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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 31 to 55 of 55. Go back in thread:
Posted by Conundrum on May 15, 2010, at 23:25:38
In reply to Re: History of depression - um?, posted by sigismund on May 15, 2010, at 20:15:16
I think nervous breakdowns was basically a major depressive episode. This is not really a currently accepted medical term. Maybe it had been at one time.
Posted by ed_uk2010 on May 16, 2010, at 2:47:10
In reply to Re: History of depression - um?, posted by sigismund on May 15, 2010, at 20:15:16
>Do people have nervous breakdowns these days?
It used to be a very popular term among the general public in Britain. I've not heard it as much recently.
I think it referred to anything which was bad enough to need a few months off work, plus or minus a hospital stay. Could be depression but also severe anxiety.
It's not a scientific term but it's no worse than most of the popular psych terminology. The worst is probably 'dysphoria', which can refer to pretty much any unpleasant emotion. Talk about vague. If someone on p-babble asks 'What should I take for dysphoria?', I really have no idea what they are talking about. Now if they said they were feeling anxious, distressed, jealous, angry, sad, agitated, bored, tired, weak, restless or frightened I would have more idea what they were talking about.
Posted by sigismund on May 16, 2010, at 16:15:03
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 16, 2010, at 2:47:10
>it's no worse than most of the popular psych terminology.
Indeed.
When duty is a more compelling social force and the possibility of rescue (FWIW) by the psych profession not a feature of the landscape, it makes sense that invalidism is marked by a more violent social rupture, which is why the term has dropped out.
Take those killings of children in China, for example.
Posted by ed_uk2010 on May 16, 2010, at 16:39:06
In reply to Re: History of depression - um? » ed_uk2010, posted by sigismund on May 16, 2010, at 16:15:03
>When duty is a more compelling social force and the possibility of rescue (FWIW) by the psych profession not a feature of the landscape, it makes sense that invalidism is marked by a more violent social rupture, which is why the term has dropped out.
Hi Sigi,
Not sure that I fully understand. Do you mean that in some cultures, depression is not diagnosed because people simply don't have the option of taking on the 'sick role' unless they are totally incapacitated?
Posted by sigismund on May 16, 2010, at 17:54:05
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 16, 2010, at 16:39:06
>Do you mean that in some cultures, depression is not diagnosed because people simply don't have the option of taking on the 'sick role' unless they are totally incapacitated?
Exactly. If being sick is not an option, you either stay as well as you can appear to be, or you crack.
The expression 'running amok', comes from Malaya, I think.
Posted by ed_uk2010 on May 17, 2010, at 13:49:27
In reply to Re: History of depression - um? » ed_uk2010, posted by sigismund on May 16, 2010, at 17:54:05
>The expression 'running amok', comes from Malaya, I think.
Isn't that when someone starts running around killing people?
Posted by sigismund on May 17, 2010, at 16:10:29
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 17, 2010, at 13:49:27
>Isn't that when someone starts running around killing people?
Yes....like those killings in China.
I wonder if mental illness manifests differently in individualistic cultures as opposed to collectivist ones.
Posted by linkadge on May 17, 2010, at 20:00:40
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 15, 2010, at 16:55:11
And - in selling an illness you need to make the prognosis (for a disease without treatment) as sounding as bad as possible.
Something like 15% of the U.S. population is on antidepressants. I don't believe that this 15% would all commit suicide if their depression happened not to be treated with drugs. Infact, depending on the data you choose to look at, suicide rates have not dropped significantly since the introduction of antidepressants.
People would suffer, but for most depressions, the disease dose remit after 8-12 months. Then, typically the patient would be better for extended periods. Even in our "family history" of depression, those who didn't treat usually had 2-3 episodes in a lifetime. Yet, they were absolutely *fine* between epsiodes.
Nowadays, we are on the meds for life. Just because we have had an epsiode or two. Most of use just can't get off the drugs or don't want to get off the drugs.
Linkadge
Posted by linkadge on May 17, 2010, at 20:05:35
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 16, 2010, at 2:47:10
Perhaps this is it. For our prediction of the disease outcome, we are relying on an old definition of the disorder.
Sure, people who had the disease in the 50's, may have had a poor outcome, but can the same thing be said for the 1 in 5 Americans diagnosed with depression sometime in their lifetime these days?
Posted by linkadge on May 17, 2010, at 20:17:28
In reply to Re: History of depression - um? » ed_uk2010, posted by sigismund on May 16, 2010, at 17:54:05
>Exactly. If being sick is not an option, you >either stay as well as you can appear to be, or >you crack
Sometimes being mentally healthy simply requires the right adaptive response for the right situation. Even the thought that one should not
"have to" suffer, opens doors which directly counteract this adaptive response.We are spoiled as a society. Rising obesity is one indicator of this. Depression can be just be another manifestation of lack of psysiological stimulii. We weren't mean to sit in front of computers all day eating little white powdered donuts.
Weren't suicide rates in Brittan at an all time low during the WWII bombings?
Linkadge
Posted by linkadge on May 17, 2010, at 20:23:24
In reply to Re: History of depression - um? » ed_uk2010, posted by sigismund on May 17, 2010, at 16:10:29
>I wonder if mental illness manifests differently >in individualistic cultures as opposed to >collectivist ones.
Well, collectivist ones likely engage in more "group therapy" so to speak.
Individualist societies also learn to seek reward for ones self. Self focused reward is shallow (like crack). Reward for pleasing others probably employes different brain regions entirely -keeps us connected. Strong social networks help maintain immune responses during stressful times. Strong social networks lower cortisol during stressful events too.
Just the idea of getting ones mind off ones self is probably an extremly powerful antidepressant.
Linkadge
Posted by sigismund on May 17, 2010, at 20:42:13
In reply to Re: History of depression - um? » sigismund, posted by linkadge on May 17, 2010, at 20:23:24
If you ask Vietnamese school kids (in Vietnam) to ask you a question, mostly they will ask you your age. This is so they know which of the numerous forms of address is the appropriate one.
One girl at the English language school didn't want to come to Australia. Her friend had told her she was very lonely here. There the life is all on the street.
When a person from a culture like that goes crazy or depressed, it must be different.
Posted by chujoe on May 18, 2010, at 7:12:51
In reply to Re: History of depression - um? » linkadge, posted by sigismund on May 17, 2010, at 20:42:13
This is absolutely true. Though I'm an American I have lived for extended periods in Vietnam. One of the things I love about the place is how much of life is lived communally. But there is great pressure to conform because failure to conform often means being excluded & lonely. It is hard for us in the west to understand how frightening the prospect of loneliness is to a Vietnamese person -- whether that loneliness is caused by immigration or mental illness.
A number of people have noted lately here on PB that "mental illness" exhibits itself differently in different cultures, a fact that might give us some clues as to what happens when someone gets sick. Personally, I think it's a combination of biological predisposition and environmental influences, including the influences of the social worlds in which an individual lives.
Posted by ed_uk2010 on May 18, 2010, at 15:25:44
In reply to Re: History of depression - um? » sigismund, posted by linkadge on May 17, 2010, at 20:23:24
>Individualist societies also learn to seek reward for ones self.
I suppose it leads to people becoming quickly disatisfied?
I guess there's a growing belief in the West that we shouldn't have to feel psychological pain. Minor/temporary psychological problems are increasingly medicalised (and treated with SSRIs).
Whether or not a person's condition should be viewed as an illness is often quite subjective.
Posted by hyperfocus on May 19, 2010, at 17:48:45
In reply to Interesting article? What do you think?, posted by Laney on May 9, 2010, at 11:38:40
I can't understand how Robert Whitaker is allowed to completely misstate the facts about how depression and drugs works. His descriptions of how psych drugs work are very naive. He says stuff like psych drugs are 'stimulating' and hence can cause bipolar mania...and that drugs can convert unipolar to bipolar depression and cause cognitive problems over time. That's not really how it works. The guy clearly has very limited knowledge about psychiatry and psychopharmology and is just cherry-picking statements and studies to support his thesis. I can easily count a dozen people on PB who could right a better book than him.
Remember in the film Sixth Sense when the wife was taking Zoloft after her husband died?
My takeaway from this article and the ones posted in this thread is that people with TRD, bipolar, psychotic depression or depression co-morbid with anxiety, dissociation, etc. must be separated from people experiencing depression after a traumatic event. It's doing a disservice to everybody and just skews the data too much to keep the two groups of people together. When you try to do an empirical study you end up with absurd conclusions like in the Mercola and Newsweek article. I'm pretty sure in many people you can treat an acute episode of depression with lifestyle changes and counselling and most of all, healing time, effectively. For these people prescribing ADs may not be the best course of treatment and can cause more problems due to side effects and hitting the wrong receptors. But people with chronic, serious depression need drugs, and all of the studies show that the right drugs can help people like us.The 2nd thing is that I don't think we've got to a point where depression and other non-psychotic mental illnesses are accepted as real diseases. When I hear doctors like Mercola talking about willpower and control I get mad because they're basically saying that all people with depression can just snap out of it.
Posted by StillHopefull on May 20, 2010, at 10:47:52
In reply to Re: Interesting article? What do you think?, posted by hyperfocus on May 19, 2010, at 17:48:45
Just my opinion - worth what you pay for it... ;-D
There are times in everyone's life when things happen to cause stress, anxiety, anger, sadness, grief. If a loved one dies, certainly it is understandable to go through a very rough time, and have difficulty dealing with day to day routines. This is part of living and NOT a disease. Time, understanding, and compassion will get people through things like this.
Time, understanding, and compassion will NOT help someone who has a disease of mental illness. This is when medication is necessary and life saving.
I think that Landy is right. The DISEASE needs to be kept separate from normal human feelings that we all have from time to time.
Posted by hansi555 on May 20, 2010, at 11:04:47
In reply to Re: Interesting article? What do you think?, posted by StillHopefull on May 20, 2010, at 10:47:52
I totally agree
And that is why I also will go off the meds.I had a single episode more than 2 years ago and if I am going to try without the meds it should be now and not in 2 or 3 years from now. Besides I have had so many upps and downs that I amwondering how much the meds are doing for me...
Posted by linkadge on May 20, 2010, at 14:57:25
In reply to Re: History of depression - um? » linkadge, posted by ed_uk2010 on May 18, 2010, at 15:25:44
The way I see it, mental health is often a delicate ballance between internal and external forces.
If there is too much external and not enough internal, one can become depersonalized, socially sensitized and dependant.
If there is too much internal and not enough external, one becomes rumanative, anxious, self focused / self seeking, selfish, lonely etc.
I personally believe it is an internal / external ballance that keeps us sane. Sometimes I know I desperately need to get away from people. Sometimes I know I desperately need to connect to people.
Linkadge
Posted by linkadge on May 20, 2010, at 15:09:20
In reply to Re: Interesting article? What do you think?, posted by StillHopefull on May 20, 2010, at 10:47:52
>Time, understanding, and compassion will NOT >help someone who has a disease of mental >illness.
I'm not so sure.
Science shows that the placebo effect is real. Yes, depression is a real disease characterized by real, measurable alterations in neurochemical function. That being said, the placebo effect can also produce real measurable changes in neurochemical function.
I would say that a large percentage of people who are suffering from depression these days (or at least a large percentage of those taking SSRIs), would (and do) benefit clinically from time, understanding and compassion.
Infact, the "time" factor has been shown (statistically and clinically) to be a big variable in depression recovery. Most depressive epsidoes will clear up (meds or no meds) within 6 months to 2 years. Stressful life events play a big role in the development and recovery from depression. Understanding and compassion are the basis for the documented antidepressant effects of CBT. Understanding and compassion can help reduce stress and thus promote recovery.
Many studies show that when patients are shown true compassion within a hospital setting, they will recover faster from their illness. Somtimes the differece between an effective doctor and an innefective one, is not so much the choice of drugs, but the communication of compassion to the depressed patient.
Of course, every depressed patient claims that their depression is immune to such flaky factors, but we are all human.
Linkadge
Posted by Phillipa on May 20, 2010, at 20:09:33
In reply to Re: Interesting article? What do you think? » StillHopefull, posted by linkadge on May 20, 2010, at 15:09:20
Link I totally agree about the compassion and trusting a doc any kind is the best medicine on earth to me. Phillipa
Posted by floatingbridge on May 23, 2010, at 14:31:27
In reply to Re: History of depression - um? » linkadge, posted by ed_uk2010 on May 15, 2010, at 10:12:49
Could it be that depressives did not have time to be depressed? Hard labor was part of daily life. So much has changed culturally. Can you imagine telling a farmer to exercise more?
(What about all those hunting accidents?)
Mercola is a bit of a self-made quack-a-doodle. I read him if I want to feel paranoid.
Posted by ed_uk2010 on May 23, 2010, at 14:51:30
In reply to Re: History of depression - um? » ed_uk2010, posted by floatingbridge on May 23, 2010, at 14:31:27
>Could it be that depressives did not have time to be depressed?
In the absence of social security, mild/moderate depressives would have to continue working as their only option. Only very severe cases would be diagnosed.
Posted by floatingbridge on May 23, 2010, at 15:01:08
In reply to Re: History of depression - um? » floatingbridge, posted by ed_uk2010 on May 23, 2010, at 14:51:30
Ed, do you know I meant in no way to trivial anyone's depression or other illness? My quote sounded flippant. Apologies to all. The black dog chases me constantly.
When I think of the household labor comprising a woman's daily life 60 + years ago, it's mind-boggling. Who needed speed-walking when laundry was boiled and beat with a wooden plunging rod?
Posted by ed_uk2010 on May 23, 2010, at 15:32:59
In reply to Re: History of depression - um? » ed_uk2010, posted by floatingbridge on May 23, 2010, at 15:01:08
> Ed, do you know I meant in no way to trivial anyone's depression or other illness?
Oh I know, me neither.
The presentation of psychiatric illness differs depending on a person's cultural circumstances, and this changes over time.
Posted by Phillipa on May 23, 2010, at 19:48:51
In reply to Re: History of depression - um? » floatingbridge, posted by ed_uk2010 on May 23, 2010, at 15:32:59
So true. And FB glad I didn't have to clean then. Phillipa
This is the end of the thread.
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