Off topic: Mental Illness

Sep 14 2006 Published by under Chatter

This is *very* off-topic for this blog; it's really more of a rant on a personal subject which I think it's worth saying publicly.
I am mentally ill. I have clinical depression. CD is a thoroughly miserable illness. I'm incredibly lucky to live at a time when CD like mine is easily treated by medication. Two pills every morning, and I'm myself again.
The point of writing this isn't to tell the world that I've got clinical depression, or to say "Gosh I like my drugs". The reason that I'm writing this is gripe about how people react when they hear that I take psychiatric medication. For some reason, the fact that my *brain* has a problem that's easy to fix using medication is somehow considered to be a huge strike against me, an inexcusable sign of personal weakness.
No other illness is treated this way.
To contrast things, I also have a dreadful stomach problem. It's not actually something with a simple name; basically, it's classic reflux disorder, combined with an extremely irritable stomach, which triggers extremely painful muscular spasms. Those two together are a bad combination: the spasms behave almost like a pump, spraying acid up my esophagus. (Which is exactly as much fun as it sounds.) In order to treat this, I needed surgery. And as an after-effect of the surgery, I now get *espohageal* spasms, which are excruciating; according to people who've experienced both, they feel very much like having a heart attack. The difference is that they are more or less *continuous* for *weeks* at a time.
To treat this, I take three different drugs. One is quite expensive; about $6/day. The other two are cheap, but both have unpleasant side effects. One even contains a small quantity of an addictive opiate.
For my stomach problems, if I didn't take my drugs, the main thing that would happen would be that it would hurt. Not life threatening, not dangerous. It would just be painful. I *might* end up going through some withdrawal from the addictive one.
How many people have heard about my stomach problems? A *lot* of people. Partly because of the fact that I need to take drugs three times a day; and partly because of the fact that can create some peculiar symptoms that are visible to other people. Out of the dozens of people who've heard about my stomach problem, and know about the drugs I take for it, how many have lectured me about how I shouldn't take those nasty drugs? Zero. No one has *ever* even made a comment about how I shouldn't be taking medications for something that's just uncomfortable. Even knowing that some of the stuff I take for it is *addictive*, no one, *not one single person* has ever told me that I didn't need my medication.
But depression? It's a very different story.
What happens if I don't take my medication? I turn into a zombie. Everything turns flat, it seems almost as if things lose their color, like all the colors fade. I feel like my body weighs so much that I can't even hold my shoulders up. I don't feel *sad*; I feel *nothing*. Empty, blank, flat. Great things can happen, but they don't make me happy. *Awful* things can happen, but they don't make me sad.
What happens when I take my medication? I'm myself again. The medication doesn't make me feel happy; it makes me *feel*. With the medication, my emotions come back; I can feel happy or sad. I enjoy it when things are going well; I get sad or angry when they go poorly.
But how do people react?
Somewhat over 1/2 of the people who hear that I take an antidepressant express disapproval in some way. Around 1/3 make snide comments about "happy pills" and lecture me about how only weak-willed nebbishes who can't deal with reality need psychiatric medication.
I confess to being thoroughly mystified by this. Why is it OK for my stomach, or my heart, or my pancreas to be ill in a way that needs to be treated with medication, but it's *not* OK for my brain? Why are illnesses that originate in this one organ so different from all others, so that so many people believe that nothing can possibly go wrong with it? That there are absolutely no problems with the brain that can possibly be treated by medication?
Why is it OK for me to take expensive, addictive drugs for a painful but non-life-threatening problem with my stomach; but totally unacceptable for me to take cheap harmless drugs for a painful but non-threatening problem with my brain?

82 responses so far

  • anonymous says:

    People who have no understanding of CD confuse it with their mild and brief feelings of sadness. The way I get it, I become mentally paralyzed, unable to do basic things. Just one recent example: driving the car until it's out of gas, because I couldn't bear to stop at a gas station for 5 minutes. It's hideous.

  • MaxPolun says:

    I think a lot of it is that people don't have a real image of what a person with psychiatric problems is like (in large part because it is so stigmatised). Typically the image of a person with a psychiatric disorder is that of a "crazy" who acts compleatly irrationally, and you are obviously not one of those, people think you are just taking medicine to avoid dealing with issues. If you heard voices that weren't there people would not critisize you for taking medicine. The truth of the matter is that most people with psychiatric disorders do not fit the stereotype, but are just a little more messed up than most people.

  • QrazyQat says:

    It's not completely true that no other disease is treated that way -- a subsection of people tend to treat many diseases as failures of personal responsibility. This comes up with cancer, for instance, including many forms we don't know the cause of.
    However, I'm sure it's a more general problem with mental illnesses. It's the problem of the mysterious brain, partly. Plus fear, odd bits of fear that aren't thought out at all. This is true not just with mental illness, but with epilepsy. From my own experience seeing peoples' reactions to my late wife's seizures it's a big problem, and not unlike many of the reactions I imagine you get. Part of this -- my opinion; I've thought about this a lot -- is that people with these conditions look normal, act normal, and don't have the things we expect from a reasonable illness -- ie. you get sick, have reduced function, then either die or get better with a protracted recovery. In the case of epilepsy, you seem normal, then are suddenl;y apparently "gravely ill", then almost as suddenly perfectly fine. In your case it'd be different of course, but I think with enough similarities that I can understand the problem.

  • Blake Stacey says:

    I suspect that the double standard stems from mysticism: people have simply not yet learned that their minds are products of organic, electrochemical processes. Despite five thousand years of drinking beer and eating magic 'shrooms, we retain the superstition that there exist immaterial things called "souls", and that this ethereal machinery determines our identity and sense of self-awareness.
    I find myself reluctant to accept the use of certain psychiatric medications when the nature of the diseases are largely unknown. This is not a particularly rational attitude, and I do not apply it equally to all disorders: I'd feel more comfortable dispensing pills to treat epilepsy than hyperactivity, for example. If I or a loved one were faced with a choice between using a poorly-understood but possibly beneficial drug and avoiding it, I would feel genuinely conflicted. I'm not sure this makes me indecisive or mature. Moreover, I do not hold this attitude in a hard-and-fast manner -- and I am certainly pleased that our knowledge has advanced far enough to let these drugs exist. Go science!
    I suppose any ethical stance on medical treatment has to incorporate the fact that medical knowledge advances; a morality which refuses to acknowledge change is profoundly disgusting. (I was born by Caesarian section, a common enough procedure nowadays -- but in Shakespeare's time, I would be so freakish as to be considered not "of woman born" and from my "mother's womb untimely ripp'd". Odds are my mother wouldn't be alive now, either. Now, tell me that the laws against Caesarian birth in Elizabethan England should apply today!)

  • justawriter says:

    Why is it OK for me to take expensive, addictive drugs for a painful but non-life-threatening problem with my stomach; but totally unacceptable for me to take cheap harmless drugs for a painful but non-threatening problem with my brain?

    Because one third to one half of humanity are coproencephalons lacking the empathy some hypothetical deity gave a turnip, perhaps?

  • Rob Knop says:

    Depression is a rough one.
    The pills don't always seem to work for me. For me, though, it isn't entirely feeling flat -- what happens is that I mainly feel despair. I have trouble getting myself in enough gear to do anything, because it seems like so much effort. Because what's the point?
    Perhaps it's the same thing.
    When I started on Lexapro, it seemed to fix a lot of the problem. Nowadays, though, I occasionally go through periods where it doesn't seem to work.
    And, indeed, it's hard to convince myself that the problem isn't just that I'm lazy....
    Your description of depression doesn't quite match my experience. You say a couple of pills, and you're yourself, much like painkillers make a headache go away. In my experience, it's tricker to figure out if it's working or not, and only by observing myself over time can I figure out if it's really working. (Of course, I'm not the most reliable observer of myself, which complicates things.) I've gone through periods where everything seems like it's working just fine, but then I go into a crashing malaise after weeks or even a couple of months of being OK.
    And, of course, if this were weird stomach pains I was talking about, people would just think, hmm, what a pain. This thing I'm talking about here, though, probably labels me as unreliable, much as you say.
    -Rob

  • Peter says:

    While sympathizing and agreeing with you that the reaction is incorrect, it is relatively easy to explain (but not excuse).
    Our brains and minds are WHO WE ARE. Our bodies are not.
    Whether you believe in a soul or not (I do not) or believe that there is some sort of 'mind' apart from the brain or not (I do not) it is clear that somewhere in the brain/soul/mind is the essence of what makes us, us. This is true in a way that it is not true for bodies.
    Let's make it more extreme. Suppose, someday, they perfect brain transplants. If you had a different brain, would you be you? I don't know. It's very tricky. But if you get, say, a heart transplant, you are definitely still you.
    So, people have different reactions to drugs for mental illness than physial illness because the former affects our essence, and the latter does not.
    This is, of course, NOT to say that the reactions you experience are correct, they are not. I think people are as perfectly entitled to drugs for depression as for stomach problems (or any other physical and mental problems), and should make the decision on the same sorts of grounds.

  • usagi says:

    Short answer, if you hadn't already guessed, is that a lot of people are ill-mannered morons.
    My suspicion is that it's part of the lingering attitude of mental illness as character flaw. Addiction gets a similar rap. Funny how those things persist, isn't it? But the understanding of the brain we have today is a very recent development.
    Migraine sufferers get the same crap. People who don't get migraines don't understand it's not a bad headache, that's just the shorthand way it's described. Food poisoning isn't a bad stomach ache. It doesn't convey the experience. Depression as a clinical diagnosis doesn't have a good frame of reference in everyday experience, so most people can't grasp it (plus, like "theory" in the evolution/creationism dust up, the word means something specific and different in this context).
    There's also probably a factor Bronze Dog should do a doggerel entry about sometime: "I can do (see) it, why can't you?" e.g., I can break out of a funk without drugs, why can't you?
    Fifteen years working admin at a psychology graduate school has turned me into a radical behaviorist (it's all chemistry and electricity). The majority of people don't realize how delicate the whole system is. At the same time, it's incredibly robust and able to carry out its primary function even with grievous injury or imbalance.
    The other possible factor in the reaction is fear. They do realize how delicate the system is and fear something happening to them that will required long-term management. Long-term illness is scary, and one defense is "humor", even if such a reaction is rude and thoughtless. See paragraph one.

  • pough says:

    Maybe some people don't think their brains do anything. And perhaps they're right!

  • Kevin says:

    Peter no! See that's the problem, right there - you just segregated physical and mental problems. Mental problems ARE physical problems. That is why chemicals can alter it. It's not voodoo. That's what people don't understand - the brain is an organ like any other, and can have physical problems that need medical/pharmeceutical intervention. People don't understand that. They think the brain is full of magical properties and works with faerie dust and radio waves. Or whatever. They don't get that its a PHYSICAL problem with the brain. It just so happens that the outward effect of the physical problem is weird emotional and cognitive symptoms. The relationship is harder to understand for people, because emotions don't seem physical to people. But they are.

  • BMurray says:

    My wife has a severe variant of bi-polar disorder (manic depression) where here manic periods are dysphoric rather than euphoric. That is, when depressed she is unhappy, listless, and somewhat suicidal. When she is manic she is unhappy, suicidal, and extremely energetic and enthusiastic about it. Treatments for one half of the problem are contra-indicated for the other, so the best so far available is to extend her depressed state for as long as possible and spot-treat the manic episodes with tranquilizers.
    The stigma attached to this is horrible. Fortunately (I guess) she cannot really work effectively in this state so the fact that couldn't get work if she was able to work is not relevant. But she's also pretty much out of friends because it's easier to never call someone than to deal with the fact that they are going to be difficult sometimes.
    As for demolishing mental illness with willpower, I'd suggest any serious proponents approach their next cancer with similar tactics. Please report your findings. Cognitive therapy is helpful but in cases of extreme disorders is really only helping one cope with a mental illness and not overcome it.

  • ekzept says:

    the other thing that bugs me about social attitudes towards mental illnesses is the Oh, that's not me, it's them attitude. it results in, for instance, an organization of small businesses to which i belong vigorously lobbying the New York State legislature to drop coverage for mental illness from a law saying that if you offer insurance you need to offer insurance for mental illness, too.
    i opposed the organization's position, writing my reps that they should require coverage for mental illness. i bet a lot more people have chronic depression than know they do and they would be more productive if they were treated.
    but, no, if you want to cut costs, dump on the defenseless, whether it's people with health problems of any kind, or libraries.

  • BMurray says:

    Certainly one of the ways that mental disorders are distinctly unlike most physical disorders to outsiders is the expression. If I have a severe chronic gastro-intestinal disorder it is unlikely to express in ways that are severe to anyone but me. I mean, I may stink up your bathroom something awful, but barring the very occasional disaster that's about the extent of it.
    A person with a severe mental disorder, however, is doing the emotional equivalent of (unwillingly!) shitting on your carpet at regular intervals. The vast majority of people are unable to cope with this. Or more correctly, I expect, unwilling to do so.

  • Peter says:

    Kevin: You miss my point, perhaps I was not clear.
    I agree with you that mental problesm are physical problems. Nor do I think that the drugs work by voodoo. As I noted, I do not believe in a soul, nor do I believe that there is anything in 'mind' that is not in 'brain'. The mind is what the brain does.
    That is not my point.
    My point is that, HOWEVER whatever it is that makes up 'us' works, even if it is purely physical, the thing that makes us 'us' is in the brain, not the stomach. Call it consciouness, mind, brain, soul, character, mentality, or WHATEVER. Changing it changes us in ways that changing our gastro intestinal tracks does not.
    I am who I am because my brain is what it is, not because my stomach is what it is.
    Again, imagine a brain transplant. Let's say we take Mark's brain and put it in your head, and your brain and put it in Mark's head. Now, which one is 'you'? The one with your body, or the one with Mark's body? If neither is really you, which one is closer to being you?

  • ekzept says:

    Peter, the only think i have to say about that is that what we anatomically consider "organs" do not always divide up neatly into functional subsystems. this is particularly true of regulatory functions and especially functions involving the brain. so, for instance, hunger is something that involves cooperation between the two vagus nerves, the liver, the stomach, and the brain, and there are chemical pathways involved as well. as more is learned about these chemical signaling pathways, the less functionally separate all these "organs" appear
    the idea of self-in-the-brain is a kind of homonuclear model. to say the rest of the body isn't involved is one step away from saying our "true brain" is the "higher brain functions", as if the limbic brain and amygdala aren't crucially involved. that's the wrong image. it's an integrated package.
    also, the "me" we experience is an illusion. there are dozens and dozens of little processes running around each doing their own thing. we create an image of "me" in order to coordinate them. it's hard to see where, in all that, there's a proper "self".

  • CAlbert says:

    I can sympathize with both points of view. What I cant sympathize with someone telling me or someone else how they should feel or telling them what they feel is unnatural.
    My attitude comes mainly from personal experience. I have a close friend who is lithium-deficient Manic depressive, 99% of the time when this person is on their medication she is the person I know, when she forgets or is unable to take her lithium which is rare I can say with certainty she acts very differently (raving suicidal psycho is not an exaggeration). She is a great and caring person who leads an exemplary and happy life despite having a severe mental disorder. There is nothing unnatural about her when she takes her medication, if fact its completely opposite. She admits that she does not feel like herself if she is not medicated.
    Awhile ago when I was in High school I got caught with a pot pipe at school, because of this I had to have a psychological evaluation by the high school counselor who was a psychiatrist.
    I didn't particularity like high school and my grades reflected it, all my friends (three of them) had dropped out, so I didn't really have any friends in school. My general aloofness among other things was claimed to be due to a personality disorder (SPD), for this I was given medication and to avoid what I was told would be more legal trouble so I took it. I was not what I consider my normal self for my last two years of HS. I had memory problems, I couldn't read the books I liked to read, I could not focus on the only challenging classes I had (AP calculus and AP Physics in which I was the only student). My friends described me as unusually emotional and quite different from the laid back witty and smart person they used to know. When I finally quit taking the medication I was very depressed for about 6 months then gradually became what I consider myself again.
    I guess the point I'm trying to make is that how we think we should feel is probably as varied and important to our mental well-being as any other characteristic.

  • BMurray says:

    I am who I am because my brain is what it is, not because my stomach is what it is.

    As any chronic GI problem sufferer can probably tell you, this is not precisely true. If you give a person with a mental disorder and other issues a perfectly functioning set of other organs, some of their suffering will be abated and this will be reflected in improvement of the expression of their mental disorder, though not likely remission.
    Pain, inconvenience, and other discomforts all impact the severity of the expression of mental disorders. I would be surprised to discover that mental disorders had no effect on physical ones.
    Personalities are in constant flux based on all inputs (including self-perception or self as input), including body performance, and I think it would be remarkable to assume that placing a brain in a wholely new body would result in the same person as resided in the prior body. Of course there would be substantial similarity, but also marked differences.

  • Joe Shelby says:

    i've a friend who's got it even worse - the CD is bad enough, but like those who "wake up to nyquil" and "fall asleep on two cokes", she has had the opposite reactions to every medication they've tried. the meds actually increase the suicidal tendencies rather than return things to "normal" (as normal is for the rest of us, anyways).

  • Kevin says:

    I realize you don't think all this is voodoo. But you have to understand too that you're more educated. Let's talk about transplants. I have worked in the transplant field. I know transplant doctors, and about a month ago a doctor told me she had a patient in for a kidney transplant. This particular patient was a white male, in his upper 50s. He proceeded to ask the doctor:
    "If I get a kidney from a black man, will i start craving fried chicken and watermelon?"
    I kid you not, this actually happened. In 2006. In Los Angeles. People are ignorant of how the brain works. Your brain transplant example is simply way over their heads. It IS voodoo to far, far too many people.

  • Bronze Dog says:

    There's also probably a factor Bronze Dog should do a doggerel entry about sometime: "I can do (see) it, why can't you?" e.g., I can break out of a funk without drugs, why can't you?
    Suggestion noted.

  • BMurray says:

    I've a friend who's got it even worse - the CD is bad enough, but like those who "wake up to nyquil" and "fall asleep on two cokes", she has had the opposite reactions to every medication they've tried. the meds actually increase the suicidal tendencies rather than return things to "normal" (as normal is for the rest of us, anyways).

    This is consistent with dysphoric mania and may well therefore be distinct from CD. SSRIs, MAOIs, and indeed pretty much all anti-depressants will negatively impact mania and dysphoric mania is no exception. Mania can be controlled with lithium in most cases and sometimes better treated with anti-convulsants such as those used to treat epilepsy. These can, however, contribute to depression.

  • Jim Caserta says:

    Glad to hear that you've found help that works for you, although I would differ with your opinion that depression is not a deadly illness. If you look at suicide as an outcome of depression, depression is one of the leading causes of death for young people. For the most part, people don't understand things until they go through them themselves, or someone very close to them experiences them. It's good that you've shared your story, as that might spur someone seek treatment.

  • Winawer says:

    I'm betting that at least part of the reason is a backlash against the fad that depression has in some ways become. When everybody and their celebrity dog has "depression", it trivializes the plight of those people who actually do have it. I saw a forum thread the other day where people were actually one-upping each other on the severity of their mental illness (largely self-diagnosed, of course) - sometimes with the same people coming back and re-diagnosing themselves!

  • Like Rob, I'm taking Lexapro too. As with him, it mostly helps, with rare lapses. Still, life is far better with it than without it. And people with depression who write about it help advance this understanding. Think Brooke Shields.
    For peer support, head on over to Crazymeds, http://www.crazymeds.org . It's got very refreshing and blunt talk about the challenges of being mentally interesting. It's run by a guy who is bipolar, epileptic and Asperger's-class autistic. You'll feel better.
    And I literally feel your pain about the esophageal spams. I get those, or something similar. They last only five minutes or so, but are horribly disruptive -- particularly when I'm at dinner and have to walk away, lest I lose my meal at the table. But I've learned to reduce their frequency and manage the symptoms.
    This is turning into a confessional, but thanks for writing your post!

  • Douglas Hofstadter once asked:

    Which statement seems more true?
    (1) I have a brain.
    (2) I am a brain.

    Perhaps the perception of CD and other mental disorders has something to do with this. It's not a disease of some miscellaneous component part, it's a disease of one's central core, of one's identity. It's hard for people to wrap their minds around it.

  • Peter says:

    "Start craving chicken and watermelon?????"
    ????
    !!!!???
    that's my mind boggling.
    Yes, I realize that I am more educated than most people (2 MAs, one PhD), and that my examples might be over some people's heads. But I was just trying to answer Mark's question, talking to Mark primarily and other folk here secondarily. I *KNOW* Mark could follow my example, and I would bet everyoine else here could, too.
    Also, I realize that pain can affect the brain.
    But again, I wasn't trying to articulate a full theory of consciousness. IMO, no one has come up with a really good explanation. If people WANT to discuss that, I'm game.
    It's intersting stuff. My own idea is that consciousnees/mind is an emergent property.
    Here, though, I was just trying to answer Mark's question:
    Why do people react differently to taking anti-depressants or other drugs for mental illness than they do to taking drugs for physical illness?
    and I still think my answer is correct. The brain/soul/mind/consciousness IS different. Despite the necessary qualifications, amendments, and good points raised by many here, it still is different.

  • ParanoidMarvin says:

    The mere fact of calling it a mental illness makes a false distinction between it and other illnesses. You don't find anyone walking around and saying "I've got a physical illness". In hebrew it's even worse. It's a "soul sickness". Shame is, even us poor materialists who don't think that souls exist (lacking any evidence to the contrary) can get those illnesses.

  • Peter says:

    Perhaps I should mention that, while I am not on any drugs for it, I have been depressed in the past (suicidally so for several years) and am learning disabled, as well (I have nonverbal learning disability.....sort of like Asperger's, see http://www.nldline.org ofr more....)

  • Xanthir, FCD says:

    It's exactly as Blake Stacey said. For most people, our identity isn't located in the brain, it's located in the soul. The brain is just where we maybe store our memories, or do math. All the important stuff, though, like feeling and such, are done by the immortal soul, which cannot be affected by drugs.
    Thus, any mental illness like depression is a failure of the soul, and thus is not treatable by drugs, but only by introspection/hard work/prayer. The fact that you take drugs makes you an addict and weak.
    If only neurological research was more widely understood... It's absolutely wondrous what they've found about how the brain works. For one, nearly all depression appears to be partially caused by overactivity in an area of the brain called "Area 25". Recent research shows that inserting electrodes into that area to dampen the activity immediately and strikingly removes depression from nearly everyong they've tried it on. Apparently Area 25 is a physical link between the areas of your brain that deal with the depressive emotions, and it can get stuck in high-gear, constantly transmitting messages from that area without anything able to stop it.

  • Peter says:

    Perhaps I should mention that, while I am not on any drugs for it, I have been depressed in the past (suicidally so for several years) and am learning disabled, as well (I have nonverbal learning disability.....sort of like Asperger's, see http://www.nldline.org ofr more....)

  • BMurray says:

    The mere fact of calling it a mental illness makes a false distinction between it and other illnesses. You don't find anyone walking around and saying "I've got a physical illness".

    Well, yes and no. I mean, if I have a GI disorder there are certainly cricumstances where I would refer to it as such to distiguish it from, say, a respiratory disorder. I suppose a mental disorder could be more precisely referred to as a "brain disorder" but I'm not sure that's any improvement.
    One of the chief distinctions is of course the impact on will. Is will aborgated to the disorder? If not, does it imply that the self is replaced with a self that has different goals and therefore expresses will differently? Maybe this is the source of peoples trouble with mental illness -- the expression seems willful. If I'm bleeding, there's no assumption that my action is willful, whereas if I am behaving destructively the assumption (and maybe the visceral reaction) is that it's willful. If I have a severe mental illness and as a result I behave destructively, is it willful? Should it be treated by others as such? Should it be treated medically as such?

  • Mark C. Chu-Carroll says:

    Jim:
    I didn't intend to say that depression isn't a potentially deadly illness. Depression covers a very wide range.
    I was talking specifically about myself; in terms of clinical depression, at least as it's manifested for me so far in my life, I have a relatively minor case. Before I got treated, I was never suicidal or self-destructive. (It's possible that if I hadn't gotten it treated, it might have gotten worse.) So I was saying that *in my case*, it wasn't a life-threatening disease.
    There are quite definitely many people for whom CD, or some other mental illness, *is* a major life-threatening disease. And for people in that situation, the stigma against medication for mental illnesses isn't just an irritation as it is for me; it's criminal. (And I mean that in a very literal sense; I think that if someone who causes a mentally ill person to stop taking their medication, and as a result, the ill person ends up dying - then the person who got them to stop should be criminally liable - exactly the way that they would be liable for stopping a diabetic from taking their insulin.)

  • speedwell says:

    Recent research shows that inserting electrodes into that area to dampen the activity immediately and strikingly removes depression from nearly everyong they've tried it on.
    Where do I sign? Where do I sign? Where do I sign?

  • Chris says:

    BMurray: Nobody wants to think about those issues because they subliminally realize that "will" and "willful" are not well-defined and may not correspond to anything that exists in reality.
    Once you get rid of the idea that there is a non-physical entity determining your identity and actions, and accept that your behavior and sense of self result from physical processes, it is far from clear that "will" means anything at all.
    Of course the other problem with mental illness is: who decides what's an "illness"? Lots of people have brains that behave in different ways, but are any of them "ill", and if so, which ones? Are people who firmly believe in the reality of invisible intangible supernatural entities "ill"? What about people who equally firmly believe that those entities talk to them on a regular basis? People who have an unusual amount of difficulty understanding other people's feelings and expressions? People who can hardly communicate at all with the majority of other people?

  • Mark C. Chu-Carroll says:

    ParanoidMarvin:
    The reason that I say mental illness isn't do distinguish it from physical illness; it's exactly the way that I say I've got GI problems, or my wife has asthma. It's just being specific about *what* organ or system is the problem.

  • Blake Stacey says:

    Xanthir, FCD wrote as follows:

    It's exactly as Blake Stacey said. [Yippee!] For most people, our identity isn't located in the brain, it's located in the soul. The brain is just where we maybe store our memories, or do math. All the important stuff, though, like feeling and such, are done by the immortal soul, which cannot be affected by drugs.

    Tell that to the Beatles! As Bill Hicks pointed out, they were "so high they let Ringo sing a couple of tunes". And as he goes on to add, "The rock stars who don't do drugs and in fact speak out against drugs -- we're rock against drugs! -- boy, they suck." (Yes, this comment is silly and far out of keeping with the gravitas that the subject of MarkCC's post requires. But I just can't stay serious for that long a stretch!)

  • Xanthir, FCD says:

    In other words, Mark isn't speaking of a mental/physical divide, but rather of a subset. Mental is a subset of physical, just as you might say 'intestinal illness' and be understood to be referring to a type of physical illness.
    Speedwell: The research is by Dr. Helen S Mayburg. Look it up, you never know what results you might be able to get. Maybe you can work yourself into some clinical trials.

  • Xanthir, FCD says:

    Blake Stacey: That's clearly why illegal drugs are so evil. ^_^ They can affect your soul! They're satanic!

  • Bob Mottram says:

    I blame dualism. The body is a mechanism, but the mind is a sacred province divorced from the material world.

  • megan says:

    Thank you so much for posting this. As someone with generalized anxiety disorder, I also belong to the group of people who hope to 'normalize' mental health issues by being open and frank about them. Also, if you or anyone else here is interested, I'm in a group called Active Minds (activemindsoncampus.org) that focuses specifically on raising awareness among college kids about just how detrimental mental illnesses can be, but also how common they are and how ok it is to seek help. We specifically use the physical vs. mental illness analogy a lot.

  • The Ridger says:

    You shouldn't be surprised at the transplant question: how many books and movies are based on the transfer of "soul" along with heart or hand or eye? Sure, it's entertainment, but lots of people believe it. There are more reasons than fear of not being whole in Heaven that make so many people resist organ donation. (And who really wants "evil hand issues"?)
    As for meds - well, "it's all in your mind". You can get over it. It's crap, of course: it's chemistry, as you say, and no different than insulin or high blood pressure meds. But people are magical thinkers, and it's an uphill fight.

  • ArtK says:

    Ah yes, dealing with the "get over it," or "why won't you just cheer up?" crowd. The good news is that statements like that make a pretty good litmus test of how good a friend someone really is.
    I think that some people are afraid of the fact that they aren't in complete and total control over their mental processes.

  • Doug says:

    Hi Mark:
    Just remember John Nash and what he accomplished.
    I have been thinking lately that his mind may somehow have linked mathematical object representation through
    1 - Nash Equilibrium from Mathematical Game Theory and
    2 - Nash embedding theorem from differential geometry.
    It appears that this may be possible through saddle points of mathematical representations, although this may be wishful thinking on my part.
    http://ggierz.ucr.edu/Math121/Winter...Equilibrium%22
    Energy interactions represented by games or differential geometry seem a possible way of demonstrating this.
    Perhaps if Einstein's most famous equation were modified as
    v^2 * E-attracting = E-dissipating
    lim v ->c
    where E-attracting is m and E-dissipating is E,
    it might represent the transformation of a star into a supernova?

  • rmp says:

    Personally, I'm amazed that everyone doesn't struggle with depression. My fathers favorite story on the subject was his Dr. explaining that if you had your arm half ripped off and dragging it behind you, nobody would question your need for medication. However, if it's only in your head, well, .....

  • usagi says:

    I think that some people are afraid of the fact that they aren't in complete and total control over their mental processes.

    Ding! Ding! Ding! Give the man cupie doll!

  • teddy says:

    Experience. Beyond being drunk or high on tobacco most people lack experience on what it means to have an altered state of mind. Tobacco is noticeable but brief, nonsatisfying, and easy to miss. Alcohol makes you incapable to reflect on the experience, which as such, is its own kind of special experience. Every other kind of alteration in mental state equal images of biblical rapture while you are on the wrong side.
    Good programming. As social animals people are programmed to resist depression with more ordinary means. There already exists a form of medicine. A person who, on some unconscious level can see the programming and is unable to not forget it, is also unable to benefit from such things. That you can't be happy without drugs just makes you a dick. They can't understand that sometimes it's not just a choice but involves chemistry. There is no such a thing.
    Irrational fear. Clinical depression is quite invisible and unknown. As with deformity, if one doesn't understand why it is, there is immediate revulsion and fear of somehow being contaminated by it. Insert images of biblical rapture while you are on the wrong side.
    Old habits. Most people don't understand why in a class society you can not move yourself into the class above yourself. One must have been born there to relax. Instead, you must either make success to be sociable or have the bloodline. That some people aquire medicine in order to precipitate such a miracle, is perceived illegal. Somewhere along the lines it won't fit into their world view to allow such things and the pack is correct to smell trouble.

  • Gary Carson says:

    Depression isn't just life threatening because of the potential for suicide. It can lead to a wide range of other illnesses. It changes the way you eat and sleep, leading to digestive disorders. People with depression are at a higher risk for heart attacks.
    The lack of ability to concentrate makes you much more accident prone than normal. I get many more traffic tickets when depressed, for running stop signs, speeding, etc. It can effect your periphival vision and other things.
    Suicide risk is a very small part of the fatal risks associated with depression.

  • speedwell says:

    Beyond being drunk or high on tobacco most people lack experience on what it means to have an altered state of mind.
    Pain (mental or physical) is an altered state of mind. That's why "mortifying the body" was such a big thing back in the day, and why "vision questing" was and is such a notable spiritual tool in most religions.
    I'm CD myself and mention masochism only to assure you I don't mean that, but let's be frank here... to some of us who actually don't remember what it is to be normally happy, happiness is abnormal. Fragile, precarious, frightening. Sometimes you tend to feel like "better the devil you know." It's like a dependency and I fight it as best I can, but the fact is I am not really that good at fighting it.

  • Roger says:

    Depression is a bitch. I had people say, "well just put your mind to it and you can get over it" or "Why would you a pastor get depression, you know that your mother went on to a better place." The facts are that no faith and no will can really deal with depression. It is an illness. And that mine was triggered by a specific event - my mother's death when I lost control of a car driving to the funeral of the uncle after whom I am named - doesn't make it better or worse or more understandable or less understandable. I suspect like many things there is both a genetic and environtmental component that works with it, but I am sure that I needed the medicine to get me out of that depression to where I could work on the emotions around it with a therapist. Certainly I'm Christian and I believe God used the prayers of people who cared for me. But the medicine and therapy also were needed and I thank God regularly for both.

  • Bob says:

    And try being fat too. That's another problem that the vast majority of people consider to be a moral failing.

  • themann1086 says:

    I get a lot of the same reaction... not from my friends, but from my administration at college. I was diagnosed during the 2nd semester during my freshman year (there was a trigger over winter break), and my advisor and dean thought I was "faking" it or something as an excuse for my falling grades. It was absolutely frustrating.
    Thanks for writing this, it's encouraging.

  • a says:

    I've just started taking lexapro for depression myself, and I haven't told anyone except my finance. I've had symptoms of depression throughout my life to varying degress, but this has been the first time its been severe enough to prevent me from performing my job effectively. I feel like I should be more open about it to help break down the stigma, but I guess I'm nervous about the reactions I'd get. I think I'll tell a few people I'm close to since I'll probably quit my PhD program and the depression is a contributing factor in that decision and a driving factor in how I choose to quit (ie without staying for a few more months of pressure in order to publish one last time ...)

  • Michelle says:

    Many good comments have been posted for this article, which is in itself both timely, and, I feel, an important topic for everyone to read.
    BMurray, I can completely sympathize with your wife. I, too, have bipolar disorder - rapid cycling in my case - and have gone through both extremes repeatedly. I have also experienced the loss of nearly all of my friends; fortunately, that was before I finally began treatment for the disease, and the majority of my friends started returning my calls again once I was being treated. It's been a slow and painful process to rebuild those relationships, but I am so incredibly thankful to have been given the chance. Many people aren't.
    Aside from my personal experiences with mental illness, I wrote my thesis as a graduate journalism student on geriatric mental illness. Throughout the course of my research for that thesis I became familiar with the absolutely monomental number of problems that come together to form the disastrous way mental illness is viewed in this country, and it's quite sad. Among the many I'll list just a few: the stereotypes of the "bored housewives on Prozac and other antidepressants just taking a 'happy pill' to avoid their problems," as some people have already pointed out; the painting of nearly all mentally ill people as hopeless, fully insane individuals in the television and the media; the stigma that's still left over from many of the older generations who were brought up to view "depression" as a "weakness."
    And don't even get me started on the health care industry's treatment of mental health. Most insurance policies barely cover it, or if they do, do so to a much lower extent than they do physical maladies; and the amount of research money that goes to the study of mental illness is just anemic in comparison to that used to study physical illnesses. Actually, speaking of the word anemic: I studied NIH funding charts while I was writing my thesis. A few years ago, the NIH allocated about $17 million to study depression and suicide in the elderly - less than $3 of research funding for each older adult with clinical depression or depressive symptoms. By comparison, they allocated $55 million in funding for Cooley's Anemia in 2003, which, while serious, affects less than 1,000 individuals in the entire US. That amounts to $55,000 of research funding for each patient. Does something seem off here?
    And just getting back to my personal experiences... I am thankful that I am surrounded by many people who support me, who even encouraged me to seek treatment when I was afraid to do so. Why was I afraid? Because my family does not "believe" in mental illness. I am looked down upon for taking medication that keeps me from being suicidal. I am thought of as "weak-minded" - nevermind that I have survived one undergraduate and one graduate engineering degree program and a graduate program at MIT, and that I had completed all three at the age of 24. Who, I must ask myself, is weak-minded: the individuals who seek treatment for their illnesses and manage to be successful and productive in their lives, or the people who can't bring themselves to come to terms with the scientific and medical realities that mental illness is real?
    As an aside, here is a very interesting article from the Philadelphia Inquirer, from just this week. This woman is doing some very innovative MI research:
    http://www.philly.com/mld/inquirer/living/health/15488776.htm?source=rss&channel=inquirer_health
    Kudos for writing about your experience, Mark, and best wishes.

  • Colin says:

    I think another reason for people's disdain of anti-depressants is the fact that they don't always work for people. Yours seem to be doing you wonders, which is great, but plenty of other people only are helped minimally or briefly or not at all. Additionally nowadays, anti-depressants are often the first line of defense for even mild temporary depression.
    These factors creates a situation where lots (if not a majority) of people end up escaping depression because of an environmental reason (life change, therapy, etc.) rather than a psychopharm one. Thus it's really unsurprising that people maintain the position that you can cure depression without drugs. It's a true statement, but not true for all people.
    Of course, even if the idea of non-drug recovery has some basis in realit this doesn't justify the social stigmatizing.

  • dogscratcher says:

    "What happens when I take my medication? I'm myself again. The medication doesn't make me feel happy; it makes me feel."
    I took Paxil for a while but got the opposite reaction: I got to the point where I just didn't care about anything. It made me mean.
    Know you're not alone. Keep up the good work. DS

  • Shuusaku says:

    I was reading through this blog for the first time and liked it alot.
    Trying to find somewhere where I could state the above this seems like a good place.

  • About a month or so ago, Michael Kinsley wrote a column about having brain surgery for his Parkinsons. He had very similar sentiments about how people reacted to hearing he was having "brain surgery" as opposed to any other type of surgery.
    More recently, I went to a meeting where someone asked a girl there "Where were you last week?"
    To which she replied "I was volunteering at (I don't remember exactly) helping disabled children."
    The first follow-up question was "Physically or mentally disabled?"
    It's interesting that people perceive such a clear dichotomy.

  • gg says:

    An interesting thing in my life: once I started taking anti-depressants (which I'm still on, on a very limited dose) I found out that roughly 50% of my friends, at least the close ones I had talked to, had been through the same sort of problems. I'm not exaggerating in the least on this, either. Whether people want to admit it or not, lots of people are struggling with depression that can't be ruled some sort of 'situational' problem.
    One other point I've always found interesting: once I 'dug myself out of my depression hole' with the aid of medication, I came to realize how much one's emotions and perceptions are linked. It would be nearly impossible to just 'get over it' myself, since everything that happened in life was colored by the fact that I felt bad -- in essence, I learned that not only can bad things make you feel miserable, but feeling miserable can make things bad. I would generally assume even positive events in my life were nothing special, because I was taking cues from my brain chemistry: If I don't feel good about things, they must not BE good.

  • David Harmon says:

    Well, congratulations on your openness! I haven't taken much flack personally regarding ADs, but I've heard from others who have. I've been suffering from depression and general anxiety since college or so, both complicated by my non-verbal learning disorder (which wasn't diagnosed until this last year).
    I think there's a whole bunch of reasons for the stigmas. One is the general ignorance about psychology and psychopharm, but another is a more basic issue: people have certain default expectations about how other people behave. Mental illness in general means that someone becomes "unpredictable" -- they may not fill those default expectations, and they might become erratic or even dangerous. After all, that's what folks see in the news, and the general public can't be bothered keeping track of a dozen kinds of mental illness, guessing at which ones are "more dangerous". To most of them, any MI is just "different", "other", "abnormal", and any social difficulties will tend to reinforce that, because in practice, that's how people test for "normality". (Ironically, in my own case, most of my social problems trace to my learning disabilities and hearing loss!)
    On the other hand, if you can wrap your "otherness" into some concept that people at least think they understand, (eccentric professor, gloomy philospher, aloof mathematician etc.) they'll be much more charitable. It's also worthwhile to keep things on more-or-less a "need-to know" basis, even though you might want to talk about it.

  • Mark C. Chu-Carroll says:

    gg:
    You're absolutely right about the perception/depression link. One of the first things that struck me when I started taking antidepressants, one of the very first things I noticed, was that my *shoulders* felt lighter. And not long after that, it seemed like the lights were brighter... like I'd been walking around in a fog, which had cleared away. It was a very strange experience.
    After my first episode of depression ended because of the medication, I tried stopping the medication. My psychiatrist said that about half of people in their first CD episode can stop the medication and not need it anymore, so I gave it a try. I was OK for about 4 or 5 months, and then it started again; and the first thing that made me realize that it was back was that feeling that the lights weren't bright enough.

  • hogeb says:

    I've developed peripheral neuropathy as the result of undiagnosed celiac sprue. For totally unrelated reasons, I was prescribed Welbutrin. Not only did my attitudes improve, but my neuropathies went away. If people can't realize that mental illness is physical and not a lack of self-control, then they are simply ignorant. Sadly, this is an area of extreme social ignorance, and it doesn't seem to be getting better. The info is out there, but it's not getting through.

  • The argument favoring caution with drugs goes like this:
    Both behavior and your stomach are much better understood than your brain, and all psychiatric drugs have side effects. How many unknown side effects is unclear. Whereas cognitive therapy has fewer side-effects, are as effective as drugs for most types of depression.
    So if you want to ride a moral high horse, take your pills and argue against science all you want. Watch me care.
    Peace and love.

  • Patness says:

    Rolf, I'm not sure if I disagree or not. It's true that using drugs is sort of the "blunt object" approach to solving problems, but changing behaviors only works insofar as behaviors are the source of a problem, and not a symptom.
    It's like my experiences with proselytizers; I am often asked how, without God, I can go on living my life. I don't know what the obsession is with making more out of ourselves than we are, but... there's a lot of people that would rather not believe that we aren't as magical as we think we are - they'd prefer a sunny, variable view of who they are than something well defined. It's clear to me that there is some sort of need being fulfilled by such a belief, and it's utility is probably similar to the utility offered to depressed persons undergoing cognitive therapy.
    Yet, there's a mysticism about what makes people who they are - free will, the soul, and any number of other things. The focus of all of this is still the brain, so when we screw with the brain, we're essentially screwing with what it means to be human on a social level.

  • Patness,
    I view this a little differently than you, for a number of reasons.
    For one thing, empirically, cognitive therapy works, invalidating the assertion that changing behaviors is akin to changing symptoms. Cognitive therapy is as effective as medication, with fewer side-effects. The idea that behaviors are symptoms, and consequently not causes, are Freudian and pre-scientific.
    Behaviors are selected by the environment. The environment's effects on you depends on your biological state, and the environment selects depressive behavior (including depressive thoughts and feelings) more easily in those who are labeled "depressive." The environment will select depressive behavior less often in depressive individuals if they take medication. But also if the undergo certain forms of psychotherapy, i.e. the evidence-based ones.
    Both drugs and therapy cause the brain to change. There is no need for a biology/environment dualism. The cause of depression is in the enviroment, but the path from environment to depressive behavior is long, and can be attacked from many perspectives.
    I don't have any strong feelings against drugs, just now I took two Ibux against headache (and I'm sure I could have found relaxation techniques or changed my lifestyle or something). I do know, though, that psychiatric drugs are problematic for a number of reasons, which is why I do advocate that depressive people should seek therapy in order to minimize their dependency on drugs.
    I think it's funny how pre-scientific notions in otherwise rational indviduals pop up whenever we talk about the soft sciences, in my case, Psychology. I live perfecly well without a God, thank you. Indeed, I live well without a soul or a mind too. I live, feel, love, think, eat and breathe, and that's almost too much anyway.

  • Mark C. Chu-Carroll says:

    Rolf:
    The statement that "cognitive therapy works as well as drugs" is a very different statement from "cognitive therapy works as well *for all patients* as drugs.
    Both psychiatric mediactions, and therapy both have respectable success rates - but both are quite far from 100% success rates. And I've yet to see *any* evidence that the group of people who get relief from medication is identical to the group of people who get relief from therapy. My impression is that they are overlapping groups, but that there is a sizeable portion of patients that can get relief from therapy but not medication, and another that can get relief from medication but not therapy.
    I'm far from an expert on the subject; by from discussions with my psychiatrist about whether to do therapy or just medication, he's pretty convinced that I would not benefit from therapy. Despite doing some probing, there is really *no reason* for me to be depressed. I'm married to an amazing woman who I love and who loves me; I've got the job I always dreamed of having, and I love it; I've got two kids that drive me crazy sometimes, but overall, they're terrific. And yet, right around the time when my daughter turned three, for absolutely no reason, I became depressed. And as I said - I explored this with my psychiatrist, who works primarily as a therapist, and he's convinced that I'm a case of, I think he called it "organic" depression, meaning that it's a depression caused primarily by genetics and biochemistry.
    In a contrasting vein, my mother, who suffers from dissociative disorder from being abused as a child, has gotten very little relief from any of a wide variety of medications that she's tried; by therapy has made a huge difference. Her illness is caused primarily by the abuse she suffered as a child; that has measurable physical effects, which is why drugs have *some* amount of effect; but the primary problem is her experiences.

  • Crosius says:

    As an instance of non-psychiatric "medical stigma:"
    My mother had a liver transplant. She takes anti-rejection drugs at meals, and people ask here about them when she's out at lunch.
    Her liver's failure was a result of a genetic predisposition, and damage from cancer- and arthritis-medications, but what do you think most people assume?
    Liver failure = alcoholic.
    People like their world to be black and white - Alcoholism is a nice neat explanation that lets them keep thinking that people whose livers fail did something to deserve it, and that maps nicely into their "I'm a nice person, so I don't have to worry about that happening to me" delusions.
    That works with mental illness, too. If they can convince themselves that you are sick because you're not as "strong" a person as they are, then they don't have to worry about CD ever happening to them. They can convince themselves they are "safe".

  • Mark,
    I see an underlying argument that if depression is caused by biology, then the cure should be medical; if it is caused by experience, then the cure should be psyhoterhapy. This line of reasoning, or any line of reasoning akin to it, is false.
    Which approach should be favored is always purely an empirical question. We know far to little about physiology to pretend to know better.
    I'm not objective here. There are traditions practiced even today that haven't caught up with the last fifty years of research. Therapy isn't what it used to be and certainly not what it is commonly portrayed as in the media.
    Cognitive therapy is about changing your behavior, not about solving childhood issues or resolving your relationship with your mother. If your psychiatrist actually claims that your depression cannot be alleviated by therapy because there is no identifiable cause for it in your personal history, then, to put it as mildly as I possibly can,
    I disagree.

  • Mark C. Chu-Carroll says:

    Rolf:
    I didn't mean to say that the difference between people who respond to medication and people who respond to therapy is a simple one. In comparing the specific cases of me and my mother, the big difference is primarily that she really does have serious problems, both behavioral and emotional, that *in her specific case*, are caused by the incredible trauma of childhood abuse. That's a clear difference from me, where I don't have any easily identifiable cause. I *don't know* if that's why my psychiatrist doesn't thinks that therapy wouldn't work. All that I really know is that when I first went to get treated for depression, I saw him once a week for long sessions; and after several months, he concluded that I was not someone whose depression was likely to respond to therapy, and we had excellent results from the antidepressant.

  • Mark C. Chu-Carroll says:

    oops, hit post too soon by accident 🙂
    My point, such as it was, was that there *are* patients who respond to medication who don't respond to therapy; and there are patients who respond to therapy who don't respond to medication. My intention was just to give two examples, one from each group. Figuring out who is a member of which group is not simple, and there aren't necessarily obvious indicators of which will work, other than experimentation.
    But I think it's unfair to say "since therapy has the same success rate as medication, then it must be bad to use medication."
    I also want to point out that the *initial* contrast you made, between my stomach problems and my depression was actually invalid. (Not that you could have known that, but it's true, and worth pointing out.)
    In the case of my GI stuff: no one knows what causes my GI problem. We know that the trouble I have now is caused by a combination of my original GI problem, and the surgery that stopped my reflux. But *why* I have that problem, and *why* for some people it goes away after surgery, and for some it doesn't *no one has a clue*. All we how is about 5-10% of people after a nissen fundoplication will develop this complication. And the treatment is *far* from benign. Among other things, it fairly dramatically lowers my blood pressure (to the point where I pretty much can't donate blood; my pressure is so low that they consider it dangerous); it causes me to have a pretty much continual headache; it's known to contribute to depression; it's somewhat sedating; and some of it is addictive. All three of the medications I take for my stomach have significant serious potential interactions with other medications. Let me tell you - that's *not* a pleasant regimen, and not a particularly benign regimen. But it gets the problem under control enough to let me live a reasonably normal happy life.
    In contrast, for my depression, I take zoloft. Zoloft has relatively few interactions with other drugs. It's main side effects are that it can trigger manic behavior on some people; and it can cause sexual effects, both reducing libido and interfering with orgasm. I'm lucky enough that I haven't experienced any significant side effects.
    So for me, the psychiatric drug seems to be relatively benign and well understood; the GI drugs are awful, potentially dangerous, and it's not particularly well understood *why* they work or why I need them.

  • complex_field says:

    My psychiatrist explained something to me: if you get CD and "recover", then your chances in some period of time (I dont remember exactly) of relapse are about 50%. If you get it again, your chances in a like interval go to ** 95% **. Ouch. I imagine that that is the basis for semi-prophylactive use of antidepressants.
    The "covered with a wet blanket" analogy was absolutely on the mark.
    Norman Vincent Peale should burn.

  • Mark C. Chu-Carroll says:

    complex_field:
    That's pretty much what my psychiatrist told me as well; after your first episode, it's somewhere around 50% recurrence; if it recurs, it's pretty much guaranteed to recur again. So given that I relapsed within just a couple of months of stopping the medication, I have no plans to stop again.

  • andy.s's stomach says:

    Speaking as a healthy stomach, I am appalled at the namby-pamby stomachs of today who can't digest their tofu and their lattes without a lot of new-fangled 'medication'.
    In my day, when we got ulcers we just kept a stiff upper pyloric sphincter and carried on.
    My great-great-grandfather's stomach crossed the plains in a covered wagon, and digested deer, buffalo and some of the Donner party and you never him rumble about it once.

  • Joshua Day says:

    I think the problem's with the true myth of the rational beast. We're animals, crazy lumps of matter doing math, but there's no good reason some lump of matter needs to work like that. And if our brains don't do what's needed to make us rational, then they just don't. There's nothing rational to be responsible for it. Responsibility comes once the rational comes.
    As a sufferer from depression, I find it as frustrating socially as you. It's like color-blindness, except worse, because people use the word 'depression' to describe a sadness-with-mourning. They don't get it.
    So they're right, in a way; sadness is bearable, and if depression meant sadness, maybe we could take it. Sadness is downright splendid next to flatness.
    Glad the medicine has taken.

  • Mark,
    Well that's food for thought: don't ever assume anything, ever 🙂 in general, though, medication works in ways that are pretty well understood, but there are many that have probematic side effects, not only the psychiatric ones.
    Nevertheless, I don't really buy your therapists's assertion that there is no therapeutic cure for you; there's a plethora out there and psychiatrists are not always as up-to-date as you would want to. I think your body would appreciate it if you could manage both your GI issues and your depression without pills. But we've already been through that.
    Good point many have made about depression. It's interesting that the emotional flatness that marks many depressions is not better known; after all, the world's most famous sufferer of depression, Prince Hamlet, clearly didn't mourn feeling bad; he mourned feeling nothing. Many sufferers, consequently, aren't even aware of it.
    I'm glad you've found a way!

  • (1) There is some statistical evidence that mathematicians have more mental illness than scientists in general.
    (2) I have written several stories about madness and mathematics, and had some poems published on that theme; see items below, from a fine website, cited in this thread of my blog
    http://magicdragon2.livejournal.com/580.html?nc=60
    (3) There is obvious prejudice against people with STD (sexually transmitted diseases), and used to be for other diseases such as leprosy.
    (4) Some 3rd generation serotonin re-uptake inhibitors actually seem to stimulate the growth of new neurons in the hypothalamus, where cells are killed during long-term Depression. No new cells ever grow after birth in the cerebral cortex.
    Science Fiction About Crazy Mathematicians
    [info]magicdragon2
    2004-06-10 06:12 am UTC
    Mathematical Fiction:
    Motif=Insanity
    a list compiled by Alex Kasman (College of Charleston)
    A Beautiful Mind (2001)
    Sylvia Nasar / Akiva Goldman
    Although the book A Beautiful Mind: A Biography of John Forbes Nash, Jr. is not fictional, Ron Howard's film (released December 2001) most certainly is. (I say this not as a complaint, but just to justify...
    According to the Law (1996)
    Solvej Balle
    Four interconnected stories are told which wrap around onto themselves like a Mobius strip. But, it is not only the structure of the story that is mathematical. In the first we meet a biochemist who...
    Antonia's Line (1995)
    Marleen Gorris
    About three or more generations of strong and self-sufficient women who live on a farm and the people around them. Antonia's granddaughter is a genius, namely a mathematician and a musician. But she...
    The Arnold Proof (2002)
    Jessica Francis Kane
    This short story begins with a quote from Philip E.B. Jourdain's essay "The Nature of Mathematics". In the quote, he explains how in the process of carrying out a complicated computation, one may want...
    Belonging to Karovsky (2002)
    Kathryn Schwille
    This short story, published in the literary magazine Crazyhorse concerns the boring and lonely Mr. Digby who was the downstairs neighbor of Karovsky, the brilliant (but of course, seriously insane) mathematician...
    The Bird with the Broken Wing (1930)
    Agatha Christie
    The Harley Quin stories (this collection, plus two later stories) are amongst the most peculiar mysteries ever written. (They certainly are Dame Agatha's most peculiar. They were also her personal...
    The Bishop Murder Case (1929)
    S.S. van Dine (pseudonym of Willard Huntington Wright)
    Our hero, Vance, says at the end of this mystery novel: "At the outset I was able to postulate a mathematician as the criminal agent. The difficulty of naming the murderer lay in the fact that nearly...
    Brazzaville Beach (1990)
    William Boyd
    Main character is a women studying chimpanzees in Africa, but her ex-husband is a set theorist who goes mad because he fails to prove a theorem. One of my favourite authors, and one of his best...
    Cryptology (2003)
    Leonard Michaels
    You know how The New Yorker likes to publish vaguely bizarre short stories that happen to take place in New York City? You know how lots of authors who want to show a character who is afraid of "real...
    Drunkard's Walk (1960)
    Frederik Pohl
    A number theorist is suffering from frequent and inexplicable suicide attempts, the latest victim of a small epidemic among academia. In between lectures on Pascal's triangle and the binomial theorem...
    Enigma (1995)
    Robert Harris / Tom Stoppard
    In this this espionage story set in England's Bletchley Park at the height of the Second World War, Tom Jericho is a clever mathematician at the famous code breaking facility who -- either despite or because...
    The Fairy Chessmen (1951)
    Henry Kuttner
    A mathematician whose research involves a type of chess played with variable rules ("fairy chess") is the only one able to solve an "equation from the future" in which the constants are treated as variables...
    The Ghost from the Grand Banks (1990)
    Arthur C. Clarke
    The topics change from the Titanic to a giant octopus but a central one is the Mandelbrot set. We are introduced to mathematician-cum-computer wizard Edith Craig who invents software to fix the Y2K...
    Good Benito (1994)
    Alan P. Lightman
    This novel presents many instances in the life of mathematical physicist Bennett Lang, the "Benito" of the title. The different scenes, presented non-chronologically, cover most of his life from early...
    Habitus (1998)
    James Flint
    There is no doubt that this novel is a work of mathematical fiction, but I'm not sure how to describe it. I think the best word for it may be "uneven". It does some great things, both presenting some...
    [continued next post]
    (Reply to this)(Thread)
    Alfred North Whitehead: Mathematics = divine madness - [info]magicdragon2, 2006-03-04 05:18 am UTC
    Science Fiction About Crazy Mathematicians, 2
    [info]magicdragon2
    2004-06-10 06:20 am UTC (link) DeleteFreezeScreen Select
    Hannah, Divided (2002)
    Adele Griffin
    The story of a 13 year old girl living in rural Pennsylvania in 1934, "Hannah" presents us with yet another fictional account of someone who is not only talented in mathematics but also psychologically...
    The Hollow Man (1993)
    Dan Simmons
    A psychic mathematician is driven to the edge of insanity as his life partner approaches death. Apparently there are a lot of formulas and references to real mathematical theories and physical theories....
    Incompleteness (2004)
    Apostolos Doxiadis
    A play by the author of Uncle Petros and Goldbach's Conjecture on the last, sad days in the life of Kurt Godel. After a "workshop production" in Athens, Greece (June 24-28, 2003) the show's official debut...
    [magicdragon2 notes that Godel did indeed prove that time travel was possible, if the universe is rotating fat enough. This was when Godel had the office next to Einstin at Princeton's Institute for Advanced Study. Einstein agreed with Godel, in this case...]
    Inflexible Logic (1940)
    Russell Maloney
    There is a famous example of probability which (in one of its many forms) states that six chimpanzees randomly typing at six typewriters would eventually reproduce all of the books in the British museum....
    An Invisible Sign of My Own (2000)
    Aimee Bender
    Mona Gray is a second grade math teacher for whom math is not only a job, but a beloved friend, an obsession and a security blanket. In this first novel we learn about the events that have shaped her and her creative teaching methods.
    Logicomix (2003)
    Apostolos Doxiadis / Christos Papadimitriou
    A graphic novel on the history of mathematical logic by the authors of Uncle Petros and Goldbach's Conjecture and Turing. In an interview (available online here) Papadimitriou says: It is really...
    Morte di un matematico napoletano (1992)
    Mario Martone (director)
    "This movie describes the last day in [the] life of a famous Italian mathematician: Renato Caccioppoli. He was a fascinating and discussed person in Naples' political and cultural life. [A] member...
    Nymphomation (2000)
    Jeff Noon
    A math professor's theory of "nymphomation" (described in the book as a way for numbers to mate) is used to develop a lottery game called "Domino Bones" that entirely takes over the city of Manchester,...
    Pi (1998)
    Darren Aronofsky (director)
    A mathematician discovers a new relationship between chaos theory and the number Pi which makes him a target of a dangerous religious sect and a greedy investor. The references to mathematics and its...
    Proof (2000)
    David Auburn (playwright)
    A drama about a "deranged", deceased mathematician and the daughter who had devoted her life to taking care of him. His former student and daughter find the proof of an important theorem among the mathematician's...
    Uncle Georg's Attic (2002)
    Ben Schumacher
    This short story appeared in the September 2002 issue of "Math Horizons", published by the Mathematical Association of America. In it, some kids look through an attic containing lots of stuff belonging...
    Uncle Petros and Goldbach's Conjecture (1992)
    Apostolos Doxiadis
    This novel, recently (2000) translated from Greek, follows the attempts of fictional mathematician Petros Papachristos to prove Goldbach's Conjecture (that every even number greater than two is the sum...
    The Wild Numbers (2000)
    Philibert Schogt
    Most mathematicians dream of proving a terribly important result. In this novel, mathematician Isaac Swift thinks he has done just that: solved "Beauregard's Wild Number Problem". But is his proof...
    (Reply to this)(Thread)

  • slavdude says:

    I have been suffering from a very mild but chronic depression since at least puberty. It seems to run in the men in my family (my father and brothers have it to varying degrees, and my mother does too). It has only been in the past 5 or 6 years that I got treatment for it--both therapy and medication (at first Celexa, which made me feel fuzzy and then didn't work, and now Paxil, which keeps me level and allows me to feel). Like many, I was afraid of depression, since I was afraid of mental illness in general. I guess I didn't believe until I was diagnosed that there is a biological basis to depression and similar (I don't know what to call it--disorder, problem, etc. all seem to carry a connotation of stigma) things. It does seem to me, however, that there is a social and cultural component as well to depression. Things that happen to people in their lives CAN have an effect on their mental state. While perhaps this seems obvious, consider how different people who experience similar situations respond to them differently.
    All this is a way of saying that depression is a real, treatable phenomenon; like anything else affecting the mind, different things will work for different people. In my case, it was the combination of therapy and medication (and getting out of a marriage that probably had much to do with precipitating the crisis that eventually led to my diagnosis) that allows me to be here today.
    I am a history Ph.D. who programs computers for a living. Love the blog.

  • helen h says:

    One problem with the cognitive therapy vs medication argument, particularly for those of us with milder CD(not requiring hospitalisation), is the correct application of these therapies.
    Provided you get no significant side effects, it is relatively easy to take pills once a day and see if your CD responds. However, for cognitive behavioural therapy to work, it has to be done *right*.
    My mother is a psychiatrist and as I understand it, to teach someone to use cognitive therapy to change their behaviours and actions, you need to work with them when they are at a really low point, and work with them quite intensively. Cognitive behavioual therapy isn't so effective if you start it once you are on the upward slope back to health.
    This means CBT works fine in a residential setting but for first episodes of CD, where you visit your local general practitioner, where there isn't necessarily a service available, it is impractical. I live in a rural area and when I was diagnosed, particularly as I was in no fit state to be driving to a support group, medication was a better option.
    I always rationalised it that I accept that I have an mis-wired over-reative immune system and so antihistamines help stop my eyes streaming and my nose running in response to certain stimuli, so why oughtn't I also accept that I have a mis-wired over-reactive brain which can be helped to respond normally by some selective seratonin re-uptake inhibition?

  • James says:

    I can say nothing that hasn't already been said. I'll only say that I have similar situation with CD, and have used the exact same comparison of medication for any other physical ailment. Unless it is pertinent, I simply don't bring up my medication. I'm in no way ashamed to talk about it, but I feel no obligation to explain myself to the arrogant assholes of the world.

  • Xanthir, FCD says:

    An interesting sidepoint - the research I mentioned earlier about most depression seeming to be linked to a particular area of the brain showing excessive activity (which can then be depressed with great success in curing depression) also discussed cognitive therapy.
    Basically, there are certain patterns that show up in people who respond well to medication, in the Area 25 and another area in the front of the brain. Area 25 activity goes down, and the other area's activity goes up. In people who respond well to cognitive therapy, both areas are depressed. This was an annoying discrepancy for the doctor's theory, until she realized exactly why it happened (it had to do with the way cognitive therapy changes your entire brain's activity, while drugs tend to hit more targeted areas).
    All in all, very interesting.

  • Anton Mates says:

    Rolf:

    Nevertheless, I don't really buy your therapists's assertion that there is no therapeutic cure for you; there's a plethora out there and psychiatrists are not always as up-to-date as you would want to.

    Conversely, of course, there's a plethora of medications out there, and more are being developed all the time, so bad experiences with a few shouldn't prevent you from trying others. My wife, who has CD, went through roughly a dozen pill types (usually in various combinations) before she developed the regimen which has worked very well for four years now. Everyone reacts to a given medication differently and both the prescribing psychiatrist and therapist should be helping the patient to evaluate the effects. But as you say, they aren't always up to date on the latest products.
    Really, the pros and cons for medication vs. therapy are quite similar. Both cost money, time and energy; both can improve your state of mind and help you enjoy your life; both can have very negative effects if they aren't right for you. (A lousy therapist can cause a suicide attempt just as surely as an inappropriate medication.)
    I can think of two significant differences between the two. One, pills can generally affect you more rapidly and strongly than therapy, so that both the rewards and risks are greater. And two, cognitive therapy is something you can walk away from with a permanent benefit even after you stop, while the effects of pills usually don't last once you discontinue them. That makes therapy-only a good first choice if it does the trick, but medication makes more sense for severe, chronic depression.
    I think it's generally accepted in psychiatry, too, that medication plus therapy helps more people than either treatment alone.
    Helen:

    My mother is a psychiatrist and as I understand it, to teach someone to use cognitive therapy to change their behaviours and actions, you need to work with them when they are at a really low point, and work with them quite intensively. Cognitive behavioual therapy isn't so effective if you start it once you are on the upward slope back to health.

    My wife was actually least responsive to cognitive therapy at her lowest point--helping her to consciously change behaviors was impossible when she could barely focus on another person and she woke up every day with "I need to die" as an emotional axiom. She started therapy before her depression became really severe, then added medication later on.
    Cognitive therapy was invaluable throughout, though; thanks to the self-awareness and distancing ability it granted her, she was far better at evaluating her own current emotional state and the exact effect drug X was having on her than she would have been otherwise.

  • Anton Mates says:

    And yeah, my wife doesn't tell many people about her medication either, because the majority respond with something like, "Why don't you just stop?"
    She's noticed that, almost every time she meets someone and instinctively feels close to them, it turns out (much later, when they're willing to talk about it) that they've taken pills for a mental disorder as well. Doing that seems to foster a certain humility and unwillingness to pass judgment.

  • Tracey says:

    I have been diagnosed with PTSD and bipolar disorder. People are astonished that my life has become a restrictive and lonely proposition, and either overtly or covertly advise me to "just take control of things, dammit!" That should be a simple matter, according to their lengthy advisories, adamant diatribes, and harsh soliloquies. The limited success I have obtained via countless pharmaceurical regimens and aggressive psychotherapy, they believe, merely coincide with some mysterious inner determination that I possess and am just too obstinate to acknowledge it.
    My Crohn's disease, however, is viewed by these same individuals as a bona fide nightmare and they offer unequivocal support when I indicate the intense hardship associated with straying too far from convenient facilities. In short, they offer greater quarter to a defect in my colon than to the fluctuations in moods due to a chemical maelstrom (bipolarity) within my brain. As for the PTSD, well, I suspect that seems to them as equal parts wizardry, congenital defect and moral weakness.
    My colon has a defect that must be treated with diet and medicine. It's a distressed organ, bottom line. But the brain? Surely it alone must be able to morph and heal on command...? I, too, thought that-- until I dispensed with taking my meds a few times.
    So many people with an otherwise keen acumen believe that a bona fide mental illness only occurs in an individual also afflicted with an obtuse intellect. Those whose learning capacity falls within the "normal" values are exempt from mental disease, many believe. What an insidious fallacy!
    So... The Crohn's is allowed to assume the blame for the restrictions that are part and parcel of my life. Surreptitiously, those around me would have me believe that it's either mind over matter OR that the mind doesn't matter.

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