psychology and less and less about positive entrepreneurship and tech/programming. I want to be inspired.
- cpncrunch 11y ago
  I suspect that it might be because the people who are driven to be entrepreneurs also have a higher likelihood of suffering from depression.
  - kvcc01 11y ago
    Yes. Unlike the parent, I welcome reading such stories. It keeps me cognizant of the risks of ignoring mental well-being. I think our professions (programming in particular) has more mischief potential because it makes it easy to drift into solitude while remaining productive. I can easily do my work locked up in a room with my computer sustained by Instacart without much human interaction, but therein lies sorrow. You couldn't work like that if you were a dentist or a plumber. I sometimes envy the forced social interactions of other professions.
    - a3n 11y ago
      I wonder if a life of programming, in particular, could mislead us to see big messy life as merely a stream of input, logical processing, and output.
  - DanBC 11y ago
    Suicide is the biggest killer of men aged between 20-34, and 35 to 49, in the UK. Rates are similarly high in the US - in 2013 one person died by suicide every 12 minutes. I'm not sure that entrepreneurs have higher rates of depression or suicidality. I think that depression and suicide are just very very common.
- davehimself 11y ago
  Are you depressed?
- 11y ago
deleted 11y ago
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halis 11y ago
I had a brother that committed suicide 7 years ago and his story was similar to yours. A history of extreme emotional swings and hospitalization for attempting suicide. I was the best man at his wedding. Once he got married and had three sons I thought that was the end of that part of his life. In my mind, no one with three little boys could ever kill themselves. I was wrong. As soon as his marriage started to fall apart, he did it. If anyone reading this knows someone that suffers from depression, never underestimate the power of depression.
- kvcc01 11y ago
  Your story is very sad, I'm truly sorry. An important risk factor for career-oriented married men is total abdication of social efforts and leaving it to the spouse "to manage the social calendar." In the long run, this causes men's own friendships to atrophy. Then, if your spouse divorces you (or pre-deceases you), you find yourself without any functional support structure, which could trigger depression or worse. I learned this from a book I read a while ago ("Lonely at the Top"), which tries to explain the causes of male suicide, especially among successful men. I vowed then, that if I get married, I'd make a very deliberate effort to maintain those friendships I had before the marriage. It's quite possible that someday, those friendships will be all that you may have left to rely on.
  - judk 11y ago
    This is so important, and one of the subtle reasons that the modern divorce-friendly culture adds dangers to men.
physcab 11y ago
While I don't really understand the differences between CBT and DBT, I've been seeing a therapist who has prescribed a lot of the treatments the author mentions. It never occurred to me that I suffered with anxiety but through a series of events I started having panic attacks and sought help. I've since learned that anxiety is often a front for emotions that cannot be adequately expressed or processed. For me, it's all the "unhealthy" emotions - anger, sadness, shame. The tools I've been able to deploy in anxiety fits include mindfulness: simply concentrating on my breathing and realizing how my body is reacting to stimuli. Often just meditating for a few minutes helps lower my anxiety, get my breathing under control and stop my heart from pounding. There's also journaling my emotions several times a day. I built an app that sends me an SMS asking me how I am feeling and why and logs the response for later analysis. It's not easy building new skills. It's also not easy re-training your mind after a lifetime of negative thinking. But so far its been working, and I've been able to do it drug free.
- binxbolling 11y ago
  > I built an app that sends me an SMS asking me how I am feeling and why and logs the response for later analysis. Please share if possible! Sounds great.
pvnick 11y ago
This is an important article. Dialectical behavior therapy and other mindfulness-based treatments are rapidly becoming go-to therapeutic methods. While I wasn't depressed or suicidal, about two months ago I started DBT training through a book [1], but used another audio book for mindfulness training [2]. The results have been fairly profound. The key is "radical acceptance". The universe is perfect in this moment, even if there are things you don't particularly like. You are a worthy and lovable person in this moment, even as there are certain aspects of yourself that you are currently trying to change. That's the dialectical part of dialectical behavior therapy. The idea of radical acceptance is something that can be applied right now, even before learning the skills. The author talks about shame. Shame convinces us that we are broken, that we aren't good enough. It tends to get passed through generations due to the way we are raised and the way we raise our children. Treating that shame is very effective for convincing us that we are, in fact, good enough. A book called Taming Your Outer Child [3], accompanied by meditations developed by John Bradshaw meant to get one in touch with one's inner child [4], are both very powerful for healing that shame. Finally, I can't help but add a TED talk by Brene Brown called the Power of Vulnerability [5]. In it she describes the idea of feeling worthy and "enough," and how it is key to happiness and living a fulfilled life. For me, it was helpful because it gave me a concrete idea to work towards. [1] http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1572245131 http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Wo... [2] http://www.amazon.co.uk/Mindfulness-Eight-Week-Finding-Peace-Frantic-ebook/dp/B005NJ2T1G http://www.amazon.co.uk/Mindfulness-Eight-Week-Finding-Peace... [3] http://www.amazon.com/Taming-Your-Outer-Child-Self-Sabotage-ebook/dp/B00KC6FDLS http://www.amazon.com/Taming-Your-Outer-Child-Self-Sabotage-... [4] http://www.audible.com/pd/Self-Development/Home-Coming-Audiobook/B002VAET86 http://www.audible.com/pd/Self-Development/Home-Coming-Audio... [5] https://www.ted.com/talks/brene_brown_on_vulnerability?language=en https://www.ted.com/talks/brene_brown_on_vulnerability?langu...
HSO 11y ago
Honest question: Is it just me or did articles related to suicide appear more frequently than usual lately here, and in the general media? Or is it this bias where I just pay more attention lately and the frequency never really changed, plus/minus noise?
alexashka 11y ago
I find it curious that what strikes me as the real reason for feeling depressed - his inability to handle anxiety and reliance on medication for it, was not the first paragraph, with multiple exclamation marks around it. THAT was the problem that got fixed as far as I can tell. There was also shame, feeling of inadequacy, etc but the real issue here seems to be that once you can handle a debilitating level of anxiety, you feel empowered to go out and live life and try things. That's what so many of these depression or suicide articles/ideas seem to be missing - there is usually some debilitating condition that the person is keeping quiet about, that's contributing to the downward spiral and until that gets fixed, nothing is going to work out. The debilitating problems range from individual to individual, so how can one silver bullet be found for being suicidal or being depressed? It varies. The issue as I see it in a lot of cases, is one of not being open enough about the root of the problem with yourself and others. Sometimes they don't even really know! (Usually younger people) I have met a number of people who have depression and it's usually the same story - being very defensive about whatever the root cause might be and if you probe them, they'll clamp up. It's almost like it hurts too much to admit that you are not ok. That's where there's such enormous amounts of shame - if you've lived with a problem for a dozen years and haven't fixed it, that'll get most people down, no doubt about it. So yeah, on one hand there's definitely stigma attached to depression and being suicidal but on the other, by treating it as some unicorn of a problem, we are not helping anybody. I think an assumption that there's a root problem that once tackled, will yield massive returns, would go a long way. Coupled with recognizing that most people feel almost insurmountable amounts of pressure at one point or another and find/having people who are understanding and constructively supportive beyond 'everything's gonna be ok' is paramount.
- DanBC 11y ago
  > I have met a number of people who have depression and it's usually the same story - being very defensive about whatever the root cause might be and if you probe them, they'll clamp up. It's almost like it hurts too much to admit that you are not ok. There often isn't a root cause for depression. Asking people why they're depressed can feel like you're judging them - "What have you got to be depressed about?"
comrh 11y ago
Lithium actually did it for me. One week on it and the suicidal ideations disappeared. It is basically poisoning yourself though, can be pretty rough on your body. Also the concept of "mindfulness" is so great for those ruminations that never seem to quiet down. Yoga, meditation, running, working out, all seemed to really feed into the idea of being "present".
thomyorkie 11y ago
I've seen hypnosis and EFT help some people with depression. Unfortunately, they seem to be a treatment options that go overlooked.
javert 11y ago
This "DBT" idea seems like it's just a specific implementation of "CBT." Not something to contrast with "CBT".
joshmn 11y ago
This thread describes so many flaws to the mental health care system. Does anyone want to team up and maybe solve the problem? While I'm no domain expert, I know a ton about mental health and the process of finding a good provider that you're comfortable with. I'm a generalist, mostly back-end guy (Ruby/Rails/Postgres) with a good eye for design. I've had a few lucky exits. I think this can be another one. Email is in profile.

181 points by hudibras 11y ago

Sorry but I am still not going to subscribe to NYT just to RTFA.

As someone who has suffered from moderate but not debilitating depression for much of my adulthood, one thing that has always stood in the way of getting treatment has been finding a damn therapist. Back when I was a broke, insurance-less musician, I went to inexpensive sessions with a student therapist who listened to me talk for a semester but offered very little in the way of help. Shortly after getting insurance I asked my doctor for a therapist recommendation. The therapist she sent me to was a very nice old man who started suggesting prayer as an answer to my problems in the second session. That was also our last session. I wish there were a way to do this that eliminated some of the trial and error, because listings tend to be pretty neutral, and reviews are sparse and not particularly trustworthy. You end up picking someone who's close to you and hoping it works out. It's a great way to lose a lot of time, and you know one of the things about depression is failing to find a therapist after a few tries greatly decreases motivation to keep trying.

furyofantares 11y ago
I've felt the same way. I randomly found a therapist who has been very helpful to me and who I think is quite talented, but I only found her long after I'd given up on searching (many years later). It was essentially random happenstance. Though it also required me to become more open minded about the value someone could provide despite what I consider a less than ideal scientific literacy (in this case Myers-Briggs).
zkhalique 11y ago
Was your second session your last because the prayer suggestion made you not want to go again?
- rquantz 11y ago
  It was a little more than that - he was talking about the HAARP conspiracy theory as well. It just became clear he didn't approach the world rationally. I'm sure for some people he would be a great therapist, but not a good match for me.
  - AnkhMorporkian 11y ago
    Wow, that's and extremely weird thing to come up from the therapist in a therapy session.
    - a3n 11y ago
      That, and the bit about prayer, sounds like the therapist was focusing on his own needs rather than the needs of the client.
  - eropple 11y ago
    So I'm a sucker for conspiracy theories, and this one's a new one on me: http://en.wikipedia.org/wiki/High_Frequency_Active_Auroral_Research_Program#Conspiracy_theories http://en.wikipedia.org/wiki/High_Frequency_Active_Auroral_R...
    - rquantz 11y ago
      Yeah, I hadn't heard of it either. He started talking about it and I said, "that sounds like a conspiracy theory," and then ended up looking it up in the session because he wouldn't let it go.
- japhyr 11y ago
  Being told to pray is pretty much the antithesis of good therapy.
  - Dylan16807 11y ago
    How so? Seriously praying is an involved, focused mental state. It's not flippantly wishing.
shanusmagnus 11y ago
I think this is a general problem with the health care system. Finding somebody that's worth a shit is basically impossible to do in any sensible way, even for something as straightforward as orthopedics -- my journey towards shoulder surgery has been ridiculous to the point of farce. If it's this bad for ortho it must be unimaginably awful for anything touching mental health. What does one do? Get personal recommendations from trusted friends who've done their own searches? Are online communities any use?
- sopooneo 11y ago
  I can testify to the mental health search difficulty. A close family member is searching for a therapist for emotional help dealing with an occasionally debilitating physical health issue. The first group we found through online searches ended up being a front for a multi-level-marketing group schilling essential oils. The second group, recommended by the overseeing physician at one of the most prestigious hospitals in the United States, was actually a "new age" center, whose main advise was to try homeopathic remedies. The third group, recommended glowingly on its web page, and organized by the hospital itself for sufferers of my family member's very condition, seemed to have vanished without a trace. No one had heard of it. Turns out it went defunct years ago, but no one bothered to update or remove its associated page. That's where we stand. Infuriating. This is not quality befitting a first world nation.
  - a3n 11y ago
    I've begun to wonder if the US is really and second and a half world nation. We have so much potential, and we keep it from ourselves. Maddening.
grrrando 11y ago
If you can, I suggest finding a Psychotherapy institute (this is not the "institute" of "institutionalized"). They have many therapists on "staff", and you begin your treatment with an interview that's designed to match you to a therapist that works well for you. The interview asks about why you're seeking therapy and if you have any preferences for your therapist (male, female, young, old, religious, non-religious, etc.). And if you wind up not liking the therapist they recommend, you can ask for another without any fuss. There are a number of these offices in NYC and I'm sure there are some in other cities as well. I hope you find somebody that works for you.
msutherl 11y ago
Totally speculative, but I think this might have something to do with a high demand for good therapists. For instance, I spoke recently with a friend who was studying to practice psychoanalysis and when I asked him if he was looking for clients, he turned me down in such a way as to suggest 'you're not on the level of my clientele' or at least 'I have all the clients I need.' This was in New York where I'm sure there's a huge base of wealthy potential clients willing to pay a premium. If therapists have no problem finding clients, word of mouth may actually be the best system for them. Please correct me if I'm off-base here.
- judk 11y ago
  It's a classic NY/Jewish joke that the only doctor worth seeing is a doctor whose schedule is fully booked.
- jmnicolas 11y ago
  Or maybe he didn't want a friend as a patient. You're not supposed to bond with your therapist but if you're already a friend it's too late. So his rejection may have been ethical and not about your worth as a patient.
  - electronvolt 11y ago
    I know as someone who was a caretaker[0] for a partner, it's incredibly hard to separate making responsible choices for someone who can't always make them from your regular actual friendship or relationship with them. If you were already friends with the person, I really don't see them ever wanting to treat you formally. In the worst case they might have to make the almost impossible decision between involuntarily committing you (if they think you are a danger to yourself/others) and losing a valued friendship, or not committing you against their better instincts to preserve their friendship and risking you harming yourself/others. (Not that you are necessarily in that category ever, but if you're making a decision like "Can I ethically provide treatment for this person?" you really have to think about worst cases.) [0] I don't have any medical/therapy training, but I wound up spending a few months taking care of someone I was dating who was having a pretty severe manic episode. Very irresponsible of her doctor, in retrospect, who later said the reason he hadn't hospitalized her was because she had me to help take care of her/watch her--and we were both college students and he had met me once, briefly.
eli_gottlieb 11y ago
Oh wow. That's even worse than the therapist I tried to see after getting out of undergrad and finding myself depressed with adulthood. I said that I was depressed with the thought that life after graduation consisted exclusively of work and materialism. He said I was being immature and should grow up. Psychotherapists and psychiatrists often seem to be utter shit at serving patients as normatively neutral medical professionals, ie: not treating their own lifestyle preferences or ideological frameworks as the One True Way to Live.
- rquantz 11y ago
  Interesting, I'm not sure it's worse than your experience. I was pretty well equipped to discount the advice of a therapist pushing prayer and weird conspiracy theories. On the other hand, your therapist was an authority on mental health who was actually confirming some of the negative thoughts that depressed people often have. That would be a lot harder to defend against.
identityhiden 11y ago
I highly recommend the book "Feeling Good" (by David Burns) as an alternative to talk therapy. I (and several of my friends) have found it instrumental in overcoming depression. More importantly, it has been clinically studied and IIRC evidence suggests that it's on par with talk therapy or medication for mild to moderate depression.

DanBC 11y ago

In England DBT is patchily available. You'd usually have to be very ill, or persistant, to get it, and wait times can be too long. There has been a focus on CBT. That's great because for most people CBT is effective and short, but as this article says it doesn't work for everyone. Very recently there is a lot of work to improve access to other talking therapies. Patients now have more choice about where to get their treatment; maximum times for waiting are going to be introduced; "parity of esteem" with physical health is more important. (Although watch out: You may have to wait 18 weeks to have a hip replaced, so you may have to wait 18 weeks to start your psychological therapy.) One of the problems is that DBT needs experienced (expensive) practitioners, and tends to be used for people who are iller and who need a bit more support. So it's harder for health trusts to implement DBT programmes. Not trying to make excuses for them - I campaign pretty hard to improve treatment for people with a diagnosis of personality disorder and access to therapy is one of the main things. > And as imperfect as my D.B.T. practice was early on, I found that just taking anxiety down a degree or two gave me a measure of control over my decision making in the presence of intense emotion. The lesson was profound. I couldn’t eliminate anxiety from my life, but I could learn how to tolerate it, and cope without making the situation worse. This is a really nice point. It's an iterative process. You work at it.

wcummings 11y ago
Having done CBT, I found the complaints in the article really puzzling. Glad the author found something that worked for him, though.
- mattmanser 11y ago
  Especially as what he describes sounds like CBT anyway.
- NPMaxwell 11y ago
  What jumps out at me is that, as far as I know, CBT training focuses on having the therapist provide cognitive tools to reduce awful automatic thoughts and emotions. The therapist empowers the client. Some therapists bring from their own prior experience the ability to manage anxiety, shame, and guilt by leading the conversation, but others approach their work like computer programmers -- for them the task is to get the code in there. If you have ever seen a talented salesperson alternate pushing and withdrawal as they manage the prospect's anxiety and vanity while bringing them to a purchase, you have seen the element that is present in some CBT, but not part of the official training. Without that management by the therapist, the client may feel worse in sessions, and might come away with the sense that CBT is belittling. An irony here is that the greater respect of empowering the client may feel like less respect.

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Chinmayh 11y ago

I am not surprised that a treatment that is so effective to the author has remained unknown to him for so long. I have had feelings of suicide for the last 14 years. I personally hate meeting psychologists, because they can be so unpredictable. Some of the better ones prescribed me medicine, some of the worse ones, told me I had to stop crying and find solutions to my problems, that I was lazy. I was also told because I could do my job and earn a good living, I had nothing wrong. Few acknowledge that having no friends for 14 years can be disruptive. I am in a state where every moment is sad, but over the years at least I have learnt to keep a happy face on the outside and wait for something to happen. I just wished psychologists be more scientific and stop considering everything trial and error!

a3n 11y ago
> I am in a state where every moment is sad Please, keep trying. As for trial and error, we're far from knowing everything. Among a list of things known to have worked for various people, it is still somewhat trial and error finding out which of those things will work for any individual. We're big bags of meat, bone and mystery, and solving that mystery is a challenge, for ourselves and for our practitioners.
cpncrunch 11y ago
Here are some suggestions that worked for me, and may (or may not) help. I find that depression -- at least for me -- has two main causes: [1] Excessive emotional response to bad situations (similar to what the author of this article is experiencing). and: [2] Insufficient motivation/goals/joy. My solution to [1] is twofold: mindfulness and resolution. Be aware that excessive negative emotional responses are bad (as they lead to depression), so it is better to just observe bad situations and try not to get overly emotional. Secondly, try to resolve the issue (either by actively managing it, or by accepting that the world is just like that and you can't change it), so that the conflict doesn't arise in future. For [2], the solution is to have a purpose in life, with motivating, goal-oriented activities that you enjoy. I suspect this might be the issue for you. There is more to life than having a well-paid job. I gave up very well paid contract work 15 years ago, as I hated it. Since then I have worked on my own business. I earn a hell of a lot less money now, but I'm much happier. Having friends (or at least social contact) is also important to mental health, even if that is just saying hello to people you meet on the street, or chatting to like-minded people online. Please don't wait for something to happen. Take charge of your life and do something about it. Being depressed all the time is an unnatural state, and is your brain's way of telling you that you need to change something in your life. Sometimes you need to make major changes in your life to make things better. Feel free to email me at cpncrunchhn@gmail.com if you want to chat.

stegosaurus 11y ago

Treatment for depression is badly handled almost universally... It seems as if people still don't generally understand that it's more than 'feeling a bit sad'. If you break your knee, you will (99.9% chance) go and see a doctor. If the first doctor doesn't fix it, you'll see another. Your knee is broken, unusable, painful and you have a drive to fix it. A more serious injury will generally result in a friend/family member/passer by getting you to a doctor. If you suddenly enter a depression... even getting to the stage of seeing a doctor can fail, because suddenly everything is 'pointless' (bad wording. sorry.). And if you see them and they give bad advice, you maybe can't be bothered to see the next one. Or you miss the appointment because getting out of bed was too hard. Etc. It's more severe than most physical injuries because it affects your ability to seek help.

abandonliberty 11y ago
This is further compounded by the stigma & blame that surrounds mental illness, which can be quite severe in certain cultures/countries e.g. China
- Chinmayh 11y ago
  Add India to the list
  - tim333 11y ago
    Plus you can get banned from entering the US http://www.cbc.ca/news/canada/toronto/canadian-woman-refused-u-s-entry-because-of-depression-1.2444960 http://www.cbc.ca/news/canada/toronto/canadian-woman-refused...
    - khnd 11y ago
      wow is this forreal?
javajosh 11y ago
Not to mention the social stigma that still(!) haunts depression (and virtually all psychological injuries). Few physical injuries have any sort of stigma - and the ones that do are usually associated with depression. Certainly it would be better if that stopped entirely (and, as with homosexuality in general, and gay marriage, it seems to be happening). That said, I actually have sympathy for the stigmatizers. From their perspective a perfectly healthy person with no overt negative stimuli is profoundly unhappy for no reason. That's got to be frustrating because it's completely and totally opaque, untouchable, alien, and unaddressable. The condition stymies the compassionate person, making a mockery of their good intentions. That is frustrating, even angering, and is probably the cause of the ambient hostility that lingers around depression. Depressives behavior appears stubbornly self-destructive, which essentially and irreducibly thwarts the will of those that care for them.

colund 11y ago

Hacker News unfortunately seems to be more and more about depression/psychology and less and less about positive entrepreneurship and tech/programming. I want to be inspired.

cpncrunch 11y ago
I suspect that it might be because the people who are driven to be entrepreneurs also have a higher likelihood of suffering from depression.
- kvcc01 11y ago
  Yes. Unlike the parent, I welcome reading such stories. It keeps me cognizant of the risks of ignoring mental well-being. I think our professions (programming in particular) has more mischief potential because it makes it easy to drift into solitude while remaining productive. I can easily do my work locked up in a room with my computer sustained by Instacart without much human interaction, but therein lies sorrow. You couldn't work like that if you were a dentist or a plumber. I sometimes envy the forced social interactions of other professions.
  - a3n 11y ago
    I wonder if a life of programming, in particular, could mislead us to see big messy life as merely a stream of input, logical processing, and output.
- DanBC 11y ago
  Suicide is the biggest killer of men aged between 20-34, and 35 to 49, in the UK. Rates are similarly high in the US - in 2013 one person died by suicide every 12 minutes. I'm not sure that entrepreneurs have higher rates of depression or suicidality. I think that depression and suicide are just very very common.
davehimself 11y ago
Are you depressed?
11y ago

deleted 11y ago

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halis 11y ago

I had a brother that committed suicide 7 years ago and his story was similar to yours. A history of extreme emotional swings and hospitalization for attempting suicide. I was the best man at his wedding. Once he got married and had three sons I thought that was the end of that part of his life. In my mind, no one with three little boys could ever kill themselves. I was wrong. As soon as his marriage started to fall apart, he did it. If anyone reading this knows someone that suffers from depression, never underestimate the power of depression.

kvcc01 11y ago
Your story is very sad, I'm truly sorry. An important risk factor for career-oriented married men is total abdication of social efforts and leaving it to the spouse "to manage the social calendar." In the long run, this causes men's own friendships to atrophy. Then, if your spouse divorces you (or pre-deceases you), you find yourself without any functional support structure, which could trigger depression or worse. I learned this from a book I read a while ago ("Lonely at the Top"), which tries to explain the causes of male suicide, especially among successful men. I vowed then, that if I get married, I'd make a very deliberate effort to maintain those friendships I had before the marriage. It's quite possible that someday, those friendships will be all that you may have left to rely on.
- judk 11y ago
  This is so important, and one of the subtle reasons that the modern divorce-friendly culture adds dangers to men.

physcab 11y ago

While I don't really understand the differences between CBT and DBT, I've been seeing a therapist who has prescribed a lot of the treatments the author mentions. It never occurred to me that I suffered with anxiety but through a series of events I started having panic attacks and sought help. I've since learned that anxiety is often a front for emotions that cannot be adequately expressed or processed. For me, it's all the "unhealthy" emotions - anger, sadness, shame. The tools I've been able to deploy in anxiety fits include mindfulness: simply concentrating on my breathing and realizing how my body is reacting to stimuli. Often just meditating for a few minutes helps lower my anxiety, get my breathing under control and stop my heart from pounding. There's also journaling my emotions several times a day. I built an app that sends me an SMS asking me how I am feeling and why and logs the response for later analysis. It's not easy building new skills. It's also not easy re-training your mind after a lifetime of negative thinking. But so far its been working, and I've been able to do it drug free.

binxbolling 11y ago
> I built an app that sends me an SMS asking me how I am feeling and why and logs the response for later analysis. Please share if possible! Sounds great.

pvnick 11y ago

This is an important article. Dialectical behavior therapy and other mindfulness-based treatments are rapidly becoming go-to therapeutic methods. While I wasn't depressed or suicidal, about two months ago I started DBT training through a book [1], but used another audio book for mindfulness training [2]. The results have been fairly profound. The key is "radical acceptance". The universe is perfect in this moment, even if there are things you don't particularly like. You are a worthy and lovable person in this moment, even as there are certain aspects of yourself that you are currently trying to change. That's the dialectical part of dialectical behavior therapy. The idea of radical acceptance is something that can be applied right now, even before learning the skills. The author talks about shame. Shame convinces us that we are broken, that we aren't good enough. It tends to get passed through generations due to the way we are raised and the way we raise our children. Treating that shame is very effective for convincing us that we are, in fact, good enough. A book called Taming Your Outer Child [3], accompanied by meditations developed by John Bradshaw meant to get one in touch with one's inner child [4], are both very powerful for healing that shame. Finally, I can't help but add a TED talk by Brene Brown called the Power of Vulnerability [5]. In it she describes the idea of feeling worthy and "enough," and how it is key to happiness and living a fulfilled life. For me, it was helpful because it gave me a concrete idea to work towards. [1] http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1572245131 http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Wo... [2] http://www.amazon.co.uk/Mindfulness-Eight-Week-Finding-Peace-Frantic-ebook/dp/B005NJ2T1G http://www.amazon.co.uk/Mindfulness-Eight-Week-Finding-Peace... [3] http://www.amazon.com/Taming-Your-Outer-Child-Self-Sabotage-ebook/dp/B00KC6FDLS http://www.amazon.com/Taming-Your-Outer-Child-Self-Sabotage-... [4] http://www.audible.com/pd/Self-Development/Home-Coming-Audiobook/B002VAET86 http://www.audible.com/pd/Self-Development/Home-Coming-Audio... [5] https://www.ted.com/talks/brene_brown_on_vulnerability?language=en https://www.ted.com/talks/brene_brown_on_vulnerability?langu...

HSO 11y ago

Honest question: Is it just me or did articles related to suicide appear more frequently than usual lately here, and in the general media? Or is it this bias where I just pay more attention lately and the frequency never really changed, plus/minus noise?

alexashka 11y ago

I find it curious that what strikes me as the real reason for feeling depressed - his inability to handle anxiety and reliance on medication for it, was not the first paragraph, with multiple exclamation marks around it. THAT was the problem that got fixed as far as I can tell. There was also shame, feeling of inadequacy, etc but the real issue here seems to be that once you can handle a debilitating level of anxiety, you feel empowered to go out and live life and try things. That's what so many of these depression or suicide articles/ideas seem to be missing - there is usually some debilitating condition that the person is keeping quiet about, that's contributing to the downward spiral and until that gets fixed, nothing is going to work out. The debilitating problems range from individual to individual, so how can one silver bullet be found for being suicidal or being depressed? It varies. The issue as I see it in a lot of cases, is one of not being open enough about the root of the problem with yourself and others. Sometimes they don't even really know! (Usually younger people) I have met a number of people who have depression and it's usually the same story - being very defensive about whatever the root cause might be and if you probe them, they'll clamp up. It's almost like it hurts too much to admit that you are not ok. That's where there's such enormous amounts of shame - if you've lived with a problem for a dozen years and haven't fixed it, that'll get most people down, no doubt about it. So yeah, on one hand there's definitely stigma attached to depression and being suicidal but on the other, by treating it as some unicorn of a problem, we are not helping anybody. I think an assumption that there's a root problem that once tackled, will yield massive returns, would go a long way. Coupled with recognizing that most people feel almost insurmountable amounts of pressure at one point or another and find/having people who are understanding and constructively supportive beyond 'everything's gonna be ok' is paramount.

DanBC 11y ago
> I have met a number of people who have depression and it's usually the same story - being very defensive about whatever the root cause might be and if you probe them, they'll clamp up. It's almost like it hurts too much to admit that you are not ok. There often isn't a root cause for depression. Asking people why they're depressed can feel like you're judging them - "What have you got to be depressed about?"

comrh 11y ago

Lithium actually did it for me. One week on it and the suicidal ideations disappeared. It is basically poisoning yourself though, can be pretty rough on your body. Also the concept of "mindfulness" is so great for those ruminations that never seem to quiet down. Yoga, meditation, running, working out, all seemed to really feed into the idea of being "present".

thomyorkie 11y ago

I've seen hypnosis and EFT help some people with depression. Unfortunately, they seem to be a treatment options that go overlooked.

javert 11y ago

This "DBT" idea seems like it's just a specific implementation of "CBT." Not something to contrast with "CBT".

joshmn 11y ago

This thread describes so many flaws to the mental health care system. Does anyone want to team up and maybe solve the problem? While I'm no domain expert, I know a ton about mental health and the process of finding a good provider that you're comfortable with. I'm a generalist, mostly back-end guy (Ruby/Rails/Postgres) with a good eye for design. I've had a few lucky exits. I think this can be another one. Email is in profile.