Talk:Major depressive disorder

External link to video

On 27 October after proposing it on this talk page here, I inserted a large button under the infobox linking to a 10 minute video about depression. On 11 January, Doc James deleted it. I've learned a bit about MOS since then and am amazed it lasted that long. However, I believe the rationale outlined in the above wikilinked proposal, and the discussion behind it here, justify its inclusion on this article as an external link, so have added it to Major depressive disorder#External links. --Anthonyhcole (talk) 13:43, 31 January 2011 (UTC)

Society and culture (relevant quote)

Hello everyone.

Upon reading the "society and culture" section, a quotation by Charles-Valentin Alkan came back to mind. Probably it is not relevant enough to be included in the article but I am re-transcribing it here just for the sake of it. May it serves to inspire one on the subject. It goes as follows:

"I’m becoming daily more and more misanthropic and misogynous: nothing worthwhile, good or useful to do; no one to devote myself to. My situation makes me horridly sad and wretched. Even musical production has lost its attraction for me for I can’t see the point or goal."

Twipley (talk) 18:19, 18 March 2011 (UTC)

The use of the Van Gogh picture to create an image of depression

Hello, I think the current picture painted by Vincent Van Gogh should not be up. Van Gogh did suffer from depression, but the thing is he killed himself in the end with a gun. I know when I was depressed and saw this painting on wikipedia, the image stuck to me and I thought of it if I ever got down.

But the fact that Vincent Van Gogh committed suicide in the end should mean that it should not remain up, IMO. The painting is a portait of depression, and what happened in the end to the painter is not very good. Anyone else agree?--Dcfb111 (talk) 18:44, 28 March 2011 (UTC)

I don't understand what you are saying. Are you saying that the image should not be there because it might lead readers to think that depression is harmful? Looie496 (talk) 23:44, 28 March 2011 (UTC)

No. He is saying since the man who painted this portrait committed suicide that it gives a pessimistic outlook on recovery from depression. In wiki language, he believes too much WP:UNDUEWEIGHT is being given to the suicidal outcome of depression which is not the most common outcome. I disagree though that too much weight is given because most readers will not be familiar with the painting or the artists suicide. I am open though to suggestions of other possible images.AerobicFox (talk) 03:42, 29 March 2011 (UTC)

I also believe it's inappropriate. You wouldn't see that painting on a textbook or (dare I say) encyclopedia giving a description of depression. 216.252.86.130 (talk) 07:06, 1 April 2011 (UTC)

Depression (mood) is illustrated by Albrecht Dürer's engraving Melencolia I. --Anthonyhcole (talk) 17:56, 1 April 2011 (UTC)

I like the image and thing we should keep it. It illustrates the issue well. Doc James (talk · contribs · email) 17:59, 1 April 2011 (UTC)

This article has been difficult to illustrate. The painting has been discussed elsewhere as portraying a depressed person. I think it adds more to the article than detracts. Casliber (talk · contribs) 19:45, 1 April 2011 (UTC)

I disagree that it would not be used on a textbook. Psychology textbooks, including Abnormal Psychology textbooks, which discuss depression often use various art images on their covers and in their articles. Annaskyfox (talk) 23:00, 15 April 2011 (UTC)

I agree with AerobicFox that the majority of readers will be oblivious to the artist's suicide. I find that the illustration is appropriate and prefer it to Dürer's Melencolia I, though I would also be open to other possibilities. --Tea with toast _(talk) 00:42, 17 April 2011 (UTC)

Casliber above is a Wikipedia administrator who by profession is a psychiatrist and not an art historian. He is quite mistaken in his assertion that the painting depicts a depressed person (its provenance is discussed below here). The painting has no place in this article and should be removed. Skirtopodes (talk) 02:26, 13 January 2012 (UTC)

Treatment Discussion

It would be beneficial to discuss the controversy surrounding treatment of MDD, and come to a consensus on the most unbiased way to present current research. The current wording on the article sounds as if antidepressants offer no benefit at all. Even Kirsch admits that antidepressants are better than not receiving treatment, regardless of whether or not they separate from placebo.

Also, there is no mention of the critiques of the current research. i know that there was a panel of researchers who wrote a response to Kirsch's paper from '98, but I didn't see that anywhere in the Wiki article. I'm not sure if that should be placed in this article per se, but it could be useful to highlight that these findings are controversial, and be very clear about what the findings actually say. --Smister (talk) 08:02, 6 August 2011 (UTC)

New meta-analysis

I stumbled across this and think it should go in the article.[2]. Since omega 3 oils are apparently effective against depression, I assume if folk agree it should be added to the article that it should go in the antidepressant section or should there be a seperate section? Literaturegeek | T@1k? 13:29, 9 November 2011 (UTC)

We have to be very careful how we present this. The article does not imply, nor is would it be proper, to imply that these oils are, by themselves, effective in treating all depressions, serious depressions etc. Furthermore, the article clearly stated that Omega 3 oils weren't useful, but only fractions, probably EPA. We do not want people running down to their local GNC and think they're going to treat their depression. It's not going to happen, especially at the doses that may be required. Oh, and of course, there's conflicting publications. In fact, I can find a lot of trials that completely dispute any effect at all for EPA or other fractions of Omega-3 or its fractions. But there is one critical point....why would these oils have an effect based on what we know about what causes depression? Without a knowledge of the causal pathway, we cannot even begin to accept this study as supportive of something here. OrangeMarlin ^{Talk• Contributions} 09:10, 12 December 2011 (UTC)

Well, nobody yet knows the causal pathways by which ECT or total sleep deprivation affect depression, but clearly they do. We don't need to know causal pathways if the direct evidence is strong enough. (Which I don't think is the case for omega 3 agents, though.) Looie496 (talk) 16:53, 12 December 2011 (UTC)

Looie...point taken. But this is my anti-woo defense mechanism always pops up, even where we don't really have to know the mechanism (hell, most of treatment of depression is magic). OK, omega 3 is far above magical water cures, I admit. OrangeMarlin ^{Talk• Contributions} 17:23, 12 December 2011 (UTC)

(outdent) There is a possible theoretical mechanism and perhaps I am straying into synthesis or medical hypothesis territory, but no rule against it acccording to WP:TALK! :-P This recent review paper covers how dietary factors including omega 3 influence mood and wellbeing, by for example reducing or increasing proinflammatory cytokines. Proinflammatory cytokines are involved in major depression,[3],[4] and many antidepressants via their mechanism of actions can reduce neuroinflammation. Very interesting finding the systematic review paper OrangeMarlin that came to an opposing conclusion, thanks for adding it to the article; it may be that omega 3 is indeed ineffective in treating depression, but perhaps it works as a preventative. Perhaps omega 3 just isn't potent enough or its mechanism is not the same as antidepressants to treat depression. I would still say don't throw out the baby with the bath water or more to the point don't throw out that salmon and mackerel just yet! :-) Whether something is natural or synthetic is irrelevant, what matters is does the compound(s) exert a demonstratable pharmacological and therapeutic effect. For what it is worth I have tried fish oils recently and did not notice any significant change in my mood but still probably gonna take them as a possible preventative and for possible general health benefits or treat myself to fish a few times a week, which ever is cheaper or I feel like. :P--Literaturegeek | T@1k? 00:03, 13 December 2011 (UTC)

Vincent van Gogh's painting "At Eternity's Gate"

Why is Vincent van Gogh's painting "At Eternity's Gate" illustrating this article? The painting is not a depiction of depressive disorder.

Its provenance is very well known and very thoroughly researched. It began as a lithograph study made in van Gogh's student days as a painter at Arnhem, at a time when van Gogh himself was in good health. It was always simply and merely a study of an old man, one of a group. Van Gogh himself refers positively to the old man as a "fine sight" in a letter of the time.

The painting itself was made towards the end of van Gogh's life years later, while he was recovering from his nervous breakdown and self-harming incident in an institute at St. Remy, France. It is an exact copy of the lithograph and is one of a group of colour studies made at the time. There has never been any suggestion by academics that van Gogh was attempting to project some private desperation of his own in the painting. It is not included in a list of works from that time suggested by his most authoritative archivist, Jan Hulsker, as possibly indicative of his state of mind at the time.

But it is (or was - I refuse to look at the article again) documented as such in the Wikipedia bio of van Gogh by a cabal of contributors (including a Wikipedia administrator who is a practising psychiatrist in Australia and who I suggest ought to know better), who for some agenda of their own wish to depict Vincent van Gogh as suicidally depressed in the last three months of his life, what is simply not true or at any rate is documented as such. The quite disgraceful story of that is documented here @ http://www.gutclean.com/wpvangoghdarkdebate.html. The fact is, as is agreed by all scholarly biographers, there were no indications of van Gogh suffering from depression in the last months of his life, nor indeed is there any agreement as to the nature of whatever mental illness van Gogh did suffer from. One can add that in the past year plausible evidence has been put forward in a new book from a respected source that van Gogh was in fact the victim of a manslaughter.

I ask that this illustration be deleted forthwith. — Preceding unsigned comment added by 31.6.61.254 (talk) 01:04, 13 January 2012 (UTC)

It is a great picture that illustrates the topic well.Doc James (talk · contribs · email) 03:30, 13 January 2012 (UTC)

Well, that's your judgement. But the fact is that van Gogh did not mean to portray a depressed person and on that ground alone it is out of place. But it also makes a subtle judgement about the nature of depression, that it is necessarily associated with despair of the sort arguably portrayed here. If the article must have a fine art illustation, then I suggest Durer's Melancholia, as was originally used, is much more appropiate. 31.6.53.248 (talk) 03:44, 13 January 2012 (UTC)

We are not the only one who use it for this purppose http://www.washington.edu/news/archive/id/56102 and this ref supports our use http://books.google.ca/books?id=7yqTnHyTbfAC&pg=PA214 Doc James (talk · contribs · email) 22:20, 13 January 2012 (UTC)

That the Washington Post uses it in the same way is not justification in the absence of reliable sources that van Gogh meant the painting to represent depressive disorder (and incidentally sorrow, the title van Gogh himself appears to have given these works, is not a clinical condition). The same remark applies to your other source, a mere glance at whose content moreover suffices to establish that it is in fact a scholarly article about stereotypes, precisely the kind of stereotypes we should wish to avoid in an encyclopaedic article such as this. 31.6.61.199 (talk) 22:48, 13 January 2012 (UTC)

I personally feel that the van Gogh painting is more suitable than the Durer painting, regardless of its history. Looie496 (talk) 21:15, 14 January 2012 (UTC)

And we have another good comment here [5] Doc James (talk · contribs · email) 23:22, 14 January 2012 (UTC)

I replied thus:

No. The painting is at the Kroller-Muller in Holland (the original lithograph is apparently lost). The title "At Eternity's gate" is not van Gogh's but some traditional title and it is exhibited at K-M as "Sorrowful Old Man: At Eternity's Gate" http://www.kmm.nl/object/KM%20111.041/Sorrowing-old-man-At-Eternitys-Gate?artist=Vincent%20van%20Gogh%20%281853%20-%201890%29&characteristic=&characteristic_type=Painting&van=0&tot=0&start=63&fromsearch=1. The same collection has an accompanying lithograph from the period of the original lithograph with a title beginning "Sorrowful woman ... " and in addition there is another lithograph from that period depicting the same old man reading a book with concentration and not displaying any signs of strong emotion. It's not clear what van Gogh's theme was at the time (his letters of the time are concerned only with the technicalities of producing these lithographs) but it's clear that at most he was concerned to depict sorrow, which I expect your trained psychiatrists you mention will concede is not a clinical condition. It is in fact only the subjectivity of the viewer who introduces the idea of 'sorrow' looking at this picture, let alone a diagnosis of depressive disorder your trained psychiatrists apparently make.

If the trained pyschiatrists you mention were writing a book on depressive disorder and wished to illustrate it with a dust-jacket depicting this painting, they would have to seek the permission of the trustees of the Kroller-Muller museum and it is far from clear to me that the trustees would wish to grant that permission. As trustees of the estate and moral rights of one of our greatest ever artists, they would undoubtedly wish to see that his work was viewed freely without stereotyping or mythologising the artist and might very well look askance at this attempt to make, quite gratuitously, the painting an iconic representation of depressive disorder and the more so given the considerable difficulty in assessing to what degree illness played a part in the painter's life and indeed what the nature of that illness was.

What your trained pyschiatrists are really doing with this painting are peddling sterotypes and myths. It is absolutely disgraceful and a matter of concern to all art lovers, 'trained' or otherwise. When you consider further, as every beginning student of art history knows, that van Gogh himself wrote intelligently about the relationship between insanity and artistic creation (he took a view that was to become fashionable decades later, that society 'labelled' artists as mad and so indeed they did eventually become) it becomes little short of outrageous, because that labelling is precisely what your trained psychiatrists are doing with the subject of this painting. Skirtopodes (talk) 00:50, 15 January 2012 (UTC)

And I have replied again, see the page. Basalisk ^{inspect damage}⁄_berate 01:31, 15 January 2012 (UTC)

And I thus:

No again. It is you who deny an issue and you do it in the time honoured way of accusing me of misunderstanding the 'real' issue.

However, I shall take you as face value and treat what you decribe as the real issue - that the painting is a good representation of MDD (Major Depressive Disorder). I did notice, incidentally, that this last reply of yours moves to the royal wikisodality 'we'. Are we by any chance young and naive - a student perhaps? High school?

Whatever, will you please explain what it is about the image that makes it a good illustration of MDD? That the man is old? That he is holding his knuckles to his face in an apparent gesture of depair? What makes you say the image accurately portrays that suicide attempts and suicidal thoughts are amongst the most severe and prominent symptoms of depression (or so you characterised them for my instruction)?

Above all, will you please quote reliable sources, as should be the Wikipedia way, that attest this painting as a good image of MDD. Who are these 'trained pyschiatrists' you mention? It looks likes OR (original research) to me. Skirtopodes (talk) 02:39, 15 January 2012 (UTC)

┌────────────────────────────────────────────────────────────────────────────────────────────────────┘ I seem to recall us having this debate before and there being a commentary that linked the image to depression...only 11 pages of archives to sift through.... Casliber (talk · contribs) 05:32, 15 January 2012 (UTC)

Or alternatively, see my most recent comment here. Basalisk ^{inspect damage}⁄_berate 15:53, 15 January 2012 (UTC)

@ Basalisk. And I record my reply thus:

I have been away. You are quite juvenile. You cannot even distinguish between p -> q and q -> p. The whole point is that this merely a painting of a sorrowful old man. Just because an old man is sorrowful does not imply that he he is clinically depressed whereas indeed it may be true, as I presume you mean to instruct me, that an old man who is clinically depressed is necessarily sorrowful, nevertheless the two are not equivalent. I wonder what your mentor Casliber's professional association would make of this attempt to stereotype the old and sad as clinically depressed and in need of treatment?

I shan't notice any response you make. I have to say that if your would-be profession of choice involves the care of patients, then I can only hope that you were entirely unsuccessful in the examinations you mention. Skirtopodes (talk) 00:17, 7 February 2012 (UTC)

Hard words, Skirt, but hard luck too - I passed my finals. Since your argument has degenerated to a huge tl;dr WP:IDIDNTHEARTHAT, I think the discussion is over. The next time you embark on a tirade of vitriol like this, or the speech below, I'll report you for personal attacks (that's if one of the admins watching this page doesn't block you anyway). Finally, I'm not a psychiatrist. I've never talked to Casliber. He's not my mentor. Everyone who disagrees with you is not in a cabal. Get over it. Basalisk ^{inspect damage}⁄_berate 06:52, 9 February 2012 (UTC)

Oh, he was a troll after all. Too bad, wrestling with pigs and all that... Basalisk ^{inspect damage}⁄_berate 07:46, 11 February 2012 (UTC)

@ Casliber: well I would be grateful if you can point me to the debate. I asked a Wikipedia expert to find me the original edit and she tells me that it was made by a user called 'Sonjaa' on 28 May 2006 at this address http://en.wikipedia.org/w/index.php?title=Major_depressive_disorder&diff=next&oldid=55164823. The original text read ""Vincent van Gogh, who himself suffered from depression and commited suicide, painted this picture in 1890 of a man that can emblematise the desperation and hopelessness of depression." As far as my friend can see it was never subsequently challenged though the text was eventually edited.

I think you will agree that the original falls far short of scholarly standards. Quite apart from the need to cite a reliable source for "emblematise the desperation and hopelessness of depression" there is a problem that you yourself, a practising psychiatrist so I understand, should be acutely aware of and that is that there is no consensus of what Vincent's mental illness (if that is what it was) actually was. I don't doubt that in ordinary terms he suffered depressions but this is an article about clinical depression and whether Vincent was clinically depressed is simply not clear. I repeat there is nothing in his letters of his last three months to indicate that he was depressed, let alone suicidal. It's indeed no longer clear that in fact he committed suicide (but was rather the victim of a manslaughter).

For the last time I ask you, a Wikipedia administrator as well as a psychiatrist, to delete this image that is such a disgraceful and quite unwarranted discourtesy to the memory of Vincent van Gogh. His desperately tragic story, as that of his brother Theo, is almost unbearable to read and it is not served at all well by these pathetic and pitiful romanticisations by a clique of misguided Wikipedia editors. In his own life Vincent struggled against this kind of stereotyping and wrote eloquently and intelligently about the link between creativity and madness, which he thought merely a social construct. His own sister Wil, an early champion of feminism, was hospitalised for much of her life (four decades) on the questionable gounds of suffering dementia, a condition that apparently presented in her case in her late thirties. I take it you aware that there is a flourishing van Gogh family who are the direct decendants (through Theo) of his family? It is a disservice to them as well.

Do I really have to petition the art world on behalf of Vincent in this matter? The Kröller-Müller museum for a start might express an interest.

In the meantime I am making an edit to insert the correct title for this painting as it is currently displayed at Kröller-Müller i.e. "Sorrowing old man ('At Eternity's Gate')" http://www.kmm.nl/object/KM%20111.041/Treurende-oude-man-At-Eternitys-Gate?lang=en. The popular name 'At Eternity's Gate' is really another romanticisation, carrying roughly the same degree of authenticity as Beethoven's title 'Moonlight Sonata'. It appears on on of the early lithographs he made and nowhere else. The painting itself, as I note above, was merely a colour study he made as he was convalescing at Saint-Remy from his breakdown (the ear incident, though again it's no longer clear that in fact he mutilated himself). Your original contributor Sonjaa might care to reflect that Jan Hulsker, Vincent's most esteemed archivist and critical authority, thought not to include this painting in a list he made of paintings at the time as possibly reflecting Vincent's state of mind and thus presumably would take issue with "emblematise the desperation and hopelessness of depression".

What a complete disgrace and how utterly pathetic and pitiful your editors' responses. Skirtopodes (talk) 23:01, 6 February 2012 (UTC)

┌────────────────────────────────────────────────────────────────────────────────────────────────────┘

@ CasLiber: Skirtopodes has been blocked by Risker. That makes twice he has been blocked, once by you and once by her.

He posted first on your talk page on 13 January 2011 raising the issue of 'Sorrowing Old Man', the first time he has posted on Wikipedia on this issue. Your reply is above, saying it had been discussed before and that a commentary had been found linking the image to depression. Skirtopodes asked you to point to that commentary, but you did not reply.

I have looked through the archive and can find no such commentary. The only source I can find is the one quoted above, but that, as Skirtopodes pointed out, is in fact an academic paper to do with sterotypes which in no way seeks to support the thesis that van Gogh suffered from clinical depression.

There is no "commentary". That is a fiction.

I did find this from you Talk:Major_depressive_disorder/Archive_4#Illustrations

"Yeah, good point. The painting is rather a good one (of a sad person, that is), unfortunately Van Gogh had other mental health symptoms suggesting problems other than depression. OK, let's leave it open for a little bit but removing I think I agree with. Cheers, Casliber (talk · contribs) 21:39, 24 May 2008 (UTC)"

So why is it still here, why did you change your mind?

Looking at Talk:Major_depressive_disorder/Archive_4#Illustrations I get the impression (the large downer smiley) that you consider the whole business a bit of a joke. Is that so?

I am trying to understand your motives here. Do you perhaps regard yourself as something of an authority on Vincent van Gogh? On his health? Perhaps you have published a dissertation or an academic paper? Or perhaps you regard yourself as something of an art critic? Do you perhaps post in Wikipedia on the visual arts? Do you have any association with editors who do that might lead to conflicts of interests? Perhaps you have patients who are artists or art critics that might lead to similar conflicts of interests? In short, what is this all about?

I trust you will agree there has been adequate time for you to respond here and that if you do not do now respond adequately, then the assumption must be that you do not intend to.

I am posting this on the IP address that Risker blocked and I will copy to your talk page.

Thank you. 31.6.53.252 (talk) 23:25, 12 February 2012 (UTC)

Why are we still debating Van Gogh's mental health when it doesn't make the blindest bit of difference to the appropriateness of the image in this article? Whether Van Gogh was depressed, schizophrenic, manic, a psychopath or completely normal, the picture is still a good illustration of despair and sorrow. That's all that matters. Let's just move on from this, further discussion is not accomplishing anything. Basalisk ^{inspect damage}⁄_berate 09:40, 13 February 2012 (UTC)

I agree the painting is emblematic of the topic, whether Van Gogh intended it to be such or not. (Off topic:There is a short interview with Steven Naifeh, one of the authors of Van Gogh: The Life here.) --Anthonyhcole (talk) 03:00, 17 February 2012 (UTC)

IF people spent more time helping and talking to each other instead of arguing what painting describes what and blah blah blah, we would be a much happier world. The painting is beautiful and so is everything else in the universe, love. — Preceding unsigned comment added by 99.254.240.157 (talk) 10:51, 25 February 2012 (UTC)