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Burdens | Slate Star Codex

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[Content note: Suicide. May be guilt-inducing for people who feel like burdens. All patient characteristics have been heavily obfuscated to protect confidentiality.] The DSM lists nine criteria for major depressive disorder, of which the seventh is “feelings of worthlessness or excessive or inappropriate guilt”. There are a lot of dumb diagnostic debates over which criteria are “more important” or “more fundamental”, and for me there’s always been something special about criterion seven. People get depressed over all sorts of things. But when they’re actively suicidal, the people who aren’t just gesturing for help but totally set on it, they always say one thing: “I feel like I’m a burden”. Depression is in part a disease of distorted cognitions, a failure of rationality. I had one patient who worked for GM, very smart guy, invented a lot of safety features for cars. He was probably actively saving a bunch of people’s lives every time he checked in at the office, and he still felt like

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