Columns Nov 27, 2013 at 4:00 am



I wonder how many times in internet history a comment thread has included talk about Mr. Rogers right below a post about vorarephilia...

@99 - Oh, so have my sympathies.

Honestly, I think fetishes like yours demonstrate why we need to seriously re-think our ideas about how our erotic imaginations work and what we can do with those imaginations.

I don't get why we heap so much shame and blame onto violent, depraved, highly unusual and disgusting sexual fantasies when we don't seem to have a problem with those kinds of images and scenarios cropping up regularly in our non-sexual imaginations. People don't see anything wrong with me getting excited about movies and TV shows that have violence, gore, cannibalism, torture, humiliation, weird and complicated scenarios in them, but as soon as I get SEXUALLY excited about that stuff, I'm a freak and a weirdo? Why? Why do we think that our sexual selves are going to be that far away from the rest of our psychological selves?

Dan points out often that we tend to sexualize things that we fear, and my personal belief is that we do this in order to have control over those fears, just like we do when we write movies and books about horrible things happening and heroes coming to save the day. It's a way of resolving and containing those negative emotions. It gives you freedom to feel joy, or to feel safe in the vulnerable position of sexual arousal.

Anyway, this is sorta half-baked on my part, but bottom line, the imagination is a weird, weird place. No reason to think it shouldn't continue to be during sex.
Applause to Lady Laurel and Lolorhone.

I didn't even see what went down at 12, but just the "Yes, depressives are forever unloveable" stuff was like a punch in the gut.
@97, Ok, that explains it. I searched over and over again using different terms for that post I thought I’d read where OutInBumF advised the LW’s ex to kill herself, preferably before she had kids. And it just wasn’t there. Rather than cluing in that it had been removed, I concluded that I’d misremembered and that the apallingness had been amplified through a series of comments. My apologies, no disingenuousness intended.

“I strongly agree that the lifestyle choices of people with it should be left to them, their medical/mental support and family”

Yes. Mostly to them, though. And if after 50 years of unrelieved suffering they decide that their lives aren’t worth living any more, are you going to judge or criticize them for being wimpS? Or are you going to allow them their autonomy?

RE children: “So once again, let's leave high level choices to individuals, their doctors, physiatrists, and families.” Whoever suggested otherwise? Has anyone here proposed a eugenics bill to forcibly sterilize or execute depressed people? I don’t even remember OutInBumF doing that — just offering a strong personal opinion *not* based on false information. Other people might form different opinions based on the same information but OutInBumF’s is not irrational.
LadtyLaurel @93:

‘"Some people's depression turns out to be curable with some number of treatments. Others die of the disease."

‘This is a very silly argument to use to try to prove whether something is curable or not. Our (often quite profit-driven) medicine hasn't found the cure, our preferred treatments don't always work, therefore it's incurable?’

Your response is meaningless. “Some animals can fly but we die if they try. That just means that we haven’t figured out how to fly yet, so we should jump off buildings because flying is possible.”

Completely incoherent. You have no idea if something is curable until you cure it. Your believing it is not a proof. The day that human beings zip around in the air like bats or hummingbirds is the day we have proven that human beings can fly.

In the meantime, until that proof shows up we can’t fly and it’s meaningless to assert that we can.

It’s also meaningless to assert that all depression is treatable, or could be prevented by living 200,000 years ago. There are people we cannot treat and we do not live 200,000 years ago.

To believe that everyone experiences the same thing in the same way as you and that because your depression passed that everyone’s depression can be induced to pass is to be wrong.
Andrew Solomon’s “The Noonday Demon — an atlas of depression” is a pretty good overview of the topic from many perspectives and in many places.…
@99 "the chance of being murdered is far less than the chance of being raped, and I'm assuming that's what the letter writer was most concerned about. I can't think of any way to have one night stands that reduces risk of rape."

I start by getting a real name, and googling them to see linkedin or FB or other evidence they have a life. Then we meet in public, to assess chemistry. Then I take a picture of their driver's license and email it to my husband. None of that prevents a minor level of sexual assault, a level I wouldn't report to the police. But it means they know they won't easily get away with kidnapping or brutalizing me.
@OutinbumF - You stated : "An alcoholic has but to stop drinking. The mentally ill are at the mercy of the Dr's and their meds- better in 2013, but still not a certain fix. "

This is an extremely irresponsible statement. Alcoholism IS a mental illness, and all mental illnesses are physical in nature. There are people who drink too much, and there are alcoholics. An alcoholic has undergone a brain rewiring that makes not having alcohol akin to not breathing. There are promising treatments, but as of today, there is no cure. Alcoholism is not a choice, please be careful with your wording in the future.
I've reread RISK's letter and see that it does indeed ask which is "safer." For some reason I remembered that as asking which was "better." Now I believe the question a little silly. (My original answer was in 1.)

Assuming she wants a one night stand with a man who is a stranger to her, assuming she has done nothing to vet this guy at all, doesn't know his name, hasn't so much as checked his i.d. and googled him, assuming that her main concerns are not getting assaulted, murdered, or raped, then why is having a one night stand with him?

If safety is the issue, then the safest thing is to do the vetting. Get a reference. Talk to someone who's known him for a while. Bring a friend. Bring a weapon. (O.k. not really, but you get the idea.) Be prepared with a self defense course. If this is about safety, then don't put yourself in unsafe situations.

So I assumed this was about etiquette and uncomfortable situations, not downright horrible ones. I assumed RISK was okay with the big (and probably unlikely) risks and was asking about the smaller (more mundane and likely) ones-- like what to do when you're annoyed, bored, or irritated. Go to his place anyway.
@OutinbumF - You stated : "An alcoholic has but to stop drinking. The mentally ill are at the mercy of the Dr's and their meds- better in 2013, but still not a certain fix. "

This is an extremely irresponsible statement. Alcoholism IS a mental illness, and all mental illnesses are physical in nature. There are people who drink too much, and there are alcoholics. An alcoholic has undergone a brain rewiring that makes not having alcohol akin to not breathing. There are promising treatments, but as of today, there is no cure. Alcoholism is not a choice, please be careful with your wording in the future.
@83 - and the rest of you claiming to understand depression and its causes. Please see…. Genetics play a HUGE role, and are estimated to be involved in about 50% of depression cases. I'm not sure where you got your Psychology or Psychiatry degree, but you should get your money back.
@109 (Crinoline): Yes, I mis-remembered the letter, too. True One Night Stands are generally less the kinds that EricaP describes @197, in which two people have "met" online (they may be stated as being only interested in one night stands, and of course, any initial sexual encounter has the potential to be a one-off) and more frequently a hookup that starts somewhere in the real world. In this case, there isn't much vetting you can do to ensure your safety. I guess you have to trust the statistics which indicate that the odds are against your being raped, tortured, murdered, eaten, kidnapped. But of course those possibilities exist and if you don't want to put yourself at that kind of risk, you shouldn't have a one night stand (this isn't to say that one can't be raped, tortured, murdered, eaten, or kidnapped by someone one already knows).

Bottom line, if you're thinking about minimizing risks of murder when planning for sex, you probably shouldn't be having one night stands.
@nocute, even meeting at a bar you can take a picture of his DL, email it to a friend, and google his name. Won't save you from psychopaths prepared with a good fake id, but should improve your odds a bit.
Amazingly when someone has the dis-ease of depression, few can truly understand. If you break a leg you cannot "will" it to be instantly better. Would anyone seriously counsel someone that had suffered a gun shot wound to, "recalibrate your approach, and really get better"? The best medical care offered for this baffling disease is pills, that while they offer some help, most often come with a long list of side effects. Killing libido is common. Staying in relationship with a person suffering depression takes a strength of will and spiritual courage seldom acknowledged. Instant gratification is the hallmark of our culture. You may walk the isle today and recite the vows, but when storm clouds form, take a quick exit.
@99: I can't think of any way to have one night stands that reduces risk of rape.

Actually that's been covered: go to his place, because if you change your mind or start getting a weird vibe it's WAY easier to collect your purse and leave than it is to convince him to get out your door. Plus in the former he may not know where you live for any follow-up stalking.
@112n(EricaP): I'm sure that's true. Assuming that when you google his name, the newspaper story of how he just served 15 years for aggravated assault comes up, or his inclusion on the sex offenders registry. Otherwise, I don't know what you're going to find. Even if he has a police record, you're not going to find it by doing a Google search on his name.

But I maintain that if you are thinking that you must take a clandestine photo of his license and google him (or demand that he let you take a photo of his license and google it), you probably shouldn't be figuring out "my place or yours" questions on a first meeting.

At a certain point, a one night stand is about trust. You trust your gut. You trust the odds. You go to his place, and, if you get a bad feeling, you leave. If you can't do that--fair enough, if that's the case--you shouldn't be having one night stands. There's no foolproof way to protect against danger. One night stands include an amount of risk. You can minimize that risk, but even Pat Boone, with the right amount of alcohol, meth, or PCP, sexual frustration, and whatever else could always snap. If you're trying to find the way to reassure yourself that you are perfectly safe, you shouldn't be having sex with someone you only just met.
I want to clarify that I've had a fair amount of one night stands. I was raped during one of them and couldn't have foreseen that outcome based on doing a Google search (not that there was Google, Linkedin, or Facebook in those days, or cell phones, with or without cameras, or an Internet that was used to set up the meeting). I survived to have one night stands again.

When I go on dates now (which I don't intend to be one night stands; it's either a first and last "nice to meet you in this public place" date, or a "nice-to-meet-you-in-this-public-place-and-next-time-who-knows-what-may-happen-but-I'd-like-to-see-you-again" date that may turn into that elusive relationship I'm searching for) I get last names in advance, do whatever vetting I can, and meet publicly, with the explicit mutual understanding that there will be no private time on that first date.
These are generally men I meet online, through a dating website. My days of intentional one night stands are pretty much over.
114-- Actually, the best bet for treating depression is SSRIs + cognitive therapy. That tends to be better than just an antidepressant or therapy alone. On the other hand, exceptions abound, and the trick is to find what works for each particular patient.
"Genetics play a HUGE role, and are estimated to be involved in about 50% of depression cases."

Man I don't want to play the snob game but since you started it my degree was in Neuroscience and it was from one of the top schools on the continent (I don't want to give away toooo much about my locale).

So fun facts

- Genetics playing a role is not the same as the cause being genetic

- Adoption studies (mentioned in your link) are DEEPLY problematic for studying things like depression since maternal stress has a huge impact on fetal development - this is a huge huge huge confound

- The link you gave didn't make any particularly strong statements about the role of genetics, just that they currently think genes contribute in a large chunk of cases

In other words, there is no scientific data that supports using eugenics to get rid of depression - which was the suggestion we were contesting in the first place.
I have actually seen 50 year, intractble depression cured over and over again... With ECT. Before I started my current job (in geriatric psych), I would never have believed it. I'm not sure what my point is, just wanted to add that even long term depression isn't always a lost cause!
@105 - I'm hardly presenting myself as sole evidence, here. I'm presenting a theory - which is not my own - about how depression results from a myriad of losses and environmental stresses inherent to living in the world we live in now and how different that is from the environmental conditions we've had for most of our time as a species.

The only thing I've done is use this theory to treat myself, both in how I've chosen therapy and how I've dealt with the nutritional and biological aspects. Everything I've done is supported by a body of evidence that shows this shit works. This isn't a bunch of crackpot theories, this is where the scientific community is moving with this stuff, it's just that it takes at least a generation or two for actual medical treatments and doctors to catch up, because there is NO system of checks in place to make doctors stay up-to-date with new discoveries. None.

Case in point, I fired my first psychiatrist when I began studying neuroscience and realized how woefully out-of-date and incomplete his working knowledge of brain chemistry was. Guy didn't know that serotonin is synthesized from tryptophan (I was trying to see if he thought eating a high tryptophan diet would help reduce my need for SSRIs - it did). A respected psychiatrist with a closed practice didn't know something that I learned in 15 minutes of Wikipedia-surfing.

The information is out there if you do your homework. It's out there, it's peer-reviewed, it's solid. The only problem is that it's very, very NEW, and that's why you and I are having this argument.
@119 - THANK YOU.
@114 - SSRIs, or anti-depressants in general? That's a much wider category and I do believe certain SNRIs are very popular right now (I think I personally know more people taking Buprion right now than anything else).
nocute @116, nothing clandestine about the googling or photo. I want my date to know that my husband knows where he works and where he lives and has the ability to convince the police of what he knows about who I was with if I didn't come home on time. Googling tells me this guy has a lot to lose; it's not about uncovering an arrest record.
@114 I think the most effective approach has always been considered pills + therapy? And for some people therapy alone works. Definitely not instant gratification though.
I was GGG to an adult baby for years. It worked well. It only fell apart when he was so consumed with diapers that he would no longer meet my vanilla needs. There are guys out there who are going to be fine with it if you can be fine with their needs. But, Dan is right, you will probably be much happier with someone who shares your kink.
It's well known that SSRIs kill the sex lives of some large percentage of people who take them. That could be by diminishing desire or by making it impossible to come. Does anyone have any theories as to why?

I don't know brain chemistry, but it makes sense to me that if someone is deeply depressed they have no interest in anything including sex. I don't understand why someone who is mildly depressed can have sexual desires when not taking SSRIs and see those desires disappear once on the drugs and the mild depression lifts. I don't understand why (some) people taking SSRIs as part of a control group who are not depressed report that their ability to orgasm disappears, then returns when they get off the drugs. What's the connection in the brain?
People with major, intractable depression try:
Diet and exercise
Pills, capsules and granules from the “health-food-store”
Antidepressant medication
Downsizing to a more manageable life, scaling back goals
Various new-agey rebalancing “therapies”
Antipsychotic medication
Elaborate drug cocktails
Brain surgery

... And they stay depressed.

That’s what refractory depression means.

*** *** ***

LadyLaurel, I have no idea why you think tryptophan is a new thing. It’s not at all. It might be new to you, and you might be excited about your discovery, but it’s not new.
I like all of this, except the part naming an official spokesperson for people with depression. No. I will speak for myself.
@128 - I know it's not cutting edge, but I can only assume it wasn't widely taught when my shrink was going to school. I was trying to give the guy the benefit of the doubt, but maybe he's just a complete idiot. At any rate, he had no idea.

There are so, so many shitty therapists and doctors out there. So often, the people who go into therapy are the ones who have so many unresolved issues of their own. You have to search and search and search and search to find the good ones, which is why I don't accept "tried therapy and doctors a bunch, didn't work," as proof of anything except a flawed and inadaquate system.

I mean...I'm not saying permanent, incurable depression CAN'T be possible, but in the same way that atheists look at the God question and say, "Human invention is far more likely," I look at this and say, "Human misunderstanding of the brain is far more likely."

@127 - As I understand it, it has something to do with the SSRI interfering with the dopamine responses in the brain. It's a very weird feeling and for me, at least, it interfered with more than sex. I couldn't get excited about things like books and music and crushes the way I was used to. That's one of the reasons I stopped taking it (that, and the fact that my insurance made me start taking the generic form of the pill, which has a different composition of binders that caused me to absorb the drug differently and go completely insane, but I couldn't get my doctor to listen to me because the official line from the FDA is that the drugs are the same no matter what's in the pill itself).

I switched to St. John's Wort, which is an herbal SSRI that doesn't generally cause sexual side effects. I'd be interested in knowing what's the difference, but I doubt there's enough money in that question for there to be enough research done. At any rate, St. John's Wort isn't strong enough for everyone, but there's always SNRI anti-depressants.
Geez, people, is it really that hard to tell that Dan was being tongue-in-cheek with the "official spokesperson" comment? The internet needs a sarcasm font...
St Johns Wort only is effective in mild to moderate depression. It does indirectly interfere with sex since it interacts with hormonal birth control. Its side effects include an increased sensitivity to sun and can interact with other drugs.

There are quite a few studies on St Johns Wort, enough for some meta-analysis:….
@133 The birth control problem is why I can't take it anymore.

W/R/T "Dont shit where you eat", I always understood it to mean don't date your roommate/hall mate/best friend's sister/coworker to avoid repercussions of breakup if things don't work out. I like you definition better.

This week deseves a rereading (or 2) before I dive in. I'd like to throw in, from personal experience, that short term suicidal depression can come about with the wrong drugs/side effects. The closest I've come to suicide was caused by indiscriminant prescription of percocet w/o a warning that it could cause depression; I flushed the lot right after an offhand comment from a friend stopped me from diving out a window. I am susceptible to depression as is, and was a teenager (enough said). I am incredibly thankful to that friend, and wonder how often people don't get a warning.

Correction for 135,

Dammit, something ate the "r" from your: I like your definition better.

Thanks, Married in MA. My definition encompasses yours, too.

EricaP: No doubt your technique is a wise one. I guess I am just reacting to the definition of "One Night Stand" in a very particular way, although any first time of having sex with someone carries the possibility of becoming a one night stand if it's never repeated. I always thought of a ONS as a chance or not prearranged meeting that spontaneously leads to sex, and the two people never contact each other in any way ever again. Under those specific circumstances, it is pretty difficult to do any reconnaissance or vetting (though I guess you could take the phone/photo of a driver's license and make sure the ONS knows you're sending the photo to a third party).
Ms Laurel - Just because something is tongue-in-cheek doesn't exempt it from being Better Unsaid.

Even as a joke, his comment had an edge. Any member of the Depressed could reasonably read, "This person makes the narrative of depression hilarious (and he probably had it worse than you); if your narrative isn't hilarious, you're Doing Depressed Wrong." It could have been Mr Savage's way of trying compassionately to get Depressed People to take what he sincerely holds to be a better tack for most of them, but this isn't a subject as clearly in his wheelhouse as, say, heterosexual male bra fetishists (I'm just trying to make something up so that I don't point a finger at anyone in particular here), and the depressed are so often oppressed as well that levity might not have been the best approach.

I suppose one could make a case that it would be condescending for someone who treats almost everything with a certain amount of snark to avoid talking about depression the way he talks about Almost Everything Else. Personally, I was more put off by the ham-handed air of Celebrity Dictating Their Tastes to the Hoi Polloi (so reminiscent of Ms O'Donnell on a bad day).
A tip for verifying photo ID's: Nowadays they have UV features visible only under a black light. So get yourself a key chain LED UV light and it will be a rare fake ID that can fool you.
"I kept helping and waiting, but she was simply unable to assert herself to make healthy changes (both physical and mental). I felt trapped dating someone who couldn't take control of her life, and the patterns kept repeating."

Hey, everybody! How was Thanksgiving? I guess ol' Griz is late in the game again (this time, from enjoying my GF/SF Thanksgiving, and spent a lovely holiday quietly contemplating and giving thanks to an overflowing massive abundance of blessings).

I was heartbroken to read SAD's letter! it sounds like he is an angel of a guy willing to do anything (within reason and healthily possible) to salvage his relationship, and restore the health of his girlfriend, suffering from depression.
I wish I had something to add to SAD's situation about combatting depression. Do he and his (now ex) GF share a favorite activity together? Music? Chocolate? Movies? Football? If they could at least remain friends, could still doing what they both enjoy and sharing favorite foods take some pain out of their ended relationship?

To everyone who is saying that SAD is playing the hero and not really helping, keep in mind that it's hard for someone in a relationship with a depressed person to find the point where supportiveness ends. I was in a relationship for 8 years with a great guy who dealt with a lot of depression and anxiety issues. I tried to do what others in the comment thread have suggested: Let him do whatever helped and support in any way I could. And a lot of times, that meant doing the things SAD talks healthy meals, working out with him (which I hate, unfortunately), encouraging him to go to therapy and take his medications, etc. And sometimes a little bit of pushing and tough love helped him to pull up a little bit...and sometimes it caused him to feel guilty, angry, anxious, and/or hurt. It was very difficult to know how much and what kind of support to give at a given time.

Now, it may be possible that SAD is one of those annoying people who's looking for a charity project. But I think he deserves credit for doing what he thought would help. It's hard to know what will work, and it seems to me that his working hard to figure it out says something good about him.
R.I.P. Paul Walker.
I am shocked there aren't more people in agreement with 9, 36, and 78 (NOT spam!). People who are enforcing/inscribing their own normal status by exerting psychic pressure on someone else to "get well" are probably reinforcing the reasons for depression in the first place. People like SAD should never date anyone with any kind of mental health issue. (Good lord I pray I never date anyone like that. It sounds like jail.)

I'm a happy person now, but being pressured to live on someone else's program-for-normalcy would have prevented my ever becoming happy.
‘I'm not saying permanent, incurable depression CAN'T be possible, but in the same way that atheists look at the God question and say, "Human invention is far more likely," I look at this and say, "Human misunderstanding of the brain is far more likely."’


Scenario A: A person has been suffering and struggling with only minimal relief for 50 years despite trying everything known. The person has refractory depression.

Scenario B: A person has been suffering and struggling with only minimal relief for 50 years despite trying everything known. They only think they are suffering because their human understanding of their brain is so limited. They are perfectly fine and there is no problem.

And you think Scenario B is the most plausible one?
@146 Scenario B is not "They only think they are suffering because their human understanding of their brain is so limited. They are perfectly fine and there is no problem."

It's "we all don't know that much about the human brain and are still looking for ways to treat this horrible disease."

And yeah, it's the most plausible scenario in my not so humble opinion.
Yes, of course some people don't get better -- and whether they COULD in better circumstances or not is probably unknowable. But 50 solid years of life-not-worth-living misery is not the actual reality for most of us, much as the disease itself wants us to THINK IT IS. Is it too much to ask you to stop reinforcing the ideas that worsen this horrible conditon? Because right now, Alison Cummins, you seem bizarrely invested in persuading people with depression not to have any fucking hope.
I am appointing myself the Unofficial Spokesperson for the Depressed. Why not? My Twitter followers are small in number and most people haven't heard of my book, but I don't care. I know depression and mental illness as intimately as Mr Delaney, and I can even make fun of it too.

There is no one-size-fits-all answer. I've talked people through their relationship issues when their spouse/SO had a mental illness, and sometimes they chose to leave the relationship, for various reasons, and sometimes they stayed. I took care of my mentally ill ex for as long as I could, until he stabilized enough to move in with his parents -- by that time I was broke and emotionally empty, but I refused to abandon him because, despite his behavior, he was my friend. Though he was often suicidal, it was cancer that got him.

My husband deals with my depression and he knows that it's not a matter of him making me better, because he can't, but he supports me any way he can. Only I can take the necessary steps to get better, and it's an ongoing process. Sometimes I'm up, sometimes I'm down. Sometimes I don't want to live, but I keep working at it.

Today I want to live, because I have another book to write and because life is good. And because I haven't told enough depressed people yet that someone cares, and that there are people who get it. We're all just doing the best we can.

@107 EricaP have you guys gotten into the swinger community, or FetLife or similar at all? It seems safer to play with guys who others have certified or do full same room swaps maybe, if you've had trouble with guys not being ok in the past.
As great as Dan's podcast is, you should NEVER listen to headphones on your bicycle! I'm a cyclist myself, and I can't stand it when people come barrelling down the sidewalks or crosswalks bobbing their heads to the rocknroll podcasts blasting, as I shout "watch out! Don't hit my 4 pound toy poodle!" as Bobo gets his guts smashed out by the Savage Love fan's bike.
No, I am not saying the only outcome for people with depression is to be depressed forever. That would be silly. Almost everyone can be treated.

What I am saying is that if OutInBumF claims to have been depressed with little relief for 50 years, they may be right. And if LadyLaurel says that all depression can be treated today because 1) 200,000 years ago depression didn’t exist and 2) in the future we will be able to treat everyone unless 3) we aren’t, which just means we’re *not smart enough* to treat everyone’s depression, it doesn’t mean we *can’t* treat everyone’s depression — if she says that she’s wrong. If we can’t treat someone we can’t treat them. People who can’t be treated do exist. That is not changed by asserting without evidence that they didn’t exist 200,000 years ago, and it’s not changed by asserting that we will be able to treat them in the future.

Basically, what I’m saying is that LadyLaurel’s non-argument that *she believes* that nobody in the past or future needed/ will need to be depressed doesn’t address OutInBumF’s claim that suicide is a legitimate option for people who rationally judge that their suffering will not be relieved in the present. And that it is possible to rationally come to this conclusion.
@Alison Cummins

You missed something important.

There is a big difference between a person choosing to take action to end their own pain, and a person choosing to end their life because they believe the world will be better off without them.

On a moral level* I respect that a person's most basic and intimate right is to decide whether or not they want to live. Suicide has never made the world a better place for anyone.

Before someone troll-mentions Hitler, I think suicide was his final dick move. He totally took away the satisfaction of someone getting to kill him. What a shitbag.

*Disclaimer: Obviously when this belief conflicts with the law I have to follow the law.
@121 You ask any neuroscientist and I'm pretty sure they'd tell you we know fuck-all about this stuff. We've only just started. We're guessing, mostly. One study, ten studies, don't mean much. They're just hints. You need hundreds of studies. Over time, over labs, different approaches. Human testing. We hardly even know how vision works, much less anything truly ephemeral and complicated like complex emotions. Mostly docs just chuck chemicals down people and see what happens. There is no reporting back or accountability outside pharma drug trials, which have their own problems. The scattershot method, since the response is highly individual, is as good as any sort of systematic approach until we get full genetic screening in place to see if we can predict drug response by genotype. Maybe 10 years to that, barring privacy concerns, in which case, 50+ years.
gnot @150, I don't meet people for casual sex these days -- too busy seeing my kinky friends for fun sessions. But I wanted to describe the system I used when I was meeting strangers for sex.

Not going off alone with strangers is safer, but some people, at some times of their lives, are going to choose to go off alone with a stranger. And I just don't think that it's safe to rely on one's judgment as to whether the stranger is trustworthy. I believe that the really vicious people are often quite charming and good looking; that's what has let them get away with their misdeeds in the past. In the Gift of Fear, Gavin de Becker suggests that our gut instincts are right -- but he says we often don't trust our guts at the key moments, because the other person is charming and we want to be nice. Being aware of that issue is helpful, but doesn't remove the problem. Which is why it's helpful to tell a stranger that someone else knows the whole situation.

Mydriasis: “There is a big difference between a person choosing to take action to end their own pain, and a person choosing to end their life because they believe the world will be better off without them.”

I don’t think there [usually] is, from the life-taker’s point of view. Their own life is valueless to them so they cannot imagine that it is not valueless to others.
LW1, you did the right things. My former partner got depressed 5 years into our relationship. For almost two years he resisted all my attempts to get him to get out and do things, to seek counselling/medical help, to meditate/journal, to exercise, to keep doing the things he loved: all he would do was work, sleep, eat unhealthily, and play increasingly violent computer games. He fell out with all his friends and became a complete shut-in. He kept telling me that this was just who he was now and I should accept him, and even though I knew he wasn't himself, eventually I came to believe him and I left. Now he's meditating again, he's back in touch with his friends and family, and he's getting help and taking care of himself. It had to come from him-- as long as I was the one trying to "change" him, he resented it, and resisted, and only once I was out of the picture could he take the initiative to help himself.
Listening to spoken-word material on an MP3 player while riding a bike is not dangerous to anybody. Stop trying to force me to be bored while riding my bike you nanny-state ignoramuses. And you shouldn't trust your ears to avoid cars anyway since many of them are so quiet now.
All this talk is starting to make me realize that I was never clinically depressed. I was depressed for a long time, sure, but I was always sad about something or some things that were going on. When I fixed these problems (or, more often, when I waited them out) I wasn't so sad any more. Getting up in the morning and getting my stuff done didn't fill me with dread and leave me without impetus.

I'm getting the impression from the stories on this thread that a clinically depressed person is someone who could slay every dragon and still be as depressed as someone who's had a major life setback or stagnation. That strikes me as really darn unfair. It cost me a lot to get beyond my problems and it sucks that some people don't get anything for their time and effort.
@158- spoken word is worse as you are more acting listening and processing what you are hearing. Also, cars have horns now. I get the importance of being a rebel or whatever but its not as important as being safe and responsible. Maybe you can go for a trail ride or something.
to DRF -- huge points to you for sharing this realization -- please go into the MH field and replace some of the cockeyed folks out there who don't have a clue! excellent observation.
For HRH LadyL -- you are not the template for the rest of the melancholic members of the planet. We have uniquely wired brains -- enjoy your strategies, thanks for sharing, now do a pirouette & come down off your throne.
DRF, you’ve nailed it for many people. There are different forms of depression. Some people can’t get out of bed. Others can be very high achieving but don’t experience any satisfaction from it.

“Clinical depression” isn’t an either/or. It’s possible to be clinically mildly depressed. I think the clinical definition is that for at least the past two to six* weeks you’ve been sadder than usual, getting less enjoyment out of life than usual, less motivated than usual, eating and sleeping more or less than usual and so on.

The crucial problem with this definition is the comparison with “usual.” If you were born with a limited capacity to experience pleasure, or if you’ve been depressed for years, or if you’re bipolar or have bipolar tendencies, “usual” might be unhelpful or hard to define. This is where a clinician with both experience and empathy is useful. They recognize the depression gestalt because they have worked with so many depressed people.

A lot of clinical depression is managed by waiting it out. One reason suicide rates drop in middle age is that people with a tendency to depression recognize it when it comes around again and they know from experience that if they can just sit tight it’ll be ok. Teenagers experiencing depression for the first time may think it’s real and that only cowardice prevents them from carrying out the moral imperative to do away with themselves. [waves]

*I think six weeks is the official cutoff for being depressed, but most people who’ve been “depressed” for two weeks go on to be depressed for at least six weeks so the cutoff is often given as two weeks. Something like that.
@162 We're talking more like years, so it was my usual. However, there was always an external cause. When the cause was not in action, I was not depressed.

Let's say someone has a serious, non-internal problem, like long-term unemployment. That person is depressed wile unemployed. After finding a job, that person is no longer depressed. I'm correct in saying that this person was never clinically depressed?
@160, someone wrote: spoken word is worse as you are more acting listening and processing what you are hearing.

It's not your decision what risks I choose to take! Also, it's infuriating that as a smart person I have to be subject to rules designed to save stupid people from themselves. I do not allow the audio book I'm listening to to distract me from watching for cars while I'm on my bicycle. When you average everyone together, you end up with policies that fuck over the half of us who are above average.

Also, cars have horns now.

Which can always be heard over spoken word. And anyone who, rather than using their eyes, bets their life that drivers will blow their horns before hitting you deserves to be removed from the gene pool.
"Mydriasis: “There is a big difference between a person choosing to take action to end their own pain, and a person choosing to end their life because they believe the world will be better off without them.”

I don’t think there [usually] is, from the life-taker’s point of view. Their own life is valueless to them so they cannot imagine that it is not valueless to others."

I have to disagree. I've had a lot of conversations with people who wanted to kill themselves and they can tell the difference.

I'm not saying suicidal people don't often feel both ways, in fact I think it's extremely common, but in my experience people are able to differentiate concepts.
@102 Thanks
159-- Yours is a common confusion. When people first hear the word "depression" and first start learning about the disease, the thing that springs to mind is usually a distinction between:

1. Symptoms that have an identifiable, obvious, and immediate cause in external events like your example of prolonged unemployment (or the death of someone close or a failed marriage).

2. Those same symptoms but no one can figure out what's causing them exactly. The person feels sad, has no interest in anything, and has no energy, but the things that seem so unsettling are things that other people deal with as a matter of course-- temporary setbacks like a difficult time with a bad teacher or a disappointing date.

It's easy to jump to the conclusion that the 2nd is a clinical depression because we guess that the problem is entirely due to some chemical imbalance in the brain, since it can't be due to anything else.

Our next guess (I'm including myself in this) is that the difference must be one of severity.

That would be wrong too. The definition that clinicians use has much more to do with the length of time the symptoms last. Granted a lot more goes into the diagnosis, but duration is one of the things that's taken most into account.

That definition often bothers me because cause and severity seem to be more important to determining the most effective treatment, but I don't work in the field or make the rules.

Again, it’s not either-or. Let’s say your mother dies and you end up with a lot of family responsiblities you don’t know how to handle. You become overwhelmed and are less effective at work. There are layoffs and you’re on the list. You lie around the house watching television, drinking too much and being critical of yourself and everyone else. Your partner leaves you. You stay like this for a year and a half before you gradually pull out of your funk, get regular work and find a new partner.

This is clinical depression because 1) it’s not your usual state; 2) it interferes with your life; and 3) (as Crinoline says) it lasts longer than two to six weeks.

A common pattern is for each subsequent episode to be triggered by less and less disruption. Perhaps the next depressive episode is triggered by an asshole boss. The next one by the double-whammy of plantar fasciitis and a root canal. The following one by your toaster and your fridge breaking the same week. (You get the picture.) Also, subsequent episodes may be more severe. Maybe the first episode lasts six months but the last one lasts three years. Maybe the first time you didn’t really notice you were depressed until after you started pulling out of it, but the last time you’re actively suicidal.

While it’s easy to understand how someone could be crushed by a combination of major losses, it’s less easy to point to minor losses as a cause. But clinicians don’t really want to put themselves in the position of rating someone else’s life experiences as “legitimate” and “illegitimate” causes of their state of mind. What interests them is whether that state of mind is helpful.

First episode, mild to moderate symptoms, less than three months duration? Lifestyle modification and CBT are probably the first-line treatments of choice whether or not there’s a clear precipitating event.

Second episode, moderate to severe symptoms, has been dragging on for more than six months? I don’t care what the precipitating event is, you’re in trouble. Lifestyle modification and CBT will go a lot further if you have the support of first-line antidepressant medication.

Twelfth episode, severe symptoms, has been decades since you felt really well? You might or might not need hospitalization to keep you safe, but we’ll definitely be keeping a close eye on you while we try various drug cocktails to get you stabilized so you can go out and deal with your life.

Another way to look at it: compare to having a bum knee. Most of the time you are fine and function the same as everyone else without a bum knee. It only gives you problems when you’re carrying something heavy, you gain weight or go skiing. So you wear a knee brace, join weight watchers, do stretching exercises and you can do all those things. Maybe you also take painkillers and get knee surgery. Maybe you eventually stop skiing.

Saying, “I don’t really have a bum knee because it’s only a problem when I put extra pressure on it” is not useful when trying to get the most out of life. Can you do what you need to do? No? That’s the problem.
@167/169 I'll admit this annoys and confuses me in about equal measures. I know that my situation wasn't clinical depression, but a shitty situation where I didn't recognize I was feeding my own misery and confusing my productivity with my worth as a human being (an easy mistake in a capitalistic society). While I failed and had to suffer the consequences, it made me recognize the value of emotional intelligence and healthy coping skills, which I started to put into practice as best I could (old habits die hard).

My grandfather died last spring. The nurse warned we could leave and come back as the next step would be upsetting. I saw them take him off life support by myself from a crowded hallway with my brother on the phone. I broke down, but by the time my family came back to his room I was already ready to help my grandmother. I'm fairly certain some people in my family were upset because what time I did spend with them wasn't spent moping around the house but trying to cheer up my cousins. I was surprised that I was able to mourn properly without repressing anything (which was my habit as a kid) or wallowing indefinitely in my own emotions until they exhausted themselves. If I hadn't had the previous experience then I wouldn't developed what I was lacking which enable this modest emotional growth later on.

My point is; how do you tell the difference between someone who hasn't developed these skills and someone who is incapable of building these skills? Would the pills that help the clinically depressed hamper the growth of the others who can deal, but never learned how? I ask this sincerely, because it seems like doctors are prescribing anti-depressants rather wantonly. The doctor looking after my grandfather in his final offer even made a general recommendation to my family and I to get some to help us cope which I found downright alarming since he had never met a single one of us before that.
Really Now,

Who said anything about not being able to build skills being a criterion for being depressed? Most people can build skills and many people learn lessons from clinical depression. I learned compassion for suffering. I learned a huge amount from the aftermath of my ex-from-hell though the price of the lessons was too high. Still, I paid and I learned.

I was in a workshop for people “at risk for depression” meaning people who’d been depressed on and off for years but who were able to interact and participate and weren’t actively suicidal. It was a great workshop. One of the reasons it was so great was that I got to meet other depressed people and they were really cool. Black humour. Able to look suffering in the face. Compassionate and thoughtful. I thought, if these folks are so obviously cool maybe I have something to contribute too.

Pills don’t necessarily prevent people developing this depth. You don’t start taking pills until you’ve been suffering for a while, for one thing.

Taking pills is in itself a learning experience. It gives you a sort of standard to compare your state of mind to even when you aren’t taking them. “Oh, this is how I think when I’m depressed. Not good. How would I have responded when I was taking Zoloft and feeling resilient? Ok, let’s work towards that then.”

In my experience, no, doctors do not prescribe them wantonly at all. I had real trouble getting them.

RE the doctor caring for your grandfather. 1) Are you sure that what he was proposing was that your entire family line up for medication? Could he have had some other type of support or therapy in mind? There are various grief support groups that families may be referred to through hospitals. 2) The doctor may make general grief-support recommendations to everyone, or he may have had some thoughts about the abilities of some of your family members to manage their emotions appropriately. Even if he had not met you in person he reviewed your grandfather’s file in detail every day and I am quite sure he would have been aware of any dramas.
@169, Alison Cummings, that was a very interesting post. I agree with a lot of it, but I'm bothered by the way you seem to be downplaying the importance of life events that might cause depression. While I can understand a clinician maybe deciding it's too fraught for them to get into the business of weighing how "legitimate" one person's depression trigger is compared to another person's, that doesn't mean those distinctions don't exist. It just means maybe a clinician can't reliably make those kinds of judgments. You seem to be saying depression is depression, but it seems to me to be very useful to try to understand why each individual person is depressed, because it allows one to more intelligently weigh the pros and cons of different treatments.

Say I'm depressed and considering going on some antidepressant that has unpleasant side-effects. It makes a big difference whether my depression is being caused primarily because of some very stressful work situation I'm in, vs. some chemical imbalance that happens no matter what my life situation is. If I know that certain work situations cause me to be depressed, I can weigh the costs of changing my work situation vs. the side-effects of the medication I'm considering taking, and possibly decide I'd rather look for a different job. On the other hand if I understand that I'm very predisposed to being depressed no matter what situation I'm in, then it might make more sense for me to try the drugs, even with the side-effects.

To use your knee injury analogy, if I was trying to decide between getting knee surgery, using painkillers, or just avoiding a certain activity that bothers my knees, a good understanding of what's causing my knee to hurt would certainly be very useful in making an intelligent choice. A doctor who just automatically prescribed painkillers or surgery without researching other options like changing the patient's behavior would seem irresponsible to me.
@172 I wasn't trying to suggest that clinically depressed people don't learn anything about themselves from their depression. I was trying to make a distinction from someone who genuinely needs medication to function normally and someone who just doesn't develop the skills to recognize and deal with their emotions in a healthy manner.

Yes, he made a blanket statement to my family in general. And they didn't offer us anything besides to contact the morgue across the street.
Did I miss something? Where does letter-writer #1 indicate that "he" is a man? I found it interesting that the writer didn't seem to think it mattered. It doesn't! The person was loving and generous, above and beyond the call.
@170- You're depressing. She probably knew he wasn't in love with her. Caring about someone, and feeling sorry for them, isn't the same as love. He needed confirmation on getting out. He didn't want to feel bad, or take any responsibility for the failure of the relationship. It's simple. Either way, he deserves to be happy. She will be better off. No one wants someone as their partner, who feels 'obligated' to stay as long as they could. He was smart to leave. They both deserve better.
It's all speculation really.
@36 Thank you.
Baby baby hahahaha.
The risk...

I think if a murder is the issue, I rather be found in my own place/hotel room and that he has left some evidence. Rather than going to his cave and chancing never being found.
It has been proven that one should never multiply the crime sites. For example if you are being kidnapped it is better to fight and be killed than be taken and still be killed in a place where no one would look for you in the first place.
The risk...

I think if a murder is the issue, I rather be found in my own place/hotel room and that he has left some evidence. Rather than going to his cave and chancing never being found.
It has been proven that one should never multiply the crime sites. For example if you are being kidnapped it is better to fight and be killed than be taken and still be killed in a place where no one would look for you in the first place.
Dear Dan Savage,

My boyfriend always closes and locks the door behind him when he pees. It really bothers me and turns me off because it hurts my feelings. If he wasn't so prudish and such a prissy little puss, It would be a simple way of turning me on and arousing me for sex, to be a part of his pissing experience. He claims it's because he is pee shy. So I tested that theory; one day, I broke into my bathroom with a little screwdriver and found him peeing with his dick in his hands, standing there, grinning at me. So if he knows that I like it, and if the issue is about being pee shy, and not about a NO GIRLS ALLOWED MOMENT, then why can't he pee in front of me, especially if we have been lovers for five years now!?????

I would be grateful for your advice on how to get him to relax with his peeing moments a little more because I'm BORED. Thanks!

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