Hmm... that aligns somewhat with my own thoughts on the actual cause of depression. I've spent a lot of time thinking about since I spent a significant portion of my life depressed, and I find the current approach to it in health care unsettling.

Allow me, if you will, to engage in some inexpert speculation. If you read the following, please keep in mind that I am just some idiot on the internet and not in any way qualified to give advice.

It seems to me that depression is not a disorder, disease, or abnormality, but a necessary and purposeful reaction of the mind and brain to certain stimuli. Of course this is not always the case, and the same symptoms can be triggered by other factors that affect our neurochemistry or mental function, but in a normally functioning mind and brain I think this is true. When examined in this context, what do we find?

Depression makes us apathetic, reluctant to act, and unconfident. A while back there was an article on HN spitballing that depression and mania were related to our mind's assessment of its own ability to predict outcomes. Overconfidence in its own predictive ability manifests as mania, and low confidence manifests as depression. This makes some sense. If you are confident in your predictions you are more likely to act on them, and if you are not you are less likely to. Given this, I submit that it's possible that what depression really is, much of the time, is a philosophical problem.

Philosophy is our model of reality, and we use that model to make predictions and decide how to act in the world to affect change. When that model is known to be broken, we lower our confidence in it and act less. Over time, as more and more of our model is revealed as flawed and our confidence in it continues to plummet, we enter a state of learned helplessness. Finding ourselves unable to predict the results of our actions, we are unable to determine how to effect the changes we desire in our lives, leading to interesting contradictions like being bored and at the same time unmotivated to do things we used to enjoy. We don't want to be in this state, but we lack the ability to see a path out of it, so we become frustrated, angry, and/or sad. It can eventually reach a point where the only path out of the suffering that we're confident in, is death.

In fact, this model-breaking occurs many times in our minds' development. As we grow up we form several different models of reality, all of which are inevitably revealed to be flawed. This is the reason you find children who believe they are hidden just because they can't see you (their model of reality doesn't include the concept of different perspectives), and why the terrible twos are so terrible (the young mind is dealing with its model of reality failing), for instance. With children, however, there are plenty of people around them operating with better models of reality to help them work out a new one. Societies can also be modeled this way, and if we look at the past we find that human cultures also go through a similar pattern of forming a stable model of reality, eventually finding it flawed, suffering through process of dealing with that, and ultimately resolving the crisis. I say resolving because, in actuality, there are two solutions to the problem of realizing your model is broken: forming a new, more accurate, one; or ignoring the information that contradicts it.

This is the important point, I think: When an individual's model of reality is broken, and society cannot guide them towards a more accurate one because society itself is still operating on the model that individual has determined to be flawed, then chronic depression is a likely result. Our current societal philosophy, the one our health care system is also based on, see's this individual's suffering not as a transition period in which they form a new model, but a severe disorder. To them, the rejection of the model is a form of insanity, and unclear thinking. This is why you sometimes see people tell a depressed person an obvious platitude in an attempt to cheer them up, only for it to further frustrate the depressed individual: they are aware that the platitude is part of a flawed model.

Further, the health care system is, like most of current western society, firmly implanted in empiricism. Science and measurement are the hammer, and everything else is a nail. Society as a whole forms its model of depression on measurements and manipulation of the neurochemical and behavioral aspects of depression, the social side effects, etc, but without regard for its greater reason for being. They are witchdoctors, sacrificing chickens to drive out the demons and bloodletting to balance the humors. Sometimes it works, because even a broken clock is right twice a day, but a lot of times it doesn't.

If one were to assume that this assessment is accurate, then reason we get depressed is so that our mind is motivated to take a step back and build a more accurate model of reality. The thing to do, then, is to help the sufferer realize why they are suffering. There's nothing wrong with them, they don't have a chemical imbalance of the humors, they aren't bad people for feeling the way they do or for not having faith in what society tells them is true. They have in fact taken a step toward growth, and nearly all growth comes at the cost of suffering. They need to look hard at where reality has shone the light on their flawed conception of it, reason through the problems, and build a more accurate replacement, and we may not be equipped to help them.