A Predator of Information

Our songs will all be silenced, but what of it? Go on singing.

PSA: This Is Your Brain on Depression

2 April 2017 2:54 PM (better living through chemistry)

This is your periodic reminder that depressive realism is a bunch of bunk. Depressive realism is the ill-defined notion that either depression is the correct and healthy result of seeing the world for what it is (this is tied up with the idea that intelligent people are or must be or somehow should be unhappy) or that depression somehow strips away the illusions people wrap themselves in and allows one to see the world as it is.

Lars von Trier's (whom you may remember as the gentleman who famously combined Willem Dafoe, a fox, autophagia, and the phrase ‘chaos reigns’ into a scene in his movie Antichrist) film Melancholia was written to just this theme. Von Trier heard from a therapist that depressed people act more calmly in disasters than others because they already expect the worst (whether this is true, I don't know. If it is, it could instead be that they are more prone to dissociation, which can itself make people more prone to post-traumatic stress disorder. It could also be an effect similar to increased suicide risk on some SSRIs; patients would really like to die, but don't have the energy to kill themselves, and sometimes their motivation is restored before their desire to live. A lack of panic could, similarly, be a lack of energy.) and wished to create a world in which terrible, crippling depression was the correct response: one in which the earth was destroyed. His protagonist not only becomes calm, almost serene, as the point of destruction grows closer and everyone else descends into panic and despair, but simply knows things with great detail for no reason at all, as if her melancholy was a telegraph wire into the universe. It's a beautifully made movie and you should watch it. You probably won't like it. I didn't like it, but I'm happy to have seen it since it is very well made as a film and I like to try and grasp the feelings and thoughts of people who think differently than I. It does an excellent job of portraying how depression feels from the inside, but not how it relates to reality.

There are two fundamental problems with the claims of depressive realism. The first is that in experiments depression adds a systematic bias rather than improving overall accuracy. Depressed people believe they have less control in situations. In situations where they actually do have less control, they're right more often. In situations where they don't, they're wrong. They consistently expect worse outcomes, so when games are rigged against them, their predictions are more correct, when games aren't rigged against them, they aren't. They expect others to work against them. When they actually are in a hostile social situation they're more correct, when they aren't, they aren't.

It is undeniable that healthy people are not exemplars of rational prediction. They overestimate their likely success and the amount of control they have over things. I have long said that humans are really bad at probability to anyone who will listen. However, we should be able to agree that replacing one systematic bias with another is not called realism.

Furthermore, it's not adaptive. Perhaps if you were in Lars von Trier's world you might argue that lying still doing nothing is a rational and healthy response to the world being swallowed up by a gas giant. My sympathies lie more with the people in Seveneves who went out with songs and concerts and fireworks when all surface life was destroyed. It doesn't really matter, because ‘the end of the world’ is not happening any time soon. Even if one will be dead from some terminal disease in six months, the rest of the world will still be there afterward and they can affect it before they go.

The types of behavior that depression brings about are not adaptive for dealing with the world. Certainly not an unfriendly and dangerous world. The symptoms of depression are almost identical to sickness behavior, a state that keeps animals still, inactive, away from others, and out of trouble. Depression may, in fact, be a healthy response to disease that has somehow become enacted continually. There are researchers pursuing the theory that depression might have a strong immune or inflammatory component. Depression is not a healthy response to the world, to culture, to troubles at work, and certainly not to having someone you don't like get elected.

The second problem with depressive realism is that depression causes cognitive impairment. It interferes with your memory. It makes it difficult to concentrate. It makes one's thoughts slow and fogged. It also, famously, distorts people's thoughts. A normal person may rate their level of control in a situation overly highly, but when presented with evidence to the contrary, the normal person is more likely to consider and reason through the evidence and change their mind than a depressed person is to similarly change their mind when given evidence that their appraisal of their control in a situation is overly low.

That makes the idea of depressive realism incredibly suspect. It's not impossible that the same condition could cause some large cognitive deficits and clarity in some other areas, but it's unlikely, and I would need a lot of really good evidence to believe it.

Depressive realism does ring true to a lot of depressed people, and there's an excellent explanation for that: the aforementioned cognitive impairments and the feedback from depressive behavior. Well, that and the well-known phenomena that depression is greedy. It will reach out and find or make reasons for its own existence. Someone, when in a non-depressed state, may recognize that they merely feel lonely. In a depressed state they might not just feel lonely, but believe that everyone hates them. Every bit of kindness they're shown can be forgotten, and any slight can be magnified and turned into more evidence. They might withdraw from their friends and acquaintances or be unpleasant to them, and use the way their friends respond to bolster the belief that they are hated. They could come to the conclusion that their feelings are simply a healthy and rational response to seeing a world where everyone hates them as it is, when instead they're seeing a grotesque caricature of a world their feelings and actions have influenced.

Why does this matter to me? Because embracing depressive realism, especially in its ‘folk’ forms, destroys people's lives. Not only is it false, it doesn't even have the decency to be one of the lies that ennobles us. People who fall prey to it, instead of questioning their preconceptions, take them as truth. They decide that the world or society just doesn't value original or creative people so they won't bother. They get the ridiculous idea in their head that they are the enemy of society for this or that reason. They think they must fail, and so fail by never trying. Intelligent people, like them, see the world and all its hollowness for what it is. Empathetic people, like them, see how cruel and empty our culture really is and understand that there's no way for a healthy, sane person to exist inside it in any state of happiness; they're the real sane ones, and you would need to be delusional to be happy in such a terrible world.

You could think of it as the evil twin of Cognitive Behavioral Therapy: a learned pattern of thought optimized to make one less functional and more in thrall to one's disease.

3 responses

  1. says:

    "Depressive realism is the ill-defined notion that either depression is the correct and healthy result of seeing the world for the what it is (this is tied up with the idea that intelligent people are or must be or somehow should be unhappy) or that depression somehow strips away the illusions people wrap themselves in and allows one to see the world as it is."
    Depression is a name for the rational view of the fascism people live in today. It will always be something perceptive people have if these perceptive people live in fascism.
    To solve most cases of depression, eliminate fascism. It's as simple as that. Are you sure no one would call you depressed if you were waterboarded every day for a decade? Get real.

    This post is trash, it misinterprets and mis-assumes so much on a level near axiomatic, there's almost nothing to reply with.
    This sort of post leads to a Brave New World
    A world where people ignore reality.

  2. Azure says:

    If you wish to believe this in any consistent way that doesn't “ignore reality”, you will need to reconcile it with known medical science on the matter.

    Depression is not merely “unhappiness”. Depression is a long-lasting affective state that can be part of several disorders, most famously Major Depressive Disorder and Bipolar Affective Disorder. Symptoms include some combination of extremely low mood, an inability to experience pleasure or happiness, cognitive deficits, distorted thinking, disturbed sleep, disturbed apetite, somatic symptoms such such as feelings of lethargy, low-grade pain, and heaviness in the limbs, and in extreme cases delusions or really unpleasant hallucinations.

    If depression were the healthy and normal response to some secular social malaise, it would be rather unlikely for the ‘perceptive’ people who naturally and normally experience it to show difficulty thinking and perceiving things accurately. Also something that can cause distorted thinking, delusions, and hallucinations is not the poster-child for awareness of reality.

    There are many contributing factors to depression. Some forms of unhappiness increase the likelihood that someone will develop depression, but they do not guarantee it. Some people develop depression with no pre-existing trauma or major unhappiness.

    Other contributing factors include genetic history. Chronphysiology plays an exceptionally large role. There is the famous Seasonal Affect. Recent research also reveals that seeing brighter lights during later parts of the day can also precipitate depressive episodes. There have been a couple famous studies where depressive patients lived for a time in environments where they had no access to artificial light and were exposed to the sun whenever it was in the sky. A surprisingly large proportion of them entered complete remission. Other factors that seem to contribute to the likelihood of developing depression include the microbiome and dietary factors such as the relative ratios of Omega-3 fatty acids to Omega-6 fatty acids. There is a lot of evidence that suggests inflammation has some kind of role in depression. This is not what I would expect to see if depression were a normal and healthy response to secular social malaise.

    Also, depressive episodes seem to just stop happening in the vast majority of patients after several months to a year. In patients with major depressive disorder they come back again sometime later. This is kind of cyclic behavior is also not what I would expect if it were the natural and healthy result of secular social malaise.

    As I said before, some forms of sadness increase ones risk of depression. It seems as if it can act as a trigger in vulnerable populations who have other factors. As such, saying that depression is a normal and healthy response is a bit like saying having your throat close up and kill you is a normal and healthy response to peanuts. Some people feel as if pointing out that it is merely a contributing factor somehow blames people who experience depression; this is rather stupid. It no more blames the affected person than other individual responses to environmental factors blames the individual.

    This doesn't mean that I don't approve of making people less unhappy. I'm a utilitarian. I would want to make people less unhappy whether major depressive disorder existed or not.

    This is not to say that environmental and social factors do not play a role. In a trivial way a socialist utopia would have many fewer people in active depressive episodes, all other things being equal, because any socialist utopia worth its salt has universal healthcare that includes mental health. I would not say that lack of socialism causes depression, however.

    In a less blithe and arbitrary way, anything that causes certain kinds of unhappiness can trigger depression in vulnerable individuals. Thus, constant insecurity and privation caused by the gratuitously awful way capitalism allocates resources could certainly help precipitate depressive episodes. As could the retributive madness of a carcerative society that erects hells on earth and casts people into them for large portions of their lives. Both of these would need to be got rid of whether depression existed or not, and not all people affected by them actually go on to develop depression, though a much larger portion do than the general population.

    And, of course, some people develop depression with no emotional precipitating factor that they or anyone else can name. They simply find themselves wanting to sleep all the time, having difficulty caring about anything, just wanting to lie down and never wake up, and failing to enjoy any part of their lives. You can, of course, talk about ‘alienation’ the way Marxists do, but since a good number of them get better by changing their exposure to light throughout the day or changing their omega-3 to omega-6 ratio or taking a pill that has little other effect or even interrupting feedback cycles by learning to catch and derail self-reinforcing trains of thought, ‘alienation’ has a lot of work to do if it wants to be taken seriously as a theory.

    it seems very unlikely to me, given that some people can become depressed without an emotional trigger and that there are plenty of emotional triggers that have nothing at all to do with secular social malaise, like having someone you love die (and allow me to be clear. Grieving is normal and natural. It is only when several months after a death someone is not only sad, but finds themselves unable to feel happiness in anything, unable to pursue anything they desire to do, or finds themselves wishing they could fall asleep and never wake up that we have moved from grieving to depression), that any societal transformation would suddenly eliminate depression (let alone other mental illness.)

    You could certainly try to ignore all the medical evidence or declare it to be a conspiracy or something, but conspiracies are very difficult to pull off under open access and peer review.

    There are, of course, some legitimate complaints one may have about the current state of the art. One is that the current disease categories are constellations of symptoms that cluster in some way in the population. This is unfortunate, in that we can't do a simple test on someone who has a serious problem and find out what to treat them with. Instead we have a constellation of treatments that work very well for some people with a given set of symptoms and not for others that we have to try in order based on which ones the most people respond to. Similarly we have a bunch of physiological factors that seem to be very closely correlated to symptoms.

    This is a mess and the brain is difficult. Current research is working very hard to fix it. There is a search for biomarkers that can be used to directly diagnose people. One of the more interesting results is that you can predict with high accuracy whether a bipolar 1 patient will respond well to lithium by taking their temperature over the course of a few days.

    Some people think this lack of definite causal relations between physiology and psychiatric symptoms means the whole system is false. I don't think that conclusion is well supported. There's too much data of significance for that. It seems much more to be a science in the process of getting its act together. I expect the entire practice and theory of psychiatry to transform over time. The two most likely outcomes seem to be either a mosaic of diseases with similar outcomes but differing causes or a set of self-sustaining disease networks. Or some combination of the two. Schizophrenia might well turn out to be a few different diseases while depression ends up as a network that can be established by disturbances in some number of equilibria with individual patients differing in susceptibilities.

    One can also complain, legitimately, that capitalism makes health care, and mental healthcare in particular, worse. There is a current, ongoing scandal about the drugs doctors are likely to prescribe their patients being determined to an unhealthy degree by which drug companies take them out to lunch more often. (I don't think this means that doctors are dastardly villains, this isn't a conscious trade where the doctor trades one patient for one lunch, it's more about the doctors having unconscious positive association minds with this or that drug.)

    Capitalism also gives us the horrible problem of aborted trials. Companies will invest in developing a drug and not want to lose the money they spent. So when it looks like a trial will show their drug isn't effective, they'll cancel it and start a new trial and just keep doing this. Since all trials have a component of chance and imprecision in them, it's a bit like being able to roll twelve on a pair of dice ten times in a row if you can just declare that any role you don't like doesn't count.

    People also complain about treating mental illness as a purely individual rather than cultural phenomenon. Some people want to give culture a much larger causative role. I don't think the evidence warrants that, beyond the already stated observation that cultural factors can create more unhappiness and stress that cause depressive or other episodes in people predisposed to them by other factors. I think culture can have a very large role in improving the outcomes and quality of life of those with psychiatric problems.

    Obviously, the carcerative state has to go, for all sorts of reasons. One of its most horrible outcomes is that when mental healthcare was heavily cut, people with any sort of mental illness ended up in jails and prisons aka hells on earth. it should be obvious to anyone that this is going to do nothing but make the people involved miserable and put them under even more stress and unhappiness. We have lots of reasons to end the carcerative state even apart from mental illness. Basic decency, for a start.

    There are lots of reasons to want a universal basic income at the least. It is a societal, economic factor that can vastly increase the well-being of people with a mental illness since they can step back and stop doing something for a bit, collect themselves, seek treatment, and not have to worry about ending up homeless as a result.

    The competitive nature of current capitalist society also takes a heavy toll on the mentally (and physically) ill, as well as the merely economically unlucky. You have heard of people being unable to get a job due to having a broken resumé (large gaps between jobs). Those who have taken time off of working for mental or physical health reasons often have a hard time getting back into work, as do those who have simply had trouble being hired in economic hard times. This is also one of the reasons why women are penalized in the workplace: a woman taking time off to be with a child is penalized for it. There's a similar effect to people who take a job out of their field and come back to it later.

    This was less of an issue in the 18th and 19th centuries. People serious cases of bipolar disorder were able to be quite productive even without medication because they were not barred from their fields for times of illness or inactivity. Georg Cantor, Master of Infinity, for example spend much time in his day's equivalent of mental hospitals or making bad literary arguments, but was always able to return to mathematics whenever he wished.

    Well, not exactly. Even though he never lost his position and even during times in his life where he was financially secure he would have long periods where he was suffering depression and wished more than anything that he could work on mathematics, but was unable to work for the constant fatigue and mental fog of depression.

    Even in the kind of society you wish for, it seems almost certain to me that such forms of depression where people without material insecurity or fear of violence would suffer due to their mental illness making them unable to pursue their own self-directed goals of play and discovery.

    There are other factors. The stigma of mental illness harms people by making others not want to hire them or be around them. It makes those who are suffering unwilling to seek treatment. It's dying off, thankfully.

    There is a danger, as has happened in other revolutionary movements that declared mental illness to be a social pathology of whatever state they opposed, of resurrecting it. People who believed that mental illness was the result of some social factor that they have eliminated have had, historically, a tendency to be really horrible to those who continue to have symptoms of mental illness, treating them as reactionary malingerers or similar garbage.

  3. says:

    https://ashspace.org/contribs/carthago_deleta/living_as_a_suicidal.php

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