Depression

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prothero
 
Reply Sat 30 Jan, 2010 12:32 am
@Deckard,
Deckard;123613 wrote:
I am for Hope and I don't think Hope has to come in the form of a pill.
Expert or not, I'm going to say it: Pharmaceuticals are NEVER the ONLY cure for depression. .
I do not think too many mental health professionals would feel that pharmaceeuticals are the only cure for depression. The treatment of depression involves many modaliteis including counseling, changes in life style and life situations, and outlooks or attitudes but the use of pharmaceuticals definitely plays a role as well. In the treatment of more severe mental disease the effects of pharmaceutical interventions can be nothing short of miraculous.
Try Kay Redfied Jamaeson "Night Falls Fast" or "An Unquiet Mind", she is a John Hopkins psychiatrist who both treats and suffers from bipolar maninc depressive disorder and her insights are enlightening. Yes I have worked in this area and used these medications and properly applied the effects can be dramatic remarkable and life saving. Yes I think people are over diagnosed and over medicated but one should not discount the value of pharmaceuticals when appropriately used.
 
Deckard
 
Reply Sat 30 Jan, 2010 01:01 am
@prothero,
Any thoughts on prevention prothero? e.g. various lifestyle choices: diet, exercise, and environmental factors: chemicals, television, work environment might lead to depression. And I would think that people who have some feature that sets them apart from the crowd (race, religion, disability etc) or for some other reason have been isolated and denied full membership in social groups would be more suseptible. Maybe I'm stating the obvious here but those are some of the reasons I get mad at the comercials that say "depression is caused by a chemical imbalance" or "depression is a disease".

There is so much more going on that effects our brains. The brain is not a closed system with some chemicals sloshing around in it that occasionally get "out of balance". It is an open system with many many variables many of which I don't think are adequately considered in the Diagnostic and Statistical Manual of of Mental Disorders for example. I haven't spent much time with said manual but I know it changes with every edition. So that's another thing: the definition of depression is still evolving. Granted, it's science but it's not like solving a physics equation where you solve for x for patient y and sometimes find out yep, sure enough x = depression for patient y. Advertisers and doctors and patients shouldn't pretend that it is.
 
prothero
 
Reply Sat 30 Jan, 2010 11:44 am
@Deckard,
Deckard;123616 wrote:
Any thoughts on prevention prothero? e.g. various lifestyle choices: diet, exercise, and environmental factors: chemicals, television, work environment might lead to depression. And I would think that people who have some feature that sets them apart from the crowd (race, religion, disability etc) or for some other reason have been isolated and denied full membership in social groups would be more suseptible. Maybe I'm stating the obvious here but those are some of the reasons I get mad at the comercials that say "depression is caused by a chemical imbalance" or "depression is a disease".

There is so much more going on that effects our brains. The brain is not a closed system with some chemicals sloshing around in it that occasionally get "out of balance". It is an open system with many many variables many of which I don't think are adequately considered in the Diagnostic and Statistical Manual of of Mental Disorders for example. I haven't spent much time with said manual but I know it changes with every edition. So that's another thing: the definition of depression is still evolving. Granted, it's science but it's not like solving a physics equation where you solve for x for patient y and sometimes find out yep, sure enough x = depression for patient y. Advertisers and doctors and patients shouldn't pretend that it is.
I should add a comment here. You know doctors cant make or force patients to change their lifestyles, their life circumstances or even their attitudes. In fact doctors can not even make mentally ill and dangerous patients take their medication. So it is not too surprising that prescribing medication and giving limited advice and counseling often becomes the major role that doctors play in the treatment of depression. Most of the other interventions really are up to the individual patient. You can give good advice about interventions other than just medication but in the end the patient will decide to comply or not.

It should be remebered that for severe forms of mental illness there clearly are chemical imbalances and alterations in metabolic activity in the brain that occur which may make it hard for the patient to change their behaviors and that correcting those chemical imbalances may aid the patient in making other changes in their life which long term may alleviate the need for prolonged medication. In fact mental illness is in some ways brings into question the notion of "free" will and choice altogether.
 
Didymos Thomas
 
Reply Sat 30 Jan, 2010 12:59 pm
@prothero,
Deckard;123613 wrote:

Expert or not, I'm going to say it: Pharmaceuticals are NEVER the ONLY cure for depression.


Maybe not the only aspect of treating depression, but they sure as hell are a big help in treating depression. They play an important role in treating depression.
 
Magnus phil
 
Reply Sun 31 Jan, 2010 04:12 pm
@sometime sun,
I think my depression comes from thinking too much. It helps me to banter with other philosophers. Sometimes my inner dialog gets lonely. It's like being in a bubble, thinking too much. It feels right to me though. I wouldn't want to give it up. But, to think and not do things about it is meaningless chatter leading to no further awareness of oneself in relation to others.
 
melonkali
 
Reply Sun 31 Jan, 2010 09:09 pm
@Jebediah,
Jebediah;123158 wrote:
Most people who are depressed are not being realistic.


That is true with severe clinical depression. However, check out the studies concerning mild to moderate depression -- google "depressive realism". Mild to moderately (depending on how one defines "moderately") depressed people score higher than "normal" control subjects.
 
Jebediah
 
Reply Sun 31 Jan, 2010 10:05 pm
@melonkali,
melonkali;123975 wrote:
That is true with severe clinical depression. However, check out the studies concerning mild to moderate depression -- google "depressive realism". Mild to moderately (depending on how one defines "moderately") depressed people score higher than "normal" control subjects.


From what I remember of those studies, depressed people score more accurately when asked about their abilities etc, but not because they are being realistic, but because they are thinking "I suck". Well, not in those words exactly. Essentially, it's an irrational process that can lead to greater accuracy in some cases.

So, they can report their driving ability more accurately than a happy person, but don't have a realistic perception on the whole.
 
Deckard
 
Reply Sun 31 Jan, 2010 10:41 pm
@Jebediah,
Jebediah;123979 wrote:
From what I remember of those studies, depressed people score more accurately when asked about their abilities etc, but not because they are being realistic, but because they are thinking "I suck". Well, not in those words exactly. Essentially, it's an irrational process that can lead to greater accuracy in some cases.

So, they can report their driving ability more accurately than a happy person, but don't have a realistic perception on the whole.


I hope the scientists who design these studies are depressed otherwise the studies themselves might be unrealistic. I think many scientists are overconfident in their study making abilities. That's a joke. I'd put up one of those the LOL smilies but those things depress me.
 
melonkali
 
Reply Sun 31 Jan, 2010 11:54 pm
@Deckard,
Deckard;123176 wrote:
Perhaps it depends on what is being despaired of and thus what the object of hope is but in general I think the word "despair" represents a horrible state of mind that should always be avoided.

For example if I were to say "Well, the only appropriate thing for someone like you to do now is to just allow yourself to fall into a deep despair." or "My advice to you is to just abandon all hope right now because nothing will ever save you." at best such statements would be sarcastic, at worst they are sadistic.

However, in this day and age it may be best to keep some of your most precious hopes secret where the rabble can't pick away at them or until a time and place when you are strong enough to defend them.


Points well taken -- your last paragraph, the need to keep some hopes secret, is something I'd not thought about before, and will be chewing on.

As for despair -- I suppose it is important to differentiate between temporary, perhaps long term, and permanent hopelessness. Certainly some situations are tragic/painful enough to create temporary despair in most people.

I'd be interested in your response to a few situations going through my mind. Suppose YOU are a counselor or comforter. First, do we agree on these presumptions? If not, change what you believe is flawed.
1) You understand how in many, although not all, situations, fostering false hope, particularly if that hope affects not only someone's mood but his behavior and actions and future, can be counterproductive in the long haul.
2) You understand that platitudes and cliches, religious or otherwise, don't "work" on most people in times of real distress.
3) You understand that while some people are stronger and more resilient than others, everyone has a limit to how much emotional distress he can bear without breaking.
4) "Happy pills" (antidepressants) don't work for everyone -- there are patients in whom the side effects (of say, Type A antidepressants) may include manic "bounce" or intolerable lethargy, over-riding any benefits, and Type B antidepressants are ineffective. This is not an uncommon situation.

So, as a counselor or comforter, what is your reasoning, and more importantly, what do you say to:
a) someone whose spouse, or child, or self, has just been diagnosed with a terminal disease which gives them about 6 to 12 months of increasing pain and extreme debility;
b) someone whose spouse or child has just tragically died;
c) someone whose entire family has just died, and this person is at least partially at fault (I've seen this one -- a wife and 4 children and he was driving the car);
d) someone whose child has been missing for 1 year? 2? 3? more?
e) two elderly grandparents sitting in the pediatric intensive care waiting room when the doctor comes in and informs them the final EEG was flat, time to pull the plug on a precious 5 year old grandson they've been raising -- clue: you know and they know the odds are they'll be dead before the agony and despair abate. (Yes, I've seen this one, too.)
f) your brother/son was killed in Iraq (in my day, it was Viet Nam) -- friendly fire -- this person was against the war, as are you
g) you're working in a horrible third world area where, honestly, most of the children are going to die of starvation as their parents helplessly watch (I know people who've been in that situation), and there's no relief in sight.

The list is endless, but you get the point. If you are "the comforter", "the counselor", what CAN you say? Is not their despair a normal reaction? Most people in such tragic situations, if acting relatively un-affected, are in serious denial, which is NOT a good natural defense mechanism. It's an unstable state and will inevitably come crashing down, often catastrophically.

Is despair good? No. But are we all immune from it? No.

Do we sometimes have to accept despair as permanent? In some cases of extreme and/or prolonged distress, especially in those who don't react well to medications, yes, it may be permanent.

If you disagree, what alternative solutions do you propose?

(These questions are, of course, open to anyone who wishes to respond.)

rebecca
 
Deckard
 
Reply Mon 1 Feb, 2010 02:01 am
@melonkali,
melonkali;123987 wrote:

So, as a counselor or comforter, what is your reasoning, and more importantly, what do you say to:
a) someone whose spouse, or child, or self, has just been diagnosed with a terminal disease which gives them about 6 to 12 months of increasing pain and extreme debility;
b) someone whose spouse or child has just tragically died;
c) someone whose entire family has just died, and this person is at least partially at fault (I've seen this one -- a wife and 4 children and he was driving the car);
d) someone whose child has been missing for 1 year? 2? 3? more?
e) two elderly grandparents sitting in the pediatric intensive care waiting room when the doctor comes in and informs them the final EEG was flat, time to pull the plug on a precious 5 year old grandson they've been raising -- clue: you know and they know the odds are they'll be dead before the agony and despair abate. (Yes, I've seen this one, too.)
f) your brother/son was killed in Iraq (in my day, it was Viet Nam) -- friendly fire -- this person was against the war, as are you
g) you're working in a horrible third world area where, honestly, most of the children are going to die of starvation as their parents helplessly watch (I know people who've been in that situation), and there's no relief in sight.

The list is endless, but you get the point. If you are "the comforter", "the counselor", what CAN you say? Is not their despair a normal reaction? Most people in such tragic situations, if acting relatively un-affected, are in serious denial, which is NOT a good natural defense mechanism. It's an unstable state and will inevitably come crashing down, often catastrophically.

Is despair good? No. But are we all immune from it? No.

Do we sometimes have to accept despair as permanent? In some cases of extreme and/or prolonged distress, especially in those who don't react well to medications, yes, it may be permanent.

If you disagree, what alternative solutions do you propose?

(These questions are, of course, open to anyone who wishes to respond.)

rebecca


There is a distinction between grief and despair. Despair is grief or fear that has let go of its dignity. Despair is a letting go of the dignity of life, the dignity of loss, the dignity of grief, the dignity of dieing and the dignity of death.

If it were a sin it would seem to be the most forgivable especially in such examples as you have provided. Yet that bugaboo, the cursing of the Holy Spirit, the so called "unforgivable sin" is defined by some as an unrepentant and habitual despair. Yes these are religious things and potentially platitudinous but most on this forum are capable of setting aside the exoteric absurdities and accepting the esoteric allegories. For the rest, shunning despair in order to preserve the dignity of the human person should be secular enough.

To despair is shameful but there is no shame in grief. There is dignity in grief.

That's what I've came up with so far towards a definition of despair. I really appreciate your post melonkali. It really gets down to what it's all about.
 
melonkali
 
Reply Mon 1 Feb, 2010 10:55 am
@Jebediah,
Jebediah;123979 wrote:
From what I remember of those studies, depressed people score more accurately when asked about their abilities etc, but not because they are being realistic, but because they are thinking "I suck". Well, not in those words exactly. Essentially, it's an irrational process that can lead to greater accuracy in some cases.

So, they can report their driving ability more accurately than a happy person, but don't have a realistic perception on the whole.


So it's also possible that related studies revealing "unrealistic optimism" in "normal" subjects, particularly in the U.S., are also flawed?

Or is it possible that some of us are being duped by an old sociopolitical manipulative tool: "fostering illusions" leading to a "tyranny of optimism"? Like Marx's evaluation of religion as an opiate for the masses (I personally disagree that this is ALL religion represents, but I can see how religion can be used for that purpose)? Do you think, perhaps, at least SOME of our popular culture, news and advertising seems a bit skewed in a rose-colored-glasses kind of way?

rebecca
 
Jebediah
 
Reply Mon 1 Feb, 2010 11:12 am
@melonkali,
No, I think normal people have an inaccurate view of say, their driving ability. 95% of people will say they are above average.

But believing yourself to be worthwhile is generally realistic, because most people are.
 
SammDickens
 
Reply Mon 1 Feb, 2010 02:12 pm
@sometime sun,
Deckard, melonkali is my wife and asked for my comments on this subject. I don't know how much respect Maslow's hierarchy of needs retains, but it suggests that people in lives of desparation (e.g., despair) lose all sense of dignity.

The people of Haiti come quickly to mind here. Our friend who worked with them before the quake said they lived without even the concept of hope. For them, there is only surviving the day, or not. Even before the quake, this nation was rife with corruption at the highest levels, and getting aid to the people in need was an ordeal that only the most experienced and able organizations could effectively achieve. Even then, there were multiple bribes to be paid, and stealing of the aid supplies by those who were not in need (and those who were at least not in as great a need) was pervasive. Starvation and deprivation were a lifelong fact of life to many people in Haiti before the quake. They were born into hopelessness and indignity. They were raised in it. They died in it. Family relations were informed by it. Death is expected. Relief from want is not.

When hopelessness and want reach these extremes and interminable durations, grief becomes despair as any semblance of dignity is erased from the human soul. There remains only the instinct for survival. Maslow said that someone who has known a higher level of existence, who has lived with the assurance of food and drink, clothing, shelter, and security, may be able to retain memory and hope for such things to be regained. But prolonged deprivation gradually washes away such memories with much the rest of our humanity.

Despair is not isolated to such drastic conditions as Haiti, however. We know people in our communities who despair. How can people who have the essentials of food, drink, shelter, clothing, and security yet despair over the condition of their lives? As you say (I think), many of us have at times cause for grief in our lives. We grieve at the loss of a job, a pet, a sweetheart, or more deeply at the loss of life or illness of a family member or our home or our own health due to illness or age. Grief is natural and even procedes through established stages as we come to terms with our losses. But despair is categorically different from grief. Grief is a process; despair is a condition.

The person who despairs has given up any hope of happiness and would distrust it were it to look his way. Despair is an unconditional surrender to the trials of life. Each new problem, however small in and of itself, is seen as another boulder to be rolled up the Sisyphean slope of a mountain of overwhelming tribulation. Grief subsides like an ebbing tide, but despair only looms larger with each new challenge, because the person feels unequal to such challenges, defeated by them beforehand. Grief is a way of coming to terms with a past sorrow, despair looks to the future with an attitude of defeatism and hopelessness. "I will fail at this as I have failed at everything I have ever tried," they will think, or "Why should I even try to do this? I'll only end up looking foolish. No-one has ever appreciated anything I've ever done."

So despair is essentially different from grief, and they do not appear to be bound by any continuum of diminished dignity. But I may misunderstand how you mean that. Could you explain more?

Samm
 
Deckard
 
Reply Mon 1 Feb, 2010 03:43 pm
@SammDickens,
Samm;124171 wrote:
Deckard, melonkali is my wife and asked for my comments on this subject. I don't know how much respect Maslow's hierarchy of needs retains, but it suggests that people in lives of desparation (e.g., despair) lose all sense of dignity.

The people of Haiti come quickly to mind here.


Yes, Maslow is an important person to mention. And along with Haiti and other natural disasters I will mention torture. The state of despair is very useful to the torturer and brainwasher. (This is very Naomi Klein of me I know).

I hear what you are saying. Everyone does have a breaking point. I do, you do, everyone does. However, I don't think that we should be emphasizing this fact but rather guarding against despair and fostering new hope where hope is lost. We should be fighting despair not learning to accept it as an inevitable reality. It's a reality but it's an evil that needs to be fought.

One question is: How should we treat someone who has fallen into despair. And I say with respect. Even if a person falls into despair they should be treated with dignity. Even if someone has forgotten or never known their dignity they should be treated with dignity. For example, if I, an American with food and shelter think of the people of Haiti as a people lacking dignity then I too have already despaired.

So I am amending my definition. Despair is grief that has abandoned, forgotten or never known dignity.

I'll try to brush up on Maslow because I think he will be helpful though I am not sure if he is a foil or a complement to my own ideas. I know the basics, the hierarchy of needs and so forth but I'm not quite ready to simply defer to his authority without knowing a little more about what he actually said about each level.
 
platorepublic
 
Reply Sun 30 May, 2010 12:59 pm
@sometime sun,
I just found out that depression is an evolutionary trait that made humans survive.

You could imagine a time in history where there are two species (that could both potentially evolve into humans): one that had the ability of being depressed, the other that doesn't have such ability.

The one that had the ability of being depressed persisted its environment.

It's all about depression.
 
Twirlip
 
Reply Sun 30 May, 2010 01:03 pm
@platorepublic,
platorepublic;170913 wrote:
I just found out that depression is an evolutionary trait that made humans survive.

You could imagine a time in history where there are two species (that could both potentially evolve into humans): one that had the ability of being depressed, the other that doesn't have such ability.

The one that had the ability of being depressed persisted its environment.

It's all about depression.

Do you have a reference, or have I misunderstood, and is this a theory that you are working on yourself?
 
platorepublic
 
Reply Sun 30 May, 2010 01:07 pm
@Twirlip,
Twirlip;170916 wrote:
Do you have a reference, or have I misunderstood, and is this a theory that you are working on yourself?

This is from a lecture called "Dominance and Depression"

BIGIDEAS Best Lecturer 2008 - Marc Fournier & Robert Jan van Pelt
 
mark noble
 
Reply Mon 31 May, 2010 07:05 am
@platorepublic,
Hi Sun,

Depression is rarely, if ever, detectable to the host. It is wise to seek proffessional help, but, support from family and friends will do more good than harm - As long as they are not a part of the cause.
I wont explain the factors leading to and from - This would take a lifetime to accomplish! One thing I can say with conviction is - Those who make it through severe depression are strengthened by their experience in equal measure to the depths therein. Those who lapse into further depression, or bouts of - NEVER recovered in the first place.

Shine on, Sun.

Mark...
 
 

 
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