We Need to Have Sympathy for Those With Depression. It is an Illness

I see what you mean but I think you need to clarify your concepts. After you do this you may see things differently.

Not all "mental states" are created equal. For instance you mention arrogance and confidence. These are are attitudes, or personality traits really, not emotions. Love is similarly not strictly an emotion when you think about it, it's a disposition - we are in love, but we get angry or get sad, we don't get 'love'. Depression, someone mentioned elsewhere is like a filter, or as someone else mentioned is like having a part of you dead inside, the part that makes life bearable, the part that provides resilience to the unforgiving nature of this world we live. One gets depressed but it lasts and lasts, anger bu contrast is fleeting, so are most other emotions.

Depression usually is accompanied by a broken sleep routine, persistent negative thoughts, morbid thoughts, a lack of self-esteem, an inability to remember that life has its ups as well as its downs. Perhaps "illness" is not the right word but it certainly seems like a profound psychological disturbance, a psychological illness. When we truly have a 100% neuro-scientific of whatever it is we'll be able to use the right terms but for now "illness" may be the best term we have, so we may as well use it.

Sometimes it is; that's what therapy (sans medication) is about. That said, it's something best left to the professionals.

You generally can't reason someone out of something they didn't reason themselves into.

I wish thee well sir. Thanks for sharing, I mean it.

No. This is a misunderstanding of what CBT is about.

> But if something like "I screw up on X most of the time" or "I am in the bottom percentile for X" are statements that may occur to an analytical person that are objectively true and may directly cause negative emotions.

Okay.

> My understanding of CBT is that it suggests replacing these thoughts with positive forms like "sometimes I succeed at X" and "I'm better than most people at Y" (even if Y is something neither you nor anyone else cares about).

No.

Someone says "I screw up on X most of the time".

This is objectively true, and causes negative emotion.

Start with "What emotion do you feel?" Perhaps it's something like "shame" or "regret".

The therapist explores with you what your body is doing. When a person feels anxious their heart rate increases. Here's an important bit: try asking someone to slow down their heart rate - they can't. And it's the same if you ask someone to change a thought - they can't. The therapist will explain to you different physiological changes (sweating, breathing, heart rate, tense muscles, etc.) As you become aware of these things you can try breathing exercises to help ease tension.

Then ask what the hot thought is; what is the thought connected to "I screw up on X most of the time" that creates the feelings of shame? Perhaps the hot thought is "Other people get this, it should be really easy, I keep getting it wrong" or "I keep getting this wrong, and my team members have to keep correcting it for me, and it causes them more work and stress and tension".

You assign strengths to the emotions and to the hot thoughts.

You sit with them for a while - you're not trying to change anything yet.

And then, "I screw up on X most of the time"; well, can X be passed on to someone else who doesn't screw it up? Can someone give you extra help with X, or can they spend some time to teach you X? Notice that none of these are denying the reality of X. But now rather than worrying about stuff you can't change, you're giving yourself time to think about things you can change.

> So CBT is fine if your thoughts do not reflect reality but if they seem to encourage self-delusion.

I really fucking hate it when people condemn an evidence based effective cheap therapy based on misunderstanding and ignorance. Your attitude is causing harm to people who would benefit from CBT but who don't try it.

Again, this is part of the problem. Your argument presupposes that a good job and a happy family would be enough for anyone, that anyone who is unhappy with that life is medically abnormal. Just because someone is superficially content does not mean that their unhappiness is inexplicable. Describing a lifestyle as "objectively wonderful" is patently absurd, based as it is on the belief that it is possible to objectively judge what sort of lifestyle would make someone else happy.

The neurochemical hypothesis is incredibly dangerous, because popular perception has drifted so far from scientific consensus. It is an incredibly weak hypothesis with only the scantiest of evidence, but is accepted as solidly proven by a great many lay people - some people in this comments thread describe it as "scientific fact". Most neuropsychiatrists and psychopharmacologists will freely admit that there is no real understanding of what depression is, let alone what causes it.

Many laypeople perceive depression as a simple chemical deficiency, much like a vitamin deficiency - give someone vitamin C and their scurvy goes away, give them SSRIs and their depression goes away. In fact, SSRIs are only marginally better than placebo and have no statistically-significant effect in the majority of patients. This belief is a strong disincentive to seek out psychosocial interventions, which are at least as effective.