[qwerty68]

If mental illnesses are an actual disease, do you think that they can become terminal, like cancer and other diseases? If they can be terminal, how do we know they are and how can I handle it?

[VabGirl]

Hard to answer that

[qwerty68]

It is true that it is difficult but I am coming up to 30 years of suffering without anything helping and it feels like it might be terminal. Something has changed and not for the good.

Well, no one can objectively test me for my diagnosis so it is probably pointless to pursue answers that do not exist.

Thank you for your time.

[DocJohn]

Much about the causes and etiology of mental illness remains unknown, so there's no real data to answer your question as to whether any type of mental illness is "terminal." For some people with some disorders, it is likely they will live with a form of the disorder for their entire lives. With treatment (just like in medicine), that "living with" can still result in a good life.

Our understanding of mental illness is still in its infancy in many ways. It's a good question, but one where science doesn't yet have the answer to.

[divine1966]

Many mental illnesses or other types of disorders aren’t curable. But even not curable most are treatable as to make symptoms bearable or minimize them.

What do you mean by no one will test you for your diagnosis? Do you have a diagnosis and if yes how was it established?

[qwerty68]

I meant that there are no real tests to confirm a diagnosis, it is all subjective, including the diagnoses themselves.

It makes everything even more confused than I already am.

[lizardlady]

Originally Posted by DocJohn

Much about the causes and etiology of mental illness remains unknown, so there's no real data to answer your question as to whether any type of mental illness is "terminal." For some people with some disorders, it is likely they will live with a form of the disorder for their entire lives. With treatment (just like in medicine), that "living with" can still result in a good life.

Our understanding of mental illness is still in its infancy in many ways. It's a good question, but one where science doesn't yet have the answer to.

Doc John, you remind me of a saying I heard in grad school. "Physics and chemistry are hard sciences. The life sciences are soft science. Psychology is the impossible science."

Your comment about living a good life while dealing with a mental illness is so true for me. I've been depressed most of my life, but after therapy and finding the right drug mix I've lead a good life.

[DocJohn]

Originally Posted by qwerty68

I meant that there are no real tests to confirm a diagnosis, it is all subjective, including the diagnoses themselves.

It makes everything even more confused than I already am.

Just to be clear, although most people don't know this, most medical diagnoses don't have a specific lab test to confirm a medical diagnosis. It's a common misconception that medicine has tests for every disease. They don't.

What they do have is a constellation of symptoms, some of which can be measured through a lab test, and if you put all those together, it leads a physician to a handful of possible diagnoses. The whole TV show House MD was based around the more rare of these kinds of diagnoses.

So I would just say don't worry about the specific mechanics of diagnosing a mental disorder. What we do nowadays is really good enough in most cases to help people find an effective treatment that works for them.

[Tart Cherry Jam]

There was a long article in the New York Times earlier this year about terminal anorexia. It can be terminal. The stories described in the article were harrowing. Absolutely dreadful. The one I remember the most was of woman whose illness was accepted as terminal by her provider and by her and no more attempts were made to prolong her life and she knew she was dying and even during those last days she would go on incredibly long walks to prevent her body from gaining weight. The grasp her disease had on her mind could not be released. I posted this article in the eating disorders forum and can find it for you if you are interested, with a warning that simply reading the article through the end was very hard for me.

Anorexia in this deadliest form is an exception among mental illnesses, though, as most can be managed with the arsenal at our disposal today. You have posted about your story and we know you are at that point that for 30 years everything has been tried and failed and you feel out of options and understandably pessimistic. And it seems that the constraints of the VA system do not allow doctors to experiment with some medications. But I offer from my friend who lives quite well with treatment resistant bipolar II and who is a software engineer says: mathematically, we have so many drugs available today that if you combine them in different constellations and at different dosages, the sheer number of possible combos is staggering and something there will work if you have a doctor willing to try unusual combinations. He has such a doctor at McLean hospital and thanks to that doctor, my friend stopped trying to kill himself when his life seemed pointless to him and managed to build a life with employment (even though he did not graduate as he was too sick in college, but he took enough classes) and a family. Actually his wife never worked and they raised two daughters and he now has two grandchildren, his elder daughter's children. And he has a loyal dog who helps him work from home. He has depressive waves during which he mostly sleeps and does not attempt to work, but they are infrequent. He has moved to PNW and his doctor there is a woman willing to adjust dosages a lot and experiment and that is still needed from time to time. He is very sedentary and that is not something that he is willing to change. I am sure his life would have been even more manageable had he walked and lifted weights, but... This is a rather long story to say that he, as a math nerd who went to a top technical school, makes a combinatorics argument for the possibility of finding a winning combo out there.

To DocJohn's point: I have hypothyroidism caused by prior intake of Lithium which was diagnosed by a lab test and my presentation with symptoms in urgent care but also have a chronic intractable migraine and now also vestibular migraine for which there are no lab tests. The absence of lab tests does not make these diseases any less real, or painful if untreated. But I have ultimately found treatment for all the symptoms with pharmaceuticals. One of them is not approved in the US but widely in use in Europe and UK and I will have it shipped by a Canadian pharmacy at a reasonable cost but that is OK. I am very thankful for these drugs. And with bipolar, I am on an unusual combo and doing relatively well. It took years to get here but that is the story of iterating and trying many things that do not work until you find the thing that does.

[SquarePegGuy]

Originally Posted by qwerty68

If mental illnesses are an actual disease, do you think that they can become terminal, like cancer and other diseases? If they can be terminal, how do we know they are and how can I handle it?

I started to reply without reading any of the other responses.

Initially I thought no, that mental illness is not terminal. It affects a non-vital organ (the thinking and/or emotional parts of the brain).

But one's emotions and thoughts can lead to self-destructive behavior. TCJ gave such an example.

Comorbidities such as drug / alcohol abuse, for example, can lead to shorter life span regardless.

[Tart Cherry Jam]

I did not read it but saw an article in thr NYT email update yesterday: deaths related to alcohol are on the rise. And where you see alcohol mentioned, you can be sure that dual diagnosis is lurking in the background.

[qwerty68]

Originally Posted by SquarePegGuy

I started to reply without reading any of the other responses.

Initially I thought no, that mental illness is not terminal. It affects a non-vital organ (the thinking and/or emotional parts of the brain).

But one's emotions and thoughts can lead to self-destructive behavior. TCJ gave such an example.

Comorbidities such as drug / alcohol abuse, for example, can lead to shorter life span regardless.

Luckily, substance abuse is not an issue for me. I don't know how it isn't but even after 5 years on an opioid and too many to count for benzos, I still have no addiction issues.

Since my seizure almost 30 years ago I haven't even drunk alcohol, which is something that affects my mind and sends me into a panic, typically.

My therapist has told me two contradictory things. 1. He has never encountered anyone who has such deeply-rooted depression. My previous T said something similar but she added that it is almost my entire personality, but she sees some of my real personality from time to time. 2. He has never seen someone with severe depression be able to manage life as well as he thinks he does. I am very good at managing my disability income to the point I own a home and have decent-sized savings.

He says that is almost contradictory to my condition. He just doesn't understand that I have lived with it so long that I am used to it.

He was also very surprised that I didn't have a substance abuse problem. He and my pdoc are both so unbelieving that they made me take a drug and alcohol blood and urine screening. That kind of sucks. Never in nearly 30 years at the VA have I tested positive for something I wasn't prescribed and have never run out of meds early. I distrust them both a whole lot now.

Anyway, I am less sure it is terminal but still could be. I guess in my case it will depend if the ketamine treatments offers a way to improve, at least a little.

Hope this makes sense, had a ketamine treatment a few hours ago and they increased the dosage.

[Rose76]

It can be argued that referring to a psychological disorder as an "illness" is, to some extent, metaphorical. It's been such an apt and useful metaphor that we forget that. Some critics of "the medical model" object to what they call "the medicalization of problems of living." I believe they have a point. A big problem with "the medical model" - IMO - is that it has influenced many to see psychological disorders as forms of brain disease. That involves failure to distinguish the mind from the brain. They are not the same thing. I can agree that the mind is a function of the brain. Destroy the brain, and the mind will be gone. However the mind is not a function only of the brain. It is also a function of experience. You can have a perfectly healthy brain and a very damaged mind. Experience matters. The ideas one believes matter. The habits one has gotten into matter.

The disease model did seem a big improvement over prior paradigms, such as the "possessed by demons" model. One risks censuring, if one rejects the disease model, because others fear that doing so means regressing to a less scientific way of analyzing mind and a return to superstition. However, a lot of what has gone on in psychology and psychiatry is not all that scientific. Ideological bias infects and drives much of it. That tends to boil down to practitioners wondering how they can manipulate the physiology of the brain to produce changed behavior. I liken that to me going to an orthopedic specialist in search of treatment that will make me a better dancer. "Gee, Doctor, all my friends dance better than me. Please find out what's wrong with my legs that is causing me to be a clutz on the dance floor." Dancing is a function of the legs, but it's also a function of other things - like the quality of training that one receives, the amount of practicing that one does, and the availability of a good dance partner to practice with. I can have a perfectly decent pair of legs and yet be a crummy dancer. Likewise, you can experience horrendous psychological distress, despite having a healthy brain. It's a complicated world. Living in it successfully requires a very great deal of good training. Not everyone gets adequately trained.

Asking "What mental disease do I have . . . and is it terminal?" are the wrong questions. (I also don't believe that MSW-counselors should be in the business of diagnosing.) It would be more useful to explore "What difficulty am I having living successfully and getting my needs met?" and "What living skills do I lack?" and "How can I acquire a better approach to living successfully?" Another line of inquiry might be "What's wrong with my attitude?" and "What incorrect ideas do I have about how life works?"

Unfortunately, the disease model has turned emotionally troubled persons into "patients" who need "medical treatment" to correct the physiological pathology causing their brains to not work right. They are so relieved to be told that they have a "sickness" because they believe that means "It's not my fault." I think we'ld be better off figuring that "If I'm chronically despondent, then I must have an approach to life that is not working for me." That is self-empowering.

[Tart Cherry Jam]

I would argue that it is the brain that makes me clumsy at dancing. I do have a pair of perfectly good legs but dancing requires that I coordinate them and that most likely resides in the brain, in how the brain sends signals to my legs to move according to the rhythm of the music. The brain and also more broadly the central nervous system and possibly also the peripheral nervous system (I forgot all the physiology I learned in school and do not remember what the role of the peripheral nervous system is). So because something is wrong with my brain, I cannot make my voice sing correctly and my body move according to the music I hear. I know I.am doing thinfs wrong, signing off key and moving clumsily, but I am unable to fix it on my own. Either it is experience (I have not had good teachers and, instead, I was ridiculed as a child which caused psychological trauma) or lack of luck or some faulty nervous circuitry (I do score in the 20% percentile of online tests of discerning sounds on the website of the Yale school of medicine, but I am not completely tone deaf). If it were possible to fix such things medically, I would not go to an orthopedic surgeon to fix the legs or an ear nose and throat specialist to fix my vocal tract but instead of to this hypothetical specialist who can fix how the brain orchestrated all of those and more. We do not have such specialists.

I am sorry I am leading this thread astray but I felt compelled to dispute the dance analogy in your beautiful post, Rose.

[divine1966]

Originally Posted by Rose76

It can be argued that referring to a psychological disorder as an "illness" is, to some extent, metaphorical. It's been such an apt and useful metaphor that we forget that. Some critics of "the medical model" object to what they call "the medicalization of problems of living." I believe they have a point. A big problem with "the medical model" - IMO - is that it has influenced many to see psychological disorders as forms of brain disease. That involves failure to distinguish the mind from the brain. They are not the same thing. I can agree that the mind is a function of the brain. Destroy the brain, and the mind will be gone. However the mind is not a function only of the brain. It is also a function of experience. You can have a perfectly healthy brain and a very damaged mind. Experience matters. The ideas one believes matter. The habits one has gotten into matter.

The disease model did seem a big improvement over prior paradigms, such as the "possessed by demons" model. One risks censuring, if one rejects the disease model, because others fear that doing so means regressing to a less scientific way of analyzing mind and a return to superstition. However, a lot of what has gone on in psychology and psychiatry is not all that scientific. Ideological bias infects and drives much of it. That tends to boil down to practitioners wondering how they can manipulate the physiology of the brain to produce changed behavior. I liken that to me going to an orthopedic specialist in search of treatment that will make me a better dancer. "Gee, Doctor, all my friends dance better than me. Please find out what's wrong with my legs that is causing me to be a clutz on the dance floor." Dancing is a function of the legs, but it's also a function of other things - like the quality of training that one receives, the amount of practicing that one does, and the availability of a good dance partner to practice with. I can have a perfectly decent pair of legs and yet be a crummy dancer. Likewise, you can experience horrendous psychological distress, despite having a healthy brain. It's a complicated world. Living in it successfully requires a very great deal of good training. Not everyone gets adequately trained.

Asking "What mental disease do I have . . . and is it terminal?" are the wrong questions. (I also don't believe that MSW-counselors should be in the business of diagnosing.) It would be more useful to explore "What difficulty am I having living successfully and getting my needs met?" and "What living skills do I lack?" and "How can I acquire a better approach to living successfully?" Another line of inquiry might be "What's wrong with my attitude?" and "What incorrect ideas do I have about how life works?"

Unfortunately, the disease model has turned emotionally troubled persons into "patients" who need "medical treatment" to correct the physiological pathology causing their brains to not work right. They are so relieved to be told that they have a "sickness" because they believe that means "It's not my fault." I think we'ld be better off figuring that "If I'm chronically despondent, then I must have an approach to life that is not working for me." That is self-empowering.

Interesting post. I agree that self empowering approach of “how I can live a better life with my disease/syndrome” is a good one. But it’s not always enough.

Many mental illnesses/syndrome/diseases need to be managed by medication and otter methods because they are actual real illnesses and disorders.

My husband lives a great life, he has a great career, hobbies, friends and family, and he overcomes obstacles of his Tourette’s and severe OCD every day of his life, often inventing his own strategies of managing them. But still without OCD meds he’d not be able to. He tried. It’s not possible. He’d not be able to work or function in full capacity (not only right meds cut the edge of OCD but also mellows down some Tourette’s symptoms). He also sees a therapist every other week and has periodic med review with psychiatrist.

So it’s both: medical treatment and healthy approach to life. But both are needed.

I think it’s important to accept that one has an illness or disorder so they know they have to seek treatment in addition to developing healthy attitude towards managing their disorder.

[divine1966]

Originally Posted by Tart Cherry Jam

I would argue that it is the brain that makes me clumsy at dancing. I do have a pair of perfectly good legs but dancing requires that I coordinate them and that most likely resides in the brain, in how the brain sends signals to my legs to move according to the rhythm of the music. The brain and also more broadly the central nervous system and possibly also the peripheral nervous system (I forgot all the physiology I learned in school and do not remember what the role of the peripheral nervous system is). So because something is wrong with my brain, I cannot make my voice sing correctly and my body move according to the music I hear. I know I.am doing thinfs wrong, signing off key and moving clumsily, but I am unable to fix it on my own. Either it is experience (I have not had good teachers and, instead, I was ridiculed as a child which caused psychological trauma) or lack of luck or some faulty nervous circuitry (I do score in the 20% percentile of online tests of discerning sounds on the website of the Yale school of medicine, but I am not completely tone deaf). If it were possible to fix such things medically, I would not go to an orthopedic surgeon to fix the legs or an ear nose and throat specialist to fix my vocal tract but instead of to this hypothetical specialist who can fix how the brain orchestrated all of those and more. We do not have such specialists.

I am sorry I am leading this thread astray but I felt compelled to dispute the dance analogy in your beautiful post, Rose.

Interesting. I am tone deaf. My ears and vocal cords are fine. It’s not ears and vocal cords that cause that. It’s also hereditary, my mom was tone deaf.

[Rose76]

Originally Posted by Tart Cherry Jam

I would argue that it is the brain that makes me clumsy at dancing. I do have a pair of perfectly good legs but dancing requires that I coordinate them and that most likely resides in the brain, in how the brain sends signals to my legs to move according to the rhythm of the music. The brain and also more broadly the central nervous system and possibly also the peripheral nervous system (I forgot all the physiology I learned in school and do not remember what the role of the peripheral nervous system is). So because something is wrong with my brain, I cannot make my voice sing correctly and my body move according to the music I hear. I know I.am doing thinfs wrong, signing off key and moving clumsily, but I am unable to fix it on my own. Either it is experience (I have not had good teachers and, instead, I was ridiculed as a child which caused psychological trauma) or lack of luck or some faulty nervous circuitry (I do score in the 20% percentile of online tests of discerning sounds on the website of the Yale school of medicine, but I am not completely tone deaf). If it were possible to fix such things medically, I would not go to an orthopedic surgeon to fix the legs or an ear nose and throat specialist to fix my vocal tract but instead of to this hypothetical specialist who can fix how the brain orchestrated all of those and more. We do not have such specialists.

I am sorry I am leading this thread astray but I felt compelled to dispute the dance analogy in your beautiful post, Rose.

Thank you for giving so much thought to my analogy. I don't want to overly belabor it, but I have some thoughts in response to your post.

My late boyfriend was a very good dancer. Twelve years after we became a couple, he had a stroke. Though it put him in a wheelchair for a while, he did recover his ability to walk. His gait was altered, giving him a slight limp, but he could walk a half mile at a reasonable pace. However, he never danced again. This was a clear case of damage to the brain disrupting his ability to do something that he had previously mastered. His left side was permanently weakened and harder to control. He received excellent physical therapy, which he worked hard at. Despite months of that, there was a limit to what ability he could recover.

I have no neurological impairment affecting my mobility. As evidence of that, I happen to be a good swimmer. However, I'm not much of a dancer. There is no physiologic impairment causing that. As a teen, I was shy, didn't socialize a lot, and rarely went to dances. My lack of dancing ability was due to lack of experience. I took some dance lessons and found that dancing can be learned. I improved, but didn't stick with the classes long enough to get good at it. There is nothing a physician could have prescribed to make me learn faster. You either put in the work it takes to master a skill, or you remain unskilled.

Undoubtedly, there is a neurological component to aptitude. Some kids have superior hand-eye coordination. These kids may shine on the baseball diamond. Some kids are never going to excel at pitching a baseball, no matter how much great coaching they receive and despite a willingness to practice hard. It doesn't mean that there is something physically wrong with them that might be corrected through a medical intervention.

I happen to believe that a lot of mental distress comes from a deficit in the skills of living, especially social/interpersonal skills. It takes an awful lot of the right experiences to produce an emotionally well-adjusted, competent human being. I'm amazed that so many people turn out as well as they do. Given a serious deficit in the needed experience, a person is going to find themself floundering in life. No amount of psychtropic medication is going to remedy that. The problem is not in the wiring or chemistry of the brain. The problem is in the mind. (I do recognize that a dearth of healthy experience growing up can impact the physiological development of the brain. But, even in that case, I think it's illogical to expect that drugs can really address the problem.)

I'm not against psychotropic drugs. Taking an antidepressant changed my life. It did not imbue me with the important skills I failed to develop in childhood. (Poor performance on the dance floor was not the only symptom of that.) Nor did going for psychotherapy prove particularly helpful. There is no complicated skill that can be learned from sitting with a "life coach" for one hour weekly. What's needed is immersion in activity that brings about learning, but is not so difficult that it totally frustrates. I like to think I've acquired some of that learning. Still, once you fall seriously behind your peers in some aspect of development, it's quite likely that you'll never fully catch up. I'm mainly talking about emotional development, and I'm mainly thinking of social skills, because I believe that interpersonal difficulty drives most psychological distress.

I don't wish to derail the thread. My point is that thinking of psychological difficulty as a "disease" of the brain can be very unprofitable. It fails to lead us to addressing the root problem. Plus, it impels us in a fruitless direction, seeking a medical remedy for what is not essentially a medical problem. I agree with the OP that a psychological problem can be chronic and can worsen over time and can even impair a person's ability to survive. That doesn't make it a physiologic disease like cancer, even though it may partly manifest in some observable physical symptoms. I also agree with you, TCJ, that we are sorely in need of some better expertise in just what can be done to address the distress of having emotional problems. However, if you're waiting for the science of neurology to produce that expertise, I think you wait in vain.

[Rose76]

Originally Posted by divine1966

Interesting post. I agree that self empowering approach of “how I can live a better life with my disease/syndrome” is a good one. But it’s not always enough.

Many mental illnesses/syndrome/diseases need to be managed by medication and otter methods because they are actual real illnesses and disorders.

My husband lives a great life, he has a great career, hobbies, friends and family, and he overcomes obstacles of his Tourette’s and severe OCD every day of his life, often inventing his own strategies of managing them. But still without OCD meds he’d not be able to. He tried. It’s not possible. He’d not be able to work or function in full capacity (not only right meds cut the edge of OCD but also mellows down some Tourette’s symptoms). He also sees a therapist every other week and has periodic med review with psychiatrist.

So it’s both: medical treatment and healthy approach to life. But both are needed.

I think it’s important to accept that one has an illness or disorder so they know they have to seek treatment in addition to developing healthy attitude towards managing their disorder.

Clearly, your husband has a mental disorder. It may be neurological. I don't know. If taking medication helps it, then he does well to get his prescription and use the med. I take amitriptyline, a tricyclic antidepressant, which markedly improves my functioning. I also take hydrocodone, which keeps me more active than I'ld be without it. So I'm in no way opposed to seeing doctors and trying medication.

Often, while folding clothes, I get a back spasm from degenerative spine changes that makes me unable to continue. Thirty minutes after taking hydrocodone, I can resume folding the laundry. The pain I experienced was not due to anything wrong with my nervous system. (Pain is usually a sign that your nervous system is working appropriately.) The hydrocodone does not fix anything that's damaged in my back. Yet, it does help me to function better. I don't know why the amitriptyline helps me. No one knows. (Yes, we have theories about neurotransmitters and what goes on within the neural synapses, but no one has figured out exactly why some depressed persons experience improved well-being, while taking an antidepressant . . . and some don't.) The effectiveness of neither of those meds should be seen as evidence that my physical or emotional discomforts are the result of me having a neurological disease. The drugs do alter my physiology in a way that improves my functioning. All the same, the arthritis in my back will get worse as I continue to age. Now that I've retired and lost my significant other, I'm finding my problem with depression has gotten worse. Taking a bigger daily dosage of amitriptyline isn't going to remedy that. (I've know because I've tried that, along with everything else in the pharmacy.)

What drives my recent increase in depression is not something diseased inside my brain. It is my longstanding tendency to socially isolate, which started in childhood. Without a job to go to and a loving companion to interact with, I tend to spend my days in my recliner - reading, listening to music and watching what's on a screen. That is guaranteed to make anyone depressed, regardless of how healthy their brain might actually be. I don't need more medical intervention. I need to get out of my apartment and volunteer for a worthy cause and join some group whose members share one of my interests. Humans need satisfying social connectedness as much as they need food, water and oxygen. I was seeing a psychologist for awhile this summer. His encouragement felt good, but he wasn't telling me anything I didn't already know. I'm either going to get off the recliner and join the world around me, or I'm going to stay depressed.

Just because a medical intervention helps, that does not prove that the problem is essentially a medical problem. A person plagued with anxiety will definitely feel better, if they take enough of an anxiolytic drug, like Valium. That doesn't mean that taking Valium is a good way to help "manage" their anxiety. Believing that it is has gotten some people into an awful lot of trouble. I don't oppose the judicious use of drugs like Valium. Five years ago, I found Xanax helpful for a while. This was right after my boyfriend died, and I was left with a huge void in my life. It had me on the verge of hysteria for a while. Time passing simmered that down. I'm still working on filling that void . . . and I need to do better than I'm doing.

I say - take whatever help helps. Try everything. Medical intervention may prove supportive, even when the problem is not fundamentally a medical problem. I also think that conceptualizing problems-of-living as "brain disease" is misleading and may cause us to not focus on what we really need to be doing. I think we've become over-invested in the notion that the "the right chemical cocktail" can "stabilize" us into improved well-being. Maybe. Maybe not. Often we have maladaptive habits that need to be destabilized.

[Tart Cherry Jam]

Rose, yi ou wrote ". What's needed is immersion in activity that brings about learning, but is not so difficult that it totally frustrate". I think bit am not sure that this is what a notable Russian psychologist of the 20th century Lev Vygotsky called the zone of proximal development. This was one of his main contributions. Posthumously he became quite revered and inspired developmental psychology on the US in late 20th century. I have not read his works but my understanding is that he outlined where parents should function as teachers of their young children and by extension where other teachers should be later in the children's lives. In thr zone of proximal development, a new skill is challenging and a stretch for a child but is learnable and that promotes the skill acquisition. If a parent is trying to model something completely out of reach for a child, the child cannot learn. I do not know if Vygotsky postulated that this experience of being taught something outside of the zone of proximal development is frustrating or emotionally bad for the child but to me it would make sense. The wisdom is in finding that sweet spot of challenging but within reach. If this topic of skill acquisition is interesting to you, you may enjoy reading Lev Vygotsky's work.

I do see all your points. In the whole span of experiences, such as experiences of depression, there is a place for exactly what you are describing and a place for something internally faulty not related to a lack of skills or social interaction. I have even had experiences I called a chemical depression, meaning a depression fully caused by a chemical substance. In 2019 I tried taking Topamax to curb weight gain on Zyorexa, the drug that otherwise was a perfect fit (I have seen switched to another combo and no longer depend on Zyprexa). Soon I realized Topamax was making me depressed. I was about to go to Moscow, the city where I grew up, and at the time when I realized that depression had set it, it was so arresting that I feared that I would not be able to pack. Packing for a trip is a cognitively laden task and especially for me at that time as I had not written down a packing list and relied on the mental list. I was barely able to pack. Of course I stopped Topamax but it had a long shelf life and I was depressed for several days upon arrival. I was scheduled to meet with many of my classmates (from elementary to high school as we in our education system there is no separation of elementary, middle and high school: you are in the same building from start to finish). For most of them, it meant meeting people whom I had last seen in 1988. I thought I would not be able to get dressed and go to the cafe where we were about to meet. My best friend called me (she and I did not go to the same school together). I said that I was depressed and had trouble getting ready to leave the flat where I was staying and go to the little impromptu reunion which, by the way, was organized solely on occasion of my being in town. My best friend was surprised that I was depressed and exclaimed "how can you be depressed when you are in the city where everyone loves you!" I was too weak to explain what it means to be under the influence of a medication that depressed you. I did go to the reunion and ultimately had a very good time, so the social interaction helped to break the spell of chemical depression and after about a day or two I was completely OK as the last traces of Topamax left my system. The rest of the trip I greatly enjoyed myself. I even hosted a little party at the end and reconnected with quite a few people including my former students whom I had not seen since 1991 (when I was in college, I had a part time job teaching English at a lyceum for gifted children). And once Topamax left my system, I no longer felt arresting weakness or that to put together a sequence of simple tasks required to leave house was of unsurnountable difficulty to me. Clearly I did not change as a person in my core social skillset in the course of a week. It was just a chemical taking over and affecting the whole experience. Curiously, when I tried Topamax at other times, it did not cause depression but caused more typical side effects such as word recall problems. And there are people whom Topamax actually helps with moods. I somehow happen to be very prone to mood side effects of medications but, as my psychiatrist points out, I am also sensitive to them in a good way, too, meaning that when we find one that works, a small dose of it sufficies. I can imagine that what I feel as a side effect of an offending substance others feel as part of their wiring. And that is how otherwise social and outgoing people can start to self-isolate and go into a vicious cycle.

I also had short periods of endogenous anxiety that totally changed how I felt or acted, life an 180 degree switch. That I never tried to medicare but justvrode those periods out. But they made me realize that it is possible to lose all access to accumulated skills, social pr of living in general, and become helpless.

Maybe I am describing quintessentially bipolar experiences when a person can become the opposite of oneself.

[divine1966]

Originally Posted by Rose76

Clearly, your husband has a mental disorder. It may be neurological. I don't know. If taking medication helps it, then he does well to get his prescription and use the med. I take amitriptyline, a tricyclic antidepressant, which markedly improves my functioning. I also take hydrocodone, which keeps me more active than I'ld be without it. So I'm in no way opposed to seeing doctors and trying medication.

Often, while folding clothes, I get a back spasm from degenerative spine changes that makes me unable to continue. Thirty minutes after taking hydrocodone, I can resume folding the laundry. The pain I experienced was not due to anything wrong with my nervous system. (Pain is usually a sign that your nervous system is working appropriately.) The hydrocodone does not fix anything that's damaged in my back. Yet, it does help me to function better. I don't know why the amitriptyline helps me. No one knows. (Yes, we have theories about neurotransmitters and what goes on within the neural synapses, but no one has figured out exactly why some depressed persons experience improved well-being, while taking an antidepressant . . . and some don't.) The effectiveness of neither of those meds should be seen as evidence that my physical or emotional discomforts are the result of me having a neurological disease. The drugs do alter my physiology in a way that improves my functioning. All the same, the arthritis in my back will get worse as I continue to age. Now that I've retired and lost my significant other, I'm finding my problem with depression has gotten worse. Taking a bigger daily dosage of amitriptyline isn't going to remedy that. (I've know because I've tried that, along with everything else in the pharmacy.)

What drives my recent increase in depression is not something diseased inside my brain. It is my longstanding tendency to socially isolate, which started in childhood. Without a job to go to and a loving companion to interact with, I tend to spend my days in my recliner - reading, listening to music and watching what's on a screen. That is guaranteed to make anyone depressed, regardless of how healthy their brain might actually be. I don't need more medical intervention. I need to get out of my apartment and volunteer for a worthy cause and join some group whose members share one of my interests. Humans need satisfying social connectedness as much as they need food, water and oxygen. I was seeing a psychologist for awhile this summer. His encouragement felt good, but he wasn't telling me anything I didn't already know. I'm either going to get off the recliner and join the world around me, or I'm going to stay depressed.

Just because a medical intervention helps, that does not prove that the problem is essentially a medical problem. A person plagued with anxiety will definitely feel better, if they take enough of an anxiolytic drug, like Valium. That doesn't mean that taking Valium is a good way to help "manage" their anxiety. Believing that it is has gotten some people into an awful lot of trouble. I don't oppose the judicious use of drugs like Valium. Five years ago, I found Xanax helpful for a while. This was right after my boyfriend died, and I was left with a huge void in my life. It had me on the verge of hysteria for a while. Time passing simmered that down. I'm still working on filling that void . . . and I need to do better than I'm doing.

I say - take whatever help helps. Try everything. Medical intervention may prove supportive, even when the problem is not fundamentally a medical problem. I also think that conceptualizing problems-of-living as "brain disease" is misleading and may cause us to not focus on what we really need to be doing. I think we've become over-invested in the notion that the "the right chemical cocktail" can "stabilize" us into improved well-being. Maybe. Maybe not. Often we have maladaptive habits that need to be destabilized.

Well yeah I just used my husband as an example.

Yes Tourette’s is a neurological disorders but it’s always accompanied by other conditions, typically anxiety disorders, severe OCD in his case. His OCD isn’t caused by maladaptive behaviors or habits or not wanting to live a good life or lack of social skills. Sure there maybe are people who don’t live good life because they choose to not better themselves or to adapt bad maladaptive habits.

But I think we are talking about different things. Being prone to feeling anxious before public speaking isn’t the same as having actual anxiety disorder.

Many conditions aren’t a medical problem but many are. I do not see people being over invested in medications. In my experience most people seek whatever treatment (or no treatment) works for them. Id be careful saying that people just need to do something differently. Some do and some don’t

Oh I don’t know about Xanax and Valium. I sure hope Xanax is not being widely prescribed anymore. It’s highly addictive and potent. So is Valium. I don’t know of anyone can ever drive or work taking these meds. It might be only for a very short period of time. I sure wasn’t talking about those

Overall I just think it’s dangerous to talk about disorders as people just have to do something differently. There’s a school of thought that it’s just a cop out. Laziness. Bad choices. Bad habits. Maybe for a few people but not massively. For a lot of people disorders are very real.

We can agree to disagree

[Rose76]

I think I'm hearing a fear that, if a disorder is not a result of some organic impairment in the structure or chemistry of the brain, then it's a chosen behavior, reflecting a character flaw in the person. I'm not saying that. I'm saying that an impairment of the mind does not necessarily imply an impairment of the brain. That doesn't mean that an impairment of the mind is less real than an organic brain disease. I happen to believe that the mind is real. It can become afflicted with a disorder. Disorders of the mind are as real as real gets. No one chooses to have a mental disorder. Too much damaging experience, and/or too little appropriate experience can lead to mental malfunction, even in a person born with a completely normal brain. What happens to us matters. It matters in the extreme. What doesn't happen to us also matters. Equipping a person to function successfully in this complicated world requires an awful lot of the right training. Lots of people are poorly-trained. That doesn't mean their parents were necessarily evil or negligent. Nor does it mean that these persons were uninterested in learning what they needed to know. For a multitude of other reasons, a person can emerge from childhood with an approach to life that is simply inadequate. I don't mean only skills, like how to read a newspaper and how to balance a checkbook. There are more complex challenges like how to deal with being hazed on a new job by coworkers who are mean to newcomers. I've known some individuals who were unemployable because they could not cope with that. Under the stress of being ill-treated, they fell apart. Faced with being unfairly antagonized, they either became so passive that they were bullied mercilessly, or they became so hostile that they were let go for out-of-bounds anger displays. Being able to deflect those who would undermine you for no good reason can be very difficult to learn. It doesn't surprise me at all that some individuals respond like a deer caught in the headlights. They can experience severe emotional distress in these situations. It doesn't imply that they inherited a bad chromosome or have a neurotransmitter deficit in their brain. Most likely they just never learned how to cope with this type of adversity. Maybe they grew up in a peaceful home, exposed to little conflict.

A child who's never exposed to germs will have an underfunctioning immune system. Growing up, we actually need to have some unhappy things happen to us to get us ready for that cold, cruel world we'll be competing in. We each have what I'll call a "mental immune system." It has to be stimulated by a good bit of unhappy experience. At the same time, it must not be excessively challenged by overwhelmingly bad experiences that destroy confidence. Racking up sufficient experience that falls in the sweet zone of enough, but not too much, requires a lot of luck. None of us gets the ideal amount. I think that's the main reason why we each have our vulnerabilities. Some of us are so vulnerable that we can't cope. I don't think that's the fault of the vulnerable person. More likely, it's a mismatch between what their experience equipped them for and what life can demand in this tough world that we live in. That mismatch, IMHO, may be fundamental to what some call the "tragedy of the human condition." It is every bit as worthy of compassion as having a brain tumor.

I understand that my perspective is distrusted as sounding like a way to invalidate the struggles of persons with psychological disorders. It really isn't. I'm trying to dispute the notion that the cause of mental disorder always originates in the biology of the brain. Good genes and healthy neurons don't guarantee a high degree of mental fitness. One can have a healthy brain and a mental disorder at the same time. At one time, this was generally accepted. I'm suspicious of how it has come to be seen as heresy.

The main point, on which I think we all agree, is that mental disorders cause people to need support in a variety of forms. Some of that may be medical support. I would never wish to discourage anyone from accessing whatever they find helpful.

[Tart Cherry Jam]

The pendulum does swing and I can see that now it has gone too far in the direction of faulting receptors, neurons, and the like, ie those purely biological factors.