Response.
December 6, 2015
ceci n’est pas une thinkpiece
I.
I dislike the identity-based, power-decreasing, exhibitionist toxoplasma that comes with short-form arguments on the internet, but pretending that people don’t read this blog has moved from a valid coping mechanism to outright denial.
So I will make an exception.
@slatestarscratchpad has written a nice critique of my essay, We Need To Sing About Mental Health. Several tumblrites have posted similar thoughts, but SSC expressed them most precisely. I’ll go through the points.
Depression certainly involves a tendency to have hopeless, negative cognitions in a way that CBT can often fix. I find it odd to think of this as “the cause of” depression in a way comparable to the other hypotheses raised. You still have to explain why somebody would have intermittent six month episodes of hopeless, negative cognitions in the middle of an otherwise normal-cognition life.
“Cause” is a tricky word. Ultimately, depression is a chemical imbalance. Traumatic brain injuries can induce such an imbalance, as can uncontrolled inflammation. But for most people, the bad chemicals of depression are secondary to bad thought loops. If you pull a Book of Job on someone, then depression is likely no matter how plucky the neurotransmitters in question.
It is perhaps helpful to think of depression as an action potential. A few negative thoughts, and you feel bad, binge-watch Gossip Girl, and feel better the next day. If you get enough negative thoughts, however, then you pass a threshold and get trapped in a feedback loop: negative thoughts make you feel awful, feeling awful triggers more negative thoughts, and you exponentially fall apart.
SSC describes somebody who has “intermittent six month episodes of hopeless, negative cognitions in the middle of an otherwise normal-cognition life.” I would argue that this person’s “normal-cognition” periods feature plenty of negative thoughts, but not quite enough to reach threshold and trigger the feedback loop of true depression.
On a more optimistic note, this works in reverse. It’s extremely difficult to reach the threshold of “feeling hopeful” when clinically depressed, but once you reach this threshold, good things lead to more good things.
The idea of LSD/psilocybin/ketamine as a reset switch is interesting but I don’t think supported (not disproven, just not really looked into), and there do seem to be permanent (even lifetime!) effects of psychedelic use.
Yes, there are permanent sequelae of psychedelic use. (The word “rewiring” comes to mind.) However, I don’t think that these long-term effects are neuroprotective against depression. The short-term “reset” may help, but tolerance is a mother, so prescribe “acid Q6months” at your own peril.
I’m not sure whether the gender difference theory + this theory would imply that men recover from mental illness more than women - something that I don’t think anyone’s noticed.
I don’t think men recover more. Women are the ones “talking about mental health”, but men are no less skilled at constructing identity. Check out /r9k/, The Worst Place On The Internet: even if the (anonymous, male) users don’t explicitly mention depression/anxiety, they spend a tremendous amount of time identifying as “beta”, “NEET”, etc. This is toxic.
Not sure I agree with the perception of SSRIs/tricyclics as “just numbing people’s feelings”. First of all, a lot of people’s depression is best described as total inability to feel any emotions at all, good or bad, and antidepressants can treat that and make people feel more emotions. Second, only a fraction (probably less than ½) of people get the emotional blunting effect.
Fair point, and it’s possible that I’m typical-mind-fallacying this one. However, quoth the Wikipedia article on anhedonia: “Results indicate that emptiness is negligibly related to boredom, is closely related to feeling hopeless, pathologically lonely, and isolated, and is a robust predictor of depression and suicidal ideation (but not anxiety or suicide attempts).” To me, this indicates that “feeling empty” is still a feeling, which (thus) resolves with SSRIs.
I also don’t believe that <50% of people have emotional blunting. Rather, that many people complain about emotional blunting. A little emotional blunting ain’t bad; a bipolar woman recently told me (re: Depakote), that “I still feel the highs and the lows, I just don’t find them overwhelming.” With low-dose numbing, you just lose the extremes, e.g. depression, but I am confident that given a sufficiently high dose of Zoloft, basically anyone will have dampened emotions.
Although they praise Ozy and are suitably superficially respectful throughout, I still think analyzing their personal psychology crossed a really big line unless they got permission first. Especially since many of the quotes quoted were meant in a hyperbolic or performative nonliteral manner. I am updating towards everyone else’s concerns about assholery.
First: yes, I am an asshole. My squad’s stated goal is world domination; it says “LE” at the top of my character sheet; I scowl at puppies when I pass them on the sidewalk. Hotel Concierge: a blog for villains and villain-associates.
Second: I’m sure that many of Ozy’s quotes were performative, but that doesn’t mean they aren’t telling. Performance = ½ what you want to say, ½ what you think the audience wants to hear; hyperbole is “entertaining”, fits the latter category and gives you plausible deniability for the former. I am criticizing the character of ozymandias271, regardless of whether that person is real. In other words: You can pretend to be anyone on the internet—why did you choose this?
Third: That said, Ozy, I am deeply sorry if my essay caused you harm. I tried to criticize your worldview without maligning you as a “bad person”, but this is a difficult line to walk. Some of the quotes I used were perhaps too personal for critique. In the future, I will be more careful.
Fourth: I don’t see a way to talk about individual psychology without talking about individuals.
Bear with me for a second. I know many people in the rationalist community and elsewhere, who, despite being well-read, despite being much smart and well-spoken, make stupid, basic mistakes about how to be a human being. They don’t get dates, they get addicted to drugs, they come up with elaborate theories about how everyone else is the problem. I know people with sophisticated knowledge of politics and altruism who are pricks in day to day life.
I know many people who get the big picture and mess up the details.
Slate Star Codex has a fantastic knowledge of the underlying math of the universe, and his mission statement—“get people to cooperate in the prisoner’s dilemma”—is one I would endorse, except, you know, villainy.
But I think most people have been told “don’t be a dick” at one point in their lives. It’s the subtle frustrations of how to do this—how to be powerful and stay a decent person—that stymie people. If you want to advise people on how to face these challenges, then you have to talk about people who are facing these challenges, and you have to hit the details.
Probably the safest way to talk about the “details of individual psychology” is through fiction. I like fiction, and that’s where I’ll end up, probably.
But I have a few things to say about the real world first.