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Marshall comments on Really Extreme Altruism - Less Wrong
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Assume that he is, indeed, suffering from depression, and attempts to treat it have not been particularly successful. Does that make a difference?
The questions (1) "Is the fact that someone does X evidence of mental problems?" and (2) "Is doing X a good thing or a bad thing, on balance?" are different. As I read it, this article is addressing #2 and not #1. (I see no reason to think that there couldn't be rather a lot of things that ought to be done but that are psychologically near-impossible for most people with healthy minds.)