I have a friend who suffers from severe depression. He has stated on many occasions that he hates himself and wants to commit suicide, but he can’t go through with it because even that would be accomplishing something and he can’t accomplish anything. [...] To the best of my knowledge he has been seeing therapists and psychologists and they have been unable to help him. How should a rationalist deal with such a situation?
That is very serious business, and it is not likely that you can handle it yourself. The first thing to do is make sure he’s seeing a competent therapist. If he’s lapsed, or his therapist is actually a quack, or his therapist for some reason doesn’t know what’s going on, that could be very dangerous. So get a name, contact him or her, and pass along what you just said. In writing. That is the most important thing.
(EDIT: Actually, this is probably too slow; the time it’d take to do what the previous paragraph describes is a substantial unnecessary risk. Contact a suicide prevention hotline first, as Perplexed says.)
He has a firm delusion that he cannot do anything worthwhile, that the world is going to hell in a handbasket and nothing can possibly be done by anyone about it, and everyone else feels the same way he does, but is repressing it.
The cause of this is probably biochemical, and must be addressed at that level. Unfortunately, identifying the cause of this sort of thing is hard, and there are no good tools for it. I would start by checking the basics of his therapists’ work—diet (especially micronutrients; ask if he takes a multivitamin), a minimum amount of regular exercise (pressure him into playing a sport with you if necessary), and a minimum amount of recurring social contact (weekly events that happen automatically without him having to do anything to arrange them).
After that, start looking at pharmaceutical solutions. Don’t encourage him to change anything without the approval of a licensed professional, since if he’s already borderline suicidal then the wrong change could tip him over the edge; but do find out what he’s taking, look it up on PubMed, and ask a psychologist other than the one he’s currently seeing whether his regimen is reasonable. Whatever it is, your description suggests that either he’s not taking it, it’s not working, or it’s making things worse. You can probably distinguish between the first and the other two possibilities, but not between the second and third. That information would be useful to his therapist; but beware that it could be both that he’s not taking it and that it doesn’t work, in which case letting his therapist blame the problem on non-compliance could be a problem.
As I said to Perplexed, he lives halfway across the continent. I do know his name and mailing address, but I talk with him exclusively over IRC. I know some of the therapies and medicines he’s taken, but I don’t know what he’s taking right now.
Part of my reluctance to take matters into my own hands is that I don’t know how to reliably tell a qualified psychiatrist or psychologist from a quack. I can look up what Wikipedia says about a specific therapy like ECT, but how do I know whether what it says is accurate enough to trust my friend’s life to it? As the status quo seems unlikely to have a catastrophic turn for the worse, I’m reluctant to do anything that would change it without either a strong confidence in its efficacy or at the very least a strong confidence that it will do no harm.
As the status quo seems unlikely to have a catastrophic turn for the worse
Neither of us is qualified to judge whether that’s true.
The fact that you talk with this person exclusively over IRC limits your options a little, but it also changes things in one important respect; it greatly increases the probability that you’re the only person (or only responsible person) with this information. He might tell you things that he doesn’t tell any of the people he interacts with face to face. If you’re the only one who knows, then you can’t just sit on that information.
If you do call a hotline, the first thing they do will probably be to find out who your friend’s psychiatrist is and contact them. The information you have is sufficient to do this discretely. They are well aware that doing the wrong thing could be disastrous, and aren’t likely to do anything stupid.
That is very serious business, and it is not likely that you can handle it yourself. The first thing to do is make sure he’s seeing a competent therapist. If he’s lapsed, or his therapist is actually a quack, or his therapist for some reason doesn’t know what’s going on, that could be very dangerous. So get a name, contact him or her, and pass along what you just said. In writing. That is the most important thing.
(EDIT: Actually, this is probably too slow; the time it’d take to do what the previous paragraph describes is a substantial unnecessary risk. Contact a suicide prevention hotline first, as Perplexed says.)
The cause of this is probably biochemical, and must be addressed at that level. Unfortunately, identifying the cause of this sort of thing is hard, and there are no good tools for it. I would start by checking the basics of his therapists’ work—diet (especially micronutrients; ask if he takes a multivitamin), a minimum amount of regular exercise (pressure him into playing a sport with you if necessary), and a minimum amount of recurring social contact (weekly events that happen automatically without him having to do anything to arrange them).
After that, start looking at pharmaceutical solutions. Don’t encourage him to change anything without the approval of a licensed professional, since if he’s already borderline suicidal then the wrong change could tip him over the edge; but do find out what he’s taking, look it up on PubMed, and ask a psychologist other than the one he’s currently seeing whether his regimen is reasonable. Whatever it is, your description suggests that either he’s not taking it, it’s not working, or it’s making things worse. You can probably distinguish between the first and the other two possibilities, but not between the second and third. That information would be useful to his therapist; but beware that it could be both that he’s not taking it and that it doesn’t work, in which case letting his therapist blame the problem on non-compliance could be a problem.
As I said to Perplexed, he lives halfway across the continent. I do know his name and mailing address, but I talk with him exclusively over IRC. I know some of the therapies and medicines he’s taken, but I don’t know what he’s taking right now.
Part of my reluctance to take matters into my own hands is that I don’t know how to reliably tell a qualified psychiatrist or psychologist from a quack. I can look up what Wikipedia says about a specific therapy like ECT, but how do I know whether what it says is accurate enough to trust my friend’s life to it? As the status quo seems unlikely to have a catastrophic turn for the worse, I’m reluctant to do anything that would change it without either a strong confidence in its efficacy or at the very least a strong confidence that it will do no harm.
Neither of us is qualified to judge whether that’s true.
The fact that you talk with this person exclusively over IRC limits your options a little, but it also changes things in one important respect; it greatly increases the probability that you’re the only person (or only responsible person) with this information. He might tell you things that he doesn’t tell any of the people he interacts with face to face. If you’re the only one who knows, then you can’t just sit on that information.
If you do call a hotline, the first thing they do will probably be to find out who your friend’s psychiatrist is and contact them. The information you have is sufficient to do this discretely. They are well aware that doing the wrong thing could be disastrous, and aren’t likely to do anything stupid.
Most of the Wikipedia information on mental disorders and standard treatments for them is fairly accurate.