How to Deal with Depression—The Meta Layers
I wrote this for the Positive Vector website awhile back and lots of people have found it valuable, so I want to share it with the Less Wrong community as well. I think this applies to most people—meta suffering thing is something I see everywhere, even though it is most prominent with people who have depression. This is based on my experience with working with depressed people and with studying Buddhism, especially Big Mind. Enjoy!
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The roots of suffering are often deep. But not all of the suffering happens at the root. A lot of the suffering that people experience is “meta” suffering. Meta suffering is when you suffer because you are distressed that you are suffering. You are feeling depressed and hopeless, and there is a part of you that genuinely fears that it will never end. That you will feel this way forever. This fear of the suffering persisting can cause you much more suffering than whatever started your suffering. And it can last much longer. At some point days later, you might think to yourself about how terrible that initial suffering was, and feel fear and suffering about the possibility of it coming back.
Many people suffer as much or more from meta-suffering than suffering that comes from physical or situational sources!
The good news is that meta suffering is much easier to fix than deeper forms of suffering.
One thing you can do is to collect data* in order to develop an accurate model of how often you actually feel bad. Try monitoring your moods for awhile and get a baseline for what your moods actually are. At least half of the people who have suffered from major depression who have done this and spoken with me about it have been surprised to find that they often feel better than their self-perception when they assess their mood at random points throughout the day.
Regardless of what your default mood state or range is, once you know what it is, you are likely to feel less fear. You can look at what your mood historically does over time, and feel more confidence that this is what it will do in the future. When you are in the state of despair and wondering if it will last forever, odds are that it won’t.
Another extremely powerful technique for dealing with meta-suffering is accepting that you are suffering. The meta suffering is suffering because you really want to change your state and are not successful. If you can just be with the state and not making yourself bad or wrong for being in that state, then all you have to deal with is the base state of suffering, which will be less intense and last less long than if you tack on that extra meta layer.
The ironic thing is that just by thinking that thought, if you are prone to depression, you will probably notice yourself meta suffering and then feel guilt or shame about it. If this happens, my advice is to take it to the next level – feel compassion and acceptance for your meta-meta-suffering.
As you make this a practice, and feel acceptance and compassion for your suffering, you will feel more freedom from the meta level, and have more resources to work with the underlying suffering or depression.
Another common way in which meta suffering sabotages people with depression is for them to feel depression as soon as they start feeling good. The story that some people have is that it is futile to think that they might feel so good in the future, and it is better not to get their hopes up and have them crushed. I encourage the person with this meta suffering story to assure the meta suffering part that they do not have obligation to feel good in the future. Feeling good in the present is of value, for however long it lasts, and that is worth appreciating and a good thing.
Desiring more pleasant states is great. Working to create those states is fabulous.
Feeling guilt, shame, depression, or other suffering because of not liking your current state or projected future state does not contribute to your feeling better, and is something that is pretty purely good to release.
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I really like the way you phrased “meta-suffering” as a term for the many cognitive self-defeating cognitions. The “rumination” symptom commonly observed in people with mood and anxiety disorders (a.k.a “dwelling”) seems to be a related condition. Some Buddhists call it addiction, or attachment, to suffering.
The diathesis-stress model is a my favorite way to analyze to mental illness, including depression. In other words, I think depression is a heritable, biological phenomenon and the correlated cognitive biases create a feedback cycle—especially when you factor in the influence of environment and life experience. The cognitive biases on their own aren’t enough to cause a depressive episode, and a depressed person may not hold these same biases when their condition subsides for a period.
That being said, cognitive biases accompanying depression have been studied quite a bit. This would save you the trouble of going through an IRB to create your own study, Shannon ; ) You could always do a meta-analysis, though!
Based on Beck’s Cognitive Model, 6 primary biases emerge in depression/cognition literature.
These constructs are not definitive, as there are many theoretical models even within cognitive psych. Meta-suffering could incorporate many of these biases.
(please excuse the examples, some of them were taken directly from articles and others were re-worded to make more sense—at least to me)
A) ARBITRARY INFERENCE Drawing specific conclusions in the absence of relevant evidence (i.e. “The bus driver was driving like that because he’s taking drugs”.)
B) SELECTIVE ABSTRACTION Drawing conclusions on the basis of isolated details of an event, even if it requires ignoring other contradictory evidence. (i.e “She said she had a really good time, but didn’t like the gift I got her. She won’t to go out with me again”)
c) OVERGENERALIZATION Holding extreme beliefs based on a specific event and inappropriately applying them to dissimilar occasions or settings. (*i.e ” He was scared by that lizard. He must be afraid of animals.”)
d) MAGNIFICATION Overestimation of the significance of events (i.e. A friend of mine got robbed, this world is a dangerous place).
e) PERSONALIZATION Relating events to oneself despite their being no apparent connection (i.e He got into a car accident last week. It’s my fault I didn’t come over to hang out with him that night.)
f) DICHOTOMOUS THINKING Thinking in all-or-nothing terms, categorizing experiences only in one of two extremes rather than acknowledging grey areas. ( i.e ” I don’t play sports with my kid. I’m a terrible parent.”)
---- some of the above was taken from the articles cited below. for a more complete review of cognitive therapy for depression, check out the work of Aaron Beck.
White J, Davison GC, Haaga DA, White K. (1991) Cognitive bias in the articulated thoughts of depressed and nondepressed psychiatric patients. Journal of Mental and Nervous Disease, 180, 77-81
Krantz SE, Gallagher-Thompson D (1990) Depression and information valence influence depressive cognition. Cognitive Therapy Research14,95-108.
Beck AT (1987) Cognitive models of depression. Journal of Cognitive Psychotherapy 1, 5-37.
This is the exact opposite of my experience. Mood tracking just makes me focus on how bad I feel. Thinking “this too shall pass” of bad moods and “carpe diem” of good ones makes me go “I know I’m biased the other way, but come on, at least pretend to be consistent”. I know low points go away, but I know they’ll come back worse so it’s even more depressing. I know high points will come back, but I know they’ll be weaker each time and that soon my best mood will be my current worst mood. Actually curing the depression is the only thing that helped.
What did you use to actually cure it? Is this the kind of depression that was probably a result of a random imbalance of neurotransmitters, rather than anything actually going hugely wrong in your life? In that case, yeah–if your mood is unrelated to your surroundings and seems to be newly and frighteningly negative, I can see that tracking it wouldn’t be helpful.
Meds.
That distinction is pretty artificial. If you must know the history, my childhood sucked big time in several different ways. When circumstances improved, the depression made my life get worse rather than better. Then I got on meds, so the depression went away and I could start picking up the pieces.
Sure, if you’re in okay circumstances and it doesn’t creep up on you and you can do something about it. If you don’t actually remember the last time you were healthy, it just feels normal.
If there are hugely wrong things with your life but you’re just too lazy and scatterbrained to fix them, it’s a great idea to put them on the back burner and go fix your brain first.
Sometimes to get better, things have to get worse first. Just because something makes you focus on how bad you feel doesn’t mean it can’t be productive in the longer run. Though I suppose if you’re depression is so severe that that extra focus might tip you over the precipice, I can see why you might not want to risk it.
I am curious to know what “Actually curing the depression” required for you?
Sure—the operative word was “just”. The forms of it I could sustain didn’t help over five years or so.
Meds.
Specifically, things got so horrible that I was forced to drop my plans of getting medical insurance in order beforehand, and to go to a doctor, who promptly handed me off to a psychiatrist, who put me in the loony bin for a few days and on meds. The meds turned out to make it worse, so I was put on a different med, which worked so quickly and miraculously that the psychiatrist feared I was going hypomanic.
Thanks for sharing this. Its the first time I’ve heard this response, but not surprising that many people have it.
Its my belief that learning what reality is for you is power, even if it is depressing, because then you can see results as you change things. If you go from extreme depression to moderate depression, you might realize it while tracking, when you otherwise wouldn’t. If you realize that you have changed, you are much more likely to make lasting updates and continue in the right direction with new behaviors than if you don’t know whether or not the new behaviors are doing anything.
It sounds like MixedNuts has a problem like mine—a part of the self which is frequently poised to attack on just about any pretext. Here’s a very extreme version.
I’ve gotten some relief from working on moving my sense of self from the attacking voice to the rest of me.
I’m not sure how much habitually looking at one’s self from the outside (is this really possible? maybe it’s a hypothesized outside) is a problem in itself, and how much it’s only a problem if the outside view is a hanging judge.
I wasn’t sure why this was on topic until I saw the part where you’re explaining about how people need to actually track their moods due to them frequently being incorrect about how unhappy they are. Then I had a hindsight bias experience and was like “Wait a minute. This seems so obvious. Why do I need to read a post about it?”
I did recognize this as hindsight bias, but your post might get better ratings from others if that area were written in a way that makes it more obvious that unhappy people are biased toward thinking that they are going to be unhappy. There’s probably a name for that. “Appeal to history” or something, or some psychology term.
Then I questioned whether depression was a relevant topic for LessWrong. I naturally have an interest in the topic since I’m a psychology enthusiast, and, knowing that you work with depressed people, I became curious about what you had to say. But I wasn’t sure that others here would be interested. Then I remembered that statistic I had heard, that 50% of the population experiences depression at some point. You may want to mention that so people know why this information may be relevant here.
Also, I haven’t seen you on for a while. How have you been?
Hi Epiphany, yes good to hear from you as well!
I like your points. I did say at the top that I think this applies to everyone, but it sounds like that didn’t stand out to you, and like a lot of other people missed that as well. The suffering about suffering is something that I see pretty much everyone experience. For example, someone who is unhappy because they are tired, might think about how they are unhappy because they are tired, and worry that they are going to do things that make them tired like this a lot in the future, and see it as a persistent state. I’d say more often than not, people see their states as persistent, even when they logically can look at their lives over time and realize that the states are not persistent. So when someone is in an uncomfortable state, they often angst about it because of this bias. In Learned Optimism, Seligman talks about how the difference between optimistic and pessimistic people is which states they (biasedly) view as persistent—optimistic people identify more with their positive moods and see negative as passing, and vice-versa. When I used to be depressed, I identified with my depressed state as “real,” and all other states as passing and “not who I actually am.” (guess I should have cited this in the article!)
I’ve been good, super super busy. You? Feel free to drop me an email: shannon dot friedman at positivevector dot com.
The way I find myself most commonly experiencing meta-suffering is not when one big bad thing happens in my life, but when a lot of small frustrating things happen all within a few days. The stress becomes immense, and I think I must be anticipating more things going wrong and on some level it feels more like the universe is conspiring against me, for lack of a more scientific term.
I think the problem is that I didn’t know what you meant by meta suffering at that time, so I was unable to evaluate the claim that the topic is valuable to most people. Therefore, I ignored everything up until the point where I understood what you meant by that.
^ This is the point at which I understood what you meant.
I don’t see this happening around me so I think it is not a good example of why the meta suffering concept is applicable to a broad audience.
I believe it, but it’d be nice to have some kind of term for this (like whatever the academic or psychology term is for this bias) or a study as opposed to a reference to a person who seems to believe the same thing (Seligman).
I don’t think it’ll help people see it as relevant to them if you write about how it was relevant to you. Though, it might help them feel related to.
I think the best bet for presenting this as relevant to this audience is to dig up the study that showed that 50% of people experience depression (assuming it was a good cite. I have no memory of where I got that from).
Writing for these guys is difficult. Would you like having someone to trade feedback with? Then we can both find out about presentation problems before anybody votes us down. :)
Alienated but less so than I was last time we talked. Thanks for the email address. I saved it for if I need to email you.
I’ve just finished a major cycle of analysis and meta-analysis of my cognition in preparation for a proposed series on self-hacking in the face of mental illness, and I have reason to believe that the primary proximal cause for my depression is that I no longer want to become stronger—I only want to want to become stronger.
The reasons for this are many. Agency is hard. But, the actual process, at its proximal end, is rather easy to map: I want to want to become stronger. Becoming stronger is hard. I therefore want to believe that I’m doing something hard. Hard things hurt. I therefore focus on the pain in my life, in order to convince myself that I’m experiencing adequate levels of suffering to prove to myself that I’m actually trying. When that proves inadequate (due to insufficient evidence that I’m actually succeeding), I seek out social partners to play “why don’t you/yes but”, until that process produces sufficient suffering and embarrassment to remind me that it’s unfairly hard, and to provide my narrative-constructing submodule with fodder for the story that people are out to get me. That provides justification to give up and die, because why play a “rigged game”?
Given that most people run on similar hardware, and are programmed by similar experiences, I’m wondering how to determine whether this is a common reason why people get caught into akrasic loops.
All of this is to prevent myself from staring down the fundamental truth, that I’m terrified of embarrassment. I am terrified of the truth: that as a child, I was a medium-sized fish in a very, very small and backwards pond, and that all my grand plans of showing the world my genius were a grave mistake. That I am, in fact, ordinary, and have no special potential. That worse, I have squandered my merely-ordinary potential, out of bitterness that I was not the kind of high-level genius that effortlessly changes the world merely by Thinking Big Thoughts.
Rather than face that thought, and learn the kind of conscientiousness that would allow me to rebuild my life, I coast along on the few superior talents I do possess—rapid modeling, rapid production and testing of schemas, rapid integration of new knowledge with pre-existing schemas, and a certain unbounded creativity. I use these things to learn “just enough to get by”, and praise myself for my cleverness, rather than buckling down and getting to work—because winning is hard, and losing is embarrassing.
The problem is, I know from previous experience that this knowledge—the firm understanding that I don’t actually want to become stronger—isn’t enough to motivate me. I’ve already built patterns where I’m comfortable beating myself up for my failings, rather than working to fix them. I learned as a child that weakness deserves to be humiliated, tortured, and dominated, rather than repaired. I’ve been working on that all my life without much success, either.
The problem there is a fundamental disconnect between my morality ( all goals are instrumental to Love ), and my social model of human beings ( RAPE! KILL! DESTROY! HAHAHAHA! CRY SOME MORE! HAHAHAHA! ). When I see other human beings with problems, Love takes over, and I do everything I can to help—unless they make the mistake of empathizing with me, in which case I CRUSH the little maggots for CHOOSING THE WRONG TEAM. When I see my own problems, I try to stake myself out for the wolves, to teach myself a lesson about the audacity of thinking that the weak deserve to survive and recover.
So, my question for the community is: which direction should I work on first, and where do I get the effort to do so? Which of these processes is more likely to switch to a less destructive attractor with sufficient initial effort? Assume zero community or healthcare support, and zero financial resources (like, seriously: I mooch of people for room and board; when that fails, it’s boxes-in-alleys time). Some good support from research psychology would be appreciated—it’s the only kind of argument that I can’t adequately “yes, but”.
I’ve got some ideas what you could work on first, but my knowledge might or might not be applicable (my problems are similar but less severe, they don’t have a religious background, I’ve had more support, my degree of psychological improvement is real but small), so I’ll start by recommending another online community: the Dysfunctional Family* comment threads at Making Light. The people there are intelligent and kind, have had a variety of abuse backgrounds, and know about practical details of getting out of bad situations.
I suggest working on kindness to yourself. It’s going to be a bootstrapping process because you have a strong habit of attacking yourself, so this is going to be like building a habit against resistance.
I’ve found it helps somewhat to remember that shame/self attack is collaborating with people who are against me by imagining their attacks or their contempt even when they aren’t around. I don’t have to do that. Even if there are practical reasons to avoid setting them off, this doesn’t mean I need to imagine their emotions vividly.
Look for ways that you’re already on your side. You care enough to keep yourself alive. You’re working on finding solutions.
Recent insight: I’ve been putting a lot of energy into self-attack. It’s my energy. Maybe I can use it for something else.
I call the impulse to destroy what isn’t perfect “the Nazi in the soul”—this helps me distance myself from it. Oddly, people I’ve mentioned the phrase to find it shocking.
*Local slang from Making Light—“hlep” is useless advice that makes people feel worse. I’m hoping I haven’t been hlepy.
The Gnomes are a conceit that comment which is held for moderation is a Tower with their Lownesses, the Gnomes, and that offering food is a good bribe. You don’t actually have to bother with that—just post that you’ve been gnomed.
Alternate hypothesis: The vividness of my emotions is not under my direct control, and it is least under my direct control while I am already experiencing vivid emotions.
Experiential evidence for alternative hypothesis: I have spent approximately 30 years training myself to ‘gain control’ of my emotional responses, especially fear, anger, and shame. Several times, when I have noticed that ‘gaining control’ was simply a ‘bottling up’ process that led to an exacerbating explosion later, I have torn down the regulating mechanisms and attempted to build new, better ones.
Model-based evidence for alternative hypothesis: In the human brain, the amygdala has much shorter and stronger neural pathways to the thalamus and cerebellum than the neocortex. In fact, many of the neocortex’s pathways must pass through the limbic system to reach the somatic control areas.
Narrative analogy to describe alternate hypothesis: Gravity, like neurochemistry, is a force that we cannot escape. On earth, a bird may “hack” gravity to convert its gravitational potential into forward momentum rather than downward momentum by spreading its wings in the correct way, but only if it also possesses the correct wing structure. Birds with sufficiently damaged wings cannot fly. Likewise, humans with sufficiently damaged limbic systems or cingulate cortices cannot self-regulate; otherwise, bipolar disorder and obsessive-compulsive disorder would simply be a matter of willpower, not medication.
Conjecture: When most people talk about “controlling their emotions”, they are constructing a narrative to explain the fact that their emotions happened to subside long enough for them to experience something that feels from the inside like making a decision to calm down.
Alternative hypothesis: I care enough about the people around me to not inconvenience them with a body and a lot of emotional fallout. I care about the people around me enough to not inconvenience them with rabidly non-functional behavior. I continue to look for a solution so long as I believe that I can contain the rabidly non-functional behavior enough that it does not outweigh the inconvenience of dealing with a body and a lot of emotional fallout.
Experiential evidence for alternative hypothesis: I continually seek out opportunities to push people away, explicitly and consciously so that fewer people will have to deal with my crazy, and explicitly and consciously so that fewer people will be harmed if I am unceremoniously removed from the tapestry of their lives. I will strategically wield rabidly non-functional behavior against people who I feel I am becoming to attached to, explicitly and consciously so that they will decide that they are no longer emotionally entwined with my well-being, and will feel justified and satisfied with their own decision to remove me from their lives.
Model evidence for alternative hypothesis: My personal narrative, when confronted with setbacks, consistently contains ideation that I am the only being who is ultimately responsible for my situation (self-oriented blame for negative events), that the past is the only viable source of information with which to predict the future (a preference for permanency over transience), and that most failure modes tend to be interrelated interactions between multiple systems (a belief in pervasive processes rather than isolated processes). This is called a ‘pessimistic explanatory style’ (or more pessimistically, ‘depressive realism’), and tends to indicate depression and very poor self-esteem.
Narrative analogy to describe alternate hypothesis: Human behavior and motivation tends to follow something like a bell curve (or at least a curve with a clump in the middle and long tails on either side) across most axes. Just as there are sociopaths, who are genuinely incapable at a neurobiological level of valuing others, there are likely to be people who are genuinely incapable at a neurobiological level of valuing themselves. This can be due to organic disorder (either via brain damage or genetic abnormality), or this can be induced as a pervasive kind of “learned helplessness”, if started early enough (the old “baby elephant tied to a tree” story).
Conjecture: Most people take their self-interest as a given; if they need help with self-interest due to depression or learned helplessness, they simply need to build on the basic survival drives that already exist. For some people, those survival drives have been so thoroughly corrupted that they are useless—or worse, dangerous to tap into. (Most situations where I have had people encourage me to think selfishly have ended in rather terrifying displays of sadistic cruelty on my part, because that’s simply the only model of ‘selfishness’ that my brain can really wrap its head around.)
Side note: These are not attempts to refute you. These are acknowledgments of my own internal refutations, which I must overcome before I accept the potential wisdom of what you are saying, and which I myself do not possess the strength-of-will to disable so that I can give your hypotheses a fair shake.
At least in my case, ‘controlling my emotions’ is an indirect process that mostly involves controlling my attention and modifying my behavior and environment: Intentionally taking a break from thinking about the distressing thing until I’ve calmed down; doing things that are distracting, like watching a movie, or calming, like taking a nice shower; and arranging my environment to provide calming stimuli, like relaxing background music.
The specific procedures that work best seem to vary substantially from person to person, but procedures of this general type do appear to work for at least a significant fraction of people. (You do have avoid the failure mode of not going back to deal with the problem once you’re calm for best results though.)
I am reasonably confident that I can help with this via IM, by being a role model if nothing else.
Would it be useful to find social circumstances where a terrifying display of sadistic cruelty is the appropriate response, appreciated as an art form by observers and savored by the nominal victim?
If you mean the BDSM world, I used to be quite the diva—I trained people to dance in ballet boots and arm-binders; I put on staggering productions, I was making quite a name for myself.
Then the girls I was living and performing with broke up with me and alleged abuse, and (because I was deeply in love and had attached my ego-validation processes to their opinion of me to an unhealthy degree) I wholly internalized that narrative.
That was, in fact, the exact moment of the beginning of my collapse.
The seeds were planted a lot earlier, of course—I spent most of my childhood in rather nastily abusive situations, and developed an unhealthy obsession with status and power and dominance—but I’m fairly certain the actual structural collapse occured in mid-2006, when all the support structures that I had built to compensate for those earlier flaws got ripped away.
This suggestion needs to be more specific. Otherwise, people will just say, “well, when I thought about my mood over the past week, it wasn’t so great,” or “I already know what my mood is like.”
I found this app more-or-less at random. It has the advantage that the source code is on github so you can customize it to meet your specific needs.
Also, this article needs some citations. Like, any.
I’m not sure how including citations would improve this article. It’s based on a personal experience. If the author had gone out and done a bunch of research, chosen a depression-relieving method based on those already studied, tried it, and then written about it, it would have made sense to include citations to the original research. But at this point, with the bottom line already written, looking up a couple of articles on depression just to have citations doesn’t add anything to the presentation.
Citations to studies done personally would be enough. As-is, I have no reason to believe this article at all.
I think it would be better if the article said, “I’ve done a bunch of work with depressed people and here’s a technique that seems to work. Now I want to test it. Email me if you would like to volunteer for a study that will take about five minutes per day for two weeks.”
I would sign up for that study.
Huh. I’d love to see such a study done. I don’t know if I have the time and energy for it right now, but I will consider it and keep this in mind.
I would be willing to run a study like this for you–it would have to be long distance/online, since I’m in Canada, but I could get some of the local LW-Ottawa people to help set up an online survey format.
I’d love to participate in such a study, I’ve noticed my moods go all over the place and would like to see how such a survey would work.
That would be awesome! Would you be up for a skype call to discuss this? My email is shannon dot friedman at positivevector.com, drop me a line and I’ll send you my skype ID and availability.
Yes, good idea. We could treat this as a prediction, and try to actually test it.
I would also volunteer for such a study. (Un?)Fortunately, I doubt I’d make a valid sample, considering my recent lack of depressive states.
Okay. Recommendations I typically make are to take a baseline for two weeks of measuring daily, or for more ambitious people to measure several times throughout the day to get the baseline. What I did years ago was to set a stop watch to go off hourly, so that I was measuring my mood based on time and not based on when I thought to do it, since it is a bias to think “now is a good time to evaluate my mood.”*
After getting a baseline, how often I would recommend checking after that would depend on the specific case and how much the person likes or dislikes doing regular mood checking. I think I’d recommend taking a baseline every few months in general, and then if something wonky happens or you have reason to think things are changing or if you want to see if they are changing, to check in at those times.
Having an app with code you can modify is great, thanks for the link.
Sorry about the lack of citations, I guess I should be more careful about that before posting to LW. Its based on personal experience working with clients, and going to workshops and things like that, so I didn’t come up with it from reading, but I understand that citations are very important to this community.
*I was using a very short/simple set of metrics when measuring hourly that only took me a minute or two to fill out, I can see if I can dig it up if anyone is interested.
Citations can usually be dispensed with if you have better evidence presented in some other form. I think wording it as “this needs citations” is perhaps misleading—citations are only a good way to indicate to readers that there is clear evidence there, and lets them go look at said evidence.
While it’s well understood that evidence of the form “This fellow rationalist believes X, thus I should update towards X because [insert the long bayesian reasoning]” is technically valid, it’s also well understood (at least from what I’ve seen on LW) that humans are unable to adequately apply this by default, and so most of us deliberately reduce the effect of such updates in order to avoid such things spiraling out of control.
The charitable interpretation of “this needs citations” is: “This is interesting. Care to let us look at the numbers if you’ve found any?”
Thanks for explaining. I have not read anything else like this, hence my motivation to write it up. I imagine there is evidence out there, but I don’t know how to find it—“meta depression” is my own descriptive language, I don’t know how people in the psych community would identify this concept, so I don’t know what I would search. I’d love to hear of anything anyone else finds.
I think REBT uses the term “Awfulizing” to describe a piece of this cluster. That might be a good place to start.
Thanks. That’s a similar concept, but not what I’m most interested in—depression about being depressed is more specific than simple catastrophizing. Its the sort of thing that I think Less Wrongers would get that is more subtle than most material out there.
I believe this is exactly the kind of services a couple of LessWrong users had in mind and are offering here, though I might be conflating terms somewhere.
Correct me if I’m wrong, but giving medical advice that is not substantiated by scientific evidence is quackery.
Hm, looks to me like you committed the noncentral fallacy twice. “Scientific evidence”—evidence can still be evidence without being “scientific”. “Quackery”—yeah, there are people who scam others with fake medical advice with little regard to the others’ actual health. That doesn’t mean that all medical advice from non-doctors should be disregarded. For example, I resolved a long-standing repetitive strain injury thanks to this guy. If I decided to disregard his advice because he wasn’t a doctor, I’d probably still be controlling my computer using voice recognition (did this for almost a year and it seriously sucked).
For what it’s worth, I attribute the vast improvement in my health over the last year to quackery (that is to say, advice given by non-doctors, based on assumptions that are far from being the consensus among those within traditional scientific institutions like medical associations and universities).
I’m sure you could find literaly millions of personal anecdotes of people who allegedly got better because of homeopathy, chromotherapy, magnotherapy, faith healing and whatever form of snake oil out there.
The effectiveness of medical procedures is essentially impossible to evaluate subjectively due to large aleatory effects, individual differences, sponteneous regression and the placebo effect. On the other hand, due to the large emotional effects of illness and death, medicine is the ideal fertile ground for fallacies such as wishful thinking, confirmation bias and for outright fraud.
Therefore, the value of medical advice unsupported by science is virtually zero. In fact, it could be argued that the existence of an unscientific medical practice in a society where scientific medicine is available is actually weak evidence that such practice is ineffective and possibly fraudulent.
You’re discounting the possibility that “fringe” medical advice would have theoretical evidence behind it, as opposed to empirical evidence.
You’re also not doing an expected utility calculation. What are the costs and benefits of following this particular bit of “fringe” medical advice? In my case, the cost was: I spent a few hours reading and massaging my arm, and discovered a knot in my bicep such that when I massaged it, my wrist pain was replicated. Benefits? I got my career back. Indeed, when I first heard about “trigger points” I thought the probability that they were legit was extremely low. But in retrospect, I’m glad I followed up all the low-probability leads that I did. In fact, I wish I’d done this sort of experimentation more and sooner—the cost-benefit analysis favored it overwhelmingly. (Unfortunately, severe depression seems to make it very hard for me to motivate myself to do things that I know have only a low probability of working.)
The fact that someone is passing it off as medical advice makes the probability of it being useful medical advice way, way higher than the probability that some random string of characters is useful medical advice. I agree that “fringe” medical advice is less likely to be useful than advice you get from doctors.
Are you talking about a theory rooted in solid biological and medical science or some alternative newagey theory like chakra points? Even within the realm of scientific theories, the ability to predict the actual effectiveness and safety of a therapy is generally limited: 92% of drugs that pass in vitro tests fail animal or human trials, and these are only the drugs that have already passed the computer-based design phase.
As far as I know, there are a number of conditions, notably inflammation, that are actually made worse by massage.
That’s an irrelevant comparison, since nobody suggested to sample random strings for medical advice. In any case, an alleged medical advice also has a probability of being actually harmful way way higher than that of a random string.
You’re not wrong.
I am not claiming to be giving professional medical advice, so it is a straw man argument—saying something true as a way to falsely invalidate.
Any form of depression that requires treatment, in particular major depression, is recognized as a severe medical condition that can be disabling and in some cases fatal, since depressed people have a significant suicide risk. Thus, any advice on how to treat depression is medical advice.
Moreover, you talk about experience with your clients, and if I understand correctly, you actually work as some sort of depression counselor. Your website even says “It’s like therapy, but better.” Therefore, you are indeed giving professional medical advice that is not based on scientific evidence.
Sorry if this comes across rude, but it seems to me that what you are doing meets the definition of quackery.
I’m not an expert, but as far as I know, depression is very hard to treat and the only treatments that have shown some effectiveness supported by scientific evidence are antidepressants and cognitive behavioral therapy, and AFAIK, even antidepressants show a weak effect.
EDIT:
Just found this article that makes the point much better than me: http://www.thedailybeast.com/newsweek/2009/10/01/ignoring-the-evidence.html
The old school psych industry generally doesn’t work. I went through a decade of professional therapy with professional therapists that did nothing for me, and only had things turn around once I started getting into other forms of help such as cutting edge Buddhist related philosophies such as life coaching. I actually help people when people who go through our “legal” fucked up system generally don’t improve and often get worse. Most information out there is misleading and incomplete, including professional studies. The psych industry is a mess. The DSM is terrible, most therapists don’t even agree on diagnoses. I was misdiagnosed personally for depression and given a drug that caused me to become manic, in a way that shifted my baseline psychological state permanently and caused me very bad problems for many years, as the result of taking the advice of a very prestigious professional psychiatrist who works at Stanford.
Basically, the whole field is fucked. I’m doing and sharing what I find most effective, which I actually do get results from. You can look at the testimonials on my site if you want, it seems you found them. I’m collecting more testimonials. I know what I am doing is not perfect, but I think its among the best, and that is the best I can hope for, and I would rather help people than not do anything because I’m waiting for perfection that is never going to come while people are suffering.
Sorry about the ranting, rough night.
If you work with people who didn’t find the standard interventions helpful, and they find your assistance helpful, that doesn’t mean your thing works better—it means it works better on a group filtered for finding standard interventions unhelpful.
My group is mixed. Some didn’t find standard interventions helpful, some found them somewhat helpful and then improved more working with me. Its actually more a filter of people who think similarly enough to me to hire me. But I have also worked with random friends of friends recommendations who improved, who I think are far less like the normal cluster that is likely to find me.
I think this is close, and fortunately it is (roughly speaking) the same kinds people who are likely to read your post and take it on board. Others would be more likely to gloss over it because it isn’t as salient to them.
False dichotomy, it’s evidence for both. One conclusion might be false and the other true but other arguments are required for you to get to that point.
Yes, it is probably evidence for both, depending somewhat on what people’s beliefs are about how those in the subset likely differ from the others in the superset with regards to relative response to interventions.
However, I wouldn’t say Alicorn was presenting a dichotomy. Sure, I would have said “that doesn’t necessarily mean” in the first case and “but it does mean” in the second just for extra specificity but I wouldn’t say that is required.
I don’t understand how it isn’t a dichotomy.
As the article I linked points out, the actual penetration of science-based psychotherapy even among professionals is low, and certainly it was even lower one decade ago. Hence, your experience is far from surprising.
However, the proper course of action is to push for science-based psychotherapy, not to go for DIY or New Age (“cutting edge Buddhist related philosophies”) systems that have possibly even less scientific support than mainstream methods.
Sure, you have experience that your method works. Freud had experience that his psychoanalysis worked. So did Jung. And Moniz and Freeman with their lobotomy. They even got testimonials and Moniz even won a Nobel Prize. But these practices were not supported by scientific evidence, and they ultimately proved ineffective and, in the case of lobotomy, actively harmful.
Beware of sponteneous regression (1/3 of mental health patients get better even without therapy), the placebo effect and the confirmation bias (researchers, even professional scientists, tend to rememeber favorable outcomes and forget unfavorable ones). There is a good reason why medical experimental protocols are so strict and complex.
No problem, best wishes.
I do not know of any evidence of Freud or others using techniques that work. Do you know of any information that they published about patients having improvement with specific metrics and periods of time?
I do push for research and learning. I also am not going to sit on my ass and do nothing when I have techniques that I have witnessed for myself and measured as working. Life is not perfect. Science is great, but is really really far from getting a really good model of human psychology, and therapists are terrible at implementing, as we have repeatedly agreed. Doing the best with what what I can, is the most honorable thing I know how to do. I care much more about creating maximal utility in the world than being right and not making mistakes. The implication of your suggested strategy is that we should all sit around and twiddle our thumbs until perfection arrives, perhaps aside from some people in labs, who we are going to put all of our faith in humanity in.
[...]
Reread and noted you answered that they don’t have metrics. It is important to note that as I have said in other places, I am taking my own metrics. So I have evidence for myself that what I am doing is working. I may participate in creating studies and publishing eventually, I would definitely like to see it happen, but leading a study is not what I currently consider lowest hanging fruit for my contributions to humanity and taking care of myself at this point in time. Also, there are studies that are being done on Internal Family Systems and other things of that nature currently.
Yeah, and I sunk into depression despite over a decade of various lifehacking philosophical gizmos, and you don’t hear me saying that all of it is fucked and we should all just get on the happy pills. (You do hear me gushing overmuch about said happy pills.) If we’re trading anecdotes all we’re going to learn is that lots of stuff sometimes work but everything usually fails.
Obviously you’re helping people, so go you, and obviously you’re helping people more than conventional therapy because conventional therapy is just paying someone to kvetch at them regularly and that can only possibly help if you have no friends to do that with. (The advantage is that you can be suicidal and it’s their problem because it’s their job, whereas if a friend notices you’re suicidal it’s a suicide threat and you are a bad evil manipulative person and I should stop reading Captain Awkward.)
But I see no evidence that your coaching should be a first resort for mild depression, rather than a n-th resort after conventional means have failed or proven insufficient. And for major depression (where meds are much more useful than for mild depression anyway), what kind of presentation of major depression leaves you able to make big life changes?
Some of the conventional therapists are good to chat with and making it an economic transaction rather than talking about all the negative stuff with your friends can reduce the extent that you are a drain on them or the relationships. Trade is a wonderful thing!
I just had a mental “D’aww” moment.
For some reason, I found it cute that you felt the need or had the reflex to succinctly throw out the intended meaning of “straw man argument”.
I wouldn’t exactly rate high my prior that someone on LessWrong would misunderstand what you’re talking about when you use that specific term, which I suspect was the source of my reaction.
My experience with people in the community is almost entirely talking with people in person—I’ve read very little of the blog, so I’m used to more one on one conversation that is customized than the blog conventions. I was wrong that this article would be something the general LW crowd would like, so I’m now being more cautious about other assumptions about shared perspectives.
I can certainly see people’s objections about perspectives being shared without evidence. Unfortunately my personal evidence mostly comes from working with clients, which is a small sample and data I cannot share. My clients almost all improve over time, and I am taking stats, but not stats I can share, and the stats I’m taking are about general improvement and don’t isolate progress resulting from each of the specific techniques I use. I would love more data myself, and I think I’m doing a much better job of gathering data personally than any psych professional I’ve ever worked with as a client, although I’d still like to do better.
One upcoming data point that will be interesting to know is the depression levels of LWers. A question about depression, and other mental issues, has been asked to be included in the upcoming Massive LW Survey Of Doom. I actually expect that, not only will we have higher levels of Asperger’s than the base rate, but that we will also have higher levels of depression.
I have read (sorry, don’t remember where) that rational people are more likely to have depression, because the cognitive biases (specifically ones about how awesome you are) that protect most people are not as active. And that females who are also rational are extremely likely to have some depressive issues. It will be interesting to see if the LW survey supports this.
Poor Yvain...
“Yvain, the Knight with the Lion is a romance by Chrétien de Troyes. It was probably written in the 1170s simultaneously with Lancelot, the Knight of the Cart, and includes several references to the narrative of that poem.
It is a story of knight-errantry, with the protagonist Yvain being exiled from the favours of his lady being required to perform a number of heroic deeds before regaining her.”
Thankyou, installed!
Thanks for writing this. It doesn’t seem to be something I can work with at the moment—my self-attacks are too hair-triggered—but it seems generally true and sensible. I’m surprised it hasn’t gotten more upvotes.
Thanks for the thank you! This seems to be a polarizing post—I’ve been watching the number go up and down a fair bit as the comments have roled in—it has had at least 7 down/9 up votes that I’m aware of, plus probably a fair bit of fluctuation that I’m not aware of, landing it at +2 at this point.
I’ve seen people describe LW as a frightening place, but the seeing the wall you ran up against in some of the early comments is the first time that complaint has made sense to me.
Thanks for this, I thought it was pretty darn useful.
I think I noticed that, holding ‘objective’ (FLOABW) reasons to get sad constant, the less I have eaten recently the more likely I am to get sad. Has anyone experienced the same?
It’s “For Lack Of A Better Word”, for those like me who haven’t encountered it before.
Yeah. I actually hack this somewhat; if I’m distressed, even if I’ve objectively had enough to eat, the ritual of snacking on something little often gives me the wherewithal to at least get myself to a less stressful location.
I have. I read somewhere (don’t feel like digging up the citation right now) that you require sugar (in your blood, which does not necessarily require you to eat sugar) and B vitamins to process tryptophan into serotonin. Also, you need to have tryptophan in your system. And water. Point is, since we get necessary ingredients for our brain chemicals from food, we need food to be happy.
I think your body may object to your notion of what is an ‘objective’ reason to get sad. In fact, I’d say it’d put it right up there near the top of the list!
Well, first of all I’m nowhere near starvation (actually, I’m trying to get back down to my usual weight after a week of binge eating), and second, if my body is trying to tell me to eat more it’s doing it wrong, as I don’t actually feel hungry (unless I’ve been downright fasting for a while, or I’m already below my set point) -- I just blow some totally unrelated reasons to be sad out of proportion and dismiss reasons to be happy impostor syndrome-style, and it hadn’t occurred to me that it might have to do with my diet until recently. (Damn you, Azatoth!) BTW, it also seems to me that caffeine kind-of prevents that, but I’d have to experiment more about that.
Yup, that guy gets really confused when it comes to easily accessible high calorie foods and condoms (and only one of those is a good thing!)
You are probably right. Caffeine makes you less hungry in general as well as countering some of the effects of the associated fatigue.
Food is a very well known positive reward.
Thank you for this post.
Here is some evidence for this hypothesis
Thanks for this. Although I don’t suffer from depression, the comments about meta-suffering really resonate with me. I think (this is unverified as of yet) that my life can be improved by getting rid of meta-suffering.
I’ve noticed that I get sad