Why Aaron died • Hacker News Board

Re: Why Aaron died

#81

Post by tptacek » Tue, Feb 05, 2013, 2:53 AM UTC

thaumaturgy wrote: post #80

tptacek wrote: post #75

Earlier quoted context omitted.

His profession? He's not a prosecutor. He's not a criminal attorney. Is he even a litigator? Do I get to inveigh against all software developers every time armed drone C&C software plays a role in killing a civilian somewhere?

Sigh. No, but if someone were to criticize a particular group of software developers for writing some armed drone C&C software that had a completely disproportionate effect on its target, and you rushed to defend the software developers using a really thin argument, then I don't think there's anything wrong with pointing out that your association with software developers might be making you less than impartial. Then…

I don't concede that he did defend the prosecutor. He said the prosecutor didn't cause a suicide. It does not follow from that that Rayiner approves of the prosecutor's actions.

But your logic wouldn't work even if we stipulated that he defended the prosecutor, because defending prosecutors doesn't make you a prosecutor.

It's you, who tried to cut short a debate by saying that Rayiner was defending "his profession" and talking his own book, who's making the dubious argument.

Nobody is calling you out on it because we're all upset about Aaron Swartz and we can obviously all see which way the wind is blowing on the topic here. But I like Rayiner and would like to see him stick around here, so I'll say it: you're out of line. Stop it.

Re: Why Aaron died

#82

Post by dwj » Tue, Feb 05, 2013, 3:17 AM UTC

Speaking as someone who has actually been suicidal, it does seem pretty clear that he was depressed. From his blog posts it seems that he typically had a lot of stress-related health symptoms over the years, including depression. It seems that he simply tried to do too much, got burned out as a result, and couldn't/wouldn't talk about it to anyone. Not all depression fits nicely into the 'clinical depression' pigeonhole.

Re: Why Aaron died

#83

Post by thaumaturgy » Tue, Feb 05, 2013, 3:43 AM UTC

tptacek wrote: post #81

thaumaturgy wrote: post #80

Earlier quoted context omitted.

Sigh. No, but if someone were to criticize a particular group of software developers for writing some armed drone C&C software that had a completely disproportionate effect on its target, and you rushed to defend the software developers using a really thin argument, then I don't think there's anything wrong with pointing out that your association with software developers might be making you less than impartial. Then…

I don't concede that he did defend the prosecutor. He said the prosecutor didn't cause a suicide. It does not follow from that that Rayiner approves of the prosecutor's actions. But your logic wouldn't work even if we stipulated that he defended the prosecutor, because defending prosecutors doesn't make you a prosecutor . It's you, who tried to cut short a debate by saying that Rayiner was defending "his profession"…

I had already stopped before you jumped in, jackass. I've been saving some pretty severe words for you, but they should wait until I'm not seeing red anymore.

Re: Why Aaron died

#84

Post by gsharm » Tue, Feb 05, 2013, 4:14 AM UTC

rayiner wrote: post #72

gsharm wrote: post #65

Earlier quoted context omitted.

Any system - especially a justice system - unable to take into account peoples' circumstances is not only wasteful, but dangerous. Neutrality does not transcend doing the right thing. Justice isn't a product that is packaged and sold, it is a service, rendered on a case-by-case basis. It is done that way so that the context can be understood sufficiently well in each case. In this case it either wasn't, or they simpl…

I don't have an agenda, and I don't think the system is fine. I do, however, think a lot of people are being grandiose in condemning Carmen Ortiz. I'm an engineer at heart, and we're a conservative breed, preoccupied with tradeoffs and immune to idealistic tropes. I don't think you can get what you want: a justice system that is compassionate and sensitive to the "good guys" and harsh with the "bad guys" and also con…

It does cost a fortune to run. Considering every case meticulously on a case by case basis is exactly what they should be doing. That is not an idealistic expectation, it is a realistic one.

To have an effect, condemnation has to be of sufficient magnitude, such that the problem is acknowledged and recognized. It has to be necessarily grandiose in its nature. Given that you agree that the system is not fine, and can improve, where does your contention lie? How can you deny a problem from being recognized if you wish to solve it?

Re: Why Aaron died

#85

Post by darius42 » Tue, Feb 05, 2013, 9:23 AM UTC

lutusp wrote: post #59

xijuan wrote: post #44

Earlier quoted context omitted.

Do you know how psychiatrists or clinical psychologists diagnose depression? Have you read the DSM? Do you know how they come up with the criteria for psychiatric disorders in DSM? Do you know the controversies behind DSM? Do you know few decades ago homosexuality was regarded as a mental disorder? Do you know that there are researchers who want to introduce a new "psychiatric disorder" (i.e., hypersexual disorder) i…

> Do you know how psychiatrists or clinical psychologists diagnose depression? Yes, and do you know how much variability exists between practitioners? Diagnosis is largely a matter of personal opinion, not science. The reason for that, in turn, is because no on knows what causes depression -- it's not like a medical condition with an identified pathogen and clinically validated treatment. But the vague state of depre…

I have many bad things to say about many antidepressant. E.g., they all have very annoying side effects, at least for me, and some of the side-effects (e.g., vivid dreams) require benzos to counter. And then benzo addiction is really no fun at all.

Other side effects I experienced were clearly under-reported by the pharmaceutical companies. E.g., negative sexual side effects for Prozac that my doctor wouldn't even believe were real and not psychosomatic, until it later turned out that 25%-50% of all patients suffered these side effects, and the pharmaceutical company had neglected to inform anyone.

On other other hand, Remeron surely saved my life. I have no doubt about this. I had been in the most miserable state you could ever possibly imagine and then some, and had been this way for months, and then within a day or two of starting Remeron, I was utterly fine. (Though ironically, it may have been another antidepressant that put me in this terrible state to begin with, as I had to go off it cold turkey due to it causing a different dangerous side effect.)

As for diagnosing depression, it may certainly be the case that many cases are difficult to diagnose correctly. And there may be cases where there is no fact of the matter as to whether the particular symptoms count as depression. On the other hand, there are certainly cases where there is no question at all as to whether it's depression. I have been there quite a few times, and it's been as cut and dried as anything can be in this world.

Re: Why Aaron died

#86

Post by lutusp » Tue, Feb 05, 2013, 9:36 AM UTC

darius42 wrote: post #85

lutusp wrote: post #59

Earlier quoted context omitted.

> Do you know how psychiatrists or clinical psychologists diagnose depression? Yes, and do you know how much variability exists between practitioners? Diagnosis is largely a matter of personal opinion, not science. The reason for that, in turn, is because no on knows what causes depression -- it's not like a medical condition with an identified pathogen and clinically validated treatment. But the vague state of depre…

I have many bad things to say about many antidepressant. E.g., they all have very annoying side effects, at least for me, and some of the side-effects (e.g., vivid dreams) require benzos to counter. And then benzo addiction is really no fun at all. Other side effects I experienced were clearly under-reported by the pharmaceutical companies. E.g., negative sexual side effects for Prozac that my doctor wouldn't even be…

> On the other hand, there are certainly cases where there is no question at all as to whether it's depression.

Yes, absolutely, but saying "it was depression" is not the same as saying "depression is a disease with a proximate cause that can be identified, diagnosed and treated."

The present debate surrounding depression is global in scope. No one knows whether depression is a disease in the way that a cold is a disease, or is an extreme case of normal emotion, not amenable to any kind of diagnosis or treatment.

None of this is meant to argue that depression isn't a disease in the way that a cold is a disease -- only to say there's no reliable science behind the claims.

But we do know this -- in controlled scientific studies, antidepression drugs don't actually work for the majority of patients:

Link: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...

Title: "Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration"

Quote: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance." [Emphasis added]

Comment: Drug companies have been only publishing studies that supported their drugs, and discarding those that didn't. This study compares the outcomes for all the studies, published and unpublished, and the result is that antidepression drugs do not work for the majority of patients.

Re: Why Aaron died

#87

Post by darius42 » Tue, Feb 05, 2013, 9:58 AM UTC

lutusp wrote: post #86

darius42 wrote: post #85

Earlier quoted context omitted.

I have many bad things to say about many antidepressant. E.g., they all have very annoying side effects, at least for me, and some of the side-effects (e.g., vivid dreams) require benzos to counter. And then benzo addiction is really no fun at all. Other side effects I experienced were clearly under-reported by the pharmaceutical companies. E.g., negative sexual side effects for Prozac that my doctor wouldn't even be…

> On the other hand, there are certainly cases where there is no question at all as to whether it's depression. Yes, absolutely, but saying "it was depression" is not the same as saying "depression is a disease with a proximate cause that can be identified, diagnosed and treated." The present debate surrounding depression is global in scope. No one knows whether depression is a disease in the way that a cold is a dis…

>the result is that antidepression drugs do not work for the majority of patients.

I suspect that this is because most patients don't have the patience or wherewithal to try enough different kinds, or a doctor who is willing to combine them with benzos. The patient's patience is especially relevant since when you are depressed, the last thing in the world that you need is to add extra suffering from side-effects to your list of woes. Or at least that has been my personal experience. After a few bad experiences, I was very reluctant to try additional antidepressants, and after having become dependent on Ativan once, I vowed to never allow that to happen again either.

Ultimately though, I tried just about every modern antidepressant before finding one that worked, and I know people who had to go to tricyclics, which has caused them to become fat, but happy. Each of the antidepressants I tried affected me differently. But at this point, I am very relieved to know that if I become depressed again, there is a drug that I know for sure works for me. Knowing that is a huge weight off of my shoulders. Though having to look forward to weaning off of benzos again puts some of that weight back.

More recently I tried ketamine when I was worried that I was going to become depressed due to an unfortunate life circumstance. I'm here to say that it apparently worked as well as hyped since I never became at all depressed during a situation that would typically have sent me into a downward spiral. And with no ill side effects too boot. Too bad it's not legal....

Of course, trying many different antidepressants is not without its risks, as I alluded to previously.

Re: Why Aaron died

#88

Post by xijuan » Tue, Feb 05, 2013, 11:09 AM UTC

lutusp wrote: post #59

xijuan wrote: post #44

Earlier quoted context omitted.

Do you know how psychiatrists or clinical psychologists diagnose depression? Have you read the DSM? Do you know how they come up with the criteria for psychiatric disorders in DSM? Do you know the controversies behind DSM? Do you know few decades ago homosexuality was regarded as a mental disorder? Do you know that there are researchers who want to introduce a new "psychiatric disorder" (i.e., hypersexual disorder) i…

> Do you know how psychiatrists or clinical psychologists diagnose depression? Yes, and do you know how much variability exists between practitioners? Diagnosis is largely a matter of personal opinion, not science. The reason for that, in turn, is because no on knows what causes depression -- it's not like a medical condition with an identified pathogen and clinically validated treatment. But the vague state of depre…

I think you misunderstood me a bit. I asked that question to suggest exactly what you have said. The way they diagnose people with all the vague criteria is not scientific at all. I completely agree with you. And yes, I am also aware of the variability among practitioners.

Re: Why Aaron died

#89

Post by lutusp » Tue, Feb 05, 2013, 11:13 AM UTC

darius42 wrote: post #87

lutusp wrote: post #86

Earlier quoted context omitted.

> On the other hand, there are certainly cases where there is no question at all as to whether it's depression. Yes, absolutely, but saying "it was depression" is not the same as saying "depression is a disease with a proximate cause that can be identified, diagnosed and treated." The present debate surrounding depression is global in scope. No one knows whether depression is a disease in the way that a cold is a dis…

>the result is that antidepression drugs do not work for the majority of patients. I suspect that this is because most patients don't have the patience or wherewithal to try enough different kinds, or a doctor who is willing to combine them with benzos. The patient's patience is especially relevant since when you are depressed, the last thing in the world that you need is to add extra suffering from side-effects to y…

> I suspect that this is because most patients don't have the patience or wherewithal to try enough different kinds, or a doctor who is willing to combine them with benzos.

No, no, we're talking about controlled studies overseen by scientists, not psychologists or psychiatrists in ordinary clinical practice. Typically, such a study has an experimental and control group. The experimental group gets the drug under test and the control group gets a placebo. To minimize the possibility of bias, during the study neither the experimenters nor the subjects know which subjects are controls.

After the study, the histories of the subjects are compared, and the groups to which they belong are finally revealed. Every precaution is taken to limit bias and emotional attachments to any outcome.

As it turns out, when such studies are conducted and compared to other similarly disciplined studies, the efficacy of antidepressants evaporates. In plain English, they do not work.

That's the scientific finding. It's not an opinion, like much of psychology, it is a scientific result.

> But at this point, I am very relieved to know that if I become depressed again, there is a drug that I know for sure works for me.

Yes -- and so does astrology, but only if you sincerely believe it does.

Re: Why Aaron died

#90

Post by lutusp » Tue, Feb 05, 2013, 11:15 AM UTC

xijuan wrote: post #88

lutusp wrote: post #59

Earlier quoted context omitted.

> Do you know how psychiatrists or clinical psychologists diagnose depression? Yes, and do you know how much variability exists between practitioners? Diagnosis is largely a matter of personal opinion, not science. The reason for that, in turn, is because no on knows what causes depression -- it's not like a medical condition with an identified pathogen and clinically validated treatment. But the vague state of depre…

I think you misunderstood me a bit. I asked that question to suggest exactly what you have said. The way they diagnose people with all the vague criteria is not scientific at all. I completely agree with you. And yes, I am also aware of the variability among practitioners.

I should have read your post more carefully before assuming there was any significant division between our views.