Last week was Invisible Illness Week, as I discovered from Citronella. I also found out that one of my favourite webloggers, Katie of Minor Revisions, has been taking an anti-depressant for two years.
I bring this up because it is a very brave thing to admit to such things. I suspect that the vast majority of people do not understand depression, nor how incapacitating it can be. Depression is not sadness, or necessarily something that occurs temporarily in response to external events. It is as much an illness as cancer, or pneumonia. In many cases it goes undiagnosed, maybe until the person affected can not take any more.
The Black Queen and myself suffered from post-natal depression for a few years, and did not realize we had been sick until afterwards. We looked at ourselves one day and said “Oh! That’s what was happening to us”. We had no support, our friends did not tell us something was wrong, no one from church picked up on it: we did not realize we were suffering from something that was treatable. Once during those dark times we had friends round for dinner, one of whom is a clinical psychologist. I asked, knowing I was ‘down’, what is the definition of clinical depression. She replied that it is incapacitating; that you can not get out of bed (and there was nearly an Argument because someone didn’t want to talk about it). I thought then that I must be OK, because I could function quite well thank you very much. I thought I was just inexplicably sad.
But there is a difference between depression and sadness. The latter can usually be tied to an event, a crisis, unwelcome news. Mild depression is more of a constant companion, a black hole around which you orbit. It can indeed be the result of circumstance, a low-level nagging that wears you down. It can also be the result of a chemical imbalance. It is scary (and I understand that many depression-related suicides occur on the up-tick, because the victim never wants to feel like that again), and can be debilitating if not incapacitating.
Most of my friends and acquaintances would possibly diagnose me as monopolar manic. But there is a darkness that follows me, which I keep hidden from all except those who are very close. I have approached the edge, I have flirted with the event horizon. Fortunately I have never had severe depression, never felt I needed treatment. What I have done is learn to mould it, use it creatively. This does not always work–sometimes I end up wasting time rather than writing–but I have help from one or two people now who understand me, and encourage me.
I can not stress enough that depression sometimes requires pharmacological intervention. But sometimes it is a sign, a symptom if you like, that something is wrong and needs to be addressed. A disease that lacks a cure. For me, over the last eighteen months or so, the singularity has approached quite closely. But in the last few weeks I have been thinking about my future career directions, and I have come to a decision.
And the event horizon has receded. It has disappeared from my radar, and this is an unusual feeling.
I’ll keep you posted.
I think this is a very brave post as well. Thanks for posting, because you help every other person/couple who are in a similar situation simply by stating that they are not alone, not the only ones. It is a battle, so good luck.
I agree.
Great post, Richard. I was interested to hear that you have learned how to harness these feelings, and am looking forward to hearing more about what it was that made you turn a corner. (Do you think, as Clare Dudman mentioned in her SciBlog talk, that increased happiness will lead to more creativity? Or do you instead worry about losing something in the process?)
Good point Jenny, and something I didn’t think I could talk about in context.
Seeing as you mention it, I do worry that medication of non-debilitating depression can depress (ha ha) creativity. Clare mentioned that happiness seemed to correlate with creativity, but the control group was ‘normality’ in the studies cited. My own feeling is that creativity occurs at either end of the spectrum. Most good poets seem to have been miserable bastards, for example (as I said in the session).
I don’t believe that happiness (elation) or sadness (depression) per se lead to creativity. I think that you have to learn to harness those emotions and feelings, and that’s a very personal thing.
Thanks for posting this. I have suffered from mild depression too – it would come and go over a period of months. I seem to have become clear of it over the last couple of years, but I’m aware it might return.
I’ve seen estimates that around 10% of people have suffered from depression. It sometimes makes me wonder about all the people I meet – how many of them have suffered too?
It’s just been pointed out to me that the penultimate paragraph might be a little confusing. I wanted to say that it’s OK to take drugs to treat depression, but that sometimes there is something else that can and must be addressed. Depression can be a warning sign that something is seriously, badly wrong, and taking happy pills, or prescription medicine, might blind the sufferer to the root cause. Addressing the root cause is more important than simply trying to feel happy (and I think that Prozac can be bad because it’s often used in this way, masking the true problem).
I’ve had several bouts of severe depression in my life one thing I have come to believe that is whereas anti-depressants work for some, they did not work for me, and it was putting my life in order that has most helped. I also think that sometimes antidepressants are foisted on people too readily and they can have serious side-effects (which I unfortunately know too well).
I was surprised to read that psychologists thought that people were more creative when they were happy, because, my experience is that the reverse is often the case.
However two studies seemed to support the theory.
One was an investigation into manic depressive poets (of which there seem to be quite a few!) and surprisingly their most productive phases happened when they were not depressed.
The second was the comedy study I mentioned in the talk (although I take Karen James’s point that humour and happiness are somewhat different things).
A brave and eloquent post Richard – thanks. An thanks for the link to Minor Revisons – like you, she is a writer of some considerable skill. I’m intrigued as to the nature of your career decision but no doubt that will be the subject of future postings? Best wishes.
I don’t know that I have much of value to contribute to the discussion since the severity of my depression left me unable to get out of bed or leave the house. When I did manage to make it to work during those bad weeks, every breath hurt. Each word I had to speak to someone was a gigantic effort. The fear of going back to such a state will likely keep me medicated for the duration of my life.
I did, however, have grave concerns about how different I’d be on antidepressants. I wept bitterly about needing something to function normally and it took some time to adjust to difference. It’s hard to provide context – for me – between medication and maturity. I now read a bit less and write a lot more than I did 2 years ago. I’m more stable and settled and have chosen a career path that requires more organizational ability than creative ones. So there are differences, but I still manage a good blog post occasionally. I think of novel solutions to problems, cry when I’m sad and laugh until my stomach hurts. So it’s been a good change for me overall and a step I regret delaying because I was afraid.
Having said all that, I’m so, so happy you’re feeling well again. And, as always, continue to be such a big fan. 🙂
Richard – thanks for such a brave post. I know exactly how it feels, because I feel the same way. In my life I am perfectly ‘happy’, but there have been times when doing even the simplest things requires an immense effort, to the extent that the entire process of living seemed too boring to be worthwhile. Such suicidal thoughts as I’ve had were not through some particular crisis, but because I felt I simply couldn’t be bothered making the effort to live.
Katie put it very well: every breath hurt. Each word I had to speak to someone was a gigantic effort.
My GP put me on citalopram (a serotonin reuptake inhibitor) in the Spring and I am up to 40mg per day. I worried that this might affect my mood adversely, or I’d become a non-creative vegetable (a pak-choi, perhaps, or a mooli). Not at all. I feel very much like the same old ‘me’, except I can cope with all the things that ‘normal’ people cope with, without becoming anxious or obsessed about it all. I’m still as happy and sad or angry or pleased as I would be, only the rest of life now seems more ‘in focus’ in some indefinable way, and Mrs Gee is less inclined than she was to have me shoved off the end of the Pier.
It’s a shame that people still feel inhibited about talking about depression, as if there is a stigma about it, when in the main it’s as much of a disease state as anything else for which one might require medication. Some people have one leg longer than the other. Other people have funny-looking teeth. Yet others don’t have enough serotonin slooshling around in the brain.
But there is a darkness that follows me. As the man said – I believe it was Jackson ‘Blind Kumquat’ McCrutchnasty – if it wasn’t for bad luck, I wouldn’t have no luck at all.
Seems like many are coming out now (and thanks so much to rpg for posting this), so I’ll be as frank as those above.
Just before I lost my only sibling in 1999, I knew that I might/would obviously get depressed. I was prescribed a bottle of 30 Temazepan (10 mg) tablets to assist in the “passing away period”.
I took one on the evening of DOD. Did this have any effect? I don’t know, but I doubt it.
I strongly agree with what Richard said earlier in that,
Addressing the root cause is more important than simply trying to feel happy (and I think that Prozac can be bad because it’s often used in this way, masking the true problem).
I made a concious point after this to get back to work asap and resume life as nornmal. I ploughed my efforts back into my music/recording. With hindsight, I would say that for the next two years or so, I didn’t socialise as much as I used to but that might have been simply an age thing. Who knows.
I’ve only seen one person “on Prozac”, but sensed immediately that they were avoiding the root cause of their depression with this prescribed drug.
For many antidepressants, the effect is not manifest for a couple of weeks or a month after beginning the course. Similarly, a controlled tapering off is needed when ending the course.
I can highly recommend Lewis Wolpert’s book Malignant Sadness. It is both a moving and direct account of what it is like to be depressed (there is one awfully tragic part about how being depressed was worse than his wife dying (his wife was Jill Tweedie, who died of cancer).
The rest of the book is also of interest in this context because it describes the author’s search to understand depression from various standpoints. As well as a depressive, he’s an eminent biologist and so he found out about what is known about the neurological basis for the condition, what drugs are supposed to do, and what “alternative” approaches are used. He is a strong advocate for St John’s Wort. I don’t say whether or not I agree with some of the conclusions of the book, but it is jolly good and I think it would be the kind of book that someone who has experienced or is experiencing this condition, and who is of scientific turn of mind, would find helpful or at least informative.
Gosh.
Thanks all for commenting. Lovely to see you here Katie, especially.
wow, richard, thanks for your blog entry about this important topic! i have struggled with bipolar I disorder most of my life (well, probably ALL of my life) and despite the fact that depression and bipolar can destroy lives, there is a HUGE stigma against even mentioning it — we are supposed to “stop being wimps/whiners and pull ourselves up by the bootstraps!”
which is sort of like telling someone with two compound fractures to the legs to run — and win — a road race!
why is there so much stigma attached to mental disorders? i think it is because we don’t have a publicly visible reminder of this “disability” — some people have crutches or canes, others, wheelchairs, but people like us look like everyone else and seem to act like everyone else, too, except we “take ourselves too seriously” or are “too self-absorbed” or whatever. a chemical imbalance in one’s brain is something of a controversy, even today, and the fact that it cannot be readily and consistently diagnosed makes it lose most credibility. fortunately, researchers are working on identifying specific gene variants that are associated with these disorders so they can better identify those who are susceptible, or who have the disorder, and then work out the proper treatment for it. “for example” :http://scienceblogs.com/grrlscientist/2008/02/diagnosing_bipolar_disorder_wi.php
bq. why is there so much stigma attached to mental disorders?
I think it scares some people, to be honest.
Your link, fixed.
+n on the “very brave post”.
I have a suspicion that I have probably suffered from some kind of depression since my teens, but refuse to get a proper diagnosis, mainly because I don’t want to officially “have a thing that’s wrong with me”.
I mainly sometimes feel miserable for no good reason, and after years of this I recognize when I need to give myself a stern talking to and just deal with it. I will find a minor reason for feeling bad, and if the reason ends up being something stupid like “everyone else can walk back to where they sleep after the pub, but I have to take the stupid rental car back to the stupid motel” then, well, I need to tell myself that I’m being a complete idiot, and that sneaking off without saying goodbye is not going to solve anything (there’s nothing to be solved other than my mood), and will only make me look antisocial and weird, but that I can just park the stupid rental car near the pub and join people and cheer up. (This happened only a few days ago after one of the conference days. Some people reading this might have actually been there and only now realize that/why I was being odd. But I did cheer up, because obviously this was a stupid reason to feel bad, and even though part of me thought it was a good reason at the time, I was able to (correctly) convince myself that it was not.)
Once I get back to more active blogging I’m planning a series on “My Stupid Brain” and this self-diagnosed “something” will be in there somewhere (as will left-right confusion and lucid dreaming – two things I thought everyone had until I found out otherwise.)
I had a version of depression more like Katie’s, and probably a couple of lesser, unrecognized episodes earlier on. It was residual post-partum, and magnified by a number of difficult events at the time. I was well aware of what they were and what my personal fragilities were, and even so had a very difficult time (yes, even in France) getting to where a psychiatrist finally proposed serotonin reuptake inhibitors to me. (If I had known what to ask for! but I was a little hung up about it.) They, not the counseling, got me rebalanced, in the end.
I did feel rather uncreative during that period, but I’ve always ascribed it to the residual depression rather than the medication itself. It’s like the people who think that taking antibiotics makes them tired. It’s the infection from which they are recovering.
Anyhow, as I wrote on Katie’s comment thread, I had one unsuccessful attempt at weaning myself early, and the second one, a fair bit later, worked quite well. That was a good number of years ago, with no relapse even after a couple of other highly difficult life events. Just to say, people always do change over time, so a depressive is not always necessarily a depressive.
I’ve just come back here, and have to say I am astonished at how common this is! I felt a little wary about saying anything, and now I find we are all pretty much the same. Thank you Richard.
bq. I am astonished at how common this is!
That’s it, isn’t it.
You’re not odd, or weird.
Do people think that attitude is more or less prevalent in the scientific professions?
I have to congratulate you for the strength it takes to admit to this kind of things — especially under your real name. Depression is such a common and yet such an unknown and unspoken of illness…
Citronella,
I really don’t feel that I need congratulating, but thank you for the sentiment. It’s a little bit like the Blogging Challenge –someone on the edge makes a statement so that those who are really affected can gain credibility. Or something like that!
Nice to see you here, too.
I’ve only seen one person “on Prozac”, but sensed immediately that they were avoiding the root cause of their depression with this prescribed drug.
No, you didn’t. You’re not that person’s psych consultant so you. do. not. know. anything. about. their. illness. Moreover, I guarantee you’ve known a lot more people who were taking antidepressant medication, but given your attitude I can’t say I’m surprised they kept you out of it.
Not trying to pick a fight Graham, but amateur diagnoses really piss me off, and they are very dangerous.
I have major depressive disorder — the first psychiatrist I saw was amazed I’d lived, let alone finished grad school.
I’m lucky, in a sense — I respond well to SSRIs, though I think they do take the edge off my smarts. I think that I don’t write as well, or see patterns or make intuitive leaps as well, as I did unmedicated. But also I don’t spend great bleak chunks of time barely able to move, so I’ll take the compromise.
Do people think that attitude is more or less prevalent in the scientific professions?
Less, in my experience. I waited a while after diagnosis, but it turns out I’m stable and a lot more fun to be around on my meds. So I’ve been quite open about my mental health, and I’ve never had any but supportive and understanding reactions in the workplace.
On the topic of “understanding”, do folks think that mental illness is particularly prevalent in the scientific community? I have no data, but I know quite a large number of colleagues, PIs to grad students, on varying kinds of psych meds. One of the more common reactions to finding out about my condition is to compare meds and side-effects. I wonder whether it’s like that across the whole population.
I’m stable and a lot more fun to be around on my meds. So I’ve been quite open about my mental health, and I’ve never had any but supportive and understanding reactions in the workplace.
I second that. For me, anyway. Mrs Gee thinks I’m a lot nicer. And so do my kids. I don’t think my work colleagues notice any difference. Whenevr I appear in the office they still scurry under their desks as much as they always used to.
Do people think that attitude is more or less prevalent in the scientific professions?
Not necessarily. I was going to say that it might correlate with intelligence as measured by educational achievement, but I don’t think that’s true, either. The largest single demographic with depression is young mothers, especially if they are poor. However, for obvious reasons depression in these cases is seen as purely postnatal or reactive. It might also be that in the Lower Orders (hey, so sue me) the attitude will be less one of sympathy and more one of pull-yourself-together.
I remember a cartoon in which a head teacher was berating a gormless-looking pupil and saying “if you were middle-class, you’d be dyslexic. But as you’re working class, you’re just thick”.
bq. On the topic of “understanding”, do folks think that mental illness is particularly prevalent in the scientific community?
That of course is the second part of my question. I’d be interested in the answers.
I do know a number of people who think I must be mentally ill to do what I do for the wages I get… 😉
I think we’d need to tread softly in the absence of any sort of proper data or ways of classifying “mental illness”. My gut feeling is that scientists might potentially be slightly more open to hearing a diagnosis with detachment, but I find it unlikely.
I think when considering the scientific lifestyle, particularly the progression through grad school and one or more postdocs, depression may well be the only rational response to what one experiences during those times. Living with the stress, uncertainty, pressure and many other negative forces (particularly the pursuit of one elusive experimentally derived fact) would seem to be particularly conducive to a less positive mental outlook.
My problem is with the term illness. To me mild depression is (as Richard initially suggests), something that requires a whole-life approach to treating, particularly when it is clearly caused by some factors in people’s lives.
Please note I’m not commenting on clinical depression or other disorders, just mild depression that society may seek to dismiss as ‘a case of the blues’.
I would suggest that scientists with depression may have a greater tendency to blog…
bq. I would suggest that scientists with depression may have a greater tendency to blog…
hah, yes, this is therapy.
You’ll be hearing from my accountant…
Wait a minute…if blogging is therapy, shouldn’t you be paying us, your humble readership, for our trouble?
If you’re going to take that attitude, I’ll sue you for mental anguish…
I’ll see you in court. Would you you prefer tennis, squash or badminton?
Shoes.
bq. On the topic of “understanding”, do folks think that mental illness is particularly prevalent in the scientific community?
I suspect we’re no different from the rest of society. It’s just things like depression don’t get discussed openly in the media, or indeed in society, much: we end up with a form of confirmation bias.
Is there that much difference? From my experience, I suspect that the only difference between my mild depression and full-blown clinical depression is one of degree – I suffered from a mild form of the same malady.
Incidentally, I’ll second Maxine’s recommendation of Malignant Sadness.
@Bob – I wanted to distinguish between situations where a lifestyle change (job, country, relationship) could have a positive impact, and those where medical advice is vital. It is a difference of degree, and varies by person, condition and situation. I just didn’t want to propagate the extremely damaging ‘pull yourself together and sort your life out’ attitude that many have towards all forms of mental illness. I see it as the difference between a cold and pneumonia, they differ in both severity and need for medical treatment.
@Richard: they’d look good on you…
Ah, I see what you mean, Katherine.
I agree Richard would look good in those shoes, and in the squash as well.
I’ll have you know I have very nice legs.
I’ll have you know I have very nice legs.
Err, I’ll take your word for it.
You can ask Li-Kim, too.
Well actually, don’t: she called my knees ‘knobbly’.
Richard’s legs are clearly seen in his Facebook profile picture, as he wears a kilt. While hesitating to express an opinion on the loveliness or otherwise of his legs, it is perhaps significant that he didn’t wear his kilt to SciBlog08, even though he said he would. Although I recall – yes, it’s all coming back to me now, in waves of
effluvia nauseahe did wear shorts.Nice post! My MD put me on Wellbutrin almost two years ago now. I’ve tried going off a couple of times, but I find bursting into tears on the drive to work, for no good reason, really puts a negative spin on the day… I certainly think that there’s a lot of life-issues that are tied up in all this. I am aware of a couple of identifying “external” issues somewhat beyond my control that certainly seem more in perpsective now.
My (ex-)shrink talked me into going back on the meds after I went off last time (Xmas 2006/7). Her attitude was one of “if the meds help you find balance then use them to get balanced. Once balanced you can identify and address anything else as necessary.” Good advice and ended up saving me $350/month on psychiatrist bills! >:)
One thing I am accutely aware of is the placebo effect with anti-depressants. However, I don’t know if the pharmacokinetics of placebo match those of Wellbutrin, but I vividly remember one incident about 10days after going on the meds for the first time. I caught myself in the mirror and I was smiling. I suddenly recognised the person in the mirror again, and I remember saying out loud, “Where the hell have you been!”.
I didn’t know until my MD talked to me about it that I was depressed. It seems so obvious now I look back with a little more clarity.
I suddenly recognised the person in the mirror again, and I remember saying out loud, “Where the hell have you been!”.
Yup. I know that feeling.
Ah. An interesting, and I’ll go right up the top of the comments to agree with Katherine here, brave post.
I’ve certainly had periods where I feel paralyzed – unable to start anything, complete anything, do anything much. The tricky thing is, I (like most people I suspect) have no barometer or knowledge/experience to indicate to me whether this is something “normal”, a symptom of transient (clinical? sub-clinical?) depression, or something else. And of course the overwhelming thought I have is to say to myself “get over it, you’re just being lazy, give yourself a kick in the backside and get working”, which is of course not at all the right approach if it really is clinical.
Well, I haven’t seen his facebook profile so I wouldn’t know about the Kilt. Strange, he didn’t sound Scottish though…Saw the knees briefly in London, didn’t like to stare though some people clearly did.
It is amazing from this post how many people have commented here that they have experienced the same. The power of one person being open and honest on an issue like this is clearly important. The line that gets to me the most is the one about there being a darkness that follows you. It is so very true.
Good post Richard, and as seen in the commentary section something that people can relate to. Hopefully there is less stigmata about depression and medication/symptoms nowadays than earlier.
My personal opinion is that although some states of depression will be treated with medications only, some might need both medication and change of thoughts[read; therapy]/environment/work/something else. The same with if you go on medication, it’s not necessary so for the rest of your life – but if it is, as for some – it’s not the end of the world, but a reassesment every now and then might be a good thing.
And for some the depression/state of mind is linked to a particular instance or occasion but, as Graham? said, it is not really classified as a clinical depression since there is an acute crisis linked to it. It’s after a few months, when “most people” move away from the black cloud that the medical depression comes along as a term.
I do wonder though, how often the depression state is enhanced by the fact that scientists are measured, in some large extent, in how well we think or create. That a big chunk of what we do is based on “our head”. And that this would mean that it is “worse” to be affected by something like depression since this is “something that affect your head”.
That it doesn’t, per default, affect your creativity might not be a part of the prejudice but I do wonder if this has something to do with it.
Or maybe it is just that it is disappointing and scary not to be all perfect as we “are supposed to be”?
Hopefully there is less stigmata about depression and medication/symptoms nowadays than earlier.
I hate it when I get stigmata anyway, let alone when I’m feeling blue…
darn. I knew I should have reread it again.
ok. I meant stigma. ok. sorry.
no need for bleeding like Christ in the lab…
Thanks Richard. There are various ways to address depression. One thing that cannot hurt, is a friendly circle of colleagues.
Did anyone see a recent thread started by Helen Jaques, on a recent study on personality attributes of bloggers? Based on what appears to be a very preliminary and not impressive study from what I could read of it, bloggers, particularly female ones, are said to be “more neurotic”.
Depression is, to some degree, an appropriate response to this world we live in.
Soon after I started blogging, I naturally met Dave Lull, who pointed me to this essay on introverts by Jonathan Rausch.
In terms of dealing with the day to day nitty gritty of depression, irrespective of the medication discussion, another good book is
Mind over Mood by Christine Padesky and Dennis Greenberger. The book provides some exercises for dealing with exactly the type of situation so aptly described by Eva, i.e. the escalation effect of a trivial setback into full-blown despair. In some aspects these exercises may seem simple-minded, but in that they teach some ways to be more objective about one’s feelings, they are well worth looking at, in my opinion.
I’ve been lurking so far.. yes, me too. I’ve had one serious bout of depression (this was only clear to me afterwards), about twelve years ago now. It was a gorgeous summer outside, and I was barely able to leave the apartment to go take my rubbish out, or go food shopping. Anyway.. In the end, I took some drastic action and seriously reorganised my life (I mean: seriously!). I also started running at the time.
For me, the main thing to keep things ‘going’ is to keep my head busy (and challenged), so thoughts don’t go astray. Running also helps a LOT – I actually say to people ‘it keeps me sane’, but I don’t think they realise the extent to which this is true. A good friend of mine is bipolar. She has tried MANY meds over the years, and nothing seems to really work (mostly, she says, they take a bit of the edge off the highs, but the lows are just as bad – and what’s the point in that?). She keeps things under control with excercise, too – and art she paints. She’s not at all a scientist… A lot of people with bipolar disorder are quite creative: here’s an old NYT article with an interesting case study. This, of course, links back to the earlier posts on the implications for creativity.
For myself, I also – slowly – seem to be learning the perspective thing. A good dose of, for lack of a better word, ‘detachment’ from situations that want to get to you seems to work.
Ultimately, I have to say that – I think – most of what people have described above are ‘healthy responses to life’ which we all go through.
As Åsa said:
It’s after a few months, when “most people” move away from the black cloud that the medical depression comes along as a term.
And: maybe it is just that it is disappointing and scary not to be all perfect as we “are supposed to be”
Yes, I think that may be true!
Richard, thank you for this wonderful and brave blog post. And for all those thoughtful comments. I would also like to add a personal perspective to this. As some of you know, I’m a medical oncologist and see quite a number of cancer patients every week. Obviously, there is a lot of sadness from bad news, suffering or dying, and on particular bad days it brings the tears into my eyes. Over time I have learned different strategies to deal with this sadness. Being open to a patient and his relatives is the important first step, as is talking with my colleagues. Doing something completely different at work is also important, being it basic cancer research or – science blogging. And of course the support of the family and friends.
But sadness is different from depression. And to see how brave patients and relatives often handle these difficult situations makes me feel proud of them. And we laugh a lot when the situation allows it, which makes my job also a very funny one.
I am rather moved by all the honesty here.
Thanks especially for the link about caring for your introvert, Maxine. I’ve had that piece bookmarked for a while.
On a frivolous note, I didn’t wear the kilt because there were not enough ‘yes’ votes. It’s your own fault.
Excellent post and discussion.
I have a mild anxiety disorder, with a side of mild agoraphobia. I only sought medical help when I had my first full-blown panic attack at work a couple of years ago, and then only because I thought I was having a heart attack. Luckily the on-call doctor was simply magnificent, and suddenly a whole load of other things started to make sense. (And, when I finally got up the courage to tell people at work what was wrong and why I’d dashed out of the office like that, it was amazing how many other people had the same problem).
I’ve toyed with the idea of seeing a counsellor of some kind, but again there’s that stigma of “having something wrong”. And besides, a few self-help books, a couple of dietary changes, more exercise and a new job have really helped. I still have to remind myself (and sometimes force myself) to face up to the situations that make me uncomfortable whenever I can, and to make sure I don’t let my agoraphobia stop me enjoying my life. It’s just such an effort sometimes, but it’s definitely worth it.
bq. One thing I am accutely aware of is the placebo effect with anti-depressants.
That’s something that intrigues me, and I’d like to know if you have any more thoughts on that, Ian. Going back to the comment about St John’s Wort; I don’t know how much of that is placebo, but it seems to work (admittedly my observed sample size is small), so who cares if it’s placebo?
(Discussion about whether placebos work if you know they’re placebo elided.)
@RichardW: yup, although it’s difficult to keep kicking one’s own arse.
which is silly, isn’t it? You break a leg, you go to the quack. You have pneumonia, you go to the quack
get told to take some aspirin and come back four days later in the meantime getting a temperature and then told by the HO at the XRay department on a Sunday morning that people like you usually already have been in hospital for a weekand get antibiotics.Why is depression and other ‘mental’ illness so taboo? Is it, do you think, because we–more than any other animal–are primarily creatures of our minds? Take that away and we’re like the beasts of the field?
Bah. Also meant to comment on
and that I think is the major difference between sadness and depression. At least in my experience.
Richard> I wondered if it had to do with something about the whole “what you do as a scientist is based on your head and your thoughts” so if you are ‘ill’ in your head it makes it so much more ocmplicated?
You break a leg, you go to the quack.
Yes, this is something I think is important though. Although you need your leg, no one would presume to say “you are your leg”. But we do tend to say that “we are our thoughts and mind”, right?
I think there was something along those lines in “In a beautiful mind” that I kept thinking about since he was ill but yet so brilliant and thought out all those explanations others couldn’t.
What Asa said. Plus the perception that panic attacks = lack of ability to cope with the deadlines and stress that go along with the job. When in fact I’m fine with the deadlines, it’s things like having to sit in the middle of a row in a lecture theatre with no easy exit that are more likely to set me off…
bq. it’s things like having to sit in the middle of a row in a lecture theatre with no easy exit that are more likely to set me off
I’ve been to seminars like that.
No, seriously – do NOT get between me and my nearest exit…
a lot of people mistakenly believe that agoraphobia is a fear of open spaces. I love open spaces. The word translates as “fear of the market place”, and that’s just it – a fear of public places where there is no easy way to get away from everyone without everyone noticing. Put me in a strange room and the first thing I’ll do is check for bolt holes… although I’m getting good at not actually bolting, having realised that it’s actually the worst thing I can do, long term.
@ Maxine- Thanks for the link to the Rausch essay on introverts. I’m rarely depressed or morose, I’m not an antisocial misanthrope, I don’t have social anxiety, I’m not lacking in empathy or sensitivity … I’m just introverted.
The introvert/extrovert phenotype is part of the Meyers-Briggs personality analysis, which is used in some medical schools in the US. Better to accept that people differ significantly in the ways in which they interact with the world, and with each other, than to try to fit everyone in the same personality box.
@Kristi, just a comment: Meyers-Briggs is also very widely used in the US corporate world (been through one, too)… although in my experience only to NOT act on it (acting = letting people do what they’re best at).
I’m sure I’ve written about Meyers-Briggs elsewhere (in fact, I know I have) and indeed, we took a straw poll at SciBlog ’08 in the last session. I had a cut-down version of the test before I started work at a small company in the UK, n years ago: but again, they failed to act on what they found (and what they found was pretty close to what a more ‘professional’ test came up with a couple of years later).
Just a quick add-on to not equate depression with introversion, of course. Much as it pays to recognize those who are, to avoid “driving this person nuts”.
Richard, I think the problem with mental illness, temporary or chronic, is indeed that there are heavy overtones of identity with the system that is sick. This idea of not “being yourself” anymore. Of having a “different personality” – less creative, less reactive – when on medication.
I don’t really believe there is a huge stigma to mental illness as such. However, self-diagnosis and banalization have done much to make us think that any mental changes in ourselves is frightening, because it means a loss of control, and mentioned by others is simply self-indulgent, unless they have the stigmata to prove otherwise.
(are frightening)… sorry to not preview.
bloggers, particularly female ones, are said to be “more neurotic”.
Yeah, right. And their brains are no larger than squirrels’.
On the introvert thing – what Rausch describes in his essay (thanks for that, Maxine) is a very good description of someone with mild Asperger’s syndrome. I have seen much the same with Gee Minor (she of the unicycling girrafes). The love of long, intense conversations (what Gee Minor calls ‘A Good Old Chat’); a certain bravura in front of large crowds, and at the same time a wish to be on one’s own for long periods, without the Confused Noise of other people. In that post I suggested that the incidence of Aspergic traits might be higher in scientists than in the general population. It might also be significant that people with Asperger’s also tend to be intelligent … and prone to depression, from what Jean Paul described as Weltschmerz, a weariness of the world occasioned by the realization that physical reality can never truly satisfy the longings of the mind. When Gee Minor was about three she’d approach a person (_any_ person), sigh deeply and say “What’s It All About?”
bq. I suggested that the incidence of Aspergic traits might be higher in scientists than in the general population.
I think that’s a pretty common meme. Don’t know about the depression thing, though.
On the introvert thing – what Rausch describes in his essay (thanks for that, Maxine) is a very good description of someone with mild Asperger’s syndrome.
Undoubtedly there’s overlap in the characteristics, but Asperger’s also has some defining traits that are not found in many introverts. Three that come to mind quickly (perhaps because I don’t think they apply to me or to some other introverts I know) are the narrow interests, the stereotyped and repetitive behaviors, and the physical clumsiness. Not all individuals with AS have the third trait, of course, but the first two traits are part of the original description of the syndrome.
AS is also associated with poor or unusual nonverbal communication; again, to use my own experience as an introvert, I’d say I’m much better at or more sensitive to nonverbal signals than the mindless “small talk” chatter that dominates so many social situations. In part because of my inadequate (and unwilling) “small talk” abilities, I had the role of “horse leader”, rather than “sidewalker”, at a therapeutic riding program. However, I often picked up on nonverbal signals from the riders, particularly for those whose speech was impaired (by cerebral palsy or developmental delay) or absent (autism). Too often the sidewalkers seemed focused on their stream of chatter, and I felt that if they’d just stop talking, maybe they’d be able to observe what the rider was communicating nonverbally.
Actually, one of the things that I find frustrating about internet communication is the lack of nonverbal cues – I realized early on that I was very dependent on them, and as a consequence, I think I’m often pretty bad and inept at online discourse. I feel misunderstood much more often than in “meatspace” conversations.
Actually, one of the things that I find frustrating about internet communication is the lack of nonverbal cues – I realized early on that I was very dependent on them, and as a consequence, I think I’m often pretty bad and inept at online discourse.
Interesting. I find the opposite. Online I have time to gather my thoughts and string them together in a more articulate manner, at my own pace. I can also use which ever sentence structure I choose without fear of being thought posh or something. In meatlife, that doesn’t happen often. Small talk requires me to think quickly and respond to things immediately. I am quite poor at that, so tend to avoid making small talk (for example at the SciBlog conference, I pretty much avoided everyone).
I do totally agree about the nonverbal cues however, I am far more aware of how something is said, and with which facial expression/hand gesture. I can read 10 different meanings into a simple sentence by way of the nonverbal stuff.
Damn these introverted tendencies!
bq. I do totally agree about the nonverbal cues however, I am far more aware of how something is said, and with which facial expression/hand gesture. I can read 10 different meanings into a simple sentence by way of the nonverbal stuff.
That’s funny, because it’s only recently I’ve learned to pick up on such stuff. And of course online I usually get hold of the shitty end, and end up being deadly serious when someone is being facetious.
My encounter with a person diagnosed with mild Asperger’s confirms his inability to understand non-verbal cues, and to take many verbal ones (expressions, in particular) quite literally. We learned to be careful, even though he has a great sense of humor otherwise.
Again, depression ≠ introversion ≠ Asperger’s.
And of course online I usually get hold of the shitty end, and end up being deadly serious when someone is being facetious.
I have the exact opposite problem.
It might also be significant that people with Asperger’s also tend to be intelligent … and prone to depression, from what Jean Paul described as Weltschmerz, a weariness of the world occasioned by the realization that physical reality can never truly satisfy the longings of the mind. When Gee Minor was about three she’d approach a person (any person), sigh deeply and say “What’s It All About?”
{totally unscientific} At the risk of incurring a woo-accusation, I’ll mention that according to folk wisdom (in the US, at least), a child with such characteristics is described as “having an old soul”. Some people will go so far as to say that the “old soul” has unfinished business on this Mortal Coil, and thus has returned in a new body, to “git ‘er done”.{/totally unscientific}
I do totally agree about the nonverbal cues however, I am far more aware of how something is said, and with which facial expression/hand gesture.
For me this also goes when i am talking to someone and trying to read them (most of the times unconsciously) what they think about it. Emails and internet discussions, not so much. Although it is a good thing to learn 😉
I think it is easy to mistake the traits we think fits with a scientist “focused, able to get into detail, rinse and repeat” with the traits correlated to AS.
Richard> I have been known to wonder between the types, E and I. Interestingly it could be very much correlated to my most intense part of my PhD time – when I needed to be on my own and just work in the lab focused – and other times 🙂 I find that, if nothing else a little interesting. (and navel gazing of course…)
I would love to wax lyrical about the placebo effect Richard (_cf_ comment about 2 miles above this one), but I have a headache and I need to pop a couple of sugar pills and eat some echinacea…
I agree with other posters; this is a brave post!
Sad thing is usually when I hear people say they’re depressed its because of something that happened earlier in the day, the next day they’re ebullient, so i’ve come to think of depression as somebody simply having a bad day!
narrow interests, the stereotyped and repetitive behaviors, and the physical clumsiness
If these are definitions of Asperger’s, I agree that they don’t (necessarily) apply to introverts also. I agree that introversion is certainly not the same as depression.
I understand there was relatively recently a large, formal trial of St John’s Wort (was it the first proper clicial trial of an “alternative” therapy?) and it showed no demonstrable effect. But anecdotally a lot of people, Lewis Wolpert included, swear by it.
I’ve done Meyers-Briggs a few times on various courses. It is interesting how one’s scores change with the years due to conscious choice – I take this to indicate some degree of personal development as opposed to being stuck in a rut, but this could be self-delusion!
oh. Lots of interesting comments.
Briefly, I agree with James about sadness and depression. And Heather’s inequality. And more, but it’ll have to wait until I’ve finished this mug of coffee.
Maxine> The only thing I know has been proven about St Johns wort is that it will affect the effect of Birth control pills and render them useless.
One of those things that have been studied… 😉
Åsa (and everyone)—
when my friend classified me with out my knowing, she was undecided about ‘E’ or ‘I’. I do make an effort to be sociable, and am fine (great, in fact) in front of crowds, but I always, always have to retreat to my own space in time. Happiness is writing, or reading: both solo endeavours. I emerge recharged after a time on my own.
It’s not that I hate you, it’s that I need ‘me’ time.
It is interesting how one’s scores change with the years due to conscious choice – I take this to indicate some degree of personal development as opposed to being stuck in a rut, but this could be self-delusion!
I’ve taken the MBTI instrument several times over the last 20 years, and I always get the same result (INTP “Architect”). I don’t recall being on the fence for any of the four dichotomies, either, so I must be stuck in a very deep rut indeed. However, I’ve found some of the suggestions in various MB books, for both improving interactions with other types, and for personal growth in the context of ingrained INTP traits, to be helpful. The Jungian archetype background to MBTI is interesting to me, but only in the sense that I find reading Tolkien, or Norse mythology, or Masonic symbolism interesting.
bq. However, I’ve found some of the suggestions in various MB books, for both improving interactions with other types, and for personal growth in the context of ingrained INTP traits, to be helpful.
That’s the trick, isn’t it? It’s not that your (my) personality type is inherently bad, but learning how to play to strengths and compensate for weaknesses is the real power of MBTI. All these online tests that say ‘you are x, y, z’ aren’t actually that helpful. We know we’re like that. How we relate to others and how others might cope with us better are the important things.
I actually thought at the time that the MBTI was accurate, but I also have this nagging doubt that I somehow, without really meaning to, ‘cheated’ on the answers, i.e. gave the answers that I felt would lead to the result I wanted, how I would like to see myself (see Maxine and Kristi’s comments above: was this intentional or not?). Part of my suspicion stems from how I did on extroversion-introversion. I think, similar to Richard, I come out very extrovert, but don’t think I always am. The other ‘problem’ is leadership (I’m an ENTP): Ok, I know I can lead a team of people successfully, even in very stressful situations, but I do find it VERY tiring.
@Richard: All these online tests that say ‘you are x, y, z’ aren’t actually that helpful. Are online tests accurate at all?.. For example: the BBC has a silly test on brain sex on their website. I did this, and it turns out that, apparently, I have a slightly more male than female brain. I am not sure what that means.
The write-up tells me that, under ‘Emotions and Systems’, I scored slightly below the average for women. It continues: If you scored 15 and above, you are very empathic and would be an ideal person to comfort people in a time of crisis. Women in general are better at empathising. My score was 9. At the same time, I achieved 90% on recognizing emotions from people’s eyes (another empathy test). Apparently, this means that I am a good empathiser, sensitive to other people’s emotions. Which one is it? Maybe it means that I’ll recognize if you’re not doing well, but I will be utterly incapable of helping you in any useful way…?
Another revelation is that I must have been exposed to a lot of testosterone in my mother’s womb (something to do with my ring finger being longer than my index finger). Have to remember asking her about that some time. Then again, I scored highly on ‘verbal fluency’. Studies have shown that girls develop vocabulary faster than boys. This difference in brain power is caused by levels of pre-natal testosterone.
Some people spend a LOT of time on the development of tests like this (and the website has some interesting links to ‘background’). Can they REALLY tell us anything? I do have to say that taking the test made me giggle, though…
ENTJ – I meant to say I came out an ENTJ. I think I may have just answered my own question on that one, considering the ‘verification’ of the MBTI…
The online tests are a bit of fun. That’s all.
There are trained counsellors out there who will take you through it properly, if you’re interested. And that is valuable.
Taking the MBTI test ‘properly’ would scare me but I can see how it would be valuable from the point of view of interacting with other personality types. I take online tests with a large pinch of salt, usually because I am unable to verify the source of the test. Some of it is quite interesting regardless…
bq. Taking the MBTI test ‘properly’ would scare me
Why?
I might not like the outcome…or it might explain too much, or it may just give me another label to restrict me.
you don’t think it might help you better understand yourself? Or how you interact with other people?
Well, it may do. As for interacting with other people, perhaps it will just provide me an excuse to ignore certain behaviours I have as ‘inherent’ and not try to adapt or change. Or perhaps it would give me valuable insight into why these things are the way they are and help precipitate a change. I don’t know.
Perhaps it would make things worse…
@Steffi
I looked at the test on brain sex, and realized the first question was against the clock, and just couldn’t be arsed.
What does that say about me?
@KH—no one’s making you, of course 🙂
@ Katherine – If you look at this brief description of the INTP type as an example, the idea is to change behaviors and attitudes in fairly small and positive ways. For me, the two most useful sections on that page are “ways in which the INTP can irritate others”, and “personal growth”. As an INTP, I don’t require praise for imperfect efforts, but that doesn’t mean that others feel the same. In the “personal growth” section, I’m not being asked to change my personality; rather, there are suggestions for ways in which I can change my behavior, without selling out or doing anything distasteful.
Just as a bit of fun, my favorite online personality test is the Volkonsky canine algorithm, available under the “GAMES” section of this Gone to the Dogs website. Apparently I am a Belgian Shepherd.
@Richard – well, what can I say: hubby’s in the Antarctic right now.. you know, keep me busy.
@Kristi: the dog -> blog thing is becoming clearer now.
when my friend classified me with out my knowing, she was undecided about ‘E’ or ‘I’. I do make an effort to be sociable, and am fine (great, in fact) in front of crowds, but I always, always have to retreat to my own space in time. Happiness is writing, or reading: both solo endeavours. I emerge recharged after a time on my own.
Richard> This is what I find with myself too. I need the “alone me time” in order to recharge and to be happy. (I’d be happy alone in nature/by hte sea/forest as well as reading and writing)
The main difference between the two types I end up flipping between (E and I) is that the ‘I’ is more of a thinker and the ‘E’ is the leader. Since the two middle letters are the same, the type is still a rational – the core of how you think/feel.
One harsh sentence says: “there must always be a goal-directed reason for doing anything, and people’s feelings usually are not sufficient reason” that’s where I get a bit uneasy about it all. Then again, according to the type I am like Thacher and that makes me somewhat scared too…. 😉
@Kristi I am apparently a Portuguese Water Dog, which is one of the most absurd looking pooches I have ever seen. The description is fair however. I suspect that it would be helpful for me to find ways to avoid irritating others, but as a potential INTJ, I’m not generally inclined to care because I’m better off working alone…/That was an attempt at humour/.
@ Asa/Richard – having my own office, with a door that I can shut is the best thing that has ever happened to me professionally. I can retreat whenever I want to, and just spend time in the quiet getting on with stuff. Productivity has increased exponentially, and it makes me less drained at the end of the day than having a desk in the lab used to. Nothing wrong with being like Thatcher by the way, nothing wrong with it at all.
bq. Nothing wrong with being like Thatcher by the way, nothing wrong with it at all.
Oh dear. Move over, Henry: the Tory bench is getting full.
In my Dad’s speech at my wedding last year, he told a story about attending an interesting parent-teacher meeting when I was about 7. My teacher told him about an incident that had happened a few weeks earlier, in which she’d asked the class if anyone knew what the Prime Minister was called.
I apparently put my hand up and said “I do, it’s Margaret Bloody Thatcher!”
BTW I
Can
Has
100
100th comment?
HAHAHA.
Fail.
Oh you bastard
That’s what happens when NN loads too slowly
That’s “Dr” Bastard to you.
And my first name is ‘Arrogant’. Get it right, or I’ll get depressed.
Katherine> I think it makes me nervous since I have done another test, based on “group work” and “where do you fit in the circle” and I ended up in Box 42. The same box as, yes you guessed it, Dame Thatcher. So, couple this with my childhood and the comments from my academic parents [usually this meant leftish in the 70ies] who weren’t really fans of said lady…. and here I leave politics.
Richard> I somehow think you might use unnatural means to get the 100th comment… Dr British in Exile Down Under aka Dr BEDU 😉
‘Unnatural’?
Just my native skill and charm.
And other quarks.
bq. @Richard – well, what can I say: hubby’s in the Antarctic right now.. you know, keep me busy.
Eh? Should I check back to see the context?
No, I think not, on reflection.
File under ‘excuse for wasting time on silly online tests’ and forget.
bq. The main difference between the two types I end up flipping between (E and I) is that the ‘I’ is more of a thinker and the ‘E’ is the leader.
Is that true? I often find myself the natural leader of a group.
It might be because I don’t trust any other bugger to do it probably, but still.
Kristi – I’ve taken the MBTI instrument several times over the last 20 years, and I always get the same result (INTP “Architect”). I don’t recall being on the fence for any of the four dichotomies, either, so I must be stuck in a very deep rut indeed.
Or it could mean that you know yourself well and are content with yourself as you are. My “conscious efforts” were/are “efforts to change” which could be construed as self-dissatisfaction and wanting to “be better in some way”.
I mentioned “self-delusion”: there is a point at which one cannot analyse oneself and one’s motives to oneself – and potentially no limit to self-delusion. So I don’t know if my changes in these scores (which were on occasions when the test was administered properly) reflect a sort of eternal internal restlessness or a genuine personal development or some combination of both.
What have I learned from all this? I dunno, I had better stick with something safe and true, such as “RSS is great”.
Sometimes Maxine, I think we just have to rearrange our anatomy0 and get on with life. There’s a place for self-analysis (stop sniggering at the back) and introspection, but we also have to laugh at ourselves and get on with it.
Which sort of brings this back to depression.
0 don’t make me spell it out…
I know what you mean. I stopped being so self-analytical when I had children, as something had to go at that point. (I chose the children and my job over self-analysis and sleep.)
(I didn’t go to your link so am not exactly laughing, but can guess the general point so am smiling 😉 )
_Is that true? I often find myself the natural leader of a group.
It might be because I don’t trust any other bugger to do it probably, but still._
Richard> The two types I am flipping between have the difference that the ‘I’ thinks and solves problem on its own. ‘E’ ends up a leader, sometimes as a surprise to him/herself but the main flaw (?) is that the ‘E’ type can not create as much as the ‘I’. But the ‘E’ type implements great, leading and seeing a vision etc…
Hum. Not sure I think the I/E has anything to do with creativity. Isn’t it rather where your strength comes from?
Maxine: I made exactly the same choices as you. It’s working out pretty well, all things considered. Although chronic lack of sleep compounded my reaction to certain adverse events and not only threatened my physical but my mental health for a while back there. My depression was preceded by “the year of eleven sinus infections” and a bout of peritonitis.
Funny how when I was looking for some interesting link to place for the mind-body interface, everything either had a trademark cutsie expression or involved a “mind – body – spirit” interface, which induces a urticarial reaction in my mind and body, at least. That will teach me to search with Google before PubMed. Anyhow, this link is more like what I was looking for.
Richard> In “the context of what I spoke of” the ‘vreativeity’ would be that one type is good at inventing from scratch and the other is good at ‘seeing changes and vision and tweaking and leading’. Then again, I might have misunderstood it all – but I think it is more my lack of explaining it.
and no, not creativity per se different ways of using it/having it.
Hum, maybe.
It’s a subject for another blogpost, I think. Maybe Clare should look at E vs I and creativity?
Heather: antibiotics to treat depression, perhaps? Is that why American cows are happy, not mad?
I’ve been slightly surprised to read about people enjoying the MBTI – I might have to revise my impression of it. To be honest I’ve always thought it was woo – http://skepdic.com/myersb.html – is this an unreasonable criticism of the test?
I think you can criticize the test along those lines, but there is a great deal of anecdote (I know, the plural of anecdote is not ‘data’) to show that the four axes, if you like, are useful in understanding oneself and in understanding why other people behave as they do.
Psychology is not a precise science. I think it is wrong to judge it as such. Oh, and when anyone (CPP in this case) owns the ‘rights’ to an ‘instrument’, you have to be careful: they want to make money, natch. But that does not in itself invalidate its usefulness.
I have been depressed virtually my whole life. So much so that I didn’t appreciate what it was like to not be depressed until I was in my 40’s when I was on meds that actually worked quite well. Much of it was from childhood abusive trauma, bullying by my older siblings. I have been on antidepressants for over 20 years and in psychotherapy by senior clinicians for over 25. Raising my nitric oxide level as a part of my research has done more for it than have antidepressants or psychotherapy combined.
I have been on a number of different antidepressants and in no case was my creativity worse while on them. My creativity now is better than it has ever been. If anyone ever thinks they are depressed they should be evaluated for it and receive treatment. Depression is highly treatable, and is a leading cause of death (suicide was the 11th leading cause of death in the US in 2005). I consider the stigma that people with depression receive to be a form of bullying and abuse. Something that makes depression worse rather than better.
My experience with my depression having greatly resolved when I increased my NO level has been quite useful to me in hypothesis generation as to the physiology behind depression. I now see depression as the absolutely necessary aversive state between the “normal” metabolic state, and the necessarily euphoric state of extreme metabolic stress. When an organism has to escape from a predator, the organism can’t stop because it is “tired”. Physiology must induce a state of euphoria, such that the organism can continue to run even while it runs itself to death. Death from exhaustion and death from being caught by a predator are equivalent in terms of evolution. The ability to run oneself to death is an extremely valuable survival feature.
I see the euphoria of extreme metabolic stress the same as the euphoria of drowning, of autoerotic asphyxiation, solvent huffing, the “runner’s high”, the manic state of bipolar and the euphoria produced by stimulants of abuse. It is not that these cause new sources of ATP to come online, rather pathways consuming ATP are turned off; pathways that are not needed during the period while one is running from a bear. These would include pathways for all things that take longer than the ATP crisis, including healing, reproduction, long range transport in axons, mitochondria biogenesis, autophagy, and other things. This is also a part of ischemic preconditioning; the turning off of non-essential pathways to conserve ATP during an acute ATP crisis brought on by a brief period of ischemia.
Because the near death metabolic state must to be euphoric if organisms are going to have even a slim chance of surviving it, there must be an aversive state between the “normal” state and the state of extreme metabolic stress. If there was no aversive state, then organisms would enter the near death euphoric state and risk death and injury with no benefit. That aversive state is depression.
It turns out that nitric oxide is the signal that indicates to cells the ATP status of their neighbors, and the NO level is used so that entire tissue compartments go up and down in ATP levels “in sync”. Low NO by any mechanism causes low ATP and causes greater sensitivity to triggering the ATP conservation pathways.
Triggering the fight or flight state or ischemic preconditioning is caused by a reduction in NO levels. That lowers ATP and turns off low priority ATP consuming pathways. If those pathways stay off for too long, there is degeneration. The characteristic degeneration of stimulant abuse is very similar to the characteristic degeneration of all of the other degenerative diseases. I think they are essentially “the same”.
There is hysteresis when an organism enters the fight or flight state. To overcome that hysteresis and leave the fight or flight state requires more nitric oxide. When that NO is generated neurogenically, it is called the placebo effect . The archetypal placebo effect is a mother’s “kiss it and make it better”. She is telling her child that all is well, the child is safe and that the child’s physiology can stand down from its fight or flight state.
Depression in the postpartum period is the same thing, but is much more serious. There is extreme danger that postpartum depression can progress into postpartum psychosis. I see these as fundamentally “the same”, but simply to different degrees. A critical need during lactation is to produce glucose for lactose production. There is an absolute requirement for 3-carbon substrates to do this. Lipid cannot be used to make glucose. Without glucose lactose cannot be made. Without lactose, sufficient milk of sufficient nutritional cannot be produced. I discuss the consequences of that here acute and postpartum psychosis (warning some of this is quite disturbing). I see postpartum depression and psychosis as primarily due to insufficient mitochondria in the liver secondary to insufficient nitric oxide. Prevention is better than cure, mitochondria number and NO status should be improved before pregnancy even starts.
I have mixed feelings posting so much here. I know that virtually all readers won’t have the background to appreciate it, and those that do may be unable to accept it because it is counter to so much “conventional wisdom”, such as the wrong idea of homeostasis. I am beginning to appreciate just how difficult it is for many people to even consider ideas that are outside their experience. That relates to the great trade-off of neurodevelopment along the autism spectrum, the trade-off of theory of mind for theory of reality. A post that I am still working on and hope to have within a month or so.
Richard,
I’m glad you found a fix and am grateful. Having lived for three years with a profoundly depressed man — and another three since them attempting to be parents with him after divorce — I can testify that treating this as a serious medical problem is a crucial thing. We ran into altogether too many therapists and social workers who were bent on treating depression as a “social difference”, and who wanted to normalize it rather than treating it as chronic illness. At one point I was actually (me!) called a “sanist”. Sanist. Yes, I am all in favor of people’s acquiring sanity by whatever means available. Particularly when I’ve had children with said people.
The stigma thing is nonsense but I must confess I find it highly convenient. I live in a state with reasonably good fathers-rights laws; my daughter’s dad has periods when he’s able to do things like hold responsible jobs, keep well-groomed, etc. Unfortunately, they don’t last. But were he to go to a judge during one of his good periods, and say he wanted half custody, my lawyer would say “chronically disabling and persistent mental illness” and that would be the end of the story, because stigma has a thumb on the scale. Bad for my ex, very good for my daughter, and frankly good for me. No stigma would mean thousands of dollars on legal fees and hair-falling-out stress as I tried to make the case that he’d likely be too ill again to care for her, and that although she’d be unlikely to starve or get beaten in his care, she’d end up taking care of him instead of the other way around. And frankly sometimes he has no sense. I know this is a common complaint about men, but…well, I think the baggie full of toenail clippings given to my daughter as a memento may still be one of the more vivid instances.
Perhaps one of the problems with mental-illness stigma is that it doesn’t differentiate. There’s a serious difference between ravaging-and-destructive and a misery, but you don’t see that when you toss it all into the mental-illness bin. I think there’s also a serious reluctance to deal straightforwardly with the question, “Well, what can and can’t this person do while ill, and how likely is he to be ill?” instead of conjuring up Halloween images of madhouses and 60s-era mental wards. That last is difficult in part, I think, because the mental-health advocacy movement makes it difficult. The fact is that if someone is chronically, seriously mentally ill, lack of predictability is a large part of the problem, and others must compensate for the person’s sudden loss of ability to do ________ and need for more care. That takes serious energy and flexibility, which are expensive to the supporting people. And there are limits. So at some point employers and family members may say, “Look, I know that when you’re in good shape, you can do X. The problem is you fall apart unpredictably, and we have to catch the masonry as it falls. We can’t keep doing that, and that means you’re off job X.” This is tough to have a conversation about, because it’s not permissible in mental-health-advocacy rhetoric.
Keep us posted on how the drug continues to work and influence your thinking & work, if at all. As noted on Jenny’s blog some year back, I found that subclinical doses of amytriptyline were a literal anaesthetic — I felt things less strongly, cared less, and words didn’t leap up and stick themselves to things the way they had before. I was aware of all that, and deep inside, that little worm of a spark described so nicely by Asimov was aware that this was Very Bad, but I really couldn’t care enough to do anything about it. My writing from the time is no good — competent, workmanlike, literal. No poetry. I find St. John’s Wort has a similar effect.
Which is just as well. When I was younger I was convinced I was terribly depression-prone, but since my daughter’s birth I find I’m actually just a maundering arty type. As there’s no one else here to keep it together for her, I’m on, and I do get out of bed, work, meet people, etc., so the anguish couldn’t have been that necessary. Yes, there are periods of minor depression, which is perhaps not unusual given the 8-hour home/childcare day, the living made from writing educationally destructive K12 texts, the insistance upon having an unpaid, intellectually fancy career beyond that, the chronic sleep loss, and the fact that there are no other adults in my house to talk to (or at). Things would have to get pretty bad, though, before I risked the word-jumpiness again. In the meantime it hasn’t been bad enough to make me open the garage door in the morning, look at the 8 inches of fresh snow in the driveway, close the garage door, go upstairs, and get back into bed. And it passes.
My real regret is that I’ve lost some of the exhilaration I used to get — not because I’ve changed, I think, but because I can’t afford it. They’re a tremendous energy drain, and I can’t spend two days being exhilarated/exhausted before getting back to work again.
I’ve seldom finished taking an MBTI, because I answer too many of the questions “it depends”, get annoyed, and quit. When I do finish I tend to get a different answer every time.
A very brave post, Richard.
Thank you.
Wow, I’ve found this discussion really enlightening. I’ve never personally suffered from depression, but two of the people closest to me do, and I’ve struggled alot with knowing how best to deal with it. At times, it had left me frustrated that none of my advice has seemed to make any difference; at other times it’s just left me sad that I’m unable to help or feeling guilty that at times I just don’t get it. What’s upsetting too is that it’s left me emotionally exhausted and needing space from people I care about greatly.
So a question for those of you who have suffered from depression or who have had relationships with people who are depressed – what advice would you give to the loved ones of people going through depression?
Olive, to encourage the depressed person to get treatment and support them in doing so and to understand that their depression is not about you.
It can be very tricky to be supportive without being enabling. Support them but not allow them to use you, to abuse you, or to let them use their depression to manipulate others and especially those they are in a relationship with.
@Olive:
More often than not, advice isn’t what’s actually required. Just a listening ear. Ultimately the person affected has to make their own decisions. What David said, too.
A sense of humor can be helpful too. Once when I was going through a particularly bad spot, a friend (who was worried) referred to me as “Amy put the gun down Amy.” Which was funny, and vivid, and nicely put. Oh for the old days of alt.suicide.holiday.
A nice dose of Douglas Adams seldom hurts either.
I agree with Richard; ultimately I think there’s not a tremendous amount for you can do. You can (occasionally, gently) point out the depression, since one of the hallmarks of depression is that it can be hard to see in yourself. You can do some jollying to get the person to come out with you, get some exercise, etc. But I think it’s probably best, after the initial concern, to make it clear that you’re offering a shoulder (within reason, after which there are professionals who do that sort of thing for a living) and go live, checking back every so often. While it’s important to avoid being callous about that, someone who’s depressed will likely take it hard anyway. I don’t think there’s much you can do about that either.
Much depends though on what you mean by “depression”, since it’s such a catch-all. (Richard, I look forward to the day it goes the way of socketism.)
bq. Oh for the old days of alt.suicide.holiday
Yegods. That’s a reference which will be lost on these young folk—and probably the older ones too!
This can backfire. If you’re obviously jollying someone along it’s a bit “Oh do cheer up”, and borders on not taking the problem seriously. And making a depressive laugh isn’t always a good thing. The crash afterwards can seem much worse.
Getting out, a change of environment, that can be good but again, it’s the going back to the previous situation that gives me pause.
Heh. I had to google to remind myself, but yes. It’s a broad church. Too broad perhaps.
I hadn’t thought about a crash after laughing. New one on me. Not so good then, maybe. And of course “buck up” is worse than useless.
Yes, I think it’s a little broad, depression. Actually it was funny — last night, after a long evening of telling the kid “No” and “sit down and listen and take your fingers out of your ears” I had a truly awful dream involving my ex selling my house out from under me, and this morning felt the hangover walking home after dropping the child at school. It was the sort of feeling that could easily have been dropped into the “depressed” bucket, but as I walked along I realized I wasn’t depressed, I was desolee. Which, of course, passes, but as long as we’re talking about precision in language, etc.
Poverty of language & story they’ve got in psychology.
More seriously, though, if we’d had more precise language for it, I likely wouldn’t have married my ex in the first place. I knew he’d been depressed; I knew he’d been hospitalized. I also knew plenty of other people who’d been through the things of the same name and come out the other side, occasionally a misery but on the whole reasonably content & productive. What my ex has is called depression, but it’s a different animal altogether from what I’ve seen in others & myself, a ravaging & permanent thing.