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What I have learned from my suicidal patients

theguardian.com

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Re: What I have learned from my suicidal patients

#71

Post by 0xcde4c3db »

sjg007 wrote: post #63
0xcde4c3db wrote: post #38

> To feel depressed about the state of your life is to demonstrate capacity to imagine something different, and that spark of imagination can prove a motive to change. This was arguably true for me, but not in a good way. I'm pretty sure that I started having intrusive suicidal thoughts because my depression had motivated me to try to change. Said changes utterly failed to even make a dent in my depression, finally c…

Are you still depressed? I try to have 5 good days out of 7 in a week. I found that CBT helps especially the book Feeling Good by David Burns. He has a podcast out now about a new team base cbt approach. The podcast is great and the workbooks in his books are really helpful. He has an associated clinic in Mountain View as well. The approach is practical and specific. CBT has roots in Buddhism and stoicism as well for…

I'm not sure whether I'd actually meet the criteria for a depression diagnosis anymore. I haven't been severely depressed since starting CPAP treatment, but my emotional experience is still very flat and I still have difficulty processing social interaction.

I've heard of Feeling Good and CBT in general, and without going into the gory details, it really doesn't sound like it's the right approach for me.

Re: What I have learned from my suicidal patients

#72

Post by shkkmo »

BLKNSLVR wrote: post #68
sysbin wrote: post #35

Earlier quoted context omitted.

How is suicide not an attempt at self inflicted euthanasia? I'll watch your video (thanks).

> How is suicide not an attempt at self inflicted euthanasia? There's a specific separation in my mind of the definition of the two, whether that's reflected in the dictionary or not. The video is fairly specifically about end-of-life kind of suffering, which is along the lines of my definition of euthanasia (rightly or wrongly). Re-reading my comment, and your questioning of it, I do present it more "black and white…

So as soon as we develope the ability to keep people on perpetual life support, any right to euthanasia would go out the window?

Re: What I have learned from my suicidal patients

#73

Post by snagglegaggle »

sonofhans wrote: post #12
snagglegaggle wrote: post #4

Earlier quoted context omitted.

I think you are going in the right direction. Society needs to recognize that suicide must be some evolutionarily advantageous adaptation. Many people when pressed will say they think an individual has value, but that individual often sees no actions come from that sentiment. And if someone thinks they provide no value and are not wanted, it seems logical to unburden everyone else. It would be similar to how cats go…

I do not believe there's evidence or reason to say that suicidal tendencies convey evolutionary advantage to the species. Many things seem to be accidents. Does the https://en.wikipedia.org/wiki/Photic_sneeze_reflex convey advantage? Very likely no; it's an accidental mutation that doesn't cause enough damage to be selected against. Evolution isn't directed, and there is no end state. Attributing positive effect to e…

What would convince you? It should be pretty clear at this juncture I don't have evidence. However I did give a reason; if in general depressed people feel they are not contributing or participating in society then that is pretty clear.

You can look into this further: a lack of physical activity tends to worsen depression, and a hunter-gatherer with reduced mobility and/or other issues that make it hard to interact with the group is most certainly a resource drain. It goes on and on.

Evolution isn't directed but structures and instinct that are truly against the organisms interest are the exception, not the norm.

Re: What I have learned from my suicidal patients

#74

Post by jdietrich »

cassowary37 wrote: post #64

A colleague of mine calls suicide 'a permanent solution to a temporary problem' - not to diminish it, but to recognize that for most people the desire to die is a temporary state. Whenever depression comes up on HN (as it does with surprising frequency), I'm both touched by people's willingness to share their own stories, and frustrated by otherwise very rational and logical people's speed to dismiss data. Initial tr…

STAR*D presents us with a "glass half full" problem. It's absolutely true that the majority of people will recover from depression with suitable treatment, but that leaves us with a minority who won't.

I'm not sure how to communicate those facts effectively to a wide audience. It is absolutely imperative that people with depression seek treatment and keep trying even if the first or second or fifth treatment fails, otherwise we're condemning people to unnecessary suffering; conversely, a lot of people with treatment-resistant depression are doubly stigmatised because of unreasonable expectations about the efficacy of treatment.

I do think it's useful for treatment-resistant patients to shift their focus away from recovery and towards symptomatic management - it's easy to get disheartened because you're not in remission, but a treatment that takes you from 10/10 depressed to 8/10 depressed is still useful. Eking out small reductions in symptoms and small improvements in functioning can be tedious and frustrating, but it's better than resigning yourself to interminable misery.

Re: What I have learned from my suicidal patients

#75

Post by volkl48 »

cassowary37 wrote: post #64

A colleague of mine calls suicide 'a permanent solution to a temporary problem' - not to diminish it, but to recognize that for most people the desire to die is a temporary state. Whenever depression comes up on HN (as it does with surprising frequency), I'm both touched by people's willingness to share their own stories, and frustrated by otherwise very rational and logical people's speed to dismiss data. Initial tr…

Is this data talking about a "cure" where people no longer would be labeled as having depression at all, or are we talking about clinically significant improvements/better than placebo results?

Re: What I have learned from my suicidal patients

#76

Post by sdegutis »

3pt14159 wrote: post #30

I have such conflicting views on suicide. On the one hand suicidal feelings are often temporary across the grand expanse of life, on the other hand surely there is a better way to handle people that have suffered such hardship than sterile mental hospitals, drugs, and societal shaming. It's so strange that we're allowed to have Do Not Resuscitate medical necklaces but they're only followed if something outside the pe…

The more people try to decide their own “truth” instead of living in reality, the more they will run into depression, despair, and suicide.

The real solution to these is to encourage facing reality in its entirety, including being honest when someone has a self destructive habit, tendency, interest, reaction, or hobby.

Re: What I have learned from my suicidal patients

#77

Post by jdietrich »

shrimp_emoji wrote: post #2

>The soldier who hiked out on to the moor, lay down in the heather and overdosed. Émile Durkheim, the great sociologist, theorised as to why suicide is so common among military personnel – not simply because of the devastating effects of war, or because of their easy access to weapons, but because of the depersonalising effect of army training: “Military esprit can only be strong if the individual is self-detached, a…

>Is this saying that veterans can kill themselves more easily because they have more rational clarity about the situation?

I don't think so. Doctors and veterinarians have an unusually high rate of suicide, partly because they have access to highly lethal means of suicide but also because they've become inured to mortality. For most people, the practical realities of death are somewhat foreign, which creates a psychological barrier between the urge to cease existing and the means of making that happen.

The vast majority of suicidal impulses are temporary; the vast majority of people who attempt suicide do not go on to die by suicide. While it is entirely believable that some people are afflicted with unbearable and intractable misery, that is certainly not true for most people who die by suicide.

https://www.hsph.harvard.edu/means-matter/

Re: What I have learned from my suicidal patients

#78

Post by mabcat »

boomboomsubban wrote: post #40
Fnoord wrote: post #19

Earlier quoted context omitted.

I'm on Prozac. Mild side effects? When I started with it, my muscles hurt for weeks . I had to quit coffee (temporarily). I had to stop exercising (temporarily), and I was also very tired for weeks. Slowly all of that became less severe, though it never truly went away. Add to that, when I started my partner was about to bare our first-born. It was a hell of a time in my life, in many ways. A rollercoaster for sure.…

>Nearly all medicine have side effects. People should be informed about them (it is included with the medicine, at least here). Most medicine has minimal side effects for most people. "Very common" side effects are ones that effect 10% of people taking the medication. People should be aware that side effects are possible, but they are unlikely. Going in with the attitude that side effects are inevitable makes one mor…

We ran a clinical trial of a very common antidepressant. Blinding was difficult because on the active arm damn near everyone had observable side-effects within 40 minutes of administration. Clearly not related to the placebo effect in this case, only the pharmacist knew what was in the capsules until the nausea started.

Re: What I have learned from my suicidal patients

#79

Post by mthoms »

I'd met Scott Hutchison on a few occasions. He was immensely talented and an all-around likable, humble, and hilarious, human being. The world is a better place for him having lived in it.

His family has since started a mental health charity in his honour [0].

To get a small taste of Scott's personality, have a listen to the banter at the beginning of this live performance[1]. He's one line into "The Modern Leper" (a song about living with depression) when he notices a small child near the front. Scott becomes suddenly aware how dark the subject matter is, and breaks from the song to give everyone a little laugh.

[0] https://tinychanges.com [1] https://youtu.be/ob3X77TwqEw

Edit - he also did a talk at Google before his last tour (not tech related) https://youtu.be/FT_UrM_L1vQ

Rest in peace Scott.

Re: What I have learned from my suicidal patients

#80

Post by brookside »

jdietrich wrote: post #74
cassowary37 wrote: post #64

A colleague of mine calls suicide 'a permanent solution to a temporary problem' - not to diminish it, but to recognize that for most people the desire to die is a temporary state. Whenever depression comes up on HN (as it does with surprising frequency), I'm both touched by people's willingness to share their own stories, and frustrated by otherwise very rational and logical people's speed to dismiss data. Initial tr…

STAR*D presents us with a "glass half full" problem. It's absolutely true that the majority of people will recover from depression with suitable treatment, but that leaves us with a minority who won't. I'm not sure how to communicate those facts effectively to a wide audience. It is absolutely imperative that people with depression seek treatment and keep trying even if the first or second or fifth treatment fails, o…

The term "treatment resistant depression" bothers me because, I think, a more accurate name would be "placebo resistant depression". Sorry to come off as frustrated; I'm like others in this thread with 10+ years of trying various therapies and antidepressants to end up feeling more, not less, hopeless.

David Burns does a good job explaining why antidepressants and psychotherapy don't typically work in his most recent podcast: https://feelinggood.com/2019/11/18/167-feeling-great-profess...

While David makes a good case against drugs and non-CBT therapy, I actually don't find his his fantastical anecdotes of the light-switch effectiveness of TEAM CBT therapy convincing either.

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