- If so few people are for stigmatizing mental health issues, why do mental health issues still carry a perceived stigma?
- People comparing mental health issues to physical ailments are comparing them to the wrong physical ailments
- Social media posts compare mental health issues to acute physical problems like a broken bone or an infection
- A more correct comparison is to chronic physical health issues, like irritable bowel syndrome or celiac disease
- The problem is that while we can try to address the overt discrimination that people with chronic conditions face, we can’t really address the fact that chronic conditions make you look weak and pitiable
- Mental illness sucks
- Mental illness is not an emotion
- Mental illness is pain
- Depression feels like a flu
- Anxiety feels like a heart attack
- And like with all pain, after a while, you’re willing to do anything to make it go away
- Unfortunately, there’s no good way of communicating pain
- Every mechanism we’ve come up with to communicate pain is ambiguous and encourages people to overreport
- Moreover, pain itself is not a strong indicator of the severity of the underlying condition
- Fibromyalgia is the most intense pain you can imagine, but it’s not immediately life threatening in any way
- Gastrointestinal bleeds are immediately life threatening, but cause very little pain
- Pain is part of the map, not the territory - it’s a signal, but not necessarily a reliable signal, that something is wrong
- In order to escape pain, people often seek medication
- This leads to addiction
- People try to draw a distinction between dependence and addiction
- Characterize dependence as taking drugs in order to reach a state of normal function
- Characterize addiction as taking drugs compulsively, in order to satisfy uncontrollable cravings
- This distinction is a mistake
- Addicts take drugs in order to avoid the symptoms of withdrawal caused by their dependence
- The withdrawal symptoms are the cause of the cravings that lead to escalating use
- This is why the use of opioid painkillers for chronic pain is so dangerous
- So what does addiction have to do with depression and mental health?
- It is a myth that expressing emotion is a force for good
- Expressing emotion is a form of pain relief
- And like all pain relievers, you can build tolerance to it
- How does this tolerance build
- Depressed person talks about their feelings with someone, and immediately feels better
- The next time they vent, they don’t feel as good, so they escalate the way in which they act out
- This escalation spiral leads to increasingly extreme measures, such as publicly proclaiming suicidality to an audience of thousands
- Eventually the person can’t communicate their depression at all, since everything they do is interpreted as attention-seeking drama
- While no one is perfectly neurotypical, this doesn’t mean that all forms of neurodivergence are equal or good
- This is why it’s dangerous to make your neurodivergence part of your identity - if you find a treatment that successfully addresses your problems, you’ll have to give up part of your identity in order to pursue it
- So, what can we do about this?
- Don’t think of depression as an adaptation - think of it as a bug resulting from the interaction of behaviors and thought patterns that are adaptive in isolation
- The true cause of depression is the thought loop itself, not the initial trauma or set of traumas that set off the thought loop
- So how do we deal with the thought loop?
- Anti-depressants
- Alleviate physical symptoms
- Can give you the resources you need to address the thought loop directly
- Hallucinogens
- “Reset” the way the brain thinks
- As you come back to a regular mode of thinking, your brain has a chance to avoid the thought loops that were making you depressed
- However, hallucinogens have diminishing returns
- Behavioral therapy
- Almost guaranteed to work if perfectly executed
- The problem is that perfect execution is hard
- The thing that seems to help the most with depression is just doing things
- As long as you can maintain a certain momentum, eventually the depression will lift
- The act of doing things allows you to redefine your identity away from the disorder and towards something else, which then allows you to break out of the thought loops that were keeping you trapped