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.
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.
This makes talking with him about many subjects exceedingly difficult, as he will ignore or rationalize away actual evidence as being, at best, an exception to the rule of pessimism. It’s like talking to a patient with a disorder like somatoparaphrenia, where the ordinary person can see quite obviously that the patient has a problem, but the patient confabulates. He literally cannot see reason on these subjects—his brain or this deep-seated delusion won’t let him.
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? Even if Singularity-level technology were available to repair the causes of his depression, he would refuse it if able. If such technology were available, would it be ethical to improve his quality of life against his will by changing his mind? I must confess I am almost at the point of not protesting his desire for suicide; he seems genuinely unhappy, and incapable of changing that fact of his own volition.
he has been seeing therapists and psychologists and they have been unable to help him.
As you probably already know, therapists and psychologists generally cannot prescribe anti-depressants—that takes an MD (psychiatrist). I am not a psychiatrist, nor do I play one on the internet. I have no idea whether the cause of your friend’s depression is biological or purely psychological. I have no idea whether his therapists have advised him to see a psychiatrist, or whether they are the kind of quacks who “don’t buy into the biological model”. So I don’t have the information I think I need, and I don’t even know enough about depression to know what information I do need to help you and your friend.
How should a rationalist deal with such a situation?
If I were in your shoes, I would call the local suicide prevention hotline. Tell them the story. They can give you good advice, which may include referring you to even better resources. Do it now. Those hotlines are open 24hrs, and the people (volunteers) who man them know what they are doing much more than I do.
He lives halfway across the continent, and he has been talking like this for months without doing physical harm to himself. Is it right for me to cause the intrusion into his life such a call would surely bring without stronger evidence that it’s necessary?
He is probably safe unless he starts getting less depressed, because at that point he’ll probably still be suicidal but have enough energy to do something about it. If he’s been stably in that condition for months then I don’t think it’s an emergency.
I’m fairly torn on advice for this case. If he really has tried everything and it hasn’t helped, then I don’t think living is much of an end in and of itself and he should be assisted in his wishes, or at least not prevented.(Be aware that I am biased, this is my perspective as someone who empathises with your friend)
If you think he hasn’t tried everything, then the intrusion is completely warranted. He is at the point where he literally can’t help himself. Therapy can only work if the patient has an interest in getting better, which he doesn’t.
Inklesspen, I also believe in respecting the guy’s autonomy. But it sounds like he might be willing to listen to someone who accepts the possible validity of his negative feelings and treats those feelings with respect.
The best reason for going on living is simply to see what happens next. Tell your friend to find and watch the video “Little Miss Sunshine”. Suggest that suicide might make sense, but then so might taking anti-depressant medication. But if he wants to try both, he has to do it in the right order. Shift him from talking about suicide to joking about suicide.
But, as I’ve already said, there are people who can give better advice than mine. Find out what they say.
I believe he does take medication; I remember him saying his psychologist started him on Abilify and he was terrified that Abilify would cause permanent muscle tics, as apparently it does in rare cases.
If he has a psychologist then there’s not much you can do directly to help. That’s sort of their job. However, it may help to just be there for him. And when he says something that’s obviously negative about himself and likely to be wrong, explain why it is wrong. That won’t do much, but it might help a tiny bit.
I’m told that talking about suicide is a “cry for help”. If he is your friend, you have a right and duty to help him.
Call your local suicide hotline. Educate yourself more efficiently than you are doing by asking questions here. Ask their advice, if you wish without giving your friend’s name or geographic location. They can give you far better information and better moral arguments about whether and how to intervene.
Tentative: have you tried telling him that the universe isn’t keeping score?
It seems to me that he’s running a script of trying to prove that he deserves to live. Or possibly a script about whether he’s allowed to let himself feel good about what he does. Check for influence from Ayn Rand. Some of her ideas are good, some of them are utterly poisonous.
There’s some level where he’s still trying to live, even if all he’s doing is trying to feel a little better by talking about what he’s thinking.
On the therapy side, I think bodywork helps, though it isn’t the only route. (Strong belief here.) Habitual thoughts and emotions correlate with neuromuscular pattern—that’s why, if you know someone well, you can tell what they’re thinking about by looking at them. On the therapeutic side, giving a person the experience of not going into those patterns can be useful.
I don’t know know how much difference your protesting his desire for suicide makes—as far as I can tell, it depends on how emotionally close he feels to you. It seems fairly common for people to not commit suicide because there are particular people they don’t want to hurt.
Honestly, I don’t know how much you can do. I’m having a hard fight with less serious depression—some progress, which I’ll probably write up.
Meanwhile, I think Holy Basil is doing my mood some good. This is a very tasty holy basil and rooibos blend.
As for the larger rationalist question, I don’t know. I don’t believe FAI + uploading = immortality. There’s too much that can go wrong on the individual level even if the clade survives.
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.
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.
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.
This makes talking with him about many subjects exceedingly difficult, as he will ignore or rationalize away actual evidence as being, at best, an exception to the rule of pessimism. It’s like talking to a patient with a disorder like somatoparaphrenia, where the ordinary person can see quite obviously that the patient has a problem, but the patient confabulates. He literally cannot see reason on these subjects—his brain or this deep-seated delusion won’t let him.
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? Even if Singularity-level technology were available to repair the causes of his depression, he would refuse it if able. If such technology were available, would it be ethical to improve his quality of life against his will by changing his mind? I must confess I am almost at the point of not protesting his desire for suicide; he seems genuinely unhappy, and incapable of changing that fact of his own volition.
As you probably already know, therapists and psychologists generally cannot prescribe anti-depressants—that takes an MD (psychiatrist). I am not a psychiatrist, nor do I play one on the internet. I have no idea whether the cause of your friend’s depression is biological or purely psychological. I have no idea whether his therapists have advised him to see a psychiatrist, or whether they are the kind of quacks who “don’t buy into the biological model”. So I don’t have the information I think I need, and I don’t even know enough about depression to know what information I do need to help you and your friend.
If I were in your shoes, I would call the local suicide prevention hotline. Tell them the story. They can give you good advice, which may include referring you to even better resources. Do it now. Those hotlines are open 24hrs, and the people (volunteers) who man them know what they are doing much more than I do.
He lives halfway across the continent, and he has been talking like this for months without doing physical harm to himself. Is it right for me to cause the intrusion into his life such a call would surely bring without stronger evidence that it’s necessary?
Yes. You already have the strongest evidence it is possible to get without him dying.
He is probably safe unless he starts getting less depressed, because at that point he’ll probably still be suicidal but have enough energy to do something about it. If he’s been stably in that condition for months then I don’t think it’s an emergency.
I’m fairly torn on advice for this case. If he really has tried everything and it hasn’t helped, then I don’t think living is much of an end in and of itself and he should be assisted in his wishes, or at least not prevented.(Be aware that I am biased, this is my perspective as someone who empathises with your friend)
If you think he hasn’t tried everything, then the intrusion is completely warranted. He is at the point where he literally can’t help himself. Therapy can only work if the patient has an interest in getting better, which he doesn’t.
Inklesspen, I also believe in respecting the guy’s autonomy. But it sounds like he might be willing to listen to someone who accepts the possible validity of his negative feelings and treats those feelings with respect.
The best reason for going on living is simply to see what happens next. Tell your friend to find and watch the video “Little Miss Sunshine”. Suggest that suicide might make sense, but then so might taking anti-depressant medication. But if he wants to try both, he has to do it in the right order. Shift him from talking about suicide to joking about suicide.
But, as I’ve already said, there are people who can give better advice than mine. Find out what they say.
I believe he does take medication; I remember him saying his psychologist started him on Abilify and he was terrified that Abilify would cause permanent muscle tics, as apparently it does in rare cases.
If he has a psychologist then there’s not much you can do directly to help. That’s sort of their job. However, it may help to just be there for him. And when he says something that’s obviously negative about himself and likely to be wrong, explain why it is wrong. That won’t do much, but it might help a tiny bit.
I’m told that talking about suicide is a “cry for help”. If he is your friend, you have a right and duty to help him.
Call your local suicide hotline. Educate yourself more efficiently than you are doing by asking questions here. Ask their advice, if you wish without giving your friend’s name or geographic location. They can give you far better information and better moral arguments about whether and how to intervene.
I called a suicide hotline once. I was put on hold for a long time, got frustrated, and hung up.
Tentative: have you tried telling him that the universe isn’t keeping score?
It seems to me that he’s running a script of trying to prove that he deserves to live. Or possibly a script about whether he’s allowed to let himself feel good about what he does. Check for influence from Ayn Rand. Some of her ideas are good, some of them are utterly poisonous.
There’s some level where he’s still trying to live, even if all he’s doing is trying to feel a little better by talking about what he’s thinking.
On the therapy side, I think bodywork helps, though it isn’t the only route. (Strong belief here.) Habitual thoughts and emotions correlate with neuromuscular pattern—that’s why, if you know someone well, you can tell what they’re thinking about by looking at them. On the therapeutic side, giving a person the experience of not going into those patterns can be useful.
I don’t know know how much difference your protesting his desire for suicide makes—as far as I can tell, it depends on how emotionally close he feels to you. It seems fairly common for people to not commit suicide because there are particular people they don’t want to hurt.
Honestly, I don’t know how much you can do. I’m having a hard fight with less serious depression—some progress, which I’ll probably write up.
Meanwhile, I think Holy Basil is doing my mood some good. This is a very tasty holy basil and rooibos blend.
As for the larger rationalist question, I don’t know. I don’t believe FAI + uploading = immortality. There’s too much that can go wrong on the individual level even if the clade survives.
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.