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Lots of rich/interesting conversation, both Monday night and here. Some things I want to remember/mull further, briefly (more or less) noted for myself and anyone else interested ...

The juxtaposition of discussions of schizophrenia and depression intrigues me, for several different reasons. One is that, at this point, depression is more "main stream," while schizophrenia represents, for many people, the "elephant in the room," the really frightening/challenging specter in considerations of mental health. My hunch is that this is largely cultural mythology, that the destructive potentials of depression, both for onself and for others, are at least as great in the case of depression as in the case of schizophrenia, and probably greater. Its worth thinking more about why people perceive it otherwise. My guess is that its not only a matter of media portrayal, that people are actually more frightened by others being "out of touch with reality" than of people being depressed (which is of course just another form of being "out of touch with reality"), and more fearful of themselves falling into the former state than the latter. Which returns us to some earlier discussion of the brain, whether or not it ever knows "reality," and the implications of that for thinking in new ways about mental health. For more along these lines, see "On brains in vats: who needs "reality"?".

A second thing that struck me about the juxtaposition of our schizophrenia and depression discussions was the different "research" approaches. The schizophrenia discussion took the more traditional approach, focusing on "objective" characterizations that can be made "from the outside." The depression discussion, in contrast, aggressively took a different approach, using subjective report as a starting point and asking what new understandings (and therapeutic approaches) might derive from that. It would be interesting to invert the discussion approaches, to think more about depression "from the outside" and schizophrenia "from the inside." And then to think more about the relative advantages and disadvantages of the two approaches.

The third thing that the juxtaposition of schizophrenia and depression discussions made me think about was an intriguing similarity, that what one is concerned about in both cases is actually not "depression" per se, nor "schizophrenia" per se, but rather extreme cases of both where behavior may be dangerous to the individual as well as to others. To put it differently, both depression and schizophrenia exist on spectra, with milder and more intense forms. Perhaps then it would make sense to think of "schizophrenia" and "depression" (and autism, and Tourette's, and migraine, and ....) not as in and of themselves "disabilities" or "illnesses" but rather simply as brain variations? And reserve the terms "disability" and "illness" for the more extreme versions of these where they become troubling? And treat people not for "schizophrenia" or "depression" (etc) but rather for whatever is in fact troubling? This might more easily allow us to appreciate some of the positive features of brain variation and better focus attention on what needs to be "fixed" (and why). We could acknowledge "neurodiversity" and its value while still recognizing a need for special treatment in cases where its needed, and for reasons that it is needed.

As for schizophrenia itself, my thoughts run along the lines of trying to understand the brain variation itself, independent of the extreme case problems. And the positive sides of that brain variation, which are presumably the flip side of the problems. I'm struck by the acknowledgment in several of the recommended papers that we need a new way to think about/do research on schizophrenia. A key point here, it seems to me, is "incorrect beliefs rigidly maintained." If one (as above) has reasons to suspect all beliefs are "incorrect" that would suggest that the core problem in schizophrenia is actually "rigidly maintained," ie that the brain variation involved is one that causes people to be less inclined to check understandings against experience. And perhaps unconscious ones against conscious ones? That, of course, would create problems under some circumstances but might also have advantages under others.

The depression conversation was an experiment, to see where we could go with taking seriously the idea of stories as relevant. And it at least helped to advance some thoughts I've been having out of my own experiences with depression. I was impressed with how quickly we picked up the notions of a split self, of a greyness, of a sense of loss/stuckness, of a mixed sadness/anxiety, of a loss of confidence in the ability not only to act but to think productively. of a loss of a sense of time and the associated possibility of change. The notion of a conscious/unconscious dissociation helps me (at least) make sense of all this, with the addition that it may not be so much a complete disconnection as an absence of continuing reciprocal exchange. The possible relation to Capgras is intriguing as well. And the notion of dissociation does lead on to some potentially useful further questions. What causes the dissociation? What is the unconscious doing in the dissociated state? How does one re-engage the two systems? Might this be a line of research potentially at least as productive as the ongoing search for new pharmaceuticals?

Last, if not least, some thoughts about the "would you take the hypothetical pill?" thought experiment and some of the conversation it provoked Monday and here. The straw vote, for the record, was 6 yes, 9 no, and that intrigues me, if nothing else as an indication of a potentially generative conflict. The core of the question, in my mind at least, was not whether there was virtue in living with discomfort and pain, nor whether or not one should attempt to mitigate discomfort/pain. I have lived though periods of discomfort/pain produced by depression sufficiently severe to appreciate the wish to have a way to simply make it end. I've used medication myself and still do.

At the same time, part of what has gotten me through periods of depression is a conviction that, however it feels, my brain is in fact responding adaptively to conflicts that I don't yet fully understand, and that I need to be patient while it does that. And my experiences have been consistent with that; I do come out of depressions with understandings that I doubt I would have achieved otherwise. Yes, I'd like others to be sympathetic to my discomfort when I'm depressed and to help me mitigate it and live through it, but I'd prefer to be thought of as engaged in doing something that will prove to be worthwhile (to myself and others) rather than to be regarded as "ill" or "disabled." To the extent that mental health is about story telling, and some pain/discomfort is necessarily associated with that, I'm disinclined to act simply to make the pain go away.

Do we "fix" things that seem "wrong," or do we live with them for a bit and see in what ways they might contribute to the creation of "less wrong" things that we might not otherwise have thought of? At least some "medical" problems are clearly best dealt with the first way. Maybe what's special about the mental health realm, and its associated story telling features, is its encouragement for considering the potentials of the second way as well? Maybe we want always to encourage at least some element of possibility and agency?