Mental health and mental fitness

by John Quiggin on August 2, 2022

Until now, I’ve always thought about mental health as the absence of mental illness, much as I have typically thought about the absence of physical illness. In both cases, health is the default state or unmarked category.

But as I have gone through the Covid pandemic, and become more pessimistic about the state of the world, I have reached the view that a better analogy is with physical fitness. That is, something that requires sustained effort to achieve and maintain, and is rarely fully achieved.

In particular while I have previously thought about depression as a mental illness, it’s difficult now to distinguish it from ordinary sadness. My congenital optimism now seems more like delusion. Maintaining mental balance is now hard work.

Not surprisingly, I’m not the first to come up with this idea. Searching for “mental fitness” produces lots of hits, mostly fairly recent. The majority are boosterish, introducing and promoting the idea, rather than acknowledging the difficulties associated with it. Nevertheless, I’m hoping to get some useful suggestions. I’d be interested in readers thoughts.

PS: illustrating one of the difficulties of maintaining physical fitness, I came off my bike the other day and broke my wrist. So I’m attempting to blog by dictation. It’s a challenging mental exercise

{ 45 comments }

1

Luna 08.02.22 at 3:13 am

I think this is very true, and it resonates with a program I’ve been doing for the last six months or so, in the interest of developing resilience and balance in difficult times. The Center for Healthy Minds at the University of Wisconsin-Madison studies mental well-being via neuroscience and other methods, and they have a free app with a pretty extensive meditation and mindfulness course. Many of the lessons say that training the mind is like training the body, so this post is exactly right.

I like this program for a lot of reasons. It’s a non-profit organization, it’s scientifically based with a refreshing absence of woo, and they understand that the imperfect practice that you actually do is better than some ideal that you don’t. So the practices can be anywhere from 5 to 30 minutes. As with physical fitness it takes time to see results, but what I’ve noticed after a few months is that being mindful of what is right here, right now helps a lot. So do the insights about how the mind works and the stuff it likes to make up.

I recommend it as an accessible way to get started with mindfulness and meditation, if that’s the kind of thing you’re looking for.

2

Ikonoclast 08.02.22 at 4:16 am

Perhaps over-training and over-exertion are possible in both cases, physical and mental exercises. It’s well studied, well-known, I think, that male athletes can suffer from over-training, enlarged hearts. Female athletes not so much. Also, well-known that hard training young female athletes with low body fat counts often stop menstruating and cannot fall pregnant upon training reduction until the body fat percentage goes up enough. The modern idea of fitness sometimes seems to be a search for over-fitness and over-competitiveness.

It’s probably best to cross-train or cross-exercise too, making varied types of physical and mental efforts. Or one can take it not too seriously and figure that in endless self-imposed pandemic lock-down with fit tradespeople and gardeners rare, one has to do a lot of one’s own maintenance tasks. Saves money and keeps one active. That’s the way I look at it.

Mental health – Well, you certainly need some other people to interact with. Very important is moderate physical exercise (not excessive exercise in my book), good diet and good sleep patterns. A mix of interests including listening to music and some comedy: not all serious stuff.

And one has to come to terms with one’s intrinsic make-up. Mine is excessive pessimism and chronic depression at the ideational / internal monologue level but not at a more somatic level. When I think about what I think of myself and the world, it’s all bad, very depressing. When I concentrate on absorbing tasks, mental or physical, I forget to be depressed. It’s occupational therapy basically. Keep occupied.

3

nastywoman 08.02.22 at 5:51 am

@2
Erwache und Lache!
and otherwise:
Stop making sense
(as the world does)

4

galahad 08.02.22 at 5:52 am

I went to work with 2 broken wrists, a shattered shoulder, broken thumb, and I typed with 3 fingers of only my left hand. And I finished the project on time. True story.

And that is the cue for this wonderful skit. Four Yorkshiremen, drunk.

https://m.youtube.com/watch?v=7Lb-2VaJYPw

5

Matt 08.02.22 at 6:21 am

I think this might be an interesting parallel, but I’m not sure. Apologies if it’s not. I’ve been slowly reading a history of “welfare” and support for the poor/disadvantages/those unable to care for themselves, mostly but not completely focusing on the US. One thing that’s interesting to me in it was that for a long time there was talk of “mental hygiene” and programs for and departments of “mental hygiene” that just sound really odd today. (NY state still has a “Department of Health and Mental Hygiene” but I think most people find that very strange sounding.) From this book it’s hard for me to know how far the “hygiene” idea was really different from what we’d think of as “health” today, but it does seem at least somewhat different. This at least suggests that these things might be conceptualized differently.

6

Felix 08.02.22 at 7:19 am

I fully agree with this. It’s exactly the sort of idea that seems so right that surely I must always have believed it, even though maybe this is the first time I’ve ever heard or thought it.

Your change of terminology makes necessary actions clearer and more obvious. My mental health used to get bad easily; I had to take notes and study it to learn better skills and strengthen it. In many cases, people’s mental health gets better through their lives because of that – as they’ve lived more years, they’ve learnt more skills to keep themselves happy. But simply being aware of the skill doesn’t help you cope – in fact, it can help you become depressed. You have to practise applying it until it becomes natural even in times of stress. I think that’s where the analogy to fitness comes in. By training, we can overcome greater stress.

The underlying idea isn’t exactly new – it’s exactly the principle behind a lot of modern psychotherapy. But the analogy you make helps draw out the consequences. We definitely need to centre it more. People grow up in life assuming they naturally have enough skills to deal with the stresses of life. But they need to be fit, too.

Please make this an idee fixe of yours!

7

oldster 08.02.22 at 11:28 am

Very sorry to hear about your wrist, John. I suffer from osteoporosis, and will almost certainly break my wrists in a “foosh,” the casualty department’s charming acronym for a “fall on outstretched hands”.
Complete agreement that mental fitness is a more productive concept than mental health, encouraging us to think of it as an achievement rather than a default.
It will then look quite a lot like Greek conceptions of virtue (aretê), and give rise to a disagreement parallel to that between Aristotelians and Stoics: is human mental fitness something strenuous but achieved by most functional adults, or is it something so demanding — a “regulative ideal” — that the mentally fit person is as rare as the phoenix?
A different corollary of the fitness model; we judge physical fitness on many axes, through a battery of tests. Right now, your thigh muscles are fit but your wrist is not. A fit person should be able to perform well on cardiovascular tests, strength tests, tests of agility and coordination, und so weiter.
This suggests to me that you should develop your notion of mental fitness by beginning to itemize the tasks that a mentally fit person can perform, parallel to 5 pushups and 20 situps.
Exempli gratia:
1) deal with daily frustrations (eg a flat tire) without excessive angst;
2) enjoy the company of others;
3) focus on work-related tasks for several 2-hour blocks per day;
4) form one intimate pair-bonding relationship;
5) avoid addictions to alcohol, gambling, etc.;
6) offer emotional support (at least first aid) to another person in crisis;
and so on.
7) apologize for wrongdoings and admit mistakes.
People disagree on the list of capabilities that constitutes physical fitness, and we expect sensibly written goals to allow for some interpersonal variation (higher standards of upper body strength for men, e.g.). With mental fitness, too, we should predict that different people will write different lists, and that even a sensible consensus list should allow for some interpersonal variation.
But I think the task of writing the list will be clarifying, as well as providing an entertaining parlor game. It lets us begin to anatomize the mind into its modules, so that we can say that this mental muscle is well-developed, but that mental joint needs to heal.

8

Trader Joe 08.02.22 at 11:32 am

I like the analogy and think it does a great job of making mental health an affirmative rather than a reactive state.

Where the analogy gets more tricky is in terms of prescription. If I’m trying maintain or lose weight or build core strength or improve flexibility there are well known exercises which anyone can discover which are proven to do the job if you put in the effort. The challenge of physical fitness is doing it, not getting an outcome if you do.

By contrast for mental health you not only need to do it, you need to figure out what works and what works can vary depending on what you are feeling and your ability to identify your stressors. Mindfulness is often a great place to start, but can be a rather vague prescription if you don’t really have any handle on what it is you’re trying to address.

Mental fitness is considerably more individualized as to what works. Even people with seemingly similar conditions (say mild depression) can require considerably different solutions to get results. For some, mindfulness can be the answer. For others, constructive interaction and engagement might be better. A good bit more experimentation is usually required which in itself is frustrating because not seeing results can itself contribute to the problem particularly if the core issue is one involving self-esteem or social confidence.

While I believe there is a lot one can do for themselves, there is also decidedly a line where professional help should be encouraged and unfortunately society at large still sees engaging a mental health trainer as something of a weakness whereas engaging a physical fitness trainer as a positive.

Looking forward to the discussion, it’s a very rich area to explore.

9

steven t johnson 08.02.22 at 2:17 pm

Whether you call it mental health or mental fitness, one key comparison is to occupational health or disease. As I recall somebody noted recently in comments that mortality tended to decrease in times of mass unemployment, who thought that was counterintuitive. It seems to me that it should be common sense to think that for real wear and tear on the body, going to work is the trick. It’s why somebody can go to the store for groceries and mow the lawn once a week but still not be up to going to work for eight hours a day five days a week—assuming of course they don’t get forced overtime and they don’t throw in another workday in commuting time.

The parallel is obvious, maybe too obvious: A society can impose a way of life that exerts wear and tear on an individual’s whole life. However often it is misconceived as something separate from the individual’s body, the mind is part of a whole. The work imposed on the body wears on the mind. And the same is true of an individual, which is not just an isolated free will that can choose to exercise mind and body. A life is other people (or absence of them.) When a society is sick, it makes the people in it sick. The occupation of life can cause an occupational mental illness.

A note on the medical model of mental health, as they like to call it? Medicine treats infection, trauma and organ dysfunction. When the mind isn’t functioning properly, it is illness and the medical model is appropriate. The problem in knowing what is normal functioning of the mind, given natural human variation and the role of learning as opposed to instinct is never going to be solved by doubling down on the proposition that the exercise of the individual’s free will to be mentally fit is the solution. That’s my best judgment.

10

hix 08.02.22 at 3:20 pm

Depression seems to me relativly well defined and makes rather good sense as an ilness category as opposed to a spectrum. There are borderline cases (pun non intended but still nice*) when people are very sad for a good reason and todays diagnosis criteria puts them into the sick category rather fast when the sadness takes too long. Now personality disorders, anxiety disorders …, those are very different animals. The cutoff point is pretty arbitrary and there is even a rich people exception of kind from personality disorders (if only the others suffer, not the one with the disorder it doesnt count). It is not even self evident in every case if the disorder behaviour is the wrong one.

Maybe a more trivial and non loaded example would be fear of heights: How much is realistic and can we really call it an ilness if you can´t distinguish genuinly dangerous hights from those constructed with huge effort for thrill seakers to just look dangerous?

The weird thing about depression is up to a point, depression makes people more realistic in realities assesment. The price in non functionality in addition to outright suffering is just too high to make depression a case up for debates about social construction of ilness for my taste.

11

Fake Dave 08.02.22 at 7:17 pm

Re: “mental hygiene,” some of that terminology is still around. Sleep hygiene (something I struggle with) is still emphasized for a certain kind of insomniac and basically boils down to developing positive habits like turning down the lights in the evening and keeping your sleep area tidy as well as avoiding negative habits like starting projects late at night, midnight snacking, and doing anything too strenuous or engaging (including the wrong kind of reading) at bed time. A lot of these are social norms that people in family settings do pretty well with, but completely fall apart as soon as there’s no one to keep you on track. In a field where Freudian concepts of repression and neuroses are completely discredited and the “serotonin model” of depression has come under question, Durkheim’s description of anomie has held up remarkably well, as have some of the less deterministc/robotic behaviorists who argued that small lifestyle changes could have large impacts.

12

engels 08.02.22 at 10:00 pm

Hygiene (@matt) suggests to me the absence of contaminants, which leads directly to the “cut negative people out of your life” model of well-being I’d imagine we’re all fairly familiar with by now thanks to the internet, and of which I’m not personally a fan. “Fitness” seems to make it a matter of individual effort in a way that I’m not sure is accurate or, erm, healthy. There’s a huge controversy around the concept of “mental illness” ofc and I’ve never understood why that doesn’t to extend to “health” as they each seem to me to imply the absence of the other. If you have to put all the different issues that afflict people under one heading perhaos it would be better to talk about “mental suffering” or “extreme distress” or something?

13

faustusnotes 08.03.22 at 1:29 am

John, please don’t conflate sadness and depression, they’re completely different things. I know there’s a bit of thing in the economics world at the moment to conflate depression, trauma, hopelessness, despair, sadness, struggle, addiction and vulnerability but they’re different and it’s not productive to do so.

People can experience great and powerful sadness and not become depressed, and people can be depressed even though all aspects of their life are good. It’s really, really unhelpful to conflate these two things.

Also, seeing the world as it really is is not depression. And your previous “congenital optimism” wasn’t delusion, it was privilege.

14

Fr. 08.03.22 at 6:44 am

One possible aspect of the analogy is ‘peak shape,’ which is the state that athletes try to reach for competition days, usually by going through training cycles and then going through a taper. It’s hard to achieve, and you rarely manage to achieve more than a few times per year.

15

engels 08.03.22 at 9:15 am

People can experience great and powerful sadness and not become depressed
This isn’t a reason for asserting they’re different, it’s just another way of making the assertion.

people can be depressed even though all aspects of their life are good
People can be sad even though all (other) aspects of their life are good.

Relevant to this discussion perhaps:

Little evidence that chemical imbalance causes depression, UCL scientists find
https://www.theguardian.com/society/2022/jul/20/scientists-question-widespread-use-of-antidepressants-after-survey-on-serotonin

16

SamChevre 08.03.22 at 12:41 pm

I like the analogy, and agree with the idea–mental fitness is something you work can on, and should work on.

I’ll extend, and quibble at the definition of depression. (Noting that depression has been part of my experience since I was in my teens.) I don’t think depression is characteristically like sadness: it’s more gray. (If sadness were pain, depression would be numbness.) One frequent issue with depression is that there’s very little inherent motivation to do things–any things. (One of the more dangerous-in-retrospect episodes I had, I have no memory of getting out of bed for a couple weeks–I must have at least gotten a drink a few times, but I lost a lot of weight.) And fitness-given-depression involves developing something to override that – getting out of bed and eating, getting at least some physical activity – even when all the things that “normal people” have to motivate those behaviours got lost in the depression fog.

17

joeyjoejoe 08.03.22 at 1:03 pm

“And your previous “congenital optimism” wasn’t delusion, it was privilege”

Ah, yes. Personal happiness is an unjustified gift….

18

hix 08.03.22 at 5:21 pm

What exactly is the point of “little evidence for chemical imbalance”. As long as it works, it works and antidepressants do work.* Not for everyone, but for enough to be worthwhile. The problem in my experience is that too many people either don´t even try medication at all for irrational fears or ditch it due to side efects that are harmless compared to the positive effect, or do not try through other types of medication after one does not work when it is definitly still worthwhile.

In contrast to those mrna vaccines where the mechanism is well understood and people still run amok, lots of mental health medicine has mostly we know some people are better off with it than without it reasoning going for them and big question marks about how they work.

Got a friend with a degree in biochemistry that has pretty sever schizophrenia. She always tries to convince me that this or that model about antidepressants or neuroleptica does not work, and my response is always the one above. (Also adding that i might be healthier but her education leven in general and in this field in particular is sure better, so there is no point in asuming i understand any word of the biochemistry she is talking about).

*Things like financial security also work for many and as a society, we sure should try all the sociological things. Since the ones that can be cured entirely by financial security are not 1:1 the same as the one that can be cured by medication (or theraphy, sport whatever), there is no reason for any either or.

19

engels 08.03.22 at 7:27 pm

What exactly is the point of “little evidence for chemical imbalance”. As long as it works

One point might be that anti-depressants have been pushed onto millions of people in UK by GPs and others using exactly this garbage pseudo-science (and in many cases didn’t “work,” whatever that means and might well have caused side effects including life-threatening psychological problems during withdrawal.)

20

engels 08.03.22 at 7:42 pm

The problem in my experience is that too many people either don´t even try medication at all for irrational fears or ditch it due to side efects that are harmless compared to the positive effect, or do not try through other types of medication after one does not work when it is definitly still worthwhile.

That doesn’t seem like “experience” to me but a very strong and seemingly unjustified judgment of other people’s ethical decisions about deep and personal aspects of their own lives.

21

John Quiggin 08.04.22 at 1:53 am

Faustusnotes. While you sometimes have sensible things to say, dealing with you detracts from my mental health and fitness. Please, no more comments on any of my posts, here or at my own blog

22

steven t johnson 08.04.22 at 1:56 am

Depression can have fatal results. Statistics are collected on that. And they were collected long before anti-depressants were supposedly killing people. The notion that anti-depressants “might well have caused side effects including life-threatening psychological problems during withdrawal” on the other hand seems exactly like garbage pseudo-science, pop prejudice with misused medical terminology. Perhaps alarms about use of psychotropic drugs on children and adolescents and their long-term effects is less implausible. But that wasn’t the topic at hand, was it?

The argument that anti-depressants “don’t work” as a simple, relatively cheap long-term substitute for treatment of the whole life—including financial security as hix noted—does not appear to be well-supported, no more than cheap encounter therapy or twelve-step support groups appear to be well-supported. The alleged side effects do not appear to be well-supported. Short term effects of anti-depressants do seem to be well-supported. This has not been attributed to placebo effect so far as I know. But nor do I know why everyone should be certain placebo effect is purely a matter of attitude.

23

Alan White 08.04.22 at 5:42 am

I have been basically optimistic much of my life especially about MLK’s arc of justice in history, then buoyed by Obama’s election in the US, until 2016 and Trump. Days after his election I found myself in the ER for what I though was a heart problem, only later, after an administration of the first and only Xanax I’ve ever had, to self-diagnose that I was having a panic attack thanks to my realization that Agent Orange put a full stop to my life-long glass-half-full attitudes. And my optimism has never returned since, certainly in part because of incessant repeated disappointments about a large segment of my fellow human beings’ reactions to a post-Trump “presidency”. Trump was the catalyst to bring out an explosion of everything submerged in our country (and even internationally) that is vile, hateful, and corrupt, and has continued to this day despite occasional glimmerings of hope like the 2020 election and the results of the Kansas abortion referendum yesterday. Like you John, every day I find a struggle with my mind that does in fact correlate well with that of maintaining body fitness to the best of what I can be. Contributing to positive causes helps. The late-life acknowledged fact that I am privileged by luck and place to do that has accompanied a realization that my obligation to strive to fight back is a big part of what keeps me going. I’ve seen what they could do to me because I did not prepare myself for bitter disappointment; I try every day to do even a little something–helping someone, writing another check, being kind to others–that fights back against hatred and bitterness. I’m not much, but at least I’m something. And I’ll be something until I’m nothing.

24

oldster 08.04.22 at 7:14 am

“I’m not much, but at least I’m something. And I’ll be something until I’m nothing.”
Thank you, Alan White. That sounds like a good exercise for mental fitness.

25

engels 08.04.22 at 10:34 am

Depression can have fatal results. Statistics are collected on that. And they were collected long before anti-depressants were supposedly killing people. The notion that anti-depressants “might well have caused side effects including life-threatening psychological problems during withdrawal” on the other hand seems exactly like garbage pseudo-science, pop prejudice with misused medical terminology

Sorry but this is crankery. The symptoms are well-documented and listed on any number of medical websites otherwise favorable to the use of anti-depressants, should you wish to Google. And it really doesn’t matter which set of statistics was collected first.

26

nastywoman 08.04.22 at 11:22 am

@23
Dear Mr. White –

the world
absolutely
and
entirely
LOVES
you for your comment – as an anytime-life acknowledged fact that I am privileged by luck and place to do that has accompanied a realization that my obligation to strive to fight back is the BIGGEST part of what keeps me going.

27

novakant 08.04.22 at 1:22 pm

I don’t think it’s responsible to spread misinformation (“garbage pseudo-science”) about such a sensitive and complex topic, and certainly not in the aggressive manner engels does here. And the author of the study he links to seems to have been on a crusade against the pharmacological treatment of mental health problems for decades and is rebutted in the same article by the Royal College of Psychiatrists:

Antidepressants are an effective, Nice-recommended treatment for depression that can also be prescribed for a range of physical and mental health conditions. We would not recommend for anyone to stop taking their antidepressants based on this review, and encourage anyone with concerns about their medication to contact their GP.

Especially in cases of major or clinical depression the suicide risk is so high that it would be irresponsible to refrain from prescribing antidepressants to get people out of the initial slump (in combination with some form of therapy or even inpatient treatment) so as to enable them to look at medium and long term options again.

But even in cases that are mild to moderate depression (which sucks too) it should be a matter between an individual and a health care professional to work out what works best for them. This process should be goal oriented and conducted in an atmosphere of trust – it is not helped by patients having ill-informed preconceptions.

28

Aubergine 08.04.22 at 2:19 pm

I like your mental fitness concept. It strikes me as rather Nietzschean; an acknowledgement of responsibility for what the self is becoming, a refusal to reify one’s own emotional states or give them labels so as to externalise them as if they were infections. Maybe not so good as a principle for public mental health policy, but not bad as a personal philosophy.

My congenital optimism now seems more like delusion.

I suspect you’re being too harsh on yourself. We all have our illusions; after all, what is society but a collection of illusions that we collectively agree to pretend to believe? Maybe what you need is to create some new illusions! (but that’s Nietzsche again)

29

engels 08.04.22 at 3:22 pm

Btw I didn’t say “anti-depressants don’t work”—my point was that “work” vs “don’t work” is much too simplistic for a difficult decision involving a range of medical risks and personal goals and values that vary between individuals—but anyone who would like an informed alternative to Steven J’s usual middlebrow mandarinism could do worse than this overview:
https://twitter.com/NaudetFlorian/status/1554747868598214658#m

30

hix 08.04.22 at 6:59 pm

There is one real risk spot in antidepressant threatment – when activity energy goes up while mood only does so with a time lag. That one is a job for the psychiatrist to handle. Withdrawal is just an issue of lowering the dosage slowly instead of from high to zero. And even then that only affects some patients.
The empirical evidence seems to pretty good that at least:
-financial security and independence
-behavioural theraphy and
-antidepressants all three are a lot better than placebos/do nothing
while non of them and no combination of them has a super high sucess rate. The good thing about anti depressants is that there are a lot to try out – sure the sucess probability decreases with every new attempt, still try 10 different antidepressants seems overall one of the more promising things to do.
The empirics on other threatments might well be sometimes less convincing because less standardiced approaches are just harder to measure. As long as it is no traditional Freud type psychotheraphy, why not.

31

Alan White 08.04.22 at 9:08 pm

oldster–thanks for much. I always appreciate your comments too.
nastywoman–what I said to oldster goes for you too–and though I won’t call you “Betty”, you can call me “Al”!

32

engels 08.04.22 at 9:24 pm

I don’t think it’s responsible to spread misinformation (“garbage pseudo-science”)

It’s not misinformation, it’s information: the chemical imbalance story is BS. What that means for the prescription of anti-depressants is a different question (there are some good suggestions in the Twitter thread I linked) but the defences of psychiatric orthodoxy on here have been mostly smoke-blowing, whether aggressive (like Faustusnotes) or passive-aggressive (like you).

33

steven t johnson 08.05.22 at 1:49 am

If engels didn’t mean to say antidepressants don’t work, what engels did say unfortunately really only makes sense as saying antidepressants don’t work. Citing twitter is even more crank than citing wikipedia. The airy demand to Google is also highly dubious. All anti-depressants?

As near as I can tell, hix is misrepresented as defending psychiatric “orthodoxy.” (I know I was misrepresented.) But casting it as a religious reformation against orthodoxy is symptomatic.

And the remark about “other people’s ethical decisions about deep and personal aspects of their own lives” apparently is not just a lapse but a serious symptom. The ethics of taking any drugs? The ethics of being inauthentic, not exercising your free will? The ethics of struggle against weakness? Who knows? And, should anyone else care.

The equation of deaths from major depression to purported deaths from “withdrawal” from anti-depressants is not an ethical question, but a factual one. The bland assumption that suicide has increased because, anti-depressants, does require support.

I’ve known for years that the real case for anti-depressants has always been that statistics show symptomatic relief and the so-called chemical balance theory was at best a hypothesis as to how anti-depressants might work. It is not even certain that the chemical imbalance notion was ever “orthodoxy” in the sense engels suggests. And by the way, there’s a big difference between BS and being wrong.

34

Jim Buck 08.05.22 at 6:40 am

The chemical imbalance theory, it cannot be denied, was never orthodoxy. However, the notion’s great currency has been impelled by the compelling explanatory simplifications of mental health practitioners of all grades and statuses. Having worked various roles in mental hospitals for 18 years, I would opt for ECT if depression ever took hold of me.
Albert Woodfox passed away the other day, optimistic to the last it seems:
““I have hope for humankind. It is my hope that a new human being will evolve so that needless pain and suffering, poverty, exploitation, racism, and injustice will be things of the past.”
https://www.theguardian.com/us-news/2022/aug/04/albert-woodfox-solitary-confinement-prison-angola-three

35

novakant 08.05.22 at 10:50 am

I don’t want to drag this out, but the below might be worth a look for anyone who wants to know what the psychiatric community is actually thinking with regards to the paper about the theory of chemical imbalance and the efficacy of antidepressants – unsurprisingly the matter complex.

https://www.sciencemediacentre.org/expert-reaction-to-a-review-paper-on-the-serotonin-theory-of-depression/

I have never encountered a medical practitioner who subscribed to the view that antidepressants alone would solve a patient’s problems, they always stress the need for therapy and are very aware that depression is caused by multiple factors including psychosocial ones.

Regarding John’s original point:

I think it’s good to see mental health as an ongoing process that requires vigilance, but I think it only works if we are capable of embracing our dark thoughts as part of ourselves (“here we go again”) that we won’t get rid of, while simultaneously viewing them as just that: thoughts that will come and go and don’t determine us.

This only works of course if one isn’t overwhelmed by sadness or depression.

36

Cranky Observer 08.05.22 at 12:18 pm

steven t johnson: if you google “serotonin depression link questioned” you will find references to the current medical literature, although many of the journal articles are paywalled. Short summary by a layman:
1) 1970s – brain researchers identify and publish a correlation between low levels of brain serotonin and depression
2) 1980s – pharmaceutical chemists get to work and very successfully developed SSRIs, which inhibit serotonin re-absorption and raise brain serotonin levels.
Clinical trials report that many, although not all, depression patients report improved symptoms while taking SSRIs. Side effects range from mild to moderate but are generally manageable by adults
3) early 2000s – increasing rates of suicide and attempted suicide by depressed teenagers leads to search for root cause. Researchers find that teens with depression taking SSRIs have much higher incidence of severe suicidal thoughts that those not taking the drug
4) 2005-today – based partially on 3 and partially on the general question of reproducibility in all sciences that is a current topic of concern various researchers look at the correlation between depression and serotonin with new original work, meta studies of work done 1970s-today, and re-review of the original clinical trial data.

Outcome: the causal link between serotonin and depression cannot be confirmed with the clinical trial and statistical tools that are required of new drugs today. Also, there is some evidence that the side effects in teens were observed during the original clinical trials and not followed up on (the drug developers strongly disagree with that).

So there are approved drugs on the market that clearly meet their listed chemical goal of increasing serotonin levels with no more than moderate side effects in adults, that X% of patients report help their depression symptoms, but for which the causal link that justified approval of the drug cannot be confirmed using modern tools and standards. And the number 100-X% who are not helped by SSRIs is not small and cannot be explained.

So that’s quite a pickle for patients, doctors, drug regulators, and medical ethicists.

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David in Tokyo 08.05.22 at 5:19 pm

The problem with antidepressants is that it’s real hard to find cases where they “work” in a significant manner. They do not reduce suicides (although they may change the temporal distribution of those suicides), in the cases where they are statistically significant, they are largely clinically insignificant (i.e. the change in clinical status of the average patient is a tiny fraction of one step on the depression scale; too small a change to be noticed by a patient. But enought to get a paper into a journal.)

Rumor (the scientific literature, that is) has it that the only situation where antidepressants have been shown to be clinically usefull is immediately after first-time diagnosis of magor depression. Yet, at last count, 11% of the US population was taking antidepressants. That’s seriously insane.

Oh, yes. A recent study in Europe found that patients who ended psychiatric drug treatments within less than a year had far better long-term results than patients who continued the drugs for multiple years. But most docs think that patients should never come off these drugs.

In addition to the chemical imbalance theory being completely ridiculously wrong, the Big Pharma definition of an antidepressant is “a drug that when administered to drowning rats causes said rats to struggle longer before they drown.” It’s cruel and stupid, but it’s the only thing they could come up with.

https://www.understandinganimalresearch.org.uk/news/factsheet-on-the-forced-swim-test#:~:text=All%20existing%20antidepressant%20treatments%20for,is%20no%20point%20carrying%20on.

Long story short: “While the FST is a highly effective predictive test of the antidepressant properties of a new treatment, it is now recognised that it is not a valid model of depression.”

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David in Tokyo 08.06.22 at 9:34 am

As the OP has noticed, I’m not impressed with current treatments for depression. (Sorry for the lack of references.)

Here’s a paper on that subject.

https://www.tandfonline.com/doi/abs/10.1080/15622975.2019.1635270?journalCode=iwbp20

Here’s a quote: “Results: In case of non-response, dose escalation and switching between different AD classes did not show superiority over continuation of original AD treatment. ”

What does this mean? It means that for patients who do not respond to an initial treatment (presumably with an antidepressant drug), switching to a different treatment (increased dosages, different drugs, or different treatment altogether) has no advantage over continuing a treatment that didn’t work.

It seems to me that that ought to be seen as problematic. YMMV. of course.

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engels 08.06.22 at 6:56 pm

Lots of good comments! On the OP I just want to say my own learning curve has been similar to John’s—I’ve discovered the things that keep me sane do require effort to keep up—I just worry about the implications of this insight informing public policy.

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John Quiggin 08.06.22 at 11:35 pm

Thanks, everyone for lots of interesting discussion. Oldster @7 has some particularly good suggestions

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FlyByNight 08.07.22 at 7:13 am

On the OP, Corey Keyes has worked for years on what he calls the “two continua” model, suggesting that mental health and mental well-being are related but distinct dimensions.
http://sociology.emory.edu/home/people/faculty/keyes-corey.html

Here’s a recent review paper: https://www.researchgate.net/publication/340439425_Mental_Health_andor_Mental_Illness_A_Scoping_Review_of_the_Evidence_and_Implications_of_the_Dual-Continua_Model_of_Mental_Health

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Some Guy 08.07.22 at 7:19 pm

This book (and other books by the same guy are quite good):
https://www.amazon.com/Learned-Optimism-Change-Your-Mind/dp/1400078393

One can argue about some of the theories behind this, but identifying and correcting one’s inner narrative does seem genuinely quite helpful.

This also is quite good, and seems to have some rigor to it:
https://www.amazon.com/Mindfulness-Eight-Week-Finding-Peace-Frantic/dp/1427217165

If you want to get into meditation in a serious way then this is the best practical manual:
https://www.amazon.com/Mind-Illuminated-Meditation-Integrating-Mindfulness/dp/1501156985

A little more academic/historical:
https://www.amazon.com/Philosophy-Way-Life-Spiritual-Exercises/dp/0631180338

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John Quiggin 08.07.22 at 9:57 pm

I’d like to call A halt to the discussion chemical imbalances. I lack the expertise to moderate it.

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David in Tokyo 08.08.22 at 2:17 pm

FWIW, Japan being dense of old folks (at last count (barely) over 10,000 men and (well) over 70,000 women were over the age of 100), there are lots of ads for books about dealing with old age. One the other day was quite fun, since it was mostly contrarian but technically correct (or at least reasonably arguable) points. It was so good, the author made the rounds of the TV morning shows. It’s title was something on the order of “How to make it to 80” with a subtitle of “If you make it to 80, 100 won’t be a problem at all”. Flaky, yes, but one of the bullet points in the ad was “If you find something irritating or unpleasant, don’t do it.” (With the implication “You’re almost 80, you don’t have to appologize to anyone.”) This resonated here (I just turned 70), since I really like jazz guitar, I have a great teacher, but I’m not spending enough time practicing, and being seriously irritated with myself. (Through last year I was doing better at time management. Sigh.) So my modification of that is, “”If you find something irritating or unpleasant, figure out how to fix it.” The mugginess of the summer here is making that hard, but I’m trying.

Whatever. Hang in there.

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Doug K 08.10.22 at 6:03 pm

Optimism probably is a delusion, but it’s a useful delusion. Hold on to it as long as you can..

As a lifelong pessimist I find it easy to become paralysed by despair. Here are some of my bulwarks against it.

Victor Frankl’s tragic optimism, illustrated –

Once, an elderly general practitioner consulted me because of his severe depression. He could not overcome the loss of his wife who had died two years before and whom he had loved above all else. Now how could I help him? What should I tell him? I refrained from telling him anything, but instead confronted him with a question, “What would have happened, Doctor, if you had died first, and your wife would have had to survive you?:” “Oh,” he said, “for her this would have been terrible; how she would have suffered!” Whereupon I replied, “You see, Doctor, such a suffering has been spared her, and it is you who have spared her this suffering; but now, you have to pay for it by surviving and mourning her.” He said no word but shook my hand and calmly left the office.[5]
— Viktor Frankl (1959). Man’s Search for Meaning.

This seems to me exactly what Alan White @23 (thank you Alan) is doing – “I’m not much, but at least I’m something.”

It is similar to Gramsci’s optimism of the will, dying alone in Mussolini’s jails, in a Letter from Prison –
I’m a pessimist because of intelligence, but an optimist because of will.

Also find Rebecca Solnit helpful on this, from a 2014 New Yorker article on Virginia Woolf,
Despair is a form of certainty, certainty that the future will be a lot like the present or will decline from it; despair is a confident memory of the future, in Gonzalez’s resonant phrase. Optimism is similarly confident about what will happen. Both are grounds for not acting. Hope can be the knowledge that we don’t have that memory and that reality doesn’t necessarily match our plans.

The Eastern Orthodox church, oddly enough. I’m not sure I believe in God but I believe in the congregation.

Luna @1, thank you for the links to the meditation app. Meditation like the antidepressant medications has a complex history and its mechanisms can’t necessarily be proven; like the medications it often works nonetheless.
Most of my meditation is from 2am until time to get up and start work. I sleep like a baby, wake up wailing in terror every two or three hours ;-)

Alan White @23,
Days after his election I found myself in the ER for what I though was a heart problem, only later, after an administration of the first and only Xanax I’ve ever had, to self-diagnose that I was having a panic attack thanks to my realization that Agent Orange put a full stop to my life-long glass-half-full attitudes.

I started a drinking problem after that election, which eventually landed me in the ER with heart problems.. ha. Giving up alcohol was the easy part. The doctors also wanted me to give up strenuous physical exercise which I haven’t managed yet.

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