'Life being stressful is not an illness' – GPs on mental health over-diagnosis
39 points
2 hours ago
| 15 comments
| bbc.com
| HN
intheitmines
1 hour ago
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A UK doctor friend mentioned they believed a lot of people being prescribed anti-depressants were suffering from "shit life syndrome" rather than real depression. This wasn't to belittle the issues but rather to highlight the issues they maybe facing, which society doesn't deem valuable enough to fix and the GP is one of the only perceived options they have for help.
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gtowey
1 hour ago
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Life is so insane right now that mental illness is the only rational response.
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InsideOutSanta
1 hour ago
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Yeah, I think it's very easy to say that "life being stressful is not an illness." In reality, life is often stressful in ways that can very much lead to mental illness, particularly in a society that drastically values corporate success over human well-being.
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alchemist1e9
56 minutes ago
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Global poverty at 100-year lows, US murder rate half the 90s, you’re more likely to die from obesity than starvation or violence. Objectively the cushiest moment in human history.

Yet “mental illness is the only rational response.”

Happiness = Reality − Expectations

Most of material Reality is fine. The part of Reality that’s broken is spiritual/emotional. The expectations causing unhappiness aren’t for more money or stuff, they’re subconscious, millions of years deep, baked into the species of tribe, offspring, transcendence, cosmic order.

Leftism spent half a century screaming that those instincts are bigotry, that family is oppression, that religion is a mental illness, that wanting roots or rituals or a legacy is fascism.

You can’t propagandize the human soul out of its own operating system. The subconscious still demands what it demanded in 200,000 BC. We just demolished every institution that used to answer the call and replaced them with therapy, porn, and corporate pride slogans.

That’s the real insanity. Not climate change or late-stage capitalism. The soul shows up for duty and the building’s condemned.

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baubino
40 minutes ago
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> Global poverty at 100-year lows, US murder rate half the 90s, you’re more likely to die from obesity than starvation or violence. Objectively the cushiest moment in human history.

Averages are just that - averages. They say nothing about any given individual’s experience. And probabilities aren’t assurances of a particular outcome. Just because the average person is more likely to face obesity than starvation doesn’t mean that there aren’t millions of people facing starvation in the world. Your argument is based on an incorrect use of statistics.

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heddelt
42 minutes ago
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Very well said. It's little wonder that nationalism and fascism are on the rise. Nature is healing.
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techblueberry
1 hour ago
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I feel like there’s a balance between —- a thing that really helped me in life was seeing a therapist in my early twenties who really validated a lot of my struggles and take them seriously. But also, kept me from going to far in the other direction of wallowing or being driven by a label.

Part of the problem is the medical system doesn’t have great language around this, I think in America in order for insurance to pay for therapy there has to be diagnosis. My therapists solution to that was to provide a diagnosis but we didn’t really lean into it, he just explained that’s the process.

But the language around diagnosis unfortunately has implicitly power. We probably should talk about mental illness much less that way.

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only-one1701
1 hour ago
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This is correct. It’s amazing how easy it is to relax when you don’t feel economic precarity etc.
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carlmr
1 hour ago
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This is also why I kind of hate it when rich people say that money doesn't make you happy. It's true, it doesn't but if you don't know how to pay for your next meal or worse your kids next meal, or you're sick and can't afford good care, then money does make all the difference.

In mathematical terms money might not be sufficient to make you happy, but it's a necessary condition indeed.

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mettamage
1 hour ago
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Ah thanks for putting it into the necessary/sufficient vocab. Makes so much more sense to explain it that way.
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only-one1701
1 hour ago
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Yeah, and like, a nontrivial amount of it tbqh
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echelon_musk
1 hour ago
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It's just common sense that things would not be geared toward the patient's best outcome.

It's easier (read: cheaper) for the broken NHS and cash strapped government to shovel pills than it is to get someone to revamp their life.

Imagine the alternative cost of talking therapies for the NHS. There are three year waiting lists for them already.

Depression usually occurs for a causal reason, it just may not have been found for the individual yet. It could be poor diet, lack of exercise, excessive escapism as a response to unprocessed trauma etc. Ultimately though these causes require the patient to exert effort toward improving their life, and so they have to have willpower and motivation.

Thankfully exercise can now be prescribed by doctors in the UK!

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voisin
1 hour ago
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It’s almost like we are not optimizing society for human flourishing.
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Workaccount2
1 hour ago
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There is a persistent and perhaps fundamental problem of balancing self optimization and social optimization.

A group of people are trudging through the desert with limited water arduously pumped from scattered wells. Do you ration water such that everyone gets equal amounts or such that those sweating the most get the most.

Solve this dilemma accounting for the fractal parameters that go into it, and you'll have a utopia.

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lo_zamoyski
25 minutes ago
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> balancing self optimization and social optimization

A person in a society has a right to the minimum of essential ordinary resources (food, shelter, clothing) to function as a general matter. (We have a right to pursue other goods, and in some cases a right to them once had, but we cannot say we have a right to them per se and before the fact. We have to be careful to distinguish between the two, as undisciplined and entitled people consumed by appetite tend to be unprincipled and like to inflate the list of “essentials” in self-serving ways. There’s certainly a pathology of envy at work as well, and we should in no way naturalize envy.)

In a situation of scarcity where there isn’t enough for everyone (which does not apply to the developed world), there is no solution that could satisfy that right universally. There is therefore no injustice committed when such basic resources are not distributed accordingly. Whoever gets their share gets it; whoever doesn’t simply doesn’t. You would expect competition here. Now, you could be charitable and self-sacrificial and give up your own share for another, but you have no such obligation to do so, and thus no one has the right to your share. Such charity would be an extraordinary act that transcends mere justice. It is entirely voluntary, even if heroic.

> and you'll have a utopia

Well no, you wouldn’t. This is the fallacy of consumerism and homo economicus. Even if everyone were rich, you would still have plenty of misery. The idea that human well-being is rooted in mere consumption - full stop - is at the root of so many ills. There is no well-being without virtue.

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r0ckarong
1 hour ago
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More like most people are dragging a cruise ship through a desert while being baited with the possible opportunity to belong to those enjoying the endless buffets and on-board water park.

This whole "should we ration so everybody gets some" is complete BS. There is an abundance of resources that are concentrated to a few and the rest made to suffer. We don't have to ration, we have to prevent the greedy from hogging it all. It's quite the opposite.

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ath3nd
1 hour ago
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> Solve this dilemma accounting for the fractal parameters that go into it, and you'll have a utopia.

Progressive tax on income

Progressive wealth tax

Universal basic income

Universal healthcare

Housing as a human right

Done

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candiddevmike
1 hour ago
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We are optimizing society for some human flourishing.
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TimorousBestie
1 hour ago
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It’s hard to believe that even the billionaires are flourishing.

Musk certainly doesn’t seem to be a poster child for eudaimonia, being allegedly addicted to drugs.

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gtowey
1 hour ago
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Anyone who makes like 100 million dollars and thinks to themselves "this isn't enough money to stop working and just enjoy life" has something seriously wrong with them. The billionaire class will never be happy, and it's time for society to stop letting these loonies ruin society to satisfy their insanity.
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voisin
1 hour ago
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I think it is far to keep working if you love what you are doing. To filter, there should be an absolute cap on wealth at a few hundred million dollars. This would eliminate the incentive to manipulate politics in favour of yourself, but if you want to keep working you should be doing it for society via charity or taxes on anything additional that is earned.

Have a nice ceremony and present a medal for winning capitalism.

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krapp
1 hour ago
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>To filter, there should be an absolute cap on wealth at a few hundred million dollars.

One million dollars and not a penny more. Enough for most people to live comfortably, but not enough to buy governments, or for the upper classes to never need to work again to maintain their lifestyle and privilege.

No human being needs or deserves a hundred million dollars.

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whynotmaybe
1 hour ago
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I know a guy who has a few millions that he earned while being an executive of a startup that was bought.

Some of his friends are disappointed in him because he works as a dev in a huge company and now "sits on his millions".

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InsideOutSanta
1 hour ago
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That's the crazy part. The people at the top seem to think they're better off if they can get another billion in the bank, regardless of the impact on the rest of society. But they, too, live in that same society that they are destroying.

They seem to think it's better to be a king in the Middle Ages than just a regular rich person in modern society. They forget that the lives of kings in the Middle Ages were absolutely terrible.

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daymanstep
1 hour ago
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He can retire whenever he wants.
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Workaccount2
1 hour ago
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Billionaires are a convenient distraction for the upper middle class.

The wealthiest group of people (on the whole) is the 70-95th percentile.

If we were to have the toppling of "the rich" that brought about meaningful change to the "poor", it would necessarily include the toppling of the ~$200k income households.

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TimorousBestie
1 hour ago
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Did you perhaps respond to the wrong comment? I didn’t say anything about toppling the rich or whatever.
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krapp
1 hour ago
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The purpose of capitalism is the flourishing of the capitalist classes.

The labor classes only need to be maintained like machines or draft animals, kept just alive and well enough to afford the rent on their lives so they can continue to create value.

The collective reactions to this aren't mental illness, they're trauma responses. Capitalism is accelerating towards its final form and the shock is giving people PTSD.

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vixen99
1 hour ago
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I'd dispute the 'almost'.
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functionmouse
1 hour ago
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Sometimes, you can't tell the severity of someone's needs until they're already dead. We should err towards trusting patients, and informed consent.

> Minesh Patel, associate director of policy and influencing at mental health charity Mind, said there was "no credible evidence" that mental health problems were being over-diagnosed.

> "What we do know though is that the number of people experiencing mental health problems has increased, with 1 in 5 adults now living with a common mental health condition according to the Adult Psychiatric Morbidity Survey," he said.

In an inflationary time, with shrinking social mobility and career prospects, where no one can predict what 5 years from now will look like, and no one can afford to start a family (even more so in places like the U.S.), I don't know why this is such a challenging sentiment for some to wrap their heads around. Of course distress is on the rise.

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dent9876543
1 hour ago
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I wonder if we are measuring, and therefore concentrating upon, things that turn out to be only incidental to how much we, or perhaps some of us, feel stress.
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oncallthrow
1 hour ago
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I agree that mental health conditions probably are overdiagnosed and overdiagnosis of this kind is genuinely harmful in many cases (via nocebo effect).

But equally I do think it's true that there really are more people with mental health conditions, largely because:

* life is genuinely worse today than it was 20 years ago, mostly because of technology

* the excessive amount of screen time that the average person experiences is fundamentally harmful to the natural balance of neurotransmitters in the brain

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sallveburrpi
1 hour ago
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I don’t think life is generally worse than 20 years ago. Sure some things are tougher and it depends on your class how much you feel the stress - but looking at most metrics like child mortality, literacy, starvation and people dying in armed conflicts those improved compared to 20 years ago. Sure for some there is a recent change (most notably war in Europe and genocide in Gaza) - but overall it’s still positive.

That might not be true for the USA but overall it is.

What I think is a big cause for my generation (gen-x) is that we were promised this “perfect” harmonious world beginning of the 90s/00s with all kinds of tech marvels and no more wars and oppression and freedom and abundance for everyone.

Waking up to the reality of the human condition hasn’t been easy for that generation.

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endorphine
1 hour ago
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There are also other factors that are not easily quantifiable, even though they might be more important: deep connections with other humans, supportive local communities, finding meaning in something outside of yourself, feeling connected to your vocation etc.

Byung-Chul Han would have a lot to say on this matter.

I would argue that by those measures, we are worse than let's say 50y ago.

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inglor_cz
1 hour ago
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Materially, most places in the world are better off than 20 years ago, or at least haven't worsened.

But emotionally, people now inhabit virtual places full of relentless negativity. That is the problem.

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gambiting
1 hour ago
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The "problem" is that it's all comparative, even if in absolute terms you are right - life is undeniably better than it used to be by every metric.

But to give you an example - my grandma had 8 siblings, out of which only 4 survived into adulthood. They mostly died before even turning 1, the typical "one day he was fine, the next day he turned purple and died, the nearest doctor was 2 hours away if your neighbour let you borrow a horse cart, so that's just what it was" case. Her father and her uncle were taken into Auschwitz and miraculously returned but never wanted to talk about the horrors they have seen while there. For the rest of her life she endured living under communism, seeing her peers in other countries have access to riches she could only dream of.

So now when you talk to her, how can you blame her for thinking that kids nowadays are spoiled, if they have everything provided for them, they have never experienced physical violence of any kind, but they are all depressed and sad about life being shit and saying how it was better in the good old days.

Like, from her perspective, it's impossible to understand.

But also, from the kids perspectives nowadays, all they know is a world where the "old" people have houses, jobs, stable incomes, and they cannot even hope for any of it. 50 year mortgages, 700 job applications with no interview, social media blasting images of a life that they know they can't ever have.....of course they are depressed. Just showing them stats that say "you live better, comfier, safer andd healthier lives than pretty much anyone else ever in the history of humanity" is not going to help if all they know is how much "worse" they have it than the people who came before them.

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senfiaj
36 minutes ago
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I think what definitely has improved, is the survival. We are less likely to starve, die in infancy / childhood, have longer life expectancy, etc. In the past there were also stresses. But I think the stresses were different then. They were less chronic and were more occasional instead (although probably more intense). However, after an acute stress you had a lot of time to recover. Evolutionary speaking, our brains have been adapted for that. It was necessary for our survival.

However, nowadays the stresses are different, they are more chronic / frequent. You have less time to recover from them. This is partially the result of our more complex and fast paced society / economy. Our brains are not well adapted for the modern work / educational environments and to the stresses associated with them, despite they are usually milder in intensity. Today's stress is more like to death by a thousand small cuts. Nowadays people have more anxiety, depression and suicidality. Here is a good video that talks about the modern stress: https://www.youtube.com/watch?v=Mo1A45ShcMo .

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frankc
57 minutes ago
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I actually think the social media factor is the biggest reason...we can now compare ourselves to a much, much large circle which makes our relative standing seem much worse. I think relative standing affects our happiness much more than absolute. From a mate competition standpoint, that actually makes logical sense.
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qeternity
1 hour ago
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> life is genuinely worse today than it was 20 years ago, mostly because of technology

Extraordinary claims require extraordinary evidence. Almost everything today in absolute terms is better than 20 years ago, even more so outside the developed world.

What specifically today is worse than 20 years ago?

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onionisafruit
1 hour ago
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I’m 20 years older than I was in 2005. My kids moved out of state, and I barely get to see them. My hip hurts most of the time.

Of course I’m joking, but people do generally look back fondly on their youth. I think that’s a big reason for the perception that everything is awful now compared to the recent past.

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techblueberry
1 hour ago
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To quote one of my favorite movies: “In prison I learned that everything in this world, including money, operates not on reality... but the perception of reality”

We are much more constantly aware of the chaos of our world through social media. And in regards to mental illness, perception is reality.

That and of course, housing prices. Jebus, 20 years ago I paid $400 per month for a studio apartment in the downtown of a major city.

I do find this an interesting retort though. I would argue that if a few numbers go one way, and broad sentiment goes another way, things _have_ gotten worse. Like this whole argument on “life’s gotten worse” is inherently subjective so subjective measures have more validity.

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clanky
1 hour ago
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To take the example of a minor little necessity like shelter, housing affordability is far worse today than it was 20 years ago, despite the fact that we were near the peak of a huge credit-driven housing bubble at that time.
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keiferski
1 hour ago
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Housing costs, social life (2005 is pre-iPhone), the value of an education, future outlook for careers/jobs, the mere existence of certain jobs pre-AI (i.e. writing), political polarization, to name a few off the top of my head.
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turnsout
1 hour ago
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Throughout time, people have complained that technology is ruining the world. Before AI it was the internet, and before that it was TV, nuclear power, and so on.

The quoted GP in the headline is correct. Life is just stressful. Previous generations understood this more, but my peers (Millennials) have an annoying tendency to complain that things are worse now than they ever have been, and their ADHD/anxiety is related to how "the world is now." It's BS. And it robs them of agency. Constant "happiness" should not be the goal, and the successful people Millennials admire are all living with stress and anxiety. It is normal.

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sailingparrot
52 minutes ago
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> Throughout time, people have complained that technology is ruining the world. Before AI it was the internet, and before that it was TV, nuclear power, and so on.

What if throughout time they have been right ? Any proof thst while tech brought longer lifes and more material wealth, we haven’t just spiraled down for a while in term of mental wellbeing, sense of meaning, sense of belonging etc ?

That’s obviously not true of every piece of tech (I.e. it’s hard to imagine how antibiotics or replacing a coal plant by a nuclear power plant could have negative impact of people’s mental wellbeing) but it could be true about technology in general. It’s not a stretch to believe that technologies that radically transform what a day in the life of a human being looks like, can also have an impact on said human beings life.

Our bodies and mind, have been finetuned for living in nature and hunting gathering, with a small group consisting of our families and friends for millions of years. Now we live a sedentary life, for many away from family and without any sense of community, in large, noisy, devoid of nature cities having to do day in day out the same job that is more and more compartimentalized and less and less concrete and meaningful, only to go home and sit in front of a tv to be bombarded by ads trying to induce fomo, or god forbid, doom scrolling on tik tok for hours.

If it just so happened that those two modes of life generate the exact same levels and qualities of stress in our little brains, that would be quite the coincidence.

Look at every stat around mental health: anxiety, depression, sense of meaning etc. They are all getting worse over decades. And if you think it’s caused by people just complaining more than before, look at how the rate of people willing to kill themselves, that’s the ultimate truth. All worsening.

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JohnMakin
1 hour ago
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The title is kind of baiting junk takes and misses the nuance here. Life stressors can induce depression or symptoms of it. Medication has shown to improve these symptoms. It does make treating actual chronic pathological mental illness more difficult, because of the exact attitudes expressed here.

Hint: mental illness and life being stressful is often comorbid and causal.

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strictfp
1 hour ago
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I've seen work environments that are chaotic, and people are expected to deliver things that they can't deliver without navigating and taming the chaos to do their bidding.

If course that's stressful. You can't expect individuals to tame the organization.

I think some parts of IT have deteriorated into anarchy with tyrannic leadership.

Sure, you can have anarchy. But then don't expect any particular timelines.

You can hire armies of people. But then don't expect one corner of the org to be able to deliver something that involves talking to everyone.

You can't have the cake and eat it too.

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nis0s
1 hour ago
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I think people misunderstand stress and distress, where the latter is personally inflicted on you, like being abused by a family member. In general, I think experiences due to systemic issues are different from experiencing personal issues, i.e., someone targeting you with specific intent and focus to inflict emotional or physical harm on you.

Lived experiences can add to stress, but everyone has a stressful nature to their lived experiences, as this article is saying. Being in distress, where you’re the particular target of a person or a group, is different.

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lazide
1 hour ago
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What happens when everyone feels they are being targeted (and has some justification, IMO), and so almost everyone is in distress?

But not one wants to acknowledge it, because it’s society doing it to itself?

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nis0s
1 hour ago
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There’s a difference between feeling targeted, and being targeted in actuality. If you can’t tell the difference, then you’re not being targeted.
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lazide
1 hour ago
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Who do you think isn’t being targeted by large scale manipulation attempts right now in the US?

Everyone can definitely tell. Even the cult followers. They just can’t get their heads out of their asses enough to do anything but follow with the manipulation, but it’s a very rare person indeed right now that is going ‘oh yeah, everything is actually fine’.

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nis0s
1 hour ago
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Oh okay, that’s what you meant by “target”. I make two distinctions here from my understanding: 1) if group A targets group B, then that’s not a personal attack, but a social or system issue, which I would count as a source of stress, not distress. 2) If group A targets a person, then that is a personal attack, and not a social issue, which is a source of direct conflict, and therefore distress.
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lazide
58 minutes ago
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The beauty of social media is that individuals are being targeted effectively as part of group targeting between groups.
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nis0s
19 minutes ago
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That’s stress, not distress.
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seba_dos1
3 minutes ago
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Potato potato.
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stavarotti
9 minutes ago
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Life is stressful (in some respects, overly so), but we’ve dealt with this for millennia by having a strong support system. Not to be reductive over the multitudes of problems people face today, but most can and should be solvable by having a good support system. Family and good friends with whom you can speak frankly can do wonders. It doesn’t solve the affordability or job problems, but having someone to talk to, someone that you can trust and has lived experience, can go a long way. I can’t tell you how many times I’ve solved “problems” or at least lessened their impact, by consulting family and friends.
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esperent
1 hour ago
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Life being non-stop stressful for a majority of the population is not a personal illness, it's a societal illness. Although societal illness can definitely lead back to mental illness which is a very personal affliction.

I do agree that it shouldn't be the job of GPs to prescribe away mental illness though, any more than they should be telling you what eyeglasses to wear. Those jobs should go to psychiatrists and optometrists, respectively. The GP should merely refer you to the specialist.

It does beg the question though, since society is so clearly sick and appears to be getting worse in many countries, whose job is that to fix? The obvious answers are either "politicians" , or "all of us". But politicians seem just as afflicted as the rest, or even to be adding to the sickness in many cases. And saying we all need to come together to fix it might be a truism but is basically useless.

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echelon_musk
1 hour ago
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Life being stressful is the first Noble Truth.

Perhaps GPs in the future can prescribe mindfulness more often.

They do at least have an official NHS web page on the subject: https://www.nhs.uk/mental-health/self-help/tips-and-support/...

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Hizonner
5 minutes ago
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So what? "Illness" is not necessarily a useful category or criterion for anything.
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Simplita
1 hour ago
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Interesting perspective. There’s a real challenge in separating normal stress from something that needs intervention. The line isn’t always obvious.
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KronisLV
1 hour ago
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It's also entirely possible that life is indeed just messed up in a way that human brains didn't evolve for and can't deal with - all the societal changes, breakdowns of close relationships and communities (e.g. the disappearance of the 3rd place in addition to work and home), as well as most people being stuck in an endless stressful rat race that they will not ever escape due to the state of the economy and the moneyed interests, alongside the daily stress and social media making things worse. All the injustice out there, maladaptive behaviors, normalization of hate and borderline tribal "us vs them" mentality at pretty much every turn (genders, politics, race, everything). Might be a consequence of being too exposed to information out there and not ignorant enough, but go figure.
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bluesky19283746
2 hours ago
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Diffrent times diffrent problems ,i think this Word say evrythink . We need to help people which have physical problems .
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mschuster91
1 hour ago
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Maybe, just maybe life has gotten legitimately more stressful? Like, even my parents' generation wasn't forced to move away from family and friends (aka their support network) just for career. And on top of that, a single income was enough to afford a decently sized home, stay-at-home spouse, car and children.

Compare that to today: more and more adults have to live with their parents due to cost of living, you need until age 23 until you earn your own money because you're effectively worthless without an academic degree, you get saddled with debt from acquiring said degree, when you finally have a job it's usually impossible to afford even a run-down slumlord shack unless you have two (or, worse, three) incomes... and we never had the time to actually reset after the polycrises - 2007 ff financial crisis, euro crisis, refugee crisis (in Europe), refugee crisis 2 (in Europe), Trump 1, Covid, Russian war, Trump 2...

Particularly the fact that our generation can't rely on our parents and friend networks for support any more is the largest factor to blame. And obviously, earlier generations were significantly underdiagnosed, partially because medicine literally didn't know better, partially because their parents beat them into submission with sheer violence.

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moralestapia
1 hour ago
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True.

Also, people might not be ready for this but, being able to focus intensely on one thing while being easily distracted when forced to do menial tasks is not a disorder.

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