Drugs, monopolies, gin and tonics, and electric guitars

Yeah, as the title suggests I'm a bit scattered today.  But I want, primarily, to post a quick follow-up to yesterday's post on the DSM  (was it yesterday? time seems unreal sometimes) and its mention of ketamine.

DSM kerfuffle, Part the First

This month the fifth edition of the of the Diagnostic and Statistical Manual of Mental Disorders (DSM) came out, and the release is generating more press than one might expect from the publication of a thick, dry tome that resides mostly in the offices of psychiatrists, psychologists, and insurance companies. Typically, given the media's weakness for controversy, the coverage tends to focus on the controversies surrounding the new DSM.

This piece at The Guardian covers some of the issues, in particular the objections of the British psychological establishment to the latest DSM. In anticipation of the publication of the new DSM the Division of Clinical Psychology (DCP),  part of the British Psychological Society, released a statement detailing the members' objections to the new DSM. I want to talk today about those objections. Tomorrow, time willing, I will address the concerns from within the psychiatric community, and discuss a maddening and ill-reasoned screed from a psychiatrist who worked on the previous edition of the DSM. For now, let's deal with the psychologists.

Neurobiology of Depression

Psychologists in England recently declared war on psychiatry and the "bio-medical model" of mental illness. I'll have more to say soon on this, as well as on the controversies around the new Diagnostic and Statistical Manual of Mental Disorders.  For now, however, I will just say the the psychologists are fighting a rear-guard retreat, though they don't yet seem aware that this is the case. The accumulating evidence that depression, in particular is indeed a medical—that is, a physiological—condition  is becoming overwhelming.

A recent development on this front: the work of Eric J. Nestler, MD, Ph, who is working on developing a model for human depression in mice.  A short video, in which he discusses his work:

"Months oozed by"

Several years ago one of my favorite things on the internet was the blog Hyperbole and a Half, by the wonderful Allie Brosh.  It was primarily the sensibility that attracted me: dark humor edging toward twisted, unflinching honesty, and all this wrapped around a generous core. By generous I mean: the most generous humor is often at one's own expense rather than at the expense of others. It was one of the most delightful things on the internet.

I lost track of Hyperbole as I descended deeper into my own depression. As it turns out,  Allie Brosh also lost track of Hyperbole as she descended into her own depression. She is back now, after a very long absence, and her latest and long-awaited post may be one of the better descriptions of depression we will ever see.

The post has too many important things to say, and I won't quote extensively. But she is quite good on the difficulty of dealing with people who don't understand your depression:

But people want to help. So they try harder to make you feel hopeful and positive about the situation. You explain it again, hoping they'll try a less hope-centric approach, but re-explaining your total inability to experience joy inevitably sounds kind of negative; like maybe you WANT to be depressed. The positivity starts coming out in a spray — a giant, desperate happiness sprinkler pointed directly at your face. And it keeps going like that until you're having this weird argument where you're trying to convince the person that you are far too hopeless for hope just so they'll give up on their optimism crusade and let you go back to feeling bored and lonely by yourself.

And the part that rings truest for me, given my own complicated relationship with the possibility/promise of death:

No, see,  I don't necessarily want to KILL myself. . . I just want to become dead somehow.

That is the thought I went to bed with every night for a year and half. I didn't want to kill  myself; I just wanted to never wake up again. Assuming I could get to sleep. . . .

I'm in a position now to appreciate some of the wonderful things in the world, and Hyperbole and a Half is certainly among them. Head on over and look around; her Best Of listing on the right should keep you out of trouble for a few hours. If you like velociraptors, pirates, sharks and boats, you will like what you find.