Sunday, January 13, 2013

A few thoughts on depression



This post isn't about economics at all, just to warn you.

Like everyone else, I'm very sad to hear about the suicide of Aaron Swartz, the gifted programmer and activist. I had heard of him a few times, but never really knew all the things he did. I wish I could have known him. Really, that's the worst thing about people dying...all the living people who will never get to benefit from their continued existence.

What do I have to say about Swartz' death? Well, maybe a little bit, since Swartz is said to have suffered from clinical depression. I do know a little bit about this topic, since I myself have struggled with depression for over a decade. Mine was first triggered by the sudden death of my mother in 1999, although I also have a family history of depression on my mom's side (the Swartz side, ironically, though I don't think Aaron and I were related). 

Obviously, everyone's experience of depression is different, so I don't intend these thoughts to be a universal guide or general theory. Also, bipolar disorder, or "manic depression", is another thing entirely. But that said, here are my thoughts on depression.

1. Depression is not sadness. During the most intense part of a major-depressive episode, what I've felt is nothing at all like sadness. Mostly, it's a kind of numbness, and utter lack of desire and will. Underneath that numbness, there's the sense that something awful is happening - there's a very small voice screaming in the back of your mind, but you hear it only faintly. There's an uncomfortable wrongness to everything, like the world is twisted and broken in some terrible but unidentifiable way. You feel numb, but it's an incredibly bad sort of numbness. This is accompanied by a strange lack of volition - if a genie popped out and offered me three wishes at the depth of my depression, my first wish would be for him to go away and not bother me about the other two. Looking back on this experience, I've conjectured that part of depression might be like some kind of mental "fire sprinkler system" - the brain just floods the building completely to keep it from burning down.

Depressed people often remark that it's impossible to remember what depression is like after it's over, and impossible to imagine feeling any other way when you're in the middle of it. Therefore, most of what I'm saying here comes from things I wrote when I was in the middle of major depressive episodes. I think my most colorful description was that depression was like "being staked out in the middle of a burning desert with a spear through your chest pinning you to the ground, with your eyelids cut off, staring up at the burning sun...forever." 

2. Coming out of depression is the most dangerous time. Coming out of depression, I've found, is like having your emotional system turned back on. But when it's turning back on, it sputters and backfires. You feel incredibly raw. You have days where you feel elated, like you're walking on air. And you have days when you feel black despair, rage, hysterical sadness. These latter are the only times that I've seriously thought about harming myself. And I've done a few...unwise things during these periods.

One of the most common negative episodes, for me, is what I've heard people call the "spiral" - a flood of negative emotions makes you feel like you're bringing down the people around you, which triggers more negative emotions, etc. I often experience this when coming out of depression. It comes on very rapidly. If you see this happening to a depressed person, get them away from large groups of people and high-energy social situations, as fast as possible.

3. Depressed people don't need good listeners, a sympathetic ear, or a shoulder to cry on. Most of the time, when our friends are having life problems, what they need is a sympathetic ear. They need someone to listen to their problems, to understand and accept the validity of their feelings, and to empathize. So when our friends have depression, the natural urge is to sit there and listen, and ask "What's it like?", and "Why do you feel that way?", and to nod, and make a concerned face, and tell them you understand (even though you don't), and to give them a hug. This is a good impulse, but when the person is depressed rather than sad, it's a completely misplaced impulse. This is not what depressed people need, and although it doesn't hurt them, in my experience it doesn't do them any good at all. One reason is that depressed people tend not to think that anyone can really understand what they're going through (and in fact it's very hard for a non-depressed person to understand, thank God). Another is that, while for a normal sad person, getting negative thoughts out in the open helps expunge them, for depressed people airing the negative thoughts just forces them to think their negative thoughts, without expunging them. Another is that the emotional disconnection that I mentioned in point 1 tends to short-circuit the warm, good feeling that usually comes from someone being sympathetic and friendly toward you.

4. Depressed people do need human company. For some reason, human company helps. In fact, it is the single thing that helps the most. But not the kind of company a sad person needs. What a depressed person needs is simply to talk to people, not about their problems or their negative thoughts or their depression, but about anything else - music, animals, science. The most helpful topic of conversation, I've found, is absurdity - just talking about utterly ridiculous things, gross things, vulgar offensive things, bizarre things. Shared activities, like going on a hike or playing sports, are OK, but talking is much, much more important. I really have never figured out why this works, but it does.

And of course, relationships are very, very important. Friends, I think, are the most important, because friends offer opportunity for understanding and positive interaction without much feeling of obligation or shame (see point 6). Family and lovers are important, but really, the friendship component of these relationships has to dominate, so the depressed person doesn't constantly think negative thoughts about how they've let you down. Essentially, to help a depressed person, friends need to become a bit more like family, and family a bit more like friends. Also, you should realize that just because your depressed friend or family member is unresponsive, that doesn't mean that you aren't doing him or her a lot of good.

5. Cognitive behavioral therapy really works. I've taken one antidepressant drug (Lexapro), but it did nothing perceptible for me. (This is not to say that antidepressants in general don't work; for that, ask PubMed. This is just about my personal experience.) What has worked for me is cognitive behavioral therapy. The "cognitive part" is the most important. Basically, depressed people have negative thoughts that they can't get out of their head; cognitive therapy teaches you to habitually identify, examine, and correct these negative thoughts. That really helps; once those negative thoughts aren't always racing unnoticed through the back of your mind, your brain has a much easier time repairing the damage done by a depressive episode. Also, "behavioral" therapies can be important for improving your lifestyle. 

Cognitive behavioral therapy is best done by a counseling therapist, and there are many good therapists, but also many crappy ones. It is easy to see who is good and who is crappy, but since depressed people have low volition, sometimes they need a push to ditch a bad therapist and keep looking for a good one.

6. Depressed people may need a new "narrative". I've also called this a "new perspective", but I think the word "narrative" fits better. I've discussed my "narrative theory of depression" at length with psychotherapists. Keep in mind that this theory of mine might be wrong, and even if it's right, it might only be right for a subset of depressed people!

Basically, I think that the most important repetitive negative thought that afflicts depressed people is negative self-evaluation. You think, in a very detached, dissociated way, "The person who I call 'me' is a worthless person." And I think that the main criterion that we use to evaluate people is the narrative; a story that seems to unify and make sense of a person's life. Obviously, this is not a realistic or accurate method; human beings are not consistent, we are not simple, and we don't make sense. The narratives that we construct for ourselves are mostly bullshit. We construct them out of a need to make sense of the world, not as rational scientific theories that best fit the available data. 

I feel like most people construct a narrative of their life that is basically positive. People tend to think that they are good, and also talented and special, and that their life is progressing toward some purpose. We are each the protagonist in our own story. This narrative gives them motivation, and also the overconfidence they need to take risks and exert effort (Ha! I managed to slip in a behavioral econ reference after all!). People also strive to fit their positive narratives. The part of people that conducts self-evaluations - the "internal performance review" component of the psyche, if you will - observes how well the person is living up to the positive narrative, and tries to correct deviations.

But sometimes, for some reason, people become fixated on a negative personal narrative. Instead of the protagonist or hero of the story of your life, you become the villain, or the tragedic failure. Instead of Luke Skywalker, you become Oedipus. And because we construct our narratives to have false consistency, the negative narrative starts to color absolutely everything you do. You start to see every action you take as backed by bad motives, or as doomed to failure. You perceive every emotion as base and reprehensible. The "internal performance review" part of yourself, whose task it usually to keep you toeing the line of the positive narrative, begins to throw up its hands and wish that it could just get rid of you completely.

Obviously, this could lead to some very bad things.

I believe that many depressed people are constantly afflicted by the crushing negative feedback of a negative personal narrative. And I've found that the biggest single thing that helps people out of depression is the scrapping of the negative narrative and its replacement with a positive alternative narrative. This is usually possible, because narratives are mostly constructed out of bullshit - replace the bad bullshit with good bullshit, and you win. But that is much easier said than done.

If you have depressed friends, you can, in theory, help them construct a new, positive narrative for themselves. But this is a very difficult thing to do, because a coherent, believable narrative is a rare thing, and you never quite know what will stick and what will be rejected. The good news is, if you try and fail, your depressed friend will be no worse off. Remember, depressed people are weak-willed, they have low volition and little initiative; to help your depressed friend construct a new narrative, you have to be pro-active. You've got to spontaneously volunteer positive perspectives on his or her life, without being asked to do so. 

This goes against our social instincts, since with a normal, non-depressed sad friend, doing this is kind of a mean thing to do; the friend just needs you to listen and understand, not to contradict, reinterpret, and dismiss their pain. But a depressed person is not sad, and what they need is very different from what a non-depressed sad friend needs. I'm not saying you should be an aggressive jerk, and berate your friends for thinking negative thoughts. Nor am I saying you should project fake sunny optimism about your friend's life. It takes a lot more honesty than that, not to mention finesse and creativity and careful guesswork about the nature of your friend's "negative narrative". So go slowly and carefully.

As for what kind of positive narrative to help your depressed friend construct...well, this will be very different for each person, and it will depend on what kind of negative narrative they've constructed for themselves. In general, though, I'd say that it's good to reinterpret past "failures" as necessary steps on the road to future successes. And it's important to emphasize how much potential the depressed person still has in their future - like in the movie City Slickers, when Billy Crystal convinces his depressed friend that he gets to have a "do-over" in life. In general, if you can help a depressed person visualize a different and positive future, he or she will entertain the notion that his or her past "mistakes" might have just been "Act Two" in a three-act romance, instead of the final act in a Greek tragedy.

Now, I am not saying that construction of this "new narrative" is a cure for depression. It is a complement to things like cognitive behavioral therapy, constant low-pressure human interaction, a healthy lifestyle, etc.

7. Depressed people always need to be vigilant against a relapse. Depression is like cancer - once you have it, it remits, possibly forever, but you are never "cured". Relapses are not certain, but the danger will always be there. Therefore, after recovering from a depressive episode, a depressed person must change his or her life completely and permanently. The things that you did to get out of depression, you must never stop doing for the rest of your life. You must permanently place a greater emphasis on human contact and on meaningful, positive, healthy relationships of all kinds. You must constantly think about what makes you happy and how to get it, and you must constantly take steps toward a positive future that you envision for yourself. If you allow yourself to coast, or get stuck in a rut, you will fall back into the pit and have to start all over again. And if therapy helped you, keep going to therapy forever. What's more, if you get out of depression, do lots of things to remind you about what got you out of it. Turn it into a story of personal triumph, and repeat that story to yourself. And never forget to solidify, cement, embellish, and elaborate a positive narrative of your life.


Anyway, that's the short version of my thoughts on depression. The long version could fill books. Maybe someday it will. In the meantime, remember, depression is real. It's among the worst things that can happen to you. But it is beatable.

112 comments:

  1. Anonymous3:40 PM

    I agree with this post. I've also suffered from depression. I'll share my experiences:

    * I describe my depression feels like a cold wave taking over. Its all in the mind, but I feel it on my neck, my back, then my whole body. Even if its very hot summer day. In fact summer is usually my worst month. I see the world as unlively, like I watch it through a screen.

    * Probably genetic and surely disappointment-related. On one side I have an aunt that tried to commit suicide, depressed grandparents and on the other I have depressed cousins and unknown mental problems from long-dead relatives that were sent to GULAG camps in the 40s.

    Two different experiences with antidepressants:

    * the first one I improved the day after I started taking them and I burst out laughing in the bus by myself. I wasn't an effect of the AD, I just didn't feel 'the wave' and I was happy. But learning more I think this was a strong placebo effect. ADs are definitely not "happy pills", they are "feel like a normal person pills". The side effects were dilated pupils and a caffeine like effect. The drug I took was Deanxit (tricyclic).

    * Later I wanted more - I did feel better, but I wasn't fixed so my shrink put me on Seroxat (Paroxetine), a SSRI. I temporarily lost my ability to have an erection from it, so I didn't touch the drug anymore. My erections are back, but I have an anxiety issue with sex now.

    Therapy:
    * Talk therapy seems to work. I just share stuff and explain my worries.

    Personal theory:
    * Call it rational expectations, Animal Spirit, Esprit De Corps: some things have to be done and you have to do them even if you don't feel like to. Commit 100% to solving your depression above all else and take any action necessary. This commitment seems to be more important than the drugs, therapy or lifestyle change.

    I'm still learning, and I always fear relapse, but I'm stronger than before.

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    1. I'm still learning, and I always fear relapse, but I'm stronger than before.

      That's great to hear! Keep it up.

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    2. "I'm still learning, and I always fear relapse, but I'm stronger than before."

      I like this comment. This is what my state is now.

      Delete
  2. Noah - thanks for sharing these thoughts and your battles with your own personal demons.

    There is an unfortunate corollary to your points (1), (3),(5) namely - depressed people can be a very hard to live with. Once one realizes that there is no point in being sympathetic (point 3), and one's depressed friend is emotionally numb (point 1), unwilling to share their feelings (point 3), and overwhelmingly negative (point 6)it's very hard to avoid (a) getting angry and (b) withdrawing. Family should be "more like friends" is a pretty hard prescription for a son or daughter, husband or wife, mother or father to swallow.

    Your point 5 - that cognitive therapy works - is a vitally important one. Also the point about shared activities and the joys of the absurd is extremely helpful for people who live with depression.

    May I add one other thought: dogs are the best anti-depressants. The depressed person can say no and yell at the person who says "get out of the house and go for a walk." It's much harder to say no to a dog begging to go out for a walkies.

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    1. Once one realizes that there is no point in being sympathetic (point 3), and one's depressed friend is emotionally numb (point 1), unwilling to share their feelings (point 3), and overwhelmingly negative (point 6)it's very hard to avoid (a) getting angry and (b) withdrawing.

      Yep. Most people are inherently transactional - they expect their attempts at kindness to be reciprocated, and if this doesn't happen they get angry. The people who are best at helping depressives are the people who are genuinely sympathetic - they want the other person to feel better for that person's own sake, they are fine getting no additional "reciprocation".

      Family should be "more like friends" is a pretty hard prescription for a son or daughter, husband or wife, mother or father to swallow.

      Yes.

      May I add one other thought: dogs are the best anti-depressants. The depressed person can say no and yell at the person who says "get out of the house and go for a walk." It's much harder to say no to a dog begging to go out for a walkies.

      True, and I find cats are also good, in particular the kind that will sit and purr in your lap for hours. And you never have to worry about disappointing a cat...

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    2. By the way, I'm not trying to say that "transactional" people are bad and that "genuinely sympathetic" people are good. It's just the way people are. Sometimes, the people I call "genuinely sympathetic" seem totally ungrateful when you do nice things for them, while the "transactional" people always remember to acknowledge what you do for them.

      It's just two styles of relationship.

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    3. I know the type of person you mean when you say "genuinely sympathetic" though I wouldn't use that phrase. It's the type of person who is a good nurse.

      The best thing about animals is that they live in the present. They don't worry. Hence they break the negative thought cycle.

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    4. I know the type of person you mean when you say "genuinely sympathetic" though I wouldn't use that phrase. It's the type of person who is a good nurse.

      No, you're right. "Sympathetic" isn't the right term. I don't know what is, though.

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    5. "Sympathetic" isn't the right term. I don't know what is, though.

      The best nurses are probably the ones who project empathy but in fact are stone cold professionals inside. That's what I want from a doctor or nurse - give me a surgeon with a cold heart and steady hands over the one who actually feels my pain.

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    6. Pets, pets, pets. I can't recommend them enough for depression, at least from personal experience. They don't help you reframe your life - they're not a cure - but they are comforting, and at the worst of times, that's vital.

      Also I'd just like to join the chorus and say, this is a great post, so thanks for writing it. We need a more robust and honest conversation about depression in our society, to destigmatize it and to help dispel some of the myths and misconceptions you're talking about, as well as others. Posts like this are a great start.

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  3. I commend the courage it took for you to post this. The stigma still remains.

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    1. Really? I guess I don't even understand the stigma. What's shameful about being depressed?

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    2. Anonymous11:37 AM

      Two sides to the stigma.

      One the one hand, there remain many who think that someone who's depressed is just a big whiney-head who needs to get their act together.

      On the other hand are those who accept that the depression is real, but that could have negative effects. Would you hire someone if you were worried they were likely to have a depressive episode which makes them a crappy worker? Holy shit, what if they turn into a crappy worker and then you need to fire them in the middle of a major depressive episode!? Best to just avoid it...

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    3. On the other hand are those who accept that the depression is real, but that could have negative effects. Would you hire someone if you were worried they were likely to have a depressive episode which makes them a crappy worker? Holy shit, what if they turn into a crappy worker and then you need to fire them in the middle of a major depressive episode!? Best to just avoid it...

      The scary thing is, this is completely right.

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    4. Anonymous4:35 PM

      I think part of the stigma goes hand in hand with what was said earlier about non-depressed people getting offended when their overtures are not reciprocated. It's hard to get the non-depressed person to not take it seriously.

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    5. Anonymous4:39 PM

      "Personally" not "seriously" is what I meant to type.

      Delete
    6. Anonymous4:40 PM

      So yeah, depressed people end up being labelled "creeps", "deadbeats", "jerks", etc.

      Delete
  4. I meant to say "people who live with people who live with depression" (could you edit please)

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  5. great post. there is really not enough discussion of depression in general and many people feel ashamed or embarrassed about it in the first place. the realization that one gets an infinite number of do-overs (for most things, anyway) is pretty powerful.

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  6. Noah - your thoughts on this issue: depression is seriously underdiagnosed in men. The standard "do you feel sad?" tests tend to catch depressed women and not depressed men. "Do you feel seriously pissed off and angry all the time" would catch more male depressives.

    Even though the stats say women suffer from depression more than men, there are more male suicides, more male alcoholics, etc.

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    1. I didn't know that. Interesting.

      When I was coming out of depression I had flashes of intense anger, fear, and sadness, sometimes at the same time.

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    2. See this from a supposedly reputable source: http://www.mayoclinic.com/health/depression/MH00035 "Women are nearly twice as likely as are men to struggle with depression at some point. Depression can occur at any age, but it is most common in women between the ages of 25 and 44."

      I just don't believe that the gender disparity is that large.

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    3. Anonymous7:42 PM

      Yes, exactly how I cycle, anger, fear, anxiety, sadness, guilt, it can start with any one of these emotions, and go in either direction. I'm learning to listen to my body, and mind, figuring out my triggers, documenting them, etc.
      The medical establishment is not quite ready to admit that what you put in your body, food, water, air, food additives, artificial sweeteners, GMO foods anyone?, has an effect on your mind. Women do have a tendency for eating disorders, men do to, but men don't always get treated very well by the health care system, I partially blame feminism, but I digress. I had a health issue that was ongoing, debilitating,(possibly fixable, if I'm lucky), and through healing my mind has gotten better. Cutting out sugar helped, caffeine, I'm literally afraid of, makes me think way to fast, it's been quite a journey and it's only beginning.

      Delete
  7. What an incredibly brave and honest post. Thank you for writing this, Noah.

    I recognise your description of numbness - though for me it was a kind of detachment, as if I wasn't in the same world as everyone else. A street I was walking down could be teeming with people, but it was empty as far as I was concerned. I saw the people, but I didn't connect with them. Weird. I suppose the experience is different for everyone.

    I also completely understand the need to replace the negative narrative. I spent eight years replacing mine, and I had to make some very major changes to my life. There is a cost as well as a benefit to making the sort of changes I did, and I know other people whose depression has forced them to make fundamental changes that cost them both financially and personally - the loss of a career, for example. The road out of depression is not easy.

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    1. A street I was walking down could be teeming with people, but it was empty as far as I was concerned. I saw the people, but I didn't connect with them.

      I have definitely felt like that.

      Or on a bright sunny day, I would feel like it was dark, like the light wasn't really there.

      The road out of depression is not easy.

      Understatement of the year... ;-)

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    2. Yes, I remember the unreal light thing too. One of the things I had to do was reconnect with reality. But that meant accepting who I was. The depression trap was me rejecting myself and trying to become someone else. Sorry, that's rubbish grammar....You can change lots about your life, but you can't change yourself.


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    3. I think you can change yourself! It's difficult but possible. Remember Montaigne...people aren't very consistent to begin with...

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    4. My view, from the other end of the tunnel....you don't change yourself, you discover yourself. For me, trying to be something I'm not was the dead end, discovering and accepting who I am was the way out. I suppose I had something of an identity crisis.

      Delete
    5. Montaigne4:15 PM

      Espéce de cambrioleur, je n'avais jamais dit ça,va te faire enculer.

      Delete
  8. Word...thanks for writing it.

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  9. Anonymous4:26 PM

    I'm so glad that you found your way out of that very dark place. The world desperately needs smart, kind, people who can communicate effectively about complicated subjects. It is tragic that the world has lost Aaron Swartz. I'm very happy that it still has you.

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  10. I appreciate this post. I would take your point 3 further: having a depressed person talk about his or her negative feelings can be counterproductive. It can be humiliating.

    There are also some other issues I think bear pointing out. Finding a good therapist may be outside the financial means of many families. And those in low-pay, low-security positions may have to hear their negative self-narrative reinforced by authority figures in their day-to-day life.

    Frances's point about gender roles is important as well: the stupid, archaic feeling of pressure to "be a MAN!" prevents many guys from admitting they feel powerless and need help.

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    1. Anonymous7:01 PM

      I can attest to the truth of all 3 points you make. Humiliation & powerlessness, including the financial powerlessness of not being able to afford treatment, or even just meds (no insurance) is a real suicide driver. Lost a couple of people in my life to that...

      Delete
  11. Anonymous4:46 PM

    How did you deal with the "negative narrative" (great phrase, by the way) as an academic? The reason I ask is that most of academia is about negative reinforcement (i.e. rejection), even for successful academics.

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    1. I started a blog.

      Delete
    2. This might be the funniest thing you have ever said.

      Brilliant!

      JzB

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    3. most of academia is about negative reinforcement

      Gosh - that was not my experience of it when I was on the periphery (student and research assistant co-authored six papers that got published). Academia has no more or less negative reinforcement than the private sector and much better opportunities to contribute to society.

      I started a blog.

      And an excellent blog it is too. I envy the gracefulness of your writing. Tyler Cowen has a mean streak, Brad deLong is so irritable and rude that it is off-putting, Mark Thoma's comments section is completely out of control, John Cochrane is dogmatic and arrogant and he has nothing of your skill as a word smith (or logical thinker for that matter).

      I took an SSRI for a few months ten years ago. My experience with it was that if I entered a downward spiral, the SSRI would put a floor under how low I could go.

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    4. Anonymous3:02 PM

      Absalon -- ever been a an adjunct humanties prof? You would learn a great deal about what it is to be looked at as something scraped from the bottom of a shoe.

      Delete
  12. Anonymous5:01 PM

    Really nice post. I had (possibly have ?) these feelings but I could never put them in such beautiful way.

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  13. One has to remember all things pass, and whatever you are feeling will pass. You must control your emotions or be controlled by them. Looking at them clinically, detached, in the abstract, can help, both with feeling them and feeling distinct from them.

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    1. In the abstract, this makes perfect sense.

      But I'm going to guess you have exactly zero experience with depression.

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    2. You would be wrong although this is difficult advice to follow and takes practice. It is useful in other contexts as well. Before driving, I take my coat of emotions off and place them on the seat next to me.

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    3. MaxUtility9:13 PM

      I'm not sure that I'd categorize depression as an emotion though. That kind of gets back to the sadness != depression concept. From my experience, depression has a large element of being detached in it, though that detachment is experienced as a negative rather than the neutral that one might expect.

      But we may just be debating terminology here. Being able to step outside your current experience and live in the awareness that it is temporary is probably a good defense.

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    4. The one thing the apathetic are never apathetic about is their apathy. It can be more intense than other emotions, drowning them out.

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    5. Applying apathy to apathy short circuits it. Detachment offers a passive form of control, not over depression directly, but to your response to it. You let it wash over you, coming in and going out like the tide, and wait it out. You come to savor its bitterness as its bitterness fades. Once you can do this, more active control of your emotions becomes possible until how you feel is your choice.

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    6. Anonymous5:36 AM

      I don't have experience with depression from the inside, but I have been close to a few people who have faced this challenge....

      Jazzbumpa's dismissal of Lord's reminder that "whatever you are feeling will pass" is unfair. Until Noah offered his way of conveying and framing his experience, the most articulate account of depression I have seen was noted author William Styron's account of his struggle, "Darkness Visible". His observation, after things began to get light for him again: "It is of great importance that those who are suffering a siege, perhaps for the first time, be told—be convinced, rather—that the illness will run its course and that they will pull through. A tough job, this; calling “Chin up!” from the safety of the shore to a drowning person is tantamount to insult, but it has been shown over and over again that if the encouragement is dogged enough—and the support equally committed and passionate—the endangered one can nearly always be saved."

      I'm pretty sure we can all agree that Mr. Styron had first-hand experience with depression. And his message seems pretty much identical to "One has to remember ... your feelings will pass".

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    7. Anonymous6:50 PM

      "Detachment offers a passive form of control, not over depression directly, but to your response to it."

      This does not work. It can allow you to passably function in life - or at least thing you're passably functional - but it doesn't help control depression. Even from your own posts, it sounds as though you recognize that such detachment is simply a coping mechanism, a way to "get through" the depression.

      And I would say it is a dangerous one. Most coping mechanisms for depression are, because you can grow to rely on them and they can take over. Alcoholism is the most prominent example I can think of.

      That detachment you recommend is essentially taking one of the worst parts of your depression - the inability to connect with others, to really feel things, to experience pain and sorrow and joy - and making it a shield. You can't suffer from the depression because you make that apathy, that detachment part of yourself.

      Then, when the depression passes and you're hit with that first renewal of feeling - usually negative, because depression puts you in a negative place - you already have this convenient shield of detachment to protect you from those painful emotions, right there. Chances are, you're not going to put it down.

      Unless you already have a strong degree of control, the most likely outcome of attempting detachment as a coping mechanism for depression is you'll emotionally cripple yourself. I would not recommend it to anyone.

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  14. Anonymous5:21 PM

    First of all, this is beautifully written. I'm a mental health professional and I plan on saving this, hopefully to use with clients who are having a hard time describing their experiences. Second of all, as someone who works in mental health, I wanted to add a few comments to your points:

    * It's very encouraging to hear that cognitive behavioral therapy (CBT) worked for you. Unfortunately, it doesn't work for everyone, and really attacking and revising your thoughts can be very difficult for some people with depression. Usually it's most effective with people who take some sort of antidepressant at the same time, basically to free the mind to be receptive to the therapy.

    * I'm interested in your comments about needing a new narrative. There is a form of therapy called narrative therapy that tries to do exactly what you describe, basically reconstructing your personal narrative to give more weight to to successes, and what you've gained instead of lost. It doesn't have the empirical evidence of CBT, but it does work for many people.

    Anyway, thank you.

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    1. Thanks, glad to hear it! :-)

      Obviously feel free to show the post to anyone, I wrote it in the hopes it might help someone somewhere.

      Glad to hear narrative therapy exists, though I'm not surprised there are no empirical conclusions about it, given how unique each person's narrative is. I think that when possible, it is very important to emphasize not just positive interpretations of past events, but positive possibilities in the future. Obviously this is much less possible for older patients. But positive futures justify negative pasts...

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    2. Anonymous3:22 PM

      I have noticed that CBT seems to work for the academics I've known with depression. I don't necessarily think it's because of their training, but perhaps because of the kind of minds they have to begin with that led them into academia. But this is, of course, just anecdotal.

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    3. CBT didn't do anything for me, partly I guess because of the UK system's attitude that it's a 'quick fix' doled out in doses of 6 or 12 session (so hardly the sort of longer term support Noah describes),. Partly, though, I thought that my academic 'bent' and profession meant that I was the kind of person who already looked at what they thought and poked at it and sought to balance external evidence for it - essentially that I already had the CBT type tools in my tool kit, but was still depressed despite it, so the therapy I had felt pointless because it was telling me to do something I did anyway. If that makes any sense.

      And thank you for the post. I find the stigma is particularly strong around depression in academia, where our brains are our tools and our cleverness our worth, and finding other depressed academics in the blogosphere has made me feel much less alone.

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  15. I have always struggled with guilt, and I think at the root of depression is shame. I don't disagree that sadness and depression are very different. I've been both. But depression starts with sadness, and ends up as depression when one cannot get out from underneath the burden of that sadness. And I think that most often happens when one blames oneself for their own sadness, even if subconsciously (often times people who do the most lashing out and finger pointing are protecting their own extreme shame about an issue).

    You said something about people being "transactional." Indeed. Nietzsche talked about ethical reciprocity. George Lakoff has touched on ethical debts and transactions. The behavioral economists talk about "mental accounts," and sunk-cost violations. Not only do we keep mental accounts of reciprocal deeds with one another, our Smithian Impartial Spectator keeps an ethical account of what do or do not owe ourselves. When self-perceived failures accumulate, we punish ourselves.

    Oila - depression - the unending self-punishment for failing to fulfill one's obligations to themselves. The depressed person lacks hope because in a world where he has done nothing but fail - he, in a fully Bayesian Rational sense expects himself to fail in the future. Punishment for past failings then begins to become a self-fulfilling prophesy guaranteeing future failure.

    In this light I think it is extremely important to look back in the sort of traditional Freudian sense and figure out which circumstantial sadness led eventually to the chronic depression. And like you say, it is important to re-rationalize that it was indeed circumstantial, and that the self punishing story about how you're just generally a shit person, is completely disproportional to the initial "crime."

    Guilt is a toxic emotion, because it legitimates and justifies sadness. It creates a lid on top of sadness that makes sadness impossible to release and transcend. Depression seems to me (someone who's been through years of it in the past), like a toxic combination of irrational, illegitimate guilt piled on top of sadness that needs to get dealt with more constructively.

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    1. Graham -

      You're attempting a rational analysis of the depressive state in terms of what I'll call the subjectively self-critical - or self-punishing.

      Not to gainsay any of that, but to a large extent, depression is the result of chemistry in the brain.

      I think there is a very different dimension to depression that cannot be addressed in terms of attitude, and specifically not a rational expectation of failure

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    3. umabird1:17 AM

      Thank you. I do appreciate your advice about how to keep depression at bay once one has 'conquered' it. Hope to get there some day.

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  16. Anonymous6:38 PM

    "And if therapy helped you, keep going to therapy forever" Easier said than done unless you have a lot of money or free healthcare...

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  17. There's so much that makes sense here from past experiences & what's going on with another family member currently. It's encouraging through reading to realise that I actually do love the family member (though feelings might make me think otherwise - negative narrative) and even though past personal depression has been heavily tied up in the relationship with that person. Sometimes it is just hard to know how best to support them, the family/friend illustration is helpful.
    I really do hope you get to put a book together someday!

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  18. Anonymous7:21 PM

    Thanks for sharing Noah.

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  19. J.K. Rowling was asked about the Dementors in the Harry Potter books who suck all the joy out of life.

    (Rowling is asked about dementors being “a description of depression”):
    “Yes. That is exactly what they are. It was entirely conscious. And entirely from my own experience. Depression is the most unpleasant thing I have ever experienced. It is that absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts but it’s a healthy feeling. It’s a necessary thing to feel. Depression is very different.”
    “I think [dementors] are the scariest things I’ve written.”
    –J.K. Rowling, June 2000 & March 2001


    We could all use a patronus charm (which comes from our happiest memories).

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    1. Anonymous9:39 AM

      Yeah, the dementors were familiar, but what really hit home was the story of how Sirius survived - he clung to the knowledge that he was innocent. Since that wasn't a happy memory, they couldn't take it from him.

      (Well, he also survived by turning into a dog, but that doesn't seem as relevant.)

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  20. Thanks for this post. That is all.

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  21. https://petitions.whitehouse.gov/petition/remove-united-states-district-attorney-carmen-ortiz-office-overreach-case-aaron-swartz/RQNrG1Ck?utm_source=wh.gov&utm_medium=shorturl&utm_campaign=shorturl

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  22. Anonymous9:11 PM

    Good post. Lexapro helped me a lot. Not sure why but it seemed to numb me to the negative narrative as I slowly reconstructed a more positive one. My depression was caused by the death of my brother and took me by surprise. At that time I was the parent of young children and needed to be available to my family. Drug and talk therapy combined to bring me back.

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  23. Anonymous10:22 PM

    Hey this was great. I have never suffered depression but I found that this translated pretty well to what I needed (and still need) after an episode of drug addiction. I used because my thoughts (and my 'narrative', as you say) were toxic. Sympathy can just strengthen the toxin, I needed a strong dose of reality. I've been clean for 15 years and the whole recovery process has been a chance to reboot my whole self. Tough but exhilerating. Anyway - congrats on your recovery and your clarity.

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  24. Thank you for writing this. I've struggled with anxiety and depression and this resonated with me more than I expected.

    Maybe this isn't the right place for this, but what do you think of the people who think that capitalism causes depression? My Adbusters reading leftist friends like to say that high antidepressant use in the US is symptomatic of our economic system. Seems like total ideological crap to me but IDK.

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  25. umabird1:19 AM

    Thank you. I do appreciate your advice about how to keep depression at bay once one has 'conquered' it. Hope to get there some day.

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  26. Anonymous2:58 AM

    I think I was depressed for years, but I never got a diagnosis, so maybe I was just sad.

    My life kind of fell apart during the 'great recession' I was within arms reach of achieving everything I'd dreamed of in life by early 2009, despite having persistent anxiety issues that by turns inhibited and improved my ability to get things done.

    I lost my job in one of a series of lay-offs , and nothing seemed to work after that. My boss cried when she called me into the office. It was just a matter of short-term company survival at that point.

    I won't elaborate on my downward spiral, but I think there's something to the 'Narrative theory'. Eventually I couldn't see a way that things were going to ever get any better. All the recent evidence seemed to confirm this, especially within the self-reinforcing system of interpretations that developed, even the progress that I managed to make seemed futile. I thought about suicide a lot. Luckily, I didn't own a gun, and there was no convenient place to hang myself without tearing the ceiling open to access a rafter. I also did not want to cause pain to my loved ones, although sometimes I didn't give a shit about that.

    About a year ago my best friend's dad shot himself. It was kind of fucked. He was a very kind and decent person with a loving family and many friends. But his immediate situation was somewhat similar to my own.

    I thought a lot about what must have been going through his head, and I didn't find it incomprehensible at all. But I could see that actually, he had a lot to live for, even if things were tough.

    I made up my mind not to be like him, and I decided to change. I knew about my self-defeating thoughts and I thought I would side-step them a bit, by focusing my attention exclusively on things that I could control myself. It started out pretty minimal, actually, just forcing myself to take a shower and eat breakfast counted as a victory, even if I got up at noon. I could always do a little better tomorrow. Gradually I changed my diet, sleep habits, and developed a daily routine with a list of tasks that i could check off a list. I developed a system of grocery shopping that I followed rigidly and developed to the point that I could do a week's shopping for two in 20 minutes not counting drive time. Generally, I took control of whatever I could.

    These things yielded results. I lost thirty pounds and cut back a lot on alcohol. But mostly, by controlling every aspect of my life that was within my grasp, I began to feel like I was in control of my life, and that I could change things.

    With the narrative changed, I was better able to take advantage of any possible opportunity that came my way, mainly because I didn't care about the outcome. Even if it didn't pan out, I would still be in control, so the situations no longer caused anxiety.

    Things are a lot better now.

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  27. Thank you for your post - after a short spell in early nineties I learned to look at the world and people with different eyes. After my personal experience I've now also learned from watching Mrs. through her six years of pain. The topic takes people to the less comfortable zone, and that is why the topic is mostly ignored or rationalized away - by blaming the victims (i.e own fault) or assuring oneself that "it will not happen to me" people are avoiding the pain of potentiality.

    By talking, talking, confessing, talking and still talking we are normalizing the condition and accepting that it can and indeed will hit many of us, either directly or indirectly. The Big D should be accepted as a just another fact of modern life like the rest of them.

    Oh yes, and thank you for your economics-related posts - I'm a newcomer to your blog but been very happy to recommend and link to your other articles as well!

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  28. Check out my blog at kindofblue62.wordpress.com. I have written an article about the treatment of depression

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  29. I bow my head. I'm truly impressed by your bravery and honesty. If more people in academia were as open as you on this subject, depression would probably be a little bit easier to cope with for those who suffer from it.

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    1. As someone who also suffers from a condition that is essentially close to be in a state of depression and someone who suffers anxiety disorders, I completely understand where you are coming from, Noah Smith. Hopefully, this blog-post shall help dispell misconceptions and enable more with this problem to seek and get help.

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  30. Anonymous2:12 PM

    As a right-winger, I disagree with pretty much every word you write, but this piece spoke to me, and for me, with poetry and force. Thanks for posting it.

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    1. Glad to hear it. :)

      Actually I'm planning to write more right-wing stuff soon...

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    2. I hear that's a great way to make money.

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    3. Anonymous6:35 PM

      What, the oldest profession? I heard it has great pay if you're willing to sacrafice any sort of self respect.

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    4. Har har.

      Well, I'm not quite as much of a leftie as a lot of people think...

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  31. Anonymous3:17 PM

    The opposite of love is not hate but apathy. In my experience this apathetic approach to life in general is the defining point of depression, call it a lack of love for oneself.

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    1. Anonymous3:30 PM

      That's acedia, the noonday demon. One of the seven deadly sins, often called sloth, but that's a very poor translation. Andrew Solomon's book entitled "The Noonday Demon" is a very good description of depression. Reading that,Styron's book, and now reading Prof. Smith's description, I find the similarities and differences from my own experience interesting.

      Anonymous 2

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  32. This may sound like a left-handed compliment, but I assure you that it's not intended that way.

    I've found your writing to be insightful and lucid. But nothing that you've written on your blog (and likely anywhere else) comes close to this piece.

    Bravo.

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  33. Anonymous6:15 PM

    Is it that unusual to be open about it? I'm a little younger than Noah, but aside from interviews I haven't seen any downside to being frank about depression.

    My perhaps a-typical experience: cognitive behavioral therapy has proven more or less totally useless. The concepts seem sound - changes in behavior and thought to change your damned brain - but it just hasn't worked well. What has worked far better is taking SSRIs, various mood stabilizers that were originally developed as anti-convulsants and benzodiazepines when the doctors aren't too busy hemming and hawing about the possibility of addition to do their jobs.

    Does the data really suggest CBT is all that great? I always suspect bad econometrics - all the therapists and psychiatrists I've ever met have seemed pretty shaky on statistics, and medical researchers are notoriously bad at stats:

    http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/

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    1. Anonymous3:32 PM

      Our epidemiologists would say the same about the stats of economists. :)

      anonymous 2

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    2. Anonymous6:18 PM

      I think we're usually more aware that our statistics are garbage, though.

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    3. One thing that seems clear from the research is that CBT + meds is more effective than either one alone.

      Our overall effectiveness at treating depression, through whatever means, is pretty bad (we're not much more successful at treating addiction). I think what's missing is a coherent theory of cognition, mood, etc., in which the macro (high-level models of things like beliefs, urges, moods) agrees with the micro (neuropsychology). There are a lot of really unsupported theories at the macro level (people like Freud and Lacan are still influences).

      Maybe it's not so different from economics....

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  34. Anonymous1:43 AM

    Thanks for sharing this with us Noah. I also suffer from anxiety and depression and I'm finally getting treatment for it now and it's a relief to hear from others who can understand the illness and have found out what works for them.

    Note: I also enjoy your column and read it often, just never felt the need to make a comment.

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  35. Thank you for writing this - it's easily the clearest description I've read of what depression is like and what friends can do. While my experience has been less severe, it also matches very well the unhappy periods I've had in my life.

    I think your "narrative theory" makes sense, but when I've come out of an unhappy period I haven't so much found a new story as a new situation; found a way to change something for the better. I suspect your theory could generalize to rest on a mental model of what good you are, which for some people has a narrative structure, and for other people has some other structure.

    (For me, thinking in narratives is something I have to do on purpose. I tend to think in systems, organized by how the parts relate to eachother independent of time - either by relationships that don't change over time, or by relationships that hold at a particular time. My unhappy periods have more-or-less been when the "system" of what's in my life at the time is dominated by bad things that seem hard to change.)

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  36. "I've conjectured that part of depression might be like some kind of mental "fire sprinkler system" - the brain just floods the building completely to keep it from burning down."
    Interesting comment - in my younger days (not so much now, thank goodness) I struggled a great deal with what turned out to be Bipolar, typeII (model E, with the short-barreled 37mm cannon). When I had a bad spell that sent me down to my basement office for several days of incommunicado, I used to feel like it was a circuit breaker going off; the increasing worry and stress would just pop the switch and I would go into that sort of numb fugue state you describe. No desire for interaction, in fact just the opposite; a sort of heavy need for being alone in a dark place. I suspect you're right that being 'forced' to talk would help a great deal, but everything has to be brought from outside. That sense of disinterest and inertia is really powerful. I'm glad you got out of the trap!

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  37. Julie Fauble Garrett5:55 PM

    Thank you so much for writing this. Thank you especially for saying that depression is not sadness. I find that one of the most difficult concepts to communicate to those who have not experienced depression.

    Also, depression does not really have to do with outside events. A particular loss or stress might trigger an episode, but not necessarily. I've made it through very stressful situations without getting depressed. Conversely, my most recent episode occurred when my life was, by any objective measure, good. That's what drove home to me that this is an illness that I will have to manage for the rest of my life. I have a lot of tools (medication, meditation, CBT) that help keep it in remission, but I have to be vigilant.

    You're right that relationships are vital. During the darkest parts, the main thing that kept me off the road to suicide was knowing how much pain that would cause my family. I couldn't inflict that much pain, not even to relieve my own.

    The other thing that helped was the Winston Churchill quote, "If you're going through hell, keep going."

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    1. Anonymous3:37 PM

      My kids kept me from kissing a pistol. One day, at the peak of suicidal ideation, I heard my four year old playing with his cars and singing. I knew if I offed myself,it would scar him for life From then on, that memory was the most powerful tool I had to beat the black dog.

      anonymous 2

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  38. Anonymous6:02 PM

    Thank you so much for sharing your thoughts!!!

    The hardest thing for me dealing with a wife and son that go through depression bouts, is not knowing what to do or how to go about doing things that might help somehow..... I try but can't understand what they might be going through and feeling totally unable to help.... They are under treatment, but still have periods that are very painful for all of us.....

    This note is making me think in a different way now... Thank you!!

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  39. All I hear is a bunch of whining about one thing that you could fix if you weren't too busy searching for attention.natural depression treatment

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  40. This is a fantastic post (and some great comments, too). I've had a *long* road with depression (BP1 diagnosis) and I had a couple of extra thoughts.

    1. It's interesting that you liken depression to numbness. I agree with that, but I think it's a lot like pain as well (your desert analogy seems to support this). David Foster Wallace had a great description of depression as pain.

    2. I think the narrative theory is pretty good. Narratives are primarily about meaning, and I've come to think that depression blocks my access to meaning. When depressed, I often thought of people as squirrels scurrying around to no purpose, and I was unable to perceive the pathos in human dramas. I wasn't just unaffected -- I was unable to *see* it. It made it almost impossible to write fiction (I could still write code, if I could summon the motivation).

    3. I think it's important to stress both internal and external changes when talking about getting out of depression or maintaining euthymia. CBT addresses some of the internal stuff, but you also need to change your circumstances. I was married to an extremely critical person, and if I had stayed married to her, I would probably have been doomed to recurrent relapse. This can apply to job situations, living arrangements, etc., etc.

    Thanks again for sharing this, Noah.

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  41. Anonymous7:37 PM

    As someone who has dealt with depression, your point about an emphasis on the 'negative narrative' really struck home. I'm still in that 'I don't have depression denial' phase -- I see depression as such a selfish act, and acknowledging that disgusts me.

    In any case, thanks for the post.

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    1. Depression isn't a selfish act, it's just a brick that falls on your head...the Universe is always tossing bricks at our heads...

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    2. But a strong person would get up and carry on with a bump, or dodge the brick, or catch it... at least that's what the depression says.

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  42. Anonymous10:49 PM

    I know that I have had depression majority of my life and have always lacked the courage to seek help. Thank you for this, truly, you have inspired me to finally seek some sort of professional help. I had to put my dog down this weekend. She truly saved me many times when I have felt my lowest. I have been scared how I will deal with life now that she is no longer here to help calm my heart and give me hope. I know now more than ever I need to find a way to cope and deal, to move on with life and really enjoy life. Thank you, thank you, thank you. Your post has spoken to me and touched me deeply. This post may truly have saved me, and know it is ok to be depressed and get help! Thank you.

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    1. :)

      Well, I do what I can...

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  43. Anonymous5:48 PM

    Hello -- have you ever read Ernest Becker's "Denial of Death"? It provides an interesting interpretation of depression. In the book, Becker details the general paradox of human life. Humans have both a god-like aspect (ability to reason, understand, theorize about the world) and a animal aspect (mortal, error-prone and generally insignificant participants (on an individual level) within the world). In order to create meaning in their life (i.e. focus on our value/godliness/self-worth rather than our fallibility and general insignificance), we all create structures within our lives that simplify the world and give our lives meaning. For example, finding religion is simply abiding by a set of certain rules/principles that if followed, gives your life meaning. Another structure could be working hard and starting a family, where the meaning of your life is to win the rat race and raise children. Becker posits that all of these structures are illusions and falsities that we create to distract ourselves from our own fallibility -- AND that all humans create unique and individual structures -- it is a necessary part of being a human. Depression, as Becker describes, is actually just a realization of our own fallibility -- its a result of having a more clear picture of the world as it actually is and no longer believing the illusions that you once created to give your life meaning. When I read your description, I was struck how much it fit within the model Becker provided. You may be interested in reading the book.

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  44. I think everyone should read this. During my periods of depression, people came up with the most ridiculous ways to get me to "snap out of it." I just wasn't coherent enough to tell them what I needed. Or in my case today, need.

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  45. Anonymous6:06 AM

    It's all about environment. Look, the brain is a computer, it just responds to environmental influences. For depression to go away, environment needs to change.

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  46. Anonymous9:14 AM

    Great post. I come from a profoundly depressive, alcoholic family that will not acknowledge either condition (and will explode at anyone who suggests them) and ended up numb, zoned out and increasingly suicidal in a miserable 11 year run in completely inappropriate work and work settings (large law firms - undertaken because a very depressed, self hating parent had told me for years that I'd be a loser and failure if I didn't do that, and I internalized it all). Within the last year I'd really accepted death - I would either leave my bad situation or die (by heart attack or stroke - I felt sick every day I was at work - or by suicide if necessary) and, as an occasional Zen practitioner, wonder if that acceptance of being OK with losing everything finally helped me. I got out of the career path from hell and immediately felt 500% better, and still feel about 500% better every day. So now I'm wondering if my, and my family's, depressions are chemical but seriously worsened by bad circumstances. I'm the first to make an affirmative gesture, EVER, to leave bad circumstances, so I'm the test case.

    I think the 'staked in the ground' analogy to depression is a good one. At my worst, at the office, I felt totally numb and also full-body sick every day. Like I'd been gutted like a dead fish and was walking around with an aching open cavity where all of my organs should be, and a spear through what would have been my heart. And when you feel that way physically, it really doesn't help you to feel any less numb (at that point who cares if the house burns down, the dog dies, your family moves out, etc.?).

    I'm female, but depression for me was much more anger and pure rage than sadness (maybe because I work only with men and don't get much contact with female culture). I was just plain enraged most days, at my family, colleagues and at the world. I'm still pretty pissed with my family. When your only child tells you "I feel like I've been dead for 10 years already, and just haven't fallen over yet, and I'm ready to fall over and end this mess forever" the helpful response (from someone who has spent 40 years moping, self-harming, crying and drinking all day in a bathrobe) is NOT "no, no you are wrong, I don't know what the hell is your problem, but I hate your attitude and I hate what comes out of your mouth." Some people should not have children...that's a whole other comment and post, though....

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  47. Very good post!

    "Basically, I think that the most important repetitive negative thought that afflicts depressed people is negative self-evaluation. You think, in a very detached, dissociated way, "The person who I call 'me' is a worthless person."

    Yes, that rings a bell. Also, the CBT thing you talk about is one of the things that have been great for me. "Recognizing the tendencies and stopping the thoughts from being the start of 'riding the wave to the bottom'".

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  48. Anonymous8:57 AM

    Anti-depressants are incredibly effective for most shorter term depressive episodes (months instead of years). SSNRIs and SSRIs are quite effective but what often happens is that the depressed person is not motivated enough to go back to the doctor and seek a different drug if the first or second one they've tried is no good. Also, these drugs are often prescribed by doctors who are completely incompetent - your family physicians or internists. I didn't get my medication right until I saw a psychiatrist.
    So, while CBI helps and keeps me on track, I wouldn't give up my meds for anything! They help me when nothing else can. Especially with motivation...
    About 'overprescribing antidepressant' narratives out there: how would it sound if we said that hypertension medication are just overprescribed? These kinds of comments just reveal the stigma about mental illness that persists among many.
    And finally, about capitalism causing depression - sure it does. It is a brutal way of life for most people that glorifies anti-social behavior (greed, every man for himself, etc.). That does not mean that depression is not an illness that ought to be treated. By that logic, nobody should be getting their carpal tunnel fixed because that's clearly caused by working conditions...
    Nice post.

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  49. Trixie2:45 AM

    Nice article Noah. Especially your Genie example is bang on and I totally identify with it. I have been suffering from anxiety and depression (or rather extreme sadness, hopelessness and fear) for the last 13 years, and this 'detached' kind of state for the last 1 year. I have a few points though; you have a lot of subscribers to your narrative theory, but I think there is a big assumption lying there and hence the narrative theory approach applies to only a subset of people, and it would not be correct to use it as a general principle to help depressed people. The basic underlying assumption is that depression stems from a "negative self image", where the depressed person thinks that he is worthless. But in my opinion, (and rationally) people should feel sad when they have a positive self image, they think that they 'ARE deserving', but YET don't get what they want in life. When they feel life has treated them "ünfair". And the only time they will feel life had been unfair, is if they inherently believe that they are smart, intelligent, hardworking, beautiful, kind, generous and deserving of all good things, and yet have not been given their due in life. That should be a the real cause of chronic dissatisfaction, leading to prolonged sadness and finally depression. In this case, depressed people already have a 'positive self image' thing going on (though it may not be apparent)...its just they they think they are awfully unlucky and life will never be fair to them. In this case how will the building positive narrative theory help?

    (I know you are not a health care provider and this is just a theory you came up with that possibly worked for you, but I would love to hear your and others' views on this) Thanks

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  50. Hi Noah, I had posted something, but it didn's show up. Can you please try posting it again?Thanks

    Nice article Noah. Especially your Genie example is bang on and I totally identify with it. I have been suffering from anxiety and depression (or rather extreme sadness, hopelessness and fear) for the last 13 years, and this 'detached' kind of state for the last 1 year. I have a few points though; you have a lot of subscribers to your narrative theory, but I think there is a big assumption lying there and hence the narrative theory approach applies to only a subset of people, and it would not be correct to use it as a general principle to help depressed people. The basic underlying assumption is that depression stems from a "negative self image", where the depressed person thinks that he is worthless. But in my opinion, (and rationally) people should feel sad when they have a positive self image, they think that they 'ARE deserving', but YET don't get what they want in life. When they feel life has treated them "ünfair". And the only time they will feel life had been unfair, is if they inherently believe that they are smart, intelligent, hardworking, beautiful, kind, generous and deserving of all good things, and yet have not been given their due in life. That should be a the real cause of chronic dissatisfaction, leading to prolonged sadness and finally depression. In this case, depressed people already have a 'positive self image' thing going on (though it may not be apparent)...its just they they think they are awfully unlucky and life will never be fair to them. In this case how will the building positive narrative theory help?

    (I know you are not a health care provider and this is just a theory you came up with that possibly worked for you, but I would love to hear your and others' views on this) Thanks

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  51. Anonymous2:33 PM

    I found this post via Google. I've been dealing with what I think is depression for quite some time, but it feels a lot like insanity as well. And I must say, this is the best depiction of depression I've read so far. Every other website is very unrelatable for me, which was making me think "yikes, maybe I'm just crazy..." Because it's not all about "my boyfriend left me" and "I got a bad grade" and all that...it's about a cycle of intensely negative thoughts that bring me down so low I just feel like I'm becoming those thoughts and therefor, a piece of shit for a human being. But that's a whole issue...I basically just wanted to say thank you for writing this, it was extremely helpful for me to read it.

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    1. Glad to help. ;-)

      By the way, you're not a piece of shit human being. I know several of those, and one of their distinguishing features is that they would never entertain the possibility that they are piece of shit human beings...

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    2. Yeah you're right there Mr. Noah.

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  52. Anonymous11:05 PM

    Thanks for sharing your thoughts, I agree with what you are saying about depression. I have been depressed since my parents separated 16 years ago when I was 12 years old. At first it wasn't so bad because I still had hope and desires but being depressed for so long I really lost so much time. There would be good moments and days but not for long. I would go places that I used to like going to and it just felt like I wasn't there and I couldn't have fun, I was just there emotionless. When I was 15 I saw a doctor and psychologist but they said I was not depressed. I have never taken an medication or gone to therapy. The only thing that has helped me is when I interact with people. However, I have a tendency to isolate myself socially. Recently I forced myself to meet new friends and started taking several multivitamins each day. I am starting to feel "normal" again, its only been a week. I have emotions and desires, I think I am finally coming out of this depressed state. I don't know if the vitamins have helped or not but it seems they might have. The worst part is looking back on the years that I have missed and things I have missed out on. My life just seems like such a mess right now, I gave up on everything. I want to carry on with life and find things that I like doing but it is so hard, I am worried I might slip back into the depression before I am fully out.

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  53. I suffer from clinical depression. The scary kind of depression. In addition to seeking professional help, I have also discovered a coping mechanism for myself. Horror Movies. I they are great. I even made a whole blog dedicated to the horror movies I watch trying to drowned out my blues. I go into a little more of my reasoning here:
    http://horrormoviemedication.blogspot.com/2013/02/why-horror-helps.html
    check it out if you have the time.

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  54. Dear Noah,

    Your excellent post reminded me of a piece that I wrote while in graduate school. I hadn't read it in years. Take a look if you are interested:

    'Doughboy is Depressed'

    http://jmp.sh/b/Y5L0GMQLf93bOyAsl7w9

    (It can be viewed with no downloading necessary on Jumpshare - just click on the file name.)

    If anyone else on this thread is interested, please feel welcome to check it out.

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