Posted by bretbe on May 26, 2003, at 0:56:07
In reply to Re: Real Depression, posted by Chris Doe on May 25, 2003, at 14:07:32
I think the source of some of this debate are assumptions we make about words that are used to describe subjective feelings. "Real," "depression", etc. are just words to represent how someone is feeling. I can relate to being totally frustrated hearing complaints about side-effects and thinking myself...I would take any side-effect to feel close to normal again; I would take any side-effect just to be in less pain. It does seem that if one is well enough to feel cheated by side-effects one is doing better indeed, at least emotionally. Still, that doesn't mean people don't still want to return to a more normal life both feeling better and without side-effect. Yet, I can understand the bitterness I have had hearing people complain about things that come across as petty when one is suffering so intensely. And, truthfully, as difficult as dealing with insomnia/hypersomnia or sexual dysfunction can be, it does come across as petty to someone in the depths of despair.
In throwing my hat in the ring, so to speak, for this debate, I would first suggest that some of issues being debated are fundamental problems to research in psychology and neurology or anything to with aspects of brain functionality. Arguing about what should be classified as a mental illness, what neurology, etc. is actually a discussion about an fairly loose and arbitrary labeling system:
1) Measuring subjective human experience is a fundamental problem in research because it is impossible to objectively measure, i.e., there is NO "thermometer" of the brain when it comes to mental/emotional problems/feelings/experiences. This is actually the same problem in pain research, i.e., research depends on self-report, pain to one person is felt as more painful than it would be to another, etc.
2) There is great variability in the human race both in terms of physiology and how we experience life subjectively. Thus, it is not correct to assume that just because we throw a word out like "depression," it means the same thing for everyone. Also, our huge variation in human experience means that the very same manifestation could exist in two people but have two very different causes and/or effective treatments. In fact, I believe one of the major roadblocks to better research in this field is the lack of clear definition around this word and the lack of study of "sub-types." For example, a drug may be tested and not pass FDA regulation standards because it's success rate was so low. Yet, since it may really have been profoundly effective for a small sub-type of depression but since the study included a wide range of people who loosely fit the broad definition of "depression" the results are skewed. Sadly, such a drug would never make it to market despite the potential to significantly help a specific sub-type of depression
3) Drug research is limited by the external symtomology of mice and rats. In other words, since all medications start by being tested on mice and rats and then up the chain of more complex animals to finally humans, we must rely on clever ways to "infer" human experience from observing the effects of drugs on mice...we can't ask a mouse "so, how did that make you feel?" Scientists look at the impact on motor coordination, the ability to swim, navigate mazes, etc. Thus, we have definitions of "feeling" disorders (mental illnesses) based on externally observable symptoms which may not really be the core problem from the patients point of view.
4) This brings me to one of the points that was made which is an obsession by psychiatry with a checklist of external symptomology rather than the crux of the problem which is that people just plain feel miserable, in pain, hopeless, have mental pain and anguish every bit as real as the pain have getting one's leg cut off (all pain, as is all human experience, is ultimately a fabrication of the brain anyway...consider the movie "the Matrix" as a theoretical example). Thus, again arguing about how the studies of various mental/emotional/feeling disorders gets sliced out for scientific research underscores the bigger problem that such divisions are made more out of historical tradition, and niche's professions have carved out for themselves than on some sort of universally true catagorization...it's done to simplify research and to communicate with other professionals but unfortunately the catagories themselves become seen as real and seperate when the truth is that there really is no difference between so-called physical or psychological disoders because it all relies on the physical functioning of various parts of the body, i.e., for every psychological event, there is a corresponding physiological event taking place. Where people get hung up is what is the etiology, i.e., "cause" (e.g., thinking in healthy ways versus endogenous chemical imbalances).
5) I would argue that there are mental disorders (e.g., schizophrenia) that deal with thought process dysfunctions and there are emotional disorders which deal with dysfunction in how we "feel." Of course the two are inter-related since how one thinks can affect how one feels and how one feels (e.g. paranoia or hopelessness) definitely affects how we think. It is not a one-way causality and reflects the enormous complexity of brain functioning and the humility any scientist must take in understanding the monumental undertaking to study it.To the argument of "real" depression, again, it all subjective and can be relative to what else one has experiences. To a cancer patient, chemotherapy may be the most excruciating pain imaginable. Yet, to a severely depressed/anxiety ridden individual, I would argue such pain can go even deeper as it impacts my very soul...if there is such a thing (at least it "feels" that way). Arguing about who is suffering more is a fruitless and frankly, juvenile discussion, but it is clear that all parties involved in the debate are suffering in some shape or form and simply would like to get back a life the they may only vaguely remember as closer to "normal"...I know I would. So in the meantime, I choose to live, not because I feel like it, but because ending my life...well, frankly I'm not sure other than fear that I might have missed something, despite that at times it feels like cowardice NOT to end it...that's the old thought/feeling relationship...is it bravery or cowardice that I continue to live. But regardless of the "level" of pain, so long as it isn't something resembling "normal" which is no panacea by any means, in fact a feeling most people don't appreciate...until it's gone, all of us simply hope to some day feel better. If talk therapy helps, then that is one kind of "real" depression with a fortunately effective treatment. If medication helps, then that is a kind of fortunately effective treatment with hopes that side-effects might be minimal so the normalcy feels more "normal." For those of us still waiting for something, it is natural to have a bit of anger and resentment towards what we might perceive as petty preoccupation with side-effects when we'd just be damn glad to be out of our hellish abyss
poster:bretbe
thread:91928
URL: http://www.dr-bob.org/babble/20030525/msgs/229162.html