Psychiatry Wars: a lawsuit that put psychoanalysis on trial

That doesn't really match my experience of depression unless you somehow redefine all those terms to mean something else.

It's hard to see where the libido is in someone who doesn't want to get out of bed, even to eat. Or in the case from the article, someone who feels like a piece of wood, and who paces the hospital like a Roomba.

All effects of drugs are effects and they become side effects when they are undesirable. You used to be able to buy the same medication as either a decongestant and an appetite suppressant. In either case, the other effect is a side effect.

On the other hand, if you took an antacid every day for your depression, and had no effect on it, for years, you might consider that it didn't work. However, the analysts didn't think that was possible to say about analysis.

I don't think you can decouple mental health from politics and economics. Poverty is a huge stressor, especially when combined with homelessness. So to quantify suicides accurately you'd have to exclude the effects of the relatively benign 90s with the current outbreak of extreme financial stress.

I agree with your last point though. Mental illness is the result of a complex mix of social/personal, political, and financial stressors, biochemical weaknesses, and unhelpful cognitive habits. But current diagnoses are behavioural, not contextual. And treatments tend to concentrate on one factor to the exclusion of others.

Having said that, I think "you'll feel better with insights" line of psychoanalysis continues to be bullshit. Analysis has a terrible record of delivering useful results, and "insight" usually means "learning the mental model the therapist uses without questioning it."

There are better and more effective cognitive and psychotherapeutic techniques which work more quickly and are cheaper. Combining them with chemical and welfare help shouldn't be an issue.

I'm not really depressed or I don't think I am, although many things in accounts of depressed or formerly depressed people resonate with me.

I'm basing my understanding of what depression is on accounts of people who were depressed and got their meds. They always mention starting to actually feel some emotion. Like in case of this patient it was sadness about his children that made him cry for the first time after many years of just thinking how sad it was. Another case that ifluenced my tinking was illustrated accout by Hyperbole and half. After she got her meds she initially started to feel anger then joy then sadness in sort of explosive manner. As opposed to before the meds when she was feeling just empty and wanting to not exist.

The belief that underlying cause is not events or thoughts but physical damage to nervous system comes for me from experiments with ketamine I read about, where in vivo it shows to grant very rapid improvement in depression symptoms and in vitro it literally makes neurons grow new dendrites (or similar structures).

As for me personally I recently experienced a loss of a loved one and my life is very empty right now. So I'm thinking about it a lot and I have some of the coping mechanism the patient from this article invented. Like for example I started walking a lot this year and thinking about a lot not so great things when doing that. I walked to the point I injured my feet from the sheer amount of walking. Ball of my right foot still hurts after two months since I quit. But I still can cry or laugh or be excited about stuff and while some aspects that were never my strong suit like keeping my living environment orderly are now very inadequate I managed to function for 3 years with my sadness gradually lessening.

This belief that depressive thought have physical reason I think is helping me a lot. It makes easier to disassociate from their content.

I can just gloss over their content with statement that of course I'm making up bad stories and interpretations because I'm in a bad mood caused by bad physical condition. Once I improve it by eating, sleeping and all that I'll think more reasonable thoughts.

> But not even trying? I don't think that's a rational and informed decision.

My GP told me that for mild to cases of mild to moderate depression, he’s hesitant about introducing antidepressants-be said they can worsen concentration at work, impairing performance, thereby introducing additional life stressors, leading to more depression not less. A person seeking antidepressants who was dissuaded from doing so by that advice is arguably making a much more informed choice than if he’d just given them what they wanted from the start.

Of course, there comes a degree of severity (drawing that line is sometimes a subjective judgement call) when he doesn’t have these qualms any more.

Although (this is my view, don’t know whether he agrees), if one’s situation is severe enough to warrant trying antidepressants, they might not be enough. While I’m no great fan of antipsychotics, if I was in a real crisis situation, I’d much rather something that delivers noticeable results right away, than something which might take 2-4 weeks to do nothing.

I do agree with what you're saying about severity. For something like seasonal affection disorder or a moderate depression, you'll probably not want to reach for SSRIs etc as the first cause of action, much like a gastric bypass isn't the right tool for someone who is slightly overweight. But it is a good tool to have for severe cases, and the idea of "it's not real weightloss if you didn't achieve it through power of will alone" is damaging.