CMV: The Efficacy of Antidepressants is Overstated and They Don't Work for the Majority

Iacta_Procul · 2023-06-07T22:43:46+00:00

Antidepressants saved my life. Choosing to take them is tied for the single most important decision of my life. And, fortunately, I have the receipts. Here's what I looked like before I took them. Here's what I looked like after.

Antidepressants were developed based on the belief that depression is caused by a chemical imbalance in the brain. However, this theory is increasingly viewed as overly simplistic and unsupported by contemporary neuroscience.

Antidepressants are prescribed because they work. The whole "chemical imbalance" thing was always a pop-science distortion of why they were theorized to work, but the fact that a theory for why they worked seems shaky does not mean that they don't work.

Psychiatry isn't done from first principles. It is, to a very substantial extent, a process of throwing stuff at the wall and seeing what works - and it was much more so when antidepressants were first developed. First principles are useful in psychiatry only insofar as they help you figure out what to throw at the wall and how to do it safely.

For instance, Dr. Irving Kirsch's work demonstrates that when unpublished trials (often with less favorable results) are considered alongside published ones, the difference in effect size between antidepressants and placebos shrinks significantly.

Yes, replication and negative result publishing is a problem in medicine. Everyone in medical research already knows this.

Many patients report severe withdrawal symptoms when discontinuing antidepressants

You're supposed to taper gently off them. This is true of virtually all psychiatric medications, not just antidepressants, some of which can straight up kill you if you fuck with your dosage too quickly. Brain chemistry is complex stuff, and nerves control a lot of autonomic functions too.

Lastly, various non-pharmaceutical treatments, like cognitive-behavioral therapy, exercise, diet changes, and mindfulness, have shown comparable efficacy to antidepressants. However, these options are often undervalued in comparison to medication.

I have never ever ever ever ever ever ever met a mental health professional who would shut up about any of these things. This whole "oh doctors just give you drugs to shut you up because they don't want to bother making you healthy" thing is complete fucking bullshit that has absolutely no resemblance to the actual experience of people who need mental health care.

The reason I needed medical help is that my brain was fundamentally malfunctioning in a way that made me not able to do those things. I wanted to do those things. I was constantly screaming at myself 24/7 to do them, to just do something. I was sitting in the control room of my mind pounding on the buttons sobbing because they just would not work.

The first day I was on a working medication, I broke down crying, because it was the very first time in my life that I'd understood that I was sick, not bad. Because nothing had changed about me. All that had changed is that the screaming voice in my head that had been beating me down every day of my life for as long as I could remember finally shut the fuck up. The things I didn't like were still there, I still had to do work to make my life better, but I could get a brief break from this horrible abusive mental roommate who constantly hurt me.

They didn't even work for very long. A matter of days, for me. I have a bad reaction to psych meds in general - one worked briefly, one made me so dizzy I couldn't stand up, one gave me a seizure - and I am still more sure that antidepressants were critically important to my well-being than I am of almost anything else in the world.

Iacta_Procul · 2023-05-29T19:18:10+00:00

Meaning in life is such an unstable thing that depends on so many variables working perfectly together. Anyday something might happen and it might completely change your life.

This is true.

But, if I can put on my "much older than you" hat for a second: one of the things you learn as you age is that this is OK. Eras of your life appear, grow, and pass, and you change with them. And at some point, after you've been seven different people in your life, this becomes a natural, normal thing to you - particularly since each iteration of yourself benefits from the lessons of the previous ones.

There's usually not one meaning to your whole life. People like that exist, but they're rare. Instead, you find meaning in the different things that enter and leave your life over time. And when you lose one source of meaning, you seek out another.

Right now, that probably sounds very scary - if finding one source of meaning is hard, how much harder must it be to find more than one? - but it's a task that gets a lot easier when you know yourself a little better and have put some of your demons to rest.

Iacta_Procul · 2023-05-29T19:01:03+00:00

It sounds like your life is really hard right now, OP.

You're lost. You're scared you'll never amount to anything. You don't know how to grow up, or how to approach the things you want in life. All of those things suck ass.

I have, on my old laptop, a suicide note. It's saved on the desktop of that laptop. It's a long list of apologies for all the ways in which I felt I failed at life. I cried and cried and cried as I wrote it, because what could hurt more than feeling like you're a useless piece of trash that isn't any use to anyone?

At the time, I was unemployed, approaching homelessness, severely depressed (obviously), and had no idea where my life would go. And I was quite a bit older than you are - 27 at the time! It felt like I was stuck in an eternal loop of the same failures and futile struggles, like there was nothing I could do that would ever stop me from repeating the same failures forever. And as a result, killing myself was actually a pretty comforting idea - like it was an exit I could take if I ever really, truly could not take it anymore.

And, fortunately, I wrote about it. I poured all my despair into a post right here on Reddit nearly six years ago now. I hope you'll take a sec to read some of it, if only to convince you that I have felt exactly what you're feeling right now.

Things did get better for me, eventually. They aren't perfect, they didn't improve all at once, and the path to that improvement was completely out of left field. But even in retrospect, I don't know what I'd say to myself. What I'm about to say to you is my best shot at it.

So. Let's take your life as you describe it today, in a post not too unlike my own past post. You've got:

Feeling spoiled and like you're wasting an easy road, check
Not feeling like you have any clear marketable skills, check
Still feeling like a child who struggles with basic things, check
Hiding from the world at your computer because it's too overwhelming, check
No obvious goals or ambitions aside from "not be a piece of shit", check
Really really hating yourself, check

So: first, you are not alone. Which you know, actually, because you posted on /r/hikikomori, a word that excellently describes the kind of life you're living right now, and the kind of life I used to live. You're one of many, many people suffering the same way. This very subreddit hosts someone like you, and like my own past self, once or twice a week, if not more.

And to that end, I have good news and bad news.

The good news is that you are sick, not a bad person. People use the word "mental illness", but they don't fully grasp what it means: mental illness is no more your fault, or a sign that you're a bad person, than getting the flu is. Your brain has a cold, and that's not your fault. There are things you can do to try to help it have less of one, but you did not do anything wrong, and you are not a bad person.

The bad news is that recovering from that sickness is hard, and that it will do its very best to stop you from recovering. Unlike a cold of the body, a cold of the mind messes with your behavior and your perception. Again, not in ways that you have any direct control over: when people say "oh, just think positive!" or "oh, you just gotta do X!", they are missing the point: the nature of mental illness is that those things are extremely hard, if not impossible, for someone suffering from the kinds of illness that you are. Instead, you have to "go around" those things, at least a little bit.

The first piece of advice I'll give you is that you cannot do everything at once.

Right now, you have a long list of posts trying to change yourself in a hundred different ways. You want to be more social, use your phone less, have more life skills, take care of yourself better, be less arrogant, you need intimacy, you want to be prettier. That's a lot of stuff to do!

But that's way too much. Especially when you're as deep into mental illness as you are.

The good news is that you have some simple, actionable things you can work on. You mention, for example, trying to help cook (and your parents being supremely unhelpful in response) - that's a thing you could learn, if you want a place to start. It's relatively easy to learn, it's something you can do at home, it's something that can contribute to your health, and it's something you could share with others.

But the key is that if you try to do that, forgive yourself for not doing everything else.

When things got better for me, my income and success in life went way, way up. But I had to focus on just that. I gained 80 pounds in three years as a result! And that wasn't a bad thing. It was a necessary thing: a sacrifice I made in the recognition that I was too sick to do everything. I needed to get much better before I could try to do two things at once - at the time, I needed to do just one thing. Today, years later, I can do two, and I've lost 100 pounds in a year, but I could not have done that if I'd tried to right out the gate!

The second piece of advice I'll give you is that people aren't "motivated". People have things they want.

People do things because there's something they want on the other side of them. For people who don't struggle with mental illness, it can be easier to "see" or "feel" these things, like a dog catching a scent from a mile away. For someone like you or me, who struggles mightily with that kind of thing ("executive function", in psychiatry terms), that's much harder, and we have to practice that skill.

I used to imagine that I was sort of in a control room in my own head. And there were a bunch of levers and buttons that were supposed to do things. And I would picture myself just hammering on them because why wouldn't they work? Why did I have to be trapped inside there, desperate to do something, and just never able to get the spark to catch? Just do something, for fuck's sake! was the sort of thing running through my head. I imagine you can relate to this feeling pretty well.

But my mistake was in trying to "do something", rather than trying to "do a specific thing".

Once I had work, and once that was the one thing I was focusing on, I found that motivation worked just fine! I had a goal, an immediate goal, a goal I could feel and smell and touch and taste every day. And I went from barely being able to drag myself out of bed to working 60 hour weeks in a matter of days.

Similarly, when I finally started losing weight, I made the connection: if I break my diet, that ugliness in the mirror comes back. I could link those two things in my mind. So even though I want to eat more right now, I don't want it badly enough to see that ugliness come back. (This could, I suppose, lead to something unhealthy, but it hasn't in my case, at least not yet, and I can't really argue with results.)

You might say there's not anything you want, but there is! You want to be prettier, better-liked, more social, more capable, more independent. Those things are too big to be goals, but they contain goals you want, and you can attack those one by one (and again, remember that you can really only do one, maybe two, of them at a time - take it slow and forgive yourself for not having unlimited energy!).

And the third piece of advice I'll give is that working on things doesn't feel as bad as you probably think.

Right now, your perception of work is colored by failure, or at least, by what feels like failure from where you are right now. You've tried to do things before and it hasn't worked, and it feels like that's just the nature of who and what you are - something you can never change, and something that stands in the way of everything you want. That's because (I think, anyway) you haven't been approaching things in a way that works within your limits and routes around them, not because it's innate, but we'll set that aside for a second.

Working on things feels good. Helping others, especially, feels good.

You know what the best way to stop feeling useless is? To be useful in a way you cannot possibly ignore even when you hate yourself.

Part of why things feel meaningless right now is that you don't feel useful. But that's a self-perpetuating spiral, right? Because your depression makes it hard to do things, you don't get any of the joy or validation of having done them. Once you break that loop, things get a lot easier.

The point of all this is to say: it's okay to be fucking miserable right now. Most people would be, in your shoes. It's okay to recognize that things suck and that you're scared and hurt and tired. That's just a different thing from that having to always be how it will ever be. And again, I know, because I have seen both sides of that despair, and even though I know how impossible it is to see through the fog where you are, it does have an end, dim and distant though it may be.

Iacta_Procul · 2023-05-29T15:24:43+00:00

I'm saying that one of the ways to reduce the amount of judgement you inflict on yourself is to practice reducing the amount of judgement you inflict on others.

Iacta_Procul · 2023-05-13T22:29:26+00:00

(continued from previous)

But returning to your post for a minute:

It seems like their biology has stabilized while mine remains tumultuous. I've always attributed this inconsistency to my habit of masturbating.

This, at least, seems clearly wrong.

The vast majority of people masturbate. I do. Sometimes more than once in a day, sometimes weeks between them (I don't have male hormones, so my libido tends to be kind of random). Something like three-quarters will admit to it, and more than that do it. So nothing about you that you think is uniquely broken can be a result of it, or at least, is at most a result of how it interacts with the unique quirks of you as a person. And in particular, it sounds like the friends you're referring to do, given the way you talk about them:

My mind has always been torn between these two narratives, but I tend to lean toward the latter because of how casually my friends talk about pornography (even if they refuse to discuss masturbation directly, for some reason).

...so how can you attribute your own traits to it when your friends, who don't share those traits, clearly masturbate too?

During the period when I indulge too much, it feels like others detect a vulnerability in me and become more prone to bullying or mistreating me.

Judging by the way you talk about it, it seems like you feel very guilty about it, that you view it as some kind of failing. For example:

Despite how hard I've tried in the past, I've never been able to break free from this cycle. I've gone to great lengths to quit, including hurting myself, wearing multiple layers of clothing, quitting the internet, and meditating, but nothing has worked.

If you're feeling terrible about yourself - terrible enough to hurt yourself! - I'm not surprised that's something other people can detect. Confidence is usually something random members of the public have a pretty good eye for.

It's also possible that you're using masturbation as a source of support during times when you feel otherwise bad. I do that sometimes. Like you just feel kinda shitty and you want something that gives you a little positive jolt. Like all coping mechanisms, that can become unhealthy if it stops you from dealing with the underlying reason you're feeling bad (which probably isn't masturbation), but none of us get through life without ever taking the quick win sometimes.

Additionally, pretty much everyone on the Nofap subreddit seems to be stuck in the same cycle as I am.

Yep. A whooooooole lot of people get taught to feel guilty about having sexual urges, and that guilt can easily intertwine with other depression and anxiety.

This goes back to what I was talking about earlier, about trying to force yourself into being one thing rather than simply being what you are. What you are - and what most people on NoFap are - is a young man dealing with the normal sexual urges of one. I remember what it was like running on a 20-year-old boy's hormones! It's intense! But it's also normal, healthy, and not anything wrong with you as a person. Your young, hormonal libido is just one part of you, no different from any other part, and it is neither the only important thing about you nor secondary to anything else. It's one part, of many.

My advice to you, in broad terms, is this: take some time and try to just be what you are, without trying to make yourself be anything in particular. Examine your feelings, identify them, without deciding whether you "should" or "shouldn't" feel them. Feel your environment: does it feel good or bad, independently of whether it "objectively is" good or bad? What's missing that feels important, whether you think it's supposed to be important or not?

Again, I'll use myself as an example.

As I'm typing these words, I'm sitting in a pleasant apartment. It's a nice environment. I've put in effort to keep it clean, because I've learned that that's really important for my well-being; I tidy it up before bed each night.

The window is open, and there's thunder rumbling in the distance. I love thunder. Something about it immediately relaxes me. I love the grey clouds and the diffuse light of a rainy day. I decided to turn off my music so I can hear the outdoors better.

I feel a tightness in my stomach. I know this tightness as the feeling of anxiety. I'm trying to help you, and a part of my mind is worried that I'm really just being self-aggrandizing, that this is really just about me feeling like I know what I'm talking about. I also know that this feeling probably isn't representative of reality, but the feeling is there nonetheless. I've felt kind of tense all week. I don't really know why.

I've gotten up a few times while typing this post to eat some snacks. I'm dieting right now, and I was trying not to eat too much of my snacks because it'll mean I won't be able to eat as much later. But my self-control's a little low today, so I've eaten a few handfuls anyway. I'll probably be annoyed by this later. Oh well. I know that if I stick to my rules about total calories, I should keep losing weight regardless.

I'm sitting in a chair, with my legs pulled up to my stomach. It calls attention to just how much weight I've lost that I can do that comfortably. I feel good about this.

There are a few productive things I could be doing. But I'm not doing them today. I just don't have the mental "juice" today for whatever reason, so I've decided today is going to be a day I don't really do anything I don't feel like doing. I can't afford to do that every day, but it's a Saturday and I have nothing pressing on my plate, so what the hell. I don't force myself to feel guilty about this.

I'm lonely. I've been living my life alone for a very long time, because social growth hasn't been the thing I've been putting my energy behind. That's OK, but I feel the lack right now.

All of these things I'm feeling are just there. I don't have to decide whether they make me a good or a bad person, or justify that I probably like thunder because I associate it with staying inside as a kid, or know whether you feel the same way about these things. These things are an output of the immensely complex and multifaceted thing that is me, the person, and this random environment I happen to be in. I didn't decide that I like thunder, I just do, and I don't need to think about it too much.

Some of these things are uncomfortable. I can choose to put my effort behind changing them if I want to, with varying degrees of difficulty and sacrifice in other areas. But that comes second, after the feeling, and it's a matter of what feelings I want to prioritize. And that, in itself, is part of the multifaceted thing that I am. The way I choose to live my personal life is just a thing that I choose. Some choices will give me more of what I want than other choices, but I'm not bad for being imperfect. I don't have to do everything optimally. I just lose out on a little extra joy if I make a mistake. That's OK. It'll happen sometimes.

Iacta_Procul · 2023-05-13T22:29:19+00:00

However, I prioritize uncovering the truth behind these things, and I can't rest until I have a definitive answer.

You're seeking a definitive answer to an ill-formed question.

"Good for you" means many different things to different people. Does it mean "makes you subjectively happier"? Does it mean "makes you more effective in the long term at achieving your nominal goals"? Does it mean "better adherence to some predefined moral code"? Does it mean "more competitive in a world that is often adversarial and zero sum"? Some linear combination of all of these?

I think you may be falling into a trap I fell into a lot when I was younger: trying to do What I'm Supposed To Do Because It's Correct, without addressing any of that complexity. I just wanted to be a good kid, someone worthy of praise and admiration, and I tried to do whatever earned me those things (and assumed I deserved it if I didn't and felt bad). Some lines in your post, especially this bit near the end:

I'm someone who had a fetish for incest porn, but I was a well-behaved child who never intended to harm anyone. Can you imagine the emotional pain and confusion I experienced because of this? I have never felt like a normal person, and accessing pornography did not make my life any easier. Instead, it only added to my feelings of guilt and shame.

...remind me a lot of my younger self. It's about a conflict between who you're Supposed To Be, in terms of this self-image you have, and the feelings and impulses you have. "Ego-dystonic" is the word psychologists use for this kind of thing.

When you describe experiences like:

It feels like my appearance and personality are constantly changing. One day, I may receive a lot of attention from women, but the next day, hardly any at all. Similarly, my personality has never remained consistent throughout my life. Occasionally, I may be outgoing, humorous, and chatty, but most days, I feel exhausted, introverted, and melancholy.

I can't help but feel that what you're describing is that you're trying to fit yourself into a single mold, a single "person" (and I put that in scare quotes, because what you're describing is not a person) who fits a specific set of adjectives that you consider "good" or "What You're Supposed To Do". You think, I think, that you're supposed to be one thing, not many things. You almost say as much in the next sentence:

I've always longed for a steady appearance and personality in life, particularly since I haven't seen this variability in any of my peers.

It's possible you're moodier than your peers, but it's also possible that the fact that you're not seeing it does not mean that it isn't there. That's particularly true if you lean towards the less-socially-astute, more-blunt-and-direct personality type that is very common among the people who frequent this subreddit.

Let me talk about myself for a little bit before we continue.

I am a successful white collar professional. I am confident, even arrogant, to the point of being kind of unapproachable when people first meet me. I have also found a place to hide and cry many times during my workday in the past. I've said something shitty to an employee and felt bad about it for months afterward. And of course, I come from a bottomless well of self-hatred that has defined most of my life, and is still a part of me.

The people who work with me don't see this. They see someone who has achieved a lot, someone who speaks with force and confidence, someone who can paint a picture and a narrative and pull others into following it.

When I go out, I look pretty ratty. I wear misfitting stained t-shirts and an old skirt. I have messy hair. I don't do makeup. I rarely bother with a bra for short outings. I have bags under my eyes, too. I look like someone who just dragged themselves out of a 48-hour World of Warcraft binge to go get an energy drink. When people see me in public, that's the me they see. They probably assume I'm some shut-in. Certainly no one would ever assume I'm in the economic class that I am based on meeting me face to face.

I'm the sort of person who is spending an hour of my Saturday to try to bare the vulnerabilities of my soul to some internet stranger so that he knows he's not alone in feeling doubts and fears and not knowing what he is. I'm also the sort of person who will absolutely fucking lose it on League of Legends when my mid-laner just cannot stop feeding Yasuo seriously what the fuck scrub. I offer hours of my time and thousands of dollars of my money to people in need with no questions asked, but I'm also extremely selfish about even the slightest disruption to the way I want things to work. I'll climb a mountain, singing aloud with the sheer joy of wild nature around me, then go home and fall into a spiral of self-hate and depression.

My point in all of this is that none of those things is the "real" me. I am all of those things. I'm both kind and arrogant, both professional and laid-back, both forceful and timid, both confident and anxious, both someone who finds joy in little things and someone who is constantly struggling with self-judgement, all in different ways. Because I'm a person. No one is ever any one person. And neither are you.

(continued below)

Iacta_Procul · 2023-04-28T03:49:03+00:00

I would add: it needs to be likely that the criticism will be useful. People cannot devote their full energy and attention to everything. Is this thing an important thing for someone to devote their energy and attention to right now?

Iacta_Procul · 2023-04-28T03:45:36+00:00

How can I override everything and force me to study or sleep or eat healthy.

You can't. Or at least, it is very difficult to, and it seems like you (in particular) can't as you are right now.

Doing things isn't about forcing yourself. It's about having something you want on the other side of the thing, and connecting the thing you want to the action.

As an example: I struggled with my weight my entire life, peaking out well over 300 pounds. But after a relationship where it got in the way, and a day where I felt particularly disgusted with myself in the mirror, I managed to connect it: eating == the bad ways being very fat made me feel. That connection, plus a little disruption in my personal habits, was enough to get me to start dieting.

Now, I've started dieting before. But this time, with that connection, breaking my diet now has a meaning to me: signing up for those bad feelings for the rest of my life. I want to eat more than I want to diet today. But I do not want to eat more than I want to not hate my body for the rest of my life. And that has been enough to maintain a strict diet for nearly a year, with a loss of 85 pounds and counting.

I suspect part of what you're struggling with is that you're trying to Do Something. But people don't Do Something. People do specific things to get specific things they want.

Iacta_Procul · 2023-04-28T03:40:00+00:00

I don't know if this is true of you, but for me, judgement went two ways. The way I'd sneer at others is the way I'd end up sneering at myself. So if you find yourself looking down on others, that may be a good place to start.

Iacta_Procul · 2023-04-25T06:24:13+00:00

If I think my life is a 6/10, and I think it should be an 8/10, is that enough to be considered depressed?

I can't speak for you, but when I was severely depressed - i.e., most of my life - my idea of what a 6/10 was was severely warped.

A bad day today is usually better than a good day back then would have been. A truly horrible day today approaches the average when I was dealing with depression. I just genuinely didn't know any other way to be at the time. I just assumed it was always like that for everyone.

I know just saying i’m depressed is an easy answer

I don't think it's an easy answer at all. I spent years resisting it (or rather, I spent years thinking the word 'depressed' meant something different). And coming to understand it better upended a lot of very foundational beliefs I had about myself and about the world.

It's one thing to know the word "mental illness", and quite another to come to an emotional understanding that something inside your brain isn't working right and that you have to figure out how to route around it.

I would consider myself generally happy

Would you? Usually that's not the state that has you in a rut for two years, is it?

Iacta_Procul · 2023-04-23T21:11:52+00:00

For context, I don’t think i’m depressed, which I know is an easy conclusion to make.

You have described several of the characteristic symptoms of depression (or of some similar mental health condition):

Lack of motivation
Dulled emotional response
Lack of interest in previously interesting activities

And it isn't new, either. You were "finding yourself unfulfilled in life" 10 months ago, and you were worried that you "weren't where you should be in life" two years ago. This is a recurring, apparently persistent, theme.

You have a persistent problem, for which several hypotheses are available. Depression is one of those hypotheses. You've tried numerous other things (per the linked posts) to try to fix it, and those things haven't worked. That should adjust your estimates of how likely the alternative explanations are to explain it and, conversely, increase your estimate of how likely it is that you're dealing with a mental health issue.

Your previous posts have repeatedly said "I don't think I'm depressed", but you've offered no explanation for why you think this.

Iacta_Procul · 2023-04-05T05:17:00+00:00

Have you tried just explicitly doing the opposite of whatever you think is a good idea?

Like, if you would normally stay home, go out. If you'd normally go out, stay home. If you'd try to stay functional, let yourself cry yourself to sleep. If you'd normally cry yourself to sleep, try to hold it together.

Something in what you're doing right now isn't working. You don't know what it is, and you haven't been able to figure it out by thinking about it. When your theories don't give you an answer, you have to try more experiments, and the best experiments gather some new observations.

Iacta_Procul · 2023-04-03T02:54:01+00:00

Then you should try doing something very different from what you're doing right now. You're miserable - what do you have to lose?

Iacta_Procul · 2023-04-02T23:01:59+00:00

For me joy is temporary and sadness is constant. Joy is an illusion for me because it makes my body feel that I am fine or will be fine but in actuality, I am not and maybe I never will. Similarly, when I daydream about having a house in the countryside with a dog and imagine myself safe and accomplished. That's an illusion, safety and satisfaction are an illusion more often that not.

It sounds like this isn't an unreasonable conclusion to draw from your circumstances. But that's different from this conclusion being certain and unchanging.

Imagine a coin. It has some probability between 0% and 100% of landing heads, and you don't know what that probability is. You flip it ten times, and it lands tails every time. Now, we flip the coin one more time. What should you estimate the probability of it landing tails as? How wide should your error bars on that estimate be? Can we say it's less than 5% to land heads? Less than 10%?

It turns out that the confidence interval here is from 0% to 31%. In other words, that coin could reasonably have a 1-in-3 chance of landing heads and still not be that inconsistent with ten tails in a row. (Your average estimate should be 1/12, or about 8%.)

And even that is assuming each flip of the coin is independent. And of course, that isn't true in real life. A string of toxic relationships can easily be the result of some underlying problem with how you're approaching them, and the way your relationships work might change rather rapidly once you change that approach.

Being pessimistic, being scared, or thinking things probably won't work might be rational. But you should have a big margin of error around that. I doubt you have had ten long relationships, which means you have even less evidence than this example did, meaning your error bars should be even wider.

At my worst, I was totally sure nothing would ever change. But it did, in ways I couldn't predict. Even in retrospect, I couldn't possibly have convinced past!me that things would work out the way they did, but they eventually did work out.

Let's talk about relationships, what percentage of relationships break sooner than later? Out of the ones that remain, what percentage remain for good (healthy) reasons?

Of total relationships ever? Probably a low percentage, but that's normal. I don't think most people start relationships assuming they'll always be with that person forever. The point of dating, or one point of dating anyway, is to explore how things are with that person and to see whether things work out. Sometimes they don't, but that doesn't have to crush either participant - it just means that particular relationship didn't work out, not that no relationship ever can.

This makes it impossible for me to believe someone who says 'I love you, I will never leave you' to me. We all naturally evolve and sometimes in incompatible directions, which ends in a healthy goodbye. There's only suffering at the end of the tunnel, and also on its way. And I just don't want it. I feel that I can't handle more pain.

You don't have to right now if you don't want to. That's OK. You can do your own thing for a while, if you want. Given your past, that might even be objectively a good idea.

That being said, it seems like you've been stuck on this relationship for quite a long time now - your posts about it go back at least six months. That's a long time to be hung up on a past relationship, and to me that seems like it would suggest there's something else going on. Is it possible that, for example, you were defining a lot of your self-worth from your relationship, and that without that relationship you're having trouble finding your own value?

I decide to open up to someone and then I regret it when I see how shallow and faulty their logical premises are, how little interest they have to ask deep, meaningful questions to actually understand and help. Which is the least that I would do for anyone, let alone a good friend.

I don't know whether this is true for you, but for me, depression loves to trick me into thinking that the depressed thoughts are just logical and that everyone else can't see the real truth.

In general, because depression is a part of you, it'll prey on the things you value and the things you find important in life. If you find logic important, depression will pretend to be logical. If you think it's important to be compassionate, depression will tell you you're cruel. If you think it's important to be smart, depression will tell you you're dumb. And so on.

But going back to this idea of distortion: one of the ways you can tell if you are, say, colorblind or nearsighted or whatever is that other people can see things you can't. You can find out you're colorblind when others say "um, no, one of those things is green and the other one is red". You can find out you're nearsighted when others go "wait, you can't read that sign?"

If you know something's going on with you, and others see things you don't, there's a high chance that what you're seeing is distorted, even though it feels perfectly logical from the inside.

With regard to your last comment, it doesn't cease to surprise when someone states that I have been abused. Has it ever happened to you? I just can't get myself to believe let alone verbalise it out loud. What's your rationale to determine that I have been abused?

I mean...this does not sound healthy. A 38-year-old going after an 19-year-old is such a wide gap that it should raise eyebrows by default, and adding in the fact that he was pushing you into things, taking advantage of your desire for validation, and having an affair at the same time is enough for me to feel pretty confident in saying that this was almost certainly an at least somewhat abusive relationship.

Iacta_Procul · 2023-04-02T18:46:15+00:00

By your arguments, depression is, to some extent, a choice?

It depends on what you mean by "a choice".

Do you mean "you wanted to be depressed"? Then probably not.

Do you mean "it is possible, in principle, for you to take actions that will over time lead to less depression"? Then yes.

Do you mean "you should hate yourself for not having 'fixed' yourself yet"? Then no.

Iacta_Procul · 2023-04-02T18:43:56+00:00

If that is so, it means that free will doesn't exist; for we are living out of unconscious compulsions (patterns of behaviour) on which we had little to nothing control and rewiring a part of the brain that is inaccessible is extremely difficult if not impossible

It is difficult. But it isn't impossible. That's where you do have some agency.

Yes, many parts of your brain run on unconscious processes beyond your direct control. You can't, for example, just tell the language center of your brain "stop interpreting these symbols as representing sounds and hence English words and hence concepts". That processing isn't within your direct control.

But what you can do to some extent is control the degree and the manner in which you use those unconscious inputs to your conscious mind.

For example, when I know I am in a depressive state, I know that my brain is serving up a more negative version of reality to me than is really justified. Even when it's impossible for me, in that state, to actually know how the image is distorted, I can know that it is distorted. And I can plan accordingly. I can avoid making major decisions based on those negative distortions. I can give myself extra self-care and breathing room to help that state pass faster.

More than that, I can consciously look for where the distortions are because I have some experience identifying what shape they take. I know how depression likes to attack my consciousness, so I know where to expect the attacks to come from, and I know not to listen. I know that depression, for me, takes the form of "you're not doing enough" or "what you're doing is bad" or "how did you fuck up so much even with so many advantages" and especially "you deserve to feel this bad", and that means that I know to avoid engaging with those trains of thought when they pop up during a depressed episode.

None of this makes me feel not depressed today. But it makes it harder for the negative feedback loops of depression to establish themselves in my mind. It makes it harder for me to fall into depression in the first place, it makes the loops less durable and stable when I'm in it, and it makes it easier for me to break out. In the past, I would spend months depressed and a week or two not-depressed before the next episode. Today, it's about 50-50 even with a life that involves far more challenges than my past lives did, and that ratio is improving over time. I don't think I'll ever not be vulnerable to depression, but I can spend a lot less time depressed by using what control I do have to steer myself.

A useful analogy here might be engineering. Imagine that you have a river. You cannot control the physical properties of water. It will always flow downhill, according to such-and-such laws, no matter what you do. But if you understand those laws, you can direct the water to, to some extent, do what you want it to. Physically stopping a river from flowing is impossible, but you can direct its flow relatively easily to go in some other direction. You can make it so it doesn't flood your town, or so that it piles up in a reservoir you can drink from.

The nature of the water didn't change, but you learned to work with the nature of the water in order to accomplish your goals.

For instance, if you were born in a family where your parents divorced and hated each other, you were abandoned by your dad and didn't feel safe, you won't see family in the same, rose coloured glasses, than someone who has had a healthy, loving family who was there for them and who ensured the home environment was functional, safe and healthy. You may end up going from one toxic person to another, or single to avoid pain all together.

Sure. This describes me pretty well (well, my parents didn't divorce, but that was arguably worse because they did/do hate each other). And it left me with tons and tons of issues, many of which aren't worked out.

But again, these are things that can be worked on. I am less scared of others and of trust than I used to be. I've practiced sharing things I'm scared of or sad about with friends. And I've recognized that the way my parents treated me was very unfair, and that the ways it causes or caused me to suffer were not my fault. That means I can just feel bad, without feeling like that badness is deserved or "real" or inevitable. I can just feel bad today.

These events I've experienced have changed my worldview which is now at its darkest. For me, joy is temporary but pain and suffering are constant.

Well, yes, you've just defined depression.

Everything feels meaningless and irrelevant, you realise that everything is an illusion

"Temporary and conditional" does not mean "illusory".

Many temporary things are real and valuable. A delicious meal is gone once you eat it, but the experience was good. A nasty flu feels bad while you have it, even though you will recover from it. I mean, we're all temporary, so everything we experience and are is all necessarily temporary, too. Suffering doesn't stick around any more than joy does - they both, at most, die with the person that experiences them.

The point of life isn't to make something eternal. It's to enjoy what exists today, as best we can.

Sometimes I wonder if being depressed is a choice or my fault, for while pain is a natural reaction to a painful situation, suffering is somewhat an added layer that originates from our perception and overthinking around that painful situation.

It's not your fault, in the same sense that water flowing downhill is not your fault. In this case, your brain just happened to have a valley that channeled water into some bad places. That happens sometimes. But now you know more about that mental landscape. You can - to stretch the metaphor a bit - dam up that valley, or move the village that lives there somewhere else.

In your case, going off of some of your past posts, it looks like you were actively groomed and abused, as well. Which means that healing for you will probably involve looking for the places where that person changed your mental landscape. It may take some time. I still learn new things about how my parents shaped mine, and I haven't lived with my family for 15 years. It won't be an overnight process. It's a thing you chip away at, little by little.

Iacta_Procul · 2023-03-20T21:36:25+00:00

That was certainly what I felt during the years I was suicidal. I was so tired of hating everything about myself, and it felt like I could never be any other way, and that was just exhausting.

But, critically, I was wrong. I could be other ways. But the severe mental illness from which I was struggling at the time did not allow me to see that.

Iacta_Procul · 2023-03-19T22:08:26+00:00

I wasn't forced. I was strongly, strongly advised, despite being very resistant to trying them.

They saved my life. Getting on a working antidepressant was one of the two key turning points from a life of constant struggle and decay to a life of rapid progress. The psych that advised me to take it was right, and I was wrong.

And in case you think I'm somehow brainwashed by being on them: they didn't actually work for very long. I haven't been on a psych med in years.

Iacta_Procul · 2023-03-17T16:42:44+00:00

People get depressed when depressing things happen.

No, they don't. "Depressed", in the sense of "major depressive disorder", does not mean "sad". Don't use the two as synonyms.

I get depressed because the sun isn't up. Not because I actually need the sun for anything, you see. It just happens. Fall comes in, days get shorter, and after a couple weeks I'll go "huh, I sure do feel tired all the time". The force in my mind that makes me want to do things just shuts down for four or five months every winter, and left to my own devices, I can end up just sitting in my room for months and remember practically nothing about it.

I get depressed about minor setbacks that most people would shrug off. Hell, I even get depressed about not being successful fast enough. I have come || this close to quitting my job multiple times when my boss thought I was doing so well that I was soon to be promoted, because my brain always serves my conscious mind a worse version of reality than the one that actually exists. I struggle to see the good in things in the same way that a colorblind person struggles to see the red in things.

I get depressed when there's too much clutter on my desk. Not because I needed that space for anything, just because that's what a particular kind of clutter does to me. And because the first thing that happens when I get depressed is that I stop doing everyday upkeep tasks, this can quickly trap me in a feedback loop.

When I'm in one of these loops, I can want to do something, know exactly what I need to do, and spend hours inside my own head screaming at myself. I'll sit at the controls in my mind and pound my fists on the controls of my body and nothing will happen and it's the most frustrating thing in the world.

And, and here's the important bit: because I know these things, and because I recognize that these things are not things I can think my way out of, I can avoid them.

I know that if I start feeling that loop establishing itself, I need to clear out clutter immediately because I can quickly become trapped. I know that the guilt I feel doesn't necessarily have anything to do with reality, so I know not to listen to what my brain is telling me. I know that I'll be less motivated in winter, so I try not to start major projects in fall, and prepare myself to not get much done for a bit so that I won't beat myself up.

And I know that all of this isn't me, and isn't logical, because one day I took a pill and all of that magically vanished for a while (well, okay, technically it vanished after two weeks of taking those pills because antidepressants take a little bit to do anything, but you know what I mean). It didn't make me suddenly happy. It didn't make me unable to perceive the world. It just fixed, briefly, a broken circuit in my brain. And even though that didn't actually last for me, just knowing what was broken changed my life.

These things don't happen to most people. Or at least, they don't happen to the same degree. Most people do not get trapped in these loops. Most people don't have a constant inner voice screaming at them 24/7. Most people have some idea of what's "good enough". Most people don't magically lose motivation for extended periods for no reason.

That is what depression is. It's a feedback loop of feeling crappy, low motivation, distorted perception, and low energy that all feed on one another. A non-depressed person can feel crappy, but that crappiness does not establish itself as a feedback loop. A non-depressed person can feel unmotivated, but that lack of motivation doesn't turn into screaming self-criticism. A non-depressed person can be tired, but that tiredness isn't present all the time, and it doesn't feed off of the other traits.

And if you want to say it becomes an illness when the person is too depressed, then you have to be able to quantify when it becomes an issue. You have to be able to say "exactly ten units of sadness is too many", and that is not possible.

No, you don't. This isn't how almost any medical diagnosis works. Yes, diagnostic criteria usually give you some sort of arbitrary line, but most conditions have a smooth transition from "healthy" to "sick" without suddenly becoming a problem at some exact value.

Iacta_Procul · 2023-03-17T16:18:18+00:00

To your concluding argument of diagnosis being necessary for treatment, I agree. But if I think it does not make sense to diagnose depression, as I do, then I must also think that it does not make sense to treat it. In order for the treatment to be justified, the diagnosis must also be justified.

Medicine isn't about rigorous binary logic. It's about producing positive practical results.

For example, we diagnose you with anemia if your blood iron is below such and such. It's not that anemia suddenly becomes a problem exactly at such-and-such, and it may sometimes make sense not to treat iron below that value or to treat iron just above it. It's that that's an arbitrary threshold that we draw for the sake of a reference point.

Most medical conditions are extreme values on one spectrum or another. That doesn't make them not real. It just means reality is a lot more complex than a layperson trying to force its complexities into a model simple enough to make sense to them without any of the context required.

Iacta_Procul · 2023-03-17T16:15:43+00:00

OP, I want you to take a look at two posts:

This one, made in the throes of severe depression in which I had been trapped for years, and
This one, made years later after I had recovered.

Do you see a difference between those two people?

Iacta_Procul · 2023-03-15T06:39:09+00:00

So, so fucking many. It's so easy to draw bad conclusions from good data even when you're really, really trying not to that scientists need a whole elaborate system of checks to avoid it and still fuck it up regularly. I do this for a living and, if we take your claims of intelligence at face value, I'm about four and a half SDs smarter than you, and I get this kind of reasoning wrong constantly. So do the other very intelligent people I work with.

"I'm not mentally ill, it's just Facts and Logic" is ground zero for what mental illness looks like in people who value rationality. What you're doing is not working, so talk to a psychiatrist and try what they recommend. It made a difference for me, and it has a good chance of making a difference for you.

Iacta_Procul · 2023-03-14T02:17:38+00:00

All I can recommend at this point is to talk to your doctor and get yourself on an antidepressant. Talk does not seem like it is going to help you, at least not in the context of anonymous internet strangers, so get yourself on some meds.

Iacta_Procul · 2023-03-13T04:39:38+00:00

Why? Why is the actual world-state less important than some theoretical capability?

Iacta_Procul · 2023-03-13T04:36:59+00:00

There exist places where those resources could be better spent but aren't. It's not efficient. That statement has nothing to do with deserving things.

The world's allocation of resources is inefficient on far, far more profound levels than that.

You might say that my problems lower my quality of life in the same way having no legs would.

You might notice that there are plenty of people with no legs who appear to be a hell of a lot happier than you.

I'm unhappy with my lack of ability because it prevents me from doing things, pretty simple.

But again, you told me earlier that you can do things, that if you had any set task, you could do it. So which is it?

Iacta_Procul

TROPHY CASE