The Depression Thing

Very much agreed on the exercise.

I've been writing an article in the past few days that explain why movement is so critical to fighting depression.

Still, this author's experience resonates with me in the sense that I get that taking drugs is a way to fix the depression problem.

When depression is that crippling and intense, it just doesn't seem like any one thing can help. Like you said, it's baby steps, and if drugs and therapy are on the menu along with exercise and nutrition, then all the better.

At some point, I'll be exploring the really hard causes of depression, those that come from society's own anguish.

In any case, being personally fit will add immeasurably to your mental fortitude, and events that would otherwise bowl you over won't.

https://medium.com/@geoffrey.ducharme/depression-you-can-cur...

While I did not mention this in that original contribution, here is a 200 page essay I wrote in 2008 on re-envisioning another university I attended as a post-scarcity institution -- hopefully one which countered depression and other pathologies with positive psychology, healthy action, and hope: "Post-Scarcity Princeton, or, Reading between the lines of PAW for prospective Princeton students, or, the Health Risks of Heart Disease" http://pdfernhout.net/reading-between-the-lines.html

From the introduction: "With Princeton-praising articles titled "Jumping From the Ivory Tower", it seems like PAW [Princeton Alumni Weekly] is not helping answer these deep questions. If anything, PAW is helping bury them under inappropriate humor. This essay is not intended in any way to condone violence or the abdication of personal responsibility. But it is intended to help understand some of these issues of suicide and alienation in a university context, and to make suggestions for improvements to the social part of these issues. It even tries to use humor in relation to suicide and morbid themes a bit more appropriately (satirically about PU in this case, discussing options like its voluntary peaceful self-dissolution to help a billion poor children get an education, or its metaphorical death and rebirth as an agent of global economic transcendence to a post-scarcity society of abundance for all). It is always easier to destroy than to create, so this essay includes some specific suggestions for improving the situation at Princeton University, which is a mythologically-troubled institution (even as it is filled with many wonderful and caring people)."

One issue I explore is that the virtues of elitism, competition, and excellence that Princeton University celebrates all have shadow sides like alienation, destructiveness, and perfectionism which can lead to depression, anxiety, and a host of other illnesses from extremism (including heart disease possibly from an extreme fat-free diet which killed a classmate at an early age), such as when I wrote: "I can also hope that many of these issues at PU continue to slowly change. There is some hopeful news now and then in PAW (like more profiles of alternative alumni careers), even as the deep issues about "elitism" (alienation?), "competition" (destructiveness?), and "excellence" (dissatisfaction? perfectionism? excessive self-criticism?) usually remain unspoken."

Exercise is great. I just came back from a trip and where I was killing myself for 5 days straight. The feel-goods after the exertion ended lasted about 4-5 days. Had a sweet workout on day 3, but a bit of anxiety set in day 5 with the subsequent drink to squash it..

I KNOW continuous exercise helps, however outside of the above forced circumstance I'm suspicious at this point that I exercise when I'm feeling better and not the other way around..

That's the problem people without depression don't necessarily understand; feeling good often precipitates exercise, and feeling bad often precipitates lethargy. Lethargy so bad you can feel it. I mean REALLY feel it. You can actually feel this lack of motivation working against your desire to do stuff. It's identifiable, experienceable, and yet so oppressive you can't work against it. I would liken it to people freezing in a life-or-death situation; it doesn't make much sense and you wouldn't think it would happen to you, but it's right there and real for no good reason.

EDIT: I would be happy to answer any questions about how depression/anxiety has affected me or my thoughts on it.

Zen and buddhism. (Zen is not really buddhism).

Among many others things (therapy, running, playing high level piano, amazing remote job), Zen rewired and helps me to deal with this every day.

I'd recommend this authors with all my heart to anyone:

- Thich Nhat Hanh ("You are here")

- Alan Watts

- Eckhart Tolle ("Stillness Speaks")

- Shunryū Suzuki ("Zen mind beginner's mind")

- Ryan Holiday ("Ego is the enemy")

Piano helped me quite a lot. First my teacher, I could even say my piano teacher played a more important role in helping me, more than my family ever could. Musically I felt in love with Chopin and I really hope someday to be able to play Ballade 4 op. 52. It puts me at least decade long goal (yup, it is really really hard to play that).

Running, eating healthy, etc sure. But I think it works better to have the brain thinking better first. Otherwise we'll stick in the same trap over and over, with the same bad thoughts and habits we want to break.

We need to get beyond thinking and feeling. Training ourselves to see them, observer them and letting them go. It takes a lot of time. But you can do it.

Hope something of this help someone.

Here is also some more recent (as-yet-mostly-unrealized) ideas (put together for a 2013 Knight News Challenge) towards helping people make sense of their own health issues (depression or whatever they may be) when confronted with a mass of often conflicting information often dispensed by people with undisclosed conflicts of interest:

https://web.archive.org/web/20161104203536/https://www.newsc... "We want to improve public health through free and open source public intelligence tools for individual and collective sensemaking about health topics -- especially related to nutrition and lifestyle... When confronted with a health issue, many people turn to their doctor, the internet, or friends for advice. But then what do you and your family do with all the advice you receive? What do even health professionals do with all the often conflicting information out there when they research a patient's health issues? We want to create software that helps with that challenge by making it easier for individuals and communites to collect health information (from whatever public sources including the internet), organize it, prioritize it, reason about it, act on it, and feed back the results of action into a next iteration as a learning experience."

Here is a motivational example about salt intake from that proposal, but it could just as well be about understanding depression and various options as they apply in your own life:

====

For example, consider the question of how much salt of what type is good for a specific person (you) to eat every day? How easy is it to begin to research that for yourself? How long would it take, even with a web browser and search engine at your finger tips? How would you know which study to trust and how much -- including based on who funded them or how carefully the work was done? How could the online community help organize all that information for you? If it was organized, how would any general advice you found about salt consumption apply to your own specific situation and lifestyle and family history? Would the amount of salt you needed matter based on how much you exercised, or where you lived, or whether you went outdoors a lot, or whether you ate a lot of fruits and vegetables? How would you answer the question of whether there other health factors in play that may make some people sensitive to salt, and perhaps if you improve those, maybe salt intake won't matter much? How have opinions about that changed over time? If you try changing how much salt you eat, how should you interpret any changes in how you feel?

There may well be "experts" out there who know good answers for these questions specifically about salt, but they probably are not you personally. Statistically there might be a small number of experts out of billions of people, so most people thinking about how much salt to eat are not going to be experts. So, almost everyone is left wondering which experts to trust? Even if all the experts agree, they could still be wrong, or their general advice might be easy to misinterpret for your particular situation. And if you specifically by chance are an expert on salt intake, then you probably are not an expert on phytonutrient intake or cancer treatments, and so you would be faced with this same issue in some other area of personal health. So, there can be a gap between what an expert (or community of experts) know, and what an individual or local community knows and then acts on. Part of the value of better software tools, including educational aspects, may be to help bridge that gap between expert knowledge and individual practice.

This recently temporarily "withdrawn" article on "Reduced dietary salt for the prevention of cardiovascular disease" due to "doubts raised about the integrity of research" is an a example of how dynamic the medical publication landscape can be. Withdrawal of one article does not mean other similar articles are not valid though, or that a general concept is not valid. The research landscape can seem very dynamic and conflicted, even if there may often eventually emerge broad agreement on some truths. Could better tools help even subject matter experts track all these changes? So, whether you are an expert in a field or just an individual with a health issue, there is a challenge to make sense of this all for yourself at any point in time (even if the challenges may differ somewhat for expert and patient). It is also hard to draw conclusions from small numbers of studies in a mass of large numbers of publications on complex topics (something somewhat analogous to "weak signal detection" in the intelligence community). Yet, ultimately, each of us still personally needs to decide how much salt to eat each day (or broccoli or sugar or barley), so we can't avoid the issue (even if we can ignore the issue or any new information and just keep on eating as we have in the past).

Ideally, one might imagine authoritative sources on every aspect of health (including salt consumption) which supply the best health advice for every locality specific to every person. For example, imagine the archetypal old-fashioned-but-up-to-date grizzled "country doctor" who knows entire families in a community from birth for multiple generations in a personal way and provides the best specific health advice for the area and the individual. That might range perhaps from "Salt killed your grandpap!" to "Ain't too much to worry about salt since you exercise so much working outside in the Arizona sunshine." But such a health practitioner and community is mostly just a fantasy. There may be such health practitioners and stable communities out there, but they would seem at best few and far between these days in today's highly mobile society.

Compared to the ideal mentioned above, in practice a typical real-life health interaction for all too many people is more likely to be ten minutes spent with a new physician (perhaps due to insurance plan coverage changes) who recently moved to the area, has big worries about repaying US$200K in newly-minted student loans, and has limited experience with a specific health complaint and the individual's life history (including what is not said). In regards to an issue like advice on salt consumption, even if the physician knows that in theory someone who exercises outdoors a lot probably needs to take in more salt, is there going to be time to get around to discussing that level of detail about lifestyle with the patient or how it might relate to some health issue? Would there be time to explore and address a digestive complaint perhaps unknowingly from weak stomach acid from low salt levels? It may well be that many people eat too much salt, but perhaps this specific person perhaps eats too little for his or her situation?

In practice, there are a variety of sources of health information we encounter each with various conflicts of interest and with limitations in focus, experience, time, and continuity. A person with a health issue is confronted by all that complexity, even if they may choose to delegate the authority for all their health decisions to some chosen medical practitioner. Ultimately, we can delegate "authority", but not "responsibility"; in that sense a competent adult remains responsible for his or her health regardless of who has been asked for advice or who we let perform procedures on us.

====

There is the vaguest beginning of that in a GitHub project linked here and in some other projects called Twirlip (but they've been eclipsed by a need to do other things for income): https://github.com/pdfernhout/health-decision-support-tools

Although, as in the example there using IBIS to explore choices for dental health issue, it is possible that the IBIS methodology may be good enough to get a lot of people fairly far. Likely we can do better than IBIS, but I can acknowledge it is hard to do better than IBIS for several reasons (including simplicity, learnability, speed, and collaborativeness). For more on IBIS, Dialog Mapping, and Wicked Problems, see the references I've collected here (among others on a larger topic): https://github.com/pdfernhout/High-Performance-Organizations...