Now that there is a very big discussion going on about depression

[nolabear]

and the need for attention to the feelings that might lead one to suicide, I want to take a moment to say something about the other form that depression can take. It's an old trope in the mental health field, but a pretty valid one, that depression is rage turned inward. Self loathing, inability to feel connected and to be sustained by pleasure in one's self and others leads to often unbearable despair and the belief that only the destruction of the self can stop the pain. But the reverse is the rage turned outward, toward the others who, in the broken mind of the sufferer, are withholding the care, respect, whatever the fantasy may be of what would make the pain stop. This often leads to abuse and even killing of others. It's the same syndrome (in admittedly varied forms). We can be sad for one who takes his own life, but I think it's important to recognize that, though we feel our own form of rage toward those who take the lives of others, we need to help those people too. One way to help is to destigmatize so that the families and friends of these people (who seldom seek help themselves--why would they when the world is the problem?) can look for help. Another is to limit access to firearms to those who have a history of being destructive and abusive toward others. I know it's an imperfect step, but it would save many, many lives. We can't ameliorate this horror by simply condemning those who do harm to others. We have to help them, and ourselves, by not letting the wild, rageful impulse be acted on so easily. We have to have this conversation, figure this thing out together, too.

[CaliforniaPeggy]

1. Well said, my dear nolabear...Thank you. n/t

[hifiguy]

2. I don't know if it is clinically recognized as such

but the depression issues I have struggled with on and off for years are related to real or perceived helplessness - the inability to exercise any meaningful control over basic parts of life.

Despite being an intelligent person and having an academic resume most people would kill for I have never been able to keep - and have seldom been able to get - a job in the profession I pursued. People love my work but 6-12 months later I was always out the door with no comprehensible explanation. Then in 2005 I was diagnosed Asperger's and it was a huge relief. My therapist told me that I was just enough "off" in my social interactions that people picked up on it subconsciously. And over time my "offness" wears out its welcome. I don't do eye contact, small talk, or anything more than the minimal amount of interaction with most people.

I am extremely introverted, have little desire to socialize with "neurotypicals" unless I know we share an interest, and will respond to most other people with the shortest possible answers. Put me with people who share my interests and I will gabble away like a goose on meth. And this was the real reason I was let go from every decent job I ever had. People want to work with and hire people like themselves. I ain't like anyone else. In work settings, while I am always polite and professional, things I internalized long ago, I am just not interested in most other people and am about as chatty as a stuffed moose.

During this period of unemployment I lost my home on May 1 and I am currently living in a rooming shelter where I have my own lockable space for my computer and books. My belongings are in storage at a factory owned by a friend. I am working steadily to reinstate my professional license as quickly as possible, have good support system and am healthy - I take one medication once a day and it is a mild mood-stabilizer.

I am cautiously optimistic about the future and determined to reboot my life. But the inability to control the basics of life have always been the on-switches for my major depressive episodes. I can't believe I am alone in that sense.

[nolabear]

3. Yes, you describe it well.

I expect there are places in this world where your skills are applicable and your way of interacting with people will be understood and appreciated. Keep looking. Network with those who understand and advocate.

Good luck! I'd put up a hug smiley but I imagine a might be more welcome.

[hifiguy]

5. I'll do it, then.

[nolabear]

11. WooHoo!

[jeff47]

7. Out of curiosity, what is that field?

(And feel free to ignore if you don't want to get into it)

One suggestion that worked well from some people I've known is to have a neurotypical be the "face" of the operation, and the "unusual" person do the work behind the scenes. For example, an A/V company where a guy with a typical salesman personality met with customers, but the A/V systems were designed and installed by the someone "with terrible social skills".

[hifiguy]

10. Trained as a lawyer,

in fact I was a classmate of the FLOTUS. We graduated in the same year, same school

I can write a brief that you could submit to any court in the country, including the SCOTUS, but I have very limited people skills and couldn't sell dollar bills for a quarter. And you don't advance towards partnership unless you can sell, sell, sell. I'd rather lead apes in hell.

Someplace there has to be a firm, or a small office of a big firm, that can use a workhorse writer and researcher that doesn't want to be on a partnership track. I spent three years clerking for judges, so I'd be fine in motion practice or appeals but not so much at trial.


i could see myself in government, at a non-profit, as well. I have the intellectual horsepower, but people who don't know me well tend think i am either (1) a complete, hopeless nerd, which is very true, (2) I am an arrogant asshole, which is not true at all, or (3) a nerdy, arrogant asshole, which is only half true.

[jeff47]

12. How 'bout on-staff lawyer for some company?

I work for a software development company. They hired a lawyer to draft patents. No idea if the work is at all interesting, but the job requires very little social interaction - the guy they have doing it goes out of his way to get more social interaction.

Anyway, I'm a stereotypical computer geek, so I very much understand where you're coming from. I just happened to have the fortune of enjoying writing software, and people generally putting up with "weird" people that write software.

[hifiguy]

14. In-house is also something I am considering

I don't have the math/engineering gene, unlike many people on the spectrum, though. Patent lawyers are an even weirder group, as a rule, then engineering or math majors, which is saying something. There's an old joke in the Asperger's online community that if you want to see what Asperger's looks like head for the math department of a major university.

If I had the math gene I'd probably have become an astronomer, a theoretical physicist or a cosmologist. I would love to do what Carl Sagan did and folks like Alex Filipenko does.

[lovemydog]

30. If you haven't already, please try Linked In.

It may not be right for you. But I tweaked my settings and occasionally get emails looking for staff or in-house lawyers. I don't respond to them 'cause I do my own one person consulting thing. But it's fun seeing what's out there. If you adjust to your needs, maybe something will pop up that fits. Another way might be to ask around on boards where you are comfortable. Groups that interest you the most. Good luck.

[jwirr]

4. I have mentioned that this is an issue in my family in another thread. I have two adults and a young

nephew who show signs of needing anger management in one form or another. What can be done about it. The woman is seeing a psychiatrist who tells her she has paranoia and she takes pills for that. The adult man is using mj and works to control his anger but all too often he is screaming and hollering at the drop of a hat. The boy got into trouble in school and is getting treatment for authority issues.

Am wondering what other kinds of treatment there is and does it work?

[PowerToThePeople]

6. "limit access to firearms"

Sounds like a superb idea to me.

Ban all Guns!!

[ellenrr]

8. also people who take anti-depressants can become suicidal..

so if I know someone who is very depressed and taking anti-deps, I always tell them, if they feel suicidal, it may be the meds and they should deal with that, and not consider that the impulse is actually coming from their own heart.

[hedgehog]

9. Anyone who is starting a new anti-depressant needs close monitoring by a competent

medical authority. Some people need reassurance that if they stick it out another week or so, the benefits will kick in. Others, as you note, need to come off the drug because of suicidal thoughts.

The drugs shouldn't be dismissed out of hand because of fear of suicide. When doctors stopped describing anti-depressants to their teenaged patients because of that fear, the overall rate of suicide went up.

[jeff47]

16. The way I describe it to people who've never had depression

is depression is not "I feel awful, I should kill myself." It's "I feel awful, I should kill myself....Eh, why bother".

The danger in medication is you could cure the second sentence before you cure the first. As a result, depressed people need care from a "real" mental health professional, not a Zoloft prescription from their primary care doctor.

[REP]

18. The true paradoxical reaction to antidepressants is somewhat uncommon, though

Another poster described the 'I want to die ... too much trouble' and then finds enough motivation to carry through with it once started on an antidepressant, which is different than the true paradoxical reaction to one, where the depression is made significantly worse. In either case, it is imperative that a patient seek medical help immediately if thoughts of suicide begin or become irresistible, either when starting/changing dosage of an antidepressant or if no therapy at all is being attempted.

[ellenrr]

28. Antidepressants cause akathisia in some people,

which people who have it describe as such a terrible anxiety restlessness that they want to kill themselves to stop it. In his book, The Cult of Pharmacology, Richard DeGrandpre describes a study in which healthy people were given anti-deps and they were made so anxious by the drugs that they became suicidal, and when the drugs were stopped, they were fine again. Some people murder on anti-deps, like the school-killers, and hundreds of others. You can read more on SSRI-induced suicide and murder here: http://www.medicationsense.com/articles/oct_dec_03/suicides_homicides.php

The "poster" person is the man who never had a mental problem in his life. He retired, and felt bored and restless. (not uncommon). His doctor prescribed Prozac. Two weeks later, his son was visiting, and the man killed his wife, his son, and his grand-child, under SSRI-induced akathisia.

[REP]

33. What a terrible tragedy - starting with the misdiagnosis and ending in unspeakable horror

That is one of the paradoxical reactions. I have no idea how common it is in people who are misdiagnosed and being treated for something they don't have, but I am aware it happens in people who are correctly diagnosed as well. It also happens with benzos - while I do not become violent, I become awake, alert and very agitated when given Versed as 'twilight anesthesia' and others have similar (or worse) reactions to more common benzos.

[uppityperson]

13. Are you saying people who suffer from clinical depression have rage as the cause of depression?

For many, you have it backwards. Depression causes you to feel isolated, etc.

[jeff47]

15. In the 'internal' version, the rage comes from massive self-loathing.

I've never been a fan of calling it "depression", since that tends to make people think of it as sadness.

It's much more about self-loathing. Everything else kind of flows from that - the sadness, the anger, the hopelessness, and so on.

[uppityperson]

17. Most people I know or dealt with with clinical depression, main factor is biochemical issue which

then leads to the psych issue, not self loathing or rage leading to it.

[jeff47]

20. The loathing doesn't appear from nowhere.

The biochemical problems can lead to the psychological ones, or vice versa.

Realistically, the problem is language is not a perfect method of describing what's going on. There's a lot of nuance that is extremely difficult to properly express in words.

[nolabear]

22. jeff47 is doing a good job of answering. It's all biochemical but takes psychological forms.

And psychological events (PTSD, trauma, love, joy, etc.) create biological responses. The brain gets washed in cortisol (bad) or endorphins (good) plus other chemicals in response to events and that alters the brain.

The lay descriptions aren't adequate but depression and anger do have a relationship depending on chemistry and personality. Some people might become enraged but wouldn't dream of violence. For others the boundary is far more easily crossed. Impulse control varies. Whether it's turned outward or back on the self varies.

Diagnostically Major Depressive Disorder has a number of subsets. It's not all one thing.

[justiceischeap]

19. Most people don't have any real idea of what depression is and what having it entails

Most people think it's about feeling sad--I don't feel sad most days. It's the lack of feelings that's my issue--I just don't feel much at all. No joy, no anger, no real sadness...nada. Sometimes I think it's a side effect of the meds I take and I will sometimes go off the meds just so I can feel something... even if it's sadness.

Then there are days I have to force myself out of bed because I can't just lay there and watch TV or play video games all day because it's soothing in some weird way (habits that don't hurt, I suppose).

Another thing most people don't realize is that people who struggle with depression are often quite good actors. We've learned to act happy, we've learned to laugh at the right moment, we've learned to smile or interact or do a million other things that make others perceive us as normal so when we show signs of struggle, they don't comprehend what we've been doing or how we struggle on a daily (sometimes hourly) basis.

One of my known issues is not wanting to leave the house and it can take a while for me to recognize this is my "sign" that I need more help--usually a med dosage increase or switch. However, a couple years ago I took up photography as a means of getting me out of the house because besides going to work or the grocery store, I wasn't leaving my home. I've "felt" better since then but it's still a daily struggle to deal with the day.

It's also a daily struggle to keep stock of my mental well-being... doing a mental health assessment of yourself is never fun but it's my reality and has been since about the age of 14 (almost 30 years) and it gets tiring--emotionally, physically, mentally--and when it gets tiring, some decide to say "fuck it all" and end the struggle and some of us keep fighting.

As far as those thinking it's cowardly to commit suicide...you try dealing with what we have to deal with all the time and then lets talk courage. It's not fear that leads people to commit suicide, it's being worn out from the constant struggle--the fight we fight every single day among people who think saying, "Just be happy!" will fix it all. 'Cause, you know, it never occurred to us to "just be happy!"

[nolabear]

24. You're absolutely right. It's not sadness at all, and people learn to cover it.

That's one reason I wasn't terribly surprised about Robin Williams. It was speculative of course because you don't diagnose in absentia but given his own comments, the history of using substances, and the sheer force of that need to control things through that wonderful, forceful ability he had, I suspected a terrible depression. And I am so, so sorry it got him. But I understand, too. It's asking a lot of people to go one more day in the hope we can get a grip on it, but I do, every day. I hang on tight til they can, if they can. And sometimes it works and things really do get better, temporarily or long term. Hope you find your path.

[Trillo]

21. On the one hand you want to destigmatize,

On the other you want to remove firearms. Doesn't really seem like you can have both.

[nolabear]

23. Why not?

I don't see the problem. Help me understand what you mean.

[Trillo]

25. If you remove a civil right from someone, such as owning a firearm

then then potential loss of that right solely for asking for health treatment seems a disincentive to ask for such treatment, which seems a stigmatization. Is that clear enough?

[nolabear]

26. The blind can't drive. They have a disability.

The assumption of a sense of shame is not the same as stigmatization by society. I'm not advocating refusing guns to someone who seeks help but to someone who has been convicted of a violent crime, yes.

[Trillo]

27. Driving isn't a civil right, though it is a common privilege

I don't have an issue with someone convicted of a violent crime being denied a firearm, at that point they've demonstrated a lack of responsibility, and evidence for that conviction has been presented in a hopefully impartial way. But for merely seeking treatment for an illness, no. I'm not really sure we're in any kind of disagreement.

[ellenrr]

29. In fact there is no scientific evidence for the so-called "chemical imbalance theory" which

led to the billion-dollar antidepressant industry.
see for example:
Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020392

[HereSince1628]

31. As a critical reader of this topic I'd like a link to a source for the claim

"This often leads to abuse and even killing of others."

As you use it, "often" is a very ambiguous term. In what level of measurement was it determined, and with what precision? How different is "often" from "sometimes" how similar is it to "most of the time"?

You say you're concerned about reducing stigma, but mistaken notions about the dangerousness of persons with mental illness is a major motivator of bad attitudes toward and discrimination against persons with mental illness. Ambiguity, resolved by biased personal opinion, reinforces stigma.

Across what cohort of patients was 'often' determined? It's well known that violence by persons with mental illness is mostly directed at caregivers and institutional employees. I think it is reasonable to assume there is likely a bias of perceptions within caregivers and institutional employees which makes understanding of information source and efforts taken to control bias all the more important.

Also something to flesh out the phrase

"an old trope in the mental health field, but a pretty valid one".

Tropes are rhetorical tools that rely upon figurative metaphoric language. It's really short of acceptable for a claim of fact to rest upon a metaphor, particularly when claims of psychiatric understanding not only guide treatment but public policy toward mental illness.

Moreover, what does it mean to say something is 'pretty valid'? It obviously begs the question about a degree of validity. While science requires open-mindedness to the notion that understanding is imperfect, professional statements don't sidle up to a statement of research uncertainty in this way.

Stigmatizing is the tainting of identity, whether it's about race, ethnicity, sexual orientation, religion, or mental illness. Claims about violence among the mentally ill have high risk of stigmatizing. Popular belief in the general incompetence and pervasive dangerousness of persons with mental illness are foundational to acts of discrimination against persons with mental disorders. Consequently, discussions on the topic deserve care in the introduction of evidence.

Certainly persons with mental illness can, and do, commit acts of violence and harm. But Americans believe that dangerousness is much greater than it is. Depression affects tens of millions of people a year, who overwhelmingly don't become violent against themselves or turn that depression into rage against others. And rage, planned or impulsive is a symptom found in multiple mental disorders. Discussing this topic with metaphors and anecdotes seems a poor way to fight stigma.

Consider the findings of a literature review by the Treatment Advocacy Center on violence in persons with mental disorders:
http://www.treatmentadvocacycenter.org/resources/consequences-of-lack-of-treatment/violence/1381


1. Most individuals with serious mental illnesses are not dangerous.
2. Most acts of violence are committed by individuals who are not mentally ill.
3. Being a young male or being a substance abuser (alcohol or drugs) is a greater risk factor for violent behavior than being mentally ill.
4. Individuals with serious mental illness are victimized by violent acts more often than they commit violent acts (see Backgrounder: “Victimization: One of the consequences of failing to treat individuals with serious mental illnesses”).
5. If people with serious mental illnesses are being appropriately treated, there is no evidence that they are any more dangerous than individuals in the general population.
6. All of the above statements are true, but it is also true that a small number of individuals with serious mental illnesses commit acts of violence, including 5 to 10 percent of all homicides. Almost all these acts of violence are committed by individuals who are not being treated, and many such individuals are also abusing alcohol or drugs.

[nolabear]

32. I can't help but chuckle a bit at your critique.

Not that I take exception; I welcome the talk. But your points of objection are the exact places where I pulled back and softened my language in an attempt at sounding more equitable and fair. What it did is make me sound less certain. If I was writing an academic paper I'd look up the stats, but I'm not and I hope we can have a general conversation. I'll try to explain my position.

First, the greatest problem that mental health research has is that the population is self-selecting and the stats inexact. My own experience is in my office, where again and again I talk to people who have either come in for help (turned inward) or have been convinced to come in by the threatened loss of a relationship, a job, the court or some other potentially punitive source (turned outward). My use of "often" is, as are such things, taken from the known quantity, while I know all too well how many secrets are out there. We have to generalize or we can't diagnose, treat or recommend. We also have to maintain confidentiality except in a couple of cases (immanent threat of harm to self or other, or known abuse of a child or elder--already committed abuse of another adult is not mandated reporting, a mixed bag because you feel like hell about it but if they can't tell you, you can't help). Those sent in by others are very, very difficult to help. They genuinely believe that the problem comes from others, who trigger uncontrollable responses in them. In these people it comes out in rage, but the core is unbearable anxiety, the "fight" in fight or flight. They are suffering terribly, and people will do things that to some of us are unimaginable to make the anxiety stop. PTSD in the form it takes in war veterans is one of these kinds (see how careful I'm being?) of this kind. It's panic, but it was shaped by attack and the response is to either attack back, self medicate or bury one's self away from more and more of the world. Turned outward or turned inward. It's tough calling that "mental illness" because it's lumped in with things that resemble it only in effect, not cause.

One of the most difficult things about all this is the term "mental illness" itself. Officially there are two major diagnostic Axes , numerous categories under those Axes, numerous subcategories under those. Axis I includes the things we would think of as "mental illness" in the more biochemical, medicatable sense, such as Major Depressive Disorder, Bipolar Disorder, Schizophrenia, etc. Axis II is "disorders of personality," such as Narcissistic Personality Disorder and Borderline Personality Disorder. PTSD is Axis I but may be as deeply entrenched as Axis II because trauma is the likely cause of both, and the actions taken to end suffering are generally the same. See below.

Many people suffer from combinations, i.e. Comorbid Disorders. Someone with Borderline Personality Disorder may become very depressed over the difficulties of life, develop insomnia, begin abusing substances, develop symptomatic side effects, and so on. Those people can also be subjected to things that cause PTSD and so the ball rolls. It's tricky to suss out and tricky to find suitable treatments.

I absolutely agree that the majority of people who have a "mental illness" are simply people who suffer from the slings and arrows (I like metaphor. They are often far more accurate than jargon). I have, however, exacted many a promise for the disposal of weapons in the hope that someone will be able to get better before they do themselves or others physical harm. I have encouraged victims of abuse to get out until things can be gotten in hand, or just to get out. It's not that these people are evil; I don't believe in evil. I believe in mental triage, and you can't help someone who's dead or in prison. You have to work from the inside out.

I have to go to my office. Maybe we can continue, if you like. This kind of conversation can go on for a long time. I've been having it for years and I'm nowhere near stopping.

Thanks.