The Moody Blues

So why do we find it so damn hard to offer heartfelt sympathy and support to people with mental illness?

Because we have not yet fully accepted and internalized the fact that mental life is a physical, biological phenomenon.

Okay onto the philosophical problem! At least it seemed a philosophical problem to me at the time :)

What depression taught me, in a very concrete way — in the bones so to speak — is that some assumptions I had about the self just don’t work very well.

Looking at someone else I tended to think of ‘them’ as a first approximation, as being their acts, how they behave, what they say etc. Looking at myself I tended to think of myself, again at first approximation, as being my internal life, my thoughts, my feelings and so on. Actions were epiphenomena so to speak.

…and here’s the big, horribly naive philosophical error, there was an ‘I’ a ‘myself’ the conscious bit which directed my thoughts, which subsequently directed my actions. Or at least attempted to with some tho’ not total success (obviously ‘I’ needed to master the controls better) Tada!

Of course I didn’t really think about it that concretely, it was more of a hidden assumption.

What depression taught me was that an ‘I’ in that strong naive sense, a little homonculus at the controls of the great machine, was utter nonsense. I had mistaken consciousness, that which can see the self, for control, the ability to direct the self. Because there was no control over the depressive thoughts and feelings, or indeed anything else really, to be had anywhere at least accesible to consciouness. All ran its own course.

The ‘snap of out of it’ solution rather assumes that the homunculus is in residence somewhere and can push the buttons and pull the levers to reassert control over the machine run amok.

So what actually directs the self? The conclusion that works best for me, practically, is that the whole of the self directs the self so to speak. Thoughts, acts, emotions, behaviour, imaging, happen as they happen together generating the next versions of themselves, consciousness weaving in and out every which way doing it’s watching stuff. Everything continually unfolding, and thus getting dangeriously mystical ;)

A wider bigger version of ‘I’ set to match the whole dimensions of the self.

I will also mention that because of all this discussions of ‘free-will’ look rather different to me now.

End of rambling!

I think the problem may just be the word “depression.”

Personally, I’m depressed lots of the time (following a death in the family, or when my sports team loses, or what have you), but I don’t “have depression,” which appears to be something else entirely that can require treatment or medication.

Consider, if you will, two opposite (and real) psychological disorders. One causes you to eat too little, causing severe health effects. One causes you to eat too much, causing severe health effects.

Disorder A is called Anorexia. There is lots of sympathy for the anorexic. Medical plans almost all will pay for anorexia treatments.

Disorder B doesn’t really have a name. “Overeating disorder,” maybe. But lots of us overeat all the time, but we don’t have any real disorder. We know we are just failing to use our self control. So many health plans do no cover this disorder, even those that do cover anorexia.

We tell the overeater, “Just stop eating already!” But we don’t tell the anorexic, “Just start eating!” We as a society recognize that disease.

One the one hand, we may be less likely to sympathize with people who just have more severe versions of what normal people have (say, depression or overeating). It may be enough to change the name. Create a diagnosis of “Doofhoffer’s Syndrome” that matches depression, but doesn’t strike us as something that we all have to some degree anyway.

On the other hand, it may be a deeper issue of self-control. More of us are overweight than underweight, so we see the anorexic as sick, before their problem is in the opposite of our “natural inclinations.”

Cancer is pretty unambiguous — you have it or you don’t. Depression can be easily faked and exists in varying forms ranging from normal emotional response to external events to pathology. These varieties are not as easily distinguished as the DSM would lead you to believe.

Depression is also ridiculously overdiagnosed; I was diagnosed with dysthymia and, IIRC, other forms of depression repeatedly for several years. SSRIs and countless therapists didn’t help; a change in external life circumstances did, immeasurably. So while I suppose it’s inaccurate to say that it was “all in my head,” it certainly wasn’t the medical condition that the psychologists and psychiatrists wanted to convince me it was.

To add to Zizka’s comments: Mental illness “changes you” but the “changes” are often more likely to be perceived by those around you rather than yourself. You may simply view them as a normal state of being, with “changes” having gradually accreted as your illness progresses. Indeed, denial is a hallmark of many types of mental illness (probably including severe depression at times), so that when a suffer is asked by his or her non-medical acquaintances what’s wrong, the answer usually comes back as “nothing,” and neither of them may perceive what is happening as a “medical” event or state. This can be true even when behavior is truly bizarre (which would not generally be the case with a depressed person). I haven’t suffered from clinical depression, but my dad and my sister have had major psychoses. I have concluded from my dealings with them that it is difficult for many mentally ill people to gain real insight into their illness because although they may be engaging in behavior that seems bizarre to others, it makes perfect sense to them, or they never manage to link it to their illness (rather than as something they did for no apparent reason).

I’ve written a little bit on philosophical issues surrounding depression and suicide, and I sense that people’s inability to be sympathetic toward mental illnesses like depression arises from the way in which depression undermines expectations about responsiveness and reciprocation among those who care about one another. When you care about someone who’s depressed, your love doesn’t reach them. An apsect of the condition is that ordinary signs of affection, love, etc., are often rebuffed because the depressed individual is often angry , insecure, and suspicious of others’ loving them, and so has difficulty trusting our attempts to understand or help them. Simultanesouly, depressed people have trouble loving back. This dynamic often generates a sense of helplessness among the friends and loved ones of the depressed, culminating in a desire to just leave the depressed person to her own devices. Hence, just snap out of it.

I think claims about fear of faking and the slippery slope of depression from mood to illness are misplaced. If that explanation were true, it wouldn’t apply to peoples’ perception of their own depression, since they’d know they were faking, and most people who are legitimately chemically depressed (like laura) have no idea that it’s a physical phenomenon.

True, the overlap between mood and illness can exacerbate the problem, but the underlying cause is definitely our fetishizing of the mind/body duality. The Machine gets sick, but the Ghost doesn’t. If the Ghost could get sick, there’d have to be an inner ghost that was aware of its Ghost being sick, and so on ad infinitum. Acknowledging that the very thing that apprehends sickness can be sick is a flanking maneuver on a conception that many people hold very dear.

zizka: don’t all illnesses change who we are? If I were (say) to come down with AIDS, then my personality would change pretty radically, even if I were a pure homo economicus. I would no longer have a reasonable expectation that I will live another half-century, and that would change the level of other risks and enterprises that I would think worth undertaking. And in the real world there are all sorts of physical changes that go along with that, too, which have their own impact.

sidereal: In my comments about faking, I was specifically addressing the question of why healthy people don’t give the mentally ill as much sympathy and support as they deserve. Of course someone who is mentally ill often won’t recognize it — their sickness is harming their ability to make decisions! If it didn’t, it wouldn’t be a mental illness.

“I’d probably go around telling cancer patients to ‘snap out of it’ too, if I thought they might follow my advice.”

That’s a good point, nicely made.

For my part, it wasn’t until I was about 25 that I recognized my depression for what it is. Until then, I had taken it to be situational and/or maladaptive, something I could “snap out of”. But at that point I happened to be in a life situation where all the factors I had previously thought responsible for the depression weren’t there. I was “happy”, or I should have been, yet I was unable to function and I was self-destructing. What I had thought made sense, didn’t. Something else was going on.

A big part of why things like depression aren’t accepted by many non-sufferers as legitimate physical illnesses is because it can be very ambiguous and difficult for the _sufferer_ to accept. Regardless of whether my depression was biochemical or not, I had a lifetime of habituation to it around which I molded my entire sense of self and behavior. The first year or so of being on antidepressants was, for me, a pretty confusing time while I struggled for a clear sense of who I really was. At first, the medicated “me” felt false—and this is something many, many people experience on antidepressants.

But I had an epiphany one day. I was walking beside a school playground, and I stopped to watch the kids. Watching them made me very happy. And suddenly I realized that this was essentially how I viewed life, that I thought life was wonderful. I thought about my values, my humanism, and realized that in some deep way I’m an optimist. The mental picture of self abruptly shifted; the depression was a distortion imposed upon me—it wasn’t me.

And yet, in a sense it was, because I had learned to live, as best I could, with that distorted self; and I had acquired many habits of thought and behaviors that persisted (less so these days) beyond the biochemical imperative of depression.

Or, let’s use a different, non-controversial example. As I’ve mentioned before (haven’t I?), I suffer from a genetic disorder involving collagen formation that has resulted in severe, progressive osteoarthritis at a young age. At this time, I can still walk without aids; but I need both hips replaced (and at least one shoulder), walking and other activity is limited, and I live with chronic pain always. I suffer from an indisputably severe physical disability. And yet, there are things that I could be doing to help myself that I am not. Specifically, the strength of the relevant muscles is important because they take some of the load off the joint. I _need_ to exercise, somehow, in a way that doesn’t adversely affect my joints—but it’s so very hard when, dammit, it _hurts_ to do anything. My point here is that even with indisputable organic illnesses, there’s still a lot that remains within the realm of willpower and responsibility to self.

However, the insidious nature of depression and other mental illnesses is that they directly interfere with one’s ability to be responsible for oneself in this way.

In fact, while society and most people around me see my bone disease as my “real” disability, I feel and believe, without a doubt, that my depression has been more disabling and hurtful to me than the bone disease ever has, or ever will.

Sorry if this was too long.

Neel — as I wrote I realized that all diseases change who you are. For example, a crippling knee injury makes whole categories of activities impossible and cuts you off from people you know through those activities.

I was thinking especially of the fact that some diseases invalidate you as a person (agent) in the eyes of others, whereas diabetes or hypertension or osteoporosis really doesn’t. (In athletic circles, a knee injury probably would, but not elsewhere.) But mental illness tends to put a stigma on everything you do, for everyone. (I’m also thinking of diagnoses like alcoholism and, formerly, homosexuality).

We are discussing two things here: physical illnesses that alter your mental state, and mental states that are described, in what seems to me a kind of metaphor, as “illness”. It’s hard to distinguish between the two externally, but I think it’s important; it’s possible for two people with the same physical illness to have very different mental states as a result, or even the same person at different times.

When you treat the mental state itself (rather than physical states that may produce it, such as schizophrenia or gluten intolerance) as an “illness,” the metaphor suggests a host of unhelpful or marginally helpful related concepts: drugs, hospitalization, diagnosis, symptoms, surgery, abnormality, and an opposite state of “health”. Likewise, the metaphor dismisses the mental, emotional, and subjective aspects of the situation as secondary, and often treat the mental states resulting from the illness as being somehow invalid, not “real.” This is perhaps the most destructive aspect of the medicalization of emotional suffering — the way its believers often dismiss the suffering and mental struggle itself as meaningless.

I think most people realize that this conflation of mental states and physical illnesses is misleading, but make the mistake of rejecting the medical aspect of the situation completely.

“the answer is not because they have no experience of it, on the contrary it is because they have ALL had experiences of being unhappy, have, a priori, no reason to believe that the case in question is anything other than that, AND have all had experience with social parasites who exaggerate for sympathy and more.”

This strongly reminds me of the rationale for discriminating rape victims from regular crime victims. However, numerous studies and, for example, the FBI’s own estimates, show that rape is not falsely reported any more than other crimes.

This view of depression and the social reaction to it is built around the same assumption of a distinctively high-rate of false claims. This assumption is also intuitive, but could be just as false.

You may not believe that my depression is a serious physical illness. But no matter. Because if it were or if it weren’t, my example undermines your claim. I almost never claim (and then only to closest friends and family) that I am unable to do something because I was depressed, even though it would quite often be true. Such a claim carries no weight. For it to work as an excuse, it needs to, you know, be accepted as an excuse. Your argument is that people won’t accept it as an excuse because it’s accepted as an excuse.

This was a big point of my previous post. I can barely freaking walk. X-rays of my joints look like disaster areas. Yet I can tell you that my bone disease hasn’t and doesn’t disable me as much as depression does. But I rarely make that claim (this is a huge exception) because I don’t expect anyone to either believe or understand that it’s so.

And as someone who was formerly in the highest marginal tax bracket (by a wide margin), I don’t think I can be called a “social malingerer”.

Your explanation is off-base, the other much more moderate ones are better: depression as a part of the normal human emotional spectrum and depression as an illness are both quite real but not nearly as distinct as we might like. Just as, I might mention, _physical_ pain is both normal and a serious illness. If we lived a hundred years ago and there was no known etiology for what is wrong with my joints, then “it hurts to move” would sufficiently describe my condition. But, you know, for normal people, it sometimes hurts to move as they get older, it hurts to move a day after vigorous excersize, etc. Moving in spite of pain is something that we all must learn to do to some degree. Lots of people have joint pains or mild arthritis. Because of this, if I describe my condition as “arthritis”, they tend to underestimate its severity, particularly because there’s few outward signs of illness. (And because I’m only 39.) This is the effect involved in the discounting of depression, as other people have said.

>>after years of understanding myself as someone with a tendency to depression — a couple pretty bad episodes and a lingering feeling that I was always on the edge — I was diagnosed with celiac disease, or gluten-sensitivity. Completely unexpectedly, cutting almost all of the gluten from my diet made me no longer anywhere close to depressive. It took me several months to figure out the cause and effect, but nearly a year on, it’s indisputable.

Ever unexpectedly read something that causes the lightbulb to go on in such a profound way that it is a potentially life-changing experience? This just happened to me. I would describe myself as very similar to Laura – prone to depression, with not very much needed to send me into very severe episodes of complete alienation and withdrawal. And yes, I got the “snap out of it” response from those around me, also.

This past spring, I read an article about a finding that celiac disease/gluten intolerance is very much more common than previously thought. The article mentioned physical discomforts associated with the condition that sounded familiar to me – so I went off gluten in June just to see what would pysically happen. Coincidentally, for that past 2-3 months or so, my overall mood has considerably brightened, but knowing my history, it was always like waiting for the other shoe to drop, so I just assumed that it was a temporary situation while waiting for the inevitable bleakness to return. I *never* associated mood with gluten, and I never associated the mood change with the lack of gluten. I never even considered that it might be something organic that might be changed with diet – just that being prone to depression and having my life framed by that was a permanent part of me that I was rather helpless to affect without severe medication.

WOW!

Not that it automatically follows that my experience is necessarily similar to Laura’s, but for the first time in a very long time I have a new perspective and hope about myself just from being here tonight. THANK YOU, Laura, for your post – it opened up a whole new avenue of thought for me to pursue. And THANK YOU, Jim, for mentioning this discussion to me – I’d never been here before – serendipity! And I guess THANK YOU Maria for hosting this forum. I know I’m not, in fact, technically adding to your discussion topic, but … WOW! THANK YOU all so much!

Because the international human understanding of work is that it is physical, not intellective. Things that give people headaches and disturb their ability to do monk-like white collar bourgie work is nothing compared to things that physically weaken their bodies and disrupt their ability to carry water from the well to their home.

http://www.canoe.ca/Health0201/15_warvets-ap.html
I fractured my skull over my left eye at age 5 or so when I fell from a moving car. My left eye has very poor vision.
I started drinking at age 15, did some drugs, left a military career because of the drinking (not recommended for re-enlistment), was at times a violent drunk… I never felt good unless I drank or smoked.
My wife and running kept me straight for a while, but the anger and self-hatred kept boiling over, sometimes onto my kids.
I’m 53 and on Zoloft now and am no longer plagued by anger and self-hatred. When I make a mistake, it’s just a mistake, not proof that I am stupid or useless.
If I try to cut back on the meds, the feelings return, so there is definitely something broken.

However I am well aware of what many leftists take pains to deny, that the world is full of bums, malingerers and general social parasites.

Now you have to explain why those people choose to be bums, malingerers, and general social parasites. And, if they really are, how to get them out of it.

Hint: calling them names, or punishing them, is very little use, except perhaps to your own ego.

“The ‘snap of out of it’ solution rather assumes that the homunculus is in residence somewhere and can push the buttons and pull the levers to reassert control over the machine run amok.”

Heh, exactly what I meant. The homunculus… It all changes one’s perspective of life indeed.

I have to add, having also been on the receiving end more often than the giving end of the “snap out of it” classic, I too understand that reaction at a personal level, from friends, family, etc. From people who care, that phrase can also be said with love and sympathy. And frustration too, oh yes. Sometimes you just drive people insane, when you’re screwed up. They don’t get it, cos they can’t. You don’t get it yourself. And you can get very selfish, nasty, and vindictive, when you’re screwed up. When you’re not kind to yourself first of all, you’re not exactly going to get cheers and smiles all round…

But no one ever “fakes it”. Faking depression? what the hell for? it’s not like it’s fun. If anyone somehow should feel this odd desire to fake depression, well, it means they’re really just as screwed up as if they had it for real.

I remember reading, always in the Guardian, on the debate about self-inflicted cutting among teenagers. The fakers/real sufferers debate there is very interesting. My own idea is, there’s no fakers. There can’t be. If a kid feels that cutting themselves is “cool” and they like to show it off, then it means they do have a problem, and do need some help. It doesn’t matter if they go about it in such offputting ways, doesn’t matter if they make it into a fashion statement, the very fact they’re doing it speaks a lot about their state of mind. No one reasonably happy with themselves would ever “fake” something as complicated as depression or even something as tangible as self-mutilation just to attract attention. There’s simpler, healthier ways to attract attention, like, dye your hair red or wear see-through shirts…

On depression as medical condition vs. depression as ordinary, temporary part of everybody’s life. It is different. Ordinary depression and sadness is an emotion like any other. Depression as a condition is entirely different. Has a lot of mental and physical consequences as well. Again, no one can be seriously faking that.

I don’t think that the “sympathy” that needs to be given to these illnesses is the total opposite of the “snap out of it” – sympathy is not a pat on the back, that’d be indifference. I think absence of moral judgement would be enough. Separating moralistic assumptions from understanding of psychological problems, that’s what would be really nice. If only people (sufferers first of all) could suspend the need to place the blame at all costs.

Also, I think frustration with people who do not seem to be *willing* to recover at all is totally understandable. Patience can only be stretched so far, and these illnesses take their toll on friendships, relationships, family, etc. Everyone needs some support, but, they got to be inclined to at least help themselves a little as well. It’s a two-way process, obviously.

However, I think the issue here is not reactions at a personal level, but at the wider, social level, in general. General attitudes and mentalities about it, not reactions of people directly involved.