.com.unity Forums - OT: Despair

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A while back Tom Cruise had some kind of altercation with some new reporter about depression and the "accepted" cause for it and many mental health problems.

While I did not see the airing of this interview for myself, I did note that there was a lot of hoop'la'do about it and that many mental health professionals wigged out over what he was saying.

Tom Cruise has no right to say anything that was not scripted, and he has demonstrated this. I can only guess how many lives were wasted due to that utterance, or how much money the Church of the Pyramid Scheme has stolen through his influence. But in fairness, most mental health professionals have no right to accept money from patients. Those who say psychiatry is a scam are right... but only insofar as radical Libertarians are right. For all the wrong done by governments, all their stupidity, incompetence, unnecessary suffering, warfare, taxation, bigotry, unfair imprisonment, and so forth... the good ones make the world a much better place, for almost all of their citizens.

Most computer games are trash. Should we give up on the computer game industry? ...no... just be more discerning, and realize that a playing bad game does not imply that games are bad.

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I know first hand how mental health professionals seem to group all mental health issues into one large category, "chemical imbalance."

I'm empathetic with your experience, but the converse is also true. There are psychiatrists that deny chemistry and psychology are related. These people are retarded and their platform will die of old age, much like "geologists" who denied plate tectonics. All emotion arises from chemicals, just as all processes in any organism are based on chemicals. This does not imply that chemical mechanisms are the best treatment for all disorders (e.g. excercise is almost universally favored over muscle-building steroids when recovering from surgery or lameness). But it would be folly to suggest that a non-allergic person with "Strep Throat" should "tough it out" rather than taking cheap Amoxicillin, when Strep can migrate to the heart and cause death in mere days - as happened to someone from my high school whose parents were the "tough it out" types.

In parts of the world where prescriptions are used (a seemingly necessary evil of government... note that these are the same countries where pharmacies give you medicine, rather than capsules full of chalk dust), doctors are the gatekeepers. Gatekeepers can be stupid and inept, and often have egos larger than the city walls. You may be smarter than your doctor, even in his field. But nonetheless, they serve a vital purpose, and should not be discounted! If given the choice between humbling yourself before someone you feel is incompetent and committing suicide, humility is the logical course... even for a trivial chance of success.

This may sound a bit negative, but unfortunately, that's the state of the world. In real medicine, corruption is minimized (compared to e.g. the insurance industry or tax collection), because chopping off the wrong leg or letting patients go blind due to gross negligence will get you fired... eventually. However, the mental health field has no good metrics. Depressed people are too depressed to sue, and they assume everything's their fault anyway. People don't publicize mental problems. While a knee surgery or heart transplant or antibiotic will be immediately "successful" or "unsuccessful", a psychologist can string a person along for years, and mind-altering drugs typically carry the proviso that they "may take several months to become effective". So the rampant malpractice is very hard to detect, let alone nail down.

My best friend is in medical school, and it's given me a great insight into the pathetic state of the industry. He was number 1 in his class at a top-notch US medical school (which will remain unnamed). The specialty to which he applied accepts only two students from the schools own medical school, and everyone else from other schools. My friend was denied residency at his own school in favor of two minorities (I'm just stating facts here; I'm not left-wing, right-wing, Nazi, KKK, Mormon, or a member of any other radical fundamentalist group) who were both in the bottom 20% of the class. He was not accepted at any of the other schools to which he applied, even the safeties, as they knew he would be accepted at his first choice (for residency, the applicant's choices and rankings are known to the schools, and binding - if your first choice accepts you, you must attend), and they had a better chance of landing good students if the programs gave higher rankings to people they thought would realistically attend.

Well, the medical school residency admission system is designed by idiots, since the smart people are busy doing real work. But the fact is that while there is gross incompetence, the doctors (nowadays) aren't the ones who develop drugs - they just prescribe them. If you have cancer, or macular degeneration, or chronic headaches, you may have to go to multiple idiots that string you along before you visit the smart doctor who paid attention in medical school, and cures your problem. As an example, my mother was stricken with severe, crippling vertigo - so bad she thought she would die, and could not stand - about a year ago (and by the way, vertigo and headaches are the realm of brain doctors, so this is not unrelated to the topic). She visited our family practitioner (who is honestly quite a bright guy, IMO). She went to a specialist, recommended by him. She got an MRI. The conclusion - she may have had a minor stroke; sympotoms might go away over time. The symptoms persisted on and off for months, with (rare) occasional regressions such that she couldn't leave bed for the day. In the interim, I took a neuroscience class (related to my artificial intelligence specialty) that specifically mentioned "otoliths", little deposits that form in the inner ear (Latin for "ear stones"), and did not make the connection. Then, a year later, I saw a New York Times article describing those exact same symptoms, with a case history, and it clicked - my mom's vertigo was caused by these otoliths, brushing against inner-ear cilia and chaotically interfering with the fluid density gradient, disrupting her sense of balance!

There are a well-known (in the medical community, since the 1980's) set of head maneuvers that dislodge these stones and restore a person to normality, in just minutes. No multi-thousand-dollar MRI, no months of suffering, nothing. I was excited, and emailed the link to my mom. Then, I thought I'd test my friend's skills, and called him, describing her symptoms... and after about 2 minutes of description, he said, "Sounds like otoliths. Those can be relocated and the symptoms eliminated by using the Epley manuevers." I was shocked, but then realized, "He's an ENT (Ear, Neck, Throat) specialty... I guess he should know." I said that, and he said, "No, any doctor would know that." To test this, I had him give the same set of symptoms to his fiance, a dermitologist (just started residency). And she said, "Isn't that just (some medical term) caused by otoliths? Why on Earth was she given an MRI?"

What is the point of this story? Mental problems are mysterious. Even if there is a well-known scientific basis for something, mental problems will still be treated as mysterious by those who don't know it. They will tell you the brain is still a big mystery, etc, etc, rather than sending you to someone who knows their **** to get your problem solved. Even smart people can randomly not have the right information to solve a given problem, despite easily solving other problems. So you have to take the initiative, and "fire" people, until you randomly draw a doctor who can correctly solve your problem. Doctors are not commodities, like taxi drivers and waiters and those people at the info desks in malls - a second, third, or twentieth opinion is sometimes needed to save your life or sanity, so don't just take the first one to pull up to the curb, or the one your insurance company mandates.

Back to depression: It's caused by chemicals. There are other chemicals that can reduce it in some people. There are over 20 of them; nobody knows how to tell which are useful on which people, or which side effects will manifest. Some people respond best to psychotherapy, and some to lifestyle changes; but most people with severe clinical depression only respond to drugs, and even the groups that respond to other treatments typically respond to drugs as well.

These drugs are not perfect, because even if they work for someone, they typically have nontrivial side effects. They are sort of like ancient transfusions, which only worked because everyone in the area transfusions were invented had Type-O blood, even though the people at the time had no concept of surface proteins, allergies, and immune-system rejection. In other words, if any other treatment works, then use it instead... and consider yourself a lucky minority. Otherwise, you gamble until you hit the jackpot. If a doctor looks at you and says, "I think you ought to try drug X" or "My experience is that drug Y is the best" then he's either been paid off by a drug company (true of virtually all doctors, though most don't let it affect their decisions) or he's just a moron with no understanding of statistics and sample sizes.

My suggestion to depressed people, who have never seen (or not been helped by) a doctor:
1) Visit a doctor. Period. If you have tried this, then visit a different doctor.
2) Research your condition and its treatments yourself, intensively. Doctors are fallible, but mental doctors are protected by a safety net of mystery - nobody can really know, let alone prove, that they've never helped anyone. Going in blind is like going to Vegas without knowing how to play cards.
3) You can pick any form of treatment you want. Medicines work directly on the symptoms, in a very crude way. "Therapy" works indirectly, requires a much more skilled doctor, takes much longer, and works much less frequently; however, when itdoes work, it's the best - since you're solving the problem rather than the symptoms. Unfortunately, genetic problems (e.g. a specific mental disorder that runs in your family) cannot be resolved by psychotherapy any more than a depressed Bahaman can be treated by light therapy (which is often successful on depressed Alaskans).
4) Don't put up with any crap. It's your money, your time, your body, and your life. If a (medicinal) treatment is not working after two weeks, and your doctor insists it will take several months before you know for sure, can him - he's milking you. The medical industry has published studies that seem to back this up, but they're bull****. The smoking industry has published studies indicating cigarettes are safe, too. Typically side effects of mind-altering drugs are most pronounced at first and decrease over time; so yes, they do change over time. But they act directly on your brain chemistry and almost universally have a system-halflife of a week or less. So if they aren't effective in two weeks, try something else - they probably won't magically become more effective after 2 more months. If your doctor refuses to let you switch, or ever pulls out some ego-boosting authoritative "I'm the doctor" or "I'm the expert", find a new doctor, and explain to him up front why you left the old one.

R13: You're Canadian. If you experience seasonal depression (worse in the winter compared to summer) I suggest looking into light therapy. If not, and if you've had depression constantly (or chronically) for the last couple years, without recurring crises (parents' divorce, followed by being dumped, followed by your dog dying, etc - healthy young people don't stay depressed for years after a single incident) - and especially considering your family history of suicide - I suggest you give antidepressants a second try, with a different doctor, and different drug. I had surgery on my knee, and was injected with a standard amnesia-inducing drug that is given to prevent patients from remembering the pain of surgery if they happen to wake up prematurely, and sue for "emotional damage". I remembered nothing of the conversations I had for the 24 hours after the surgery, and my memory was sketchy for several days after... I was worried about permanent damage, and on my subsequent 2 surgeries (shoulder and shoulder again - knee from soccer, shoulder from tennis, second time from climbing) I requested that they skip the amnesia drug, and I had no problems - I remember being carted into the op room, and remember waking up post-op. Side-effects can be devastating but are specific to individual drugs, not their entire class.

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Depression isn't "acquired" like AIDS is. It generates spontaneously out of the circumstances of a person's life. But Dogscoff has said it better than I can, so I'll leave it at that.

However, that's not strictly true; sometimes yes, sometimes no, and I don't know if "yes" or "no" is more common. Depression can hit a person out of the blue, like a ton of bricks, when they hit a certain age... and stay for the rest of their life. It can be triggered by a fairly minor event from which a normal person would bounce back in weeks or months... and just never go away (this is the kind that has a decent chance of being resolved by therapy). So medication is not a short-term solution for depression, any more than statins are the "quick fix" for someone whose mother, grandmother, and great-grandmother all died of heart disease at age 45. For a person without "true" depression - meaning someone who is sad, for some limited amount of time, for some specific reason - antidepressants should not be prescribed. Drugs should not be used to change emotions, IMO. But depression is not an emotion, just as limping due to a broken leg is not a form of transportation; it's a defective instance of walking. If a person is constantly unhappy, never really experiences pleasure despite intellectually knowing that action X used to be enjoyable, stays in this state with no precipitating event and no particular change over time, and has a family history of depression... that's a genetic disorder. Excercise typically improves circulation, and doctors often recommend it for people with a family history of heart failure. But if statin drugs allow a person with severe hereditary artereal plaque to be the first in their family to live to be 70 years old, why not take them? Heart attacks don't spontaneously arise in people who eat lard sandwiches every day; nor does changing your entire life to avoid "bad fat" make you immune. People in my family don't get heart attacks, but it's not because we are good people who avoid bacon and butter; we just don't have specific genetic defects regarding our cholesterol metabolism and blood vessel inner wall lining. But if I did have such a problem, I'd probably consult a dietician... and I'd sure as hell start taking statins. Which are not a short-term fix, any more than drugs are a short-term fix for chronic depression.

I don't know your specific circumstances. But again, side effects are drug-specific, and antidepressants comprise many chemicals over 3 primary distinct classes (tricyclic, SSRI, SNRI), and several others that are totally independant of these classes. Some people only respond to one class. Even within a class, drugs have different effects and side effects on different people. Tylenol causes liver failure, aspirin causes ulcers and internal bleeding (and I take it anyway), and so forth... but that doesn't mean an arthritic person shouldn't take Aleve every day for 20 years! It's a chemically distinct drug that's simply on the same shelf at the drugstore, and even though it is primarily used in the short term by people with acute injury (e.g. me, when I got a stress fracture in my foot during track), it is still highly useful in the long term. Yes, Aleve has some major side effect in .00001% of people (I forget what it is - also liver damage?), and (were I a doctor) I could counsel arthritic grandparents to stop walking around, which solves the root of their problem. I could (at huge costs in pain, money, and time) give them titanium knees, which carry a much higher risk of complications (like death) than Aleve, and maybe have a 50% chance of leaving them better-off. But it makes so much more sense to give them a painkiller, and let them go about their lives like normal people. Why should mental diseases be any different?

P.S. Hope I don't sound confrontational, except to Tom Cruise if he's reading this (that jackass) - I'm just voicing my opinions, not trying to criticize.