9 ms·

I'm a psychiatrist. When I went to med school I thought I would go the radiology route, because that's where all the cool tech is, but one of the things that dr

I'm a psychiatrist. When I went to med school I thought I would go the radiology route, because that's where all the cool tech is, but one of the things that drew me in was the unexpected consistency in the themes of severe mental illness. Paranoia is, on an academic level, a fascinating phenomenon. It also causes a lot of suffering. Please remember that these kinds of communities have sprung up in the context of the ongoing stigma of mental illness, and the limitations of present medications for psychosis (most have unpleasant side-effects). Other contributors are a mistrust of authority, and the always-complicated balance between individual liberties and involuntary treatment. Finally, a plea for some compassion. Many of these people live a deeply tormented life, and feel like they can't trust anyone. It's a hard existence for both them and their families. It might seem like a humorous phenomenon, but there's a lot of suffering here.

kordless 10y ago
Have you listened to any lectures by Gregory Bateson? He goes into some relationships around schizophrenia, computation and suffering.
gist 10y ago
> I thought I would go the radiology route, because that's where all the cool tech is Also where the money is as well (vs. Psychiatry).
- jonknee 10y ago
  Thought much less likely to be taken over by computers. Radiologists have way too good of a gig going to last.
  - gist 10y ago
    There are many areas of radiology interventional for example which is aided by but not likely to be taken over by computers. There are threats to any profession but if you look at the earnings from psych vs. radiology it would take a great deal to drive down earning in rad to the level of psych in the near term.
    - ams6110 10y ago
      I would imagine the standard radiologist "reading" of xrays for simple fractures, etc. would be ripe for automation. It's already outsourced halfway around the world in some cases, I believe.
- Aelinsaar 10y ago
  Anesthesiology is another money maker, and probably no more vulnerable to ML/AI disruption than Radiology.
InclinedPlane 10y ago
I had a close relative experience a psychotic episode and require hospitalization, it was an incredibly intense experience all around. And as you say drugs are very crude tools with unpleasant side-effects, from my personal observation I have to wonder whether those drugs actually help more than they hurt, on average. It's somewhat shocking how backward and regressive our society and medical establishment still is in their approaches to psychiatric issues. At best we're only a few steps out of the dark ages and still fumbling around.
- jMyles 10y ago
  > those drugs actually help more than they hurt It seems pretty obvious that they hurt more than they help, but for many people, the alternative to a lifetime of constant, horrible spiritual anaesthesia is occasional bouts of explosive delusions which lead to behavior that's dangerous to the patient and to others. Which would you chose?
  - InclinedPlane 10y ago
    You start with a false premise, several of them actually. You posit that drugs are the one and only defense against delusional behavior. And you assume that the drugs mentioned do in fact work as advertised. I've seen with my own eyes, and other people have reported many instances as well, when they've absolutely caused more harm, by enhancing rather than suppressing delusions and hallucinations. The reality is a lot more complicated. For some people these drugs help. For others it makes things worse. For yet others it's somewhere in between. And measuring the results accurately is incredibly difficult due to the difficulty of objectively determining someone else's cognitive state. Which is difficult enough even when it's something comparatively straightforward, when there are layers of mental illness, trauma, and complex drug interactions at play it becomes a herculean effort. And one that the medical establishment generally lacks the resources and commitment to follow through on. Some people are lucky enough to have loved ones or family members around who can accurately judge what's "normal" and what isn't in someone else's behavior and also put in the effort to find what treatments help or not and maybe shepherd someone to improved health. Many other people only have a few minutes spent on their care and most of their treatment comes out of a generic manual which might as well be a flow chart of "if X prescribe Y". This isn't helped by the widespread stigma, misunderstanding, and misinformation about mental illness that permeates society. Right now our approach to these issues is like trying to tune a malfunctioning jet engine without any knowledge of how it works and experimenting via trial and error by dumping liquid oxygen or coal dust into the intake. The fact that some people are helped leads us to the incorrect conclusion that we actually know what we're doing instead of just occasionally getting incredibly lucky.
deleted 10y ago
[deleted]
Aelinsaar 10y ago
Not just the ongoing stigma of mental illness, but the near-total destruction of our mental health infrastructure in the US since the 80's. We've seemingly made the choice that unless you're fabulously wealthy or connected and can afford exceptional private treatment, your major options are to be a family burden, in prison, or indigent.
- pasbesoin 10y ago
  And, we make physical health care harder and harder to access. Physical injuries and illnesses get poorer or no treatment, many then resulting in mental and emotional burdens. There is no "social contract" anymore. So yeah, every poor bastard for themself.
  - Aelinsaar 10y ago
    I keep wondering how long it's going to take before even the super-rich remember the kind of world that inevitably creates for everyone, the festering instability.
- phren0logy 10y ago
  This is absolutely true, but many of these patients are at best ambivalent about treatment. They do not believe they are sick.
  - Aelinsaar 10y ago
    Which is why you need an infrastructure other than prisons and the streets to manage people who cannot manage themselves.
    - vonmoltke 10y ago
      Agreed, but the system you bemoan the dismantling of was basically a prison system by another name, and arguably less humane than what they have now.
pasbesoin 10y ago
I've noticed a change in the general tone of comedy in U.S. media society, in the past some decades. For me, it was exemplified in the changes that occurred on the broadcast television show, "Saturday Night Live". I used to howl at the early SNL -- well, when they were "on"; individual skits were always hit and miss. Over subsequent "generations", it came to the point where I could no longer watch it. I've ended up feeling similar about a significant portion of mainstream "comedy" films. Eventually, I realized: It used to be, even when the portrayals were sometimes a bit vicious, that we, the audience, guided by the writers and actors, were laughing with them. That changed: Now, much of comedy is taking grossly stereotypical portrayals and laughing at them. Laughing with, we acknowledge our... weaknesses, flaws, strengths, human-ness, and bond through shared laughter over them. Defuse the discomfort and tension. Laughing at, we define and separate into groups: "Us" versus "them". And those laughing, as the "us", bond through the process of excluding the "them". Society's never been easy. But this part of it -- emblematic, for me -- has turned into a nastier place, in the U.S. media.
- hammock 10y ago
  Love the sentiment, need data on the accuracy. Even during the golden years of SNL, you had sketch artists like Chris Farley whom we were constantly being asked to laugh AT. And in Farley's case, it contributed to mental illness and his eventual death. Edit:I was thinking of the Murray/Belushi days and don't know why I thought Farley was around the same time
  - pasbesoin 10y ago
    I'm an old timer. Farley's tenure is well past the years I'm referring to, as best I remember.
  - deleted 10y ago
    [deleted]
- DonHopkins 10y ago
  I think I know what you mean -- Even if on the surface he appears to be making fun of Joe Cocker [1], Belushi's impersonation was the deepest form of respect [2] [3]! Trump's impersonation of Serge Kovaleski [4], on the other hand... [1] http://www.liveleak.com/view?i=26b_1315119865 http://www.liveleak.com/view?i=26b_1315119865 [2] http://ultimateclassicrock.com/joe-cocker-john-belushi/ http://ultimateclassicrock.com/joe-cocker-john-belushi/ [3] http://www.latimes.com/entertainment/tv/showtracker/la-et-st-joe-cockers-other-legacy-john-belushis-impression-20141222-story.html http://www.latimes.com/entertainment/tv/showtracker/la-et-st... [4] https://www.youtube.com/watch?v=HGAqmaBjQxg https://www.youtube.com/watch?v=HGAqmaBjQxg
studentrob 10y ago
> Finally, a plea for some compassion I can imagine kids online would eat these folks up without realizing what they're doing. Do mental health professionals recommend that paranoid people take breaks from the internet? I like to debate online. I try to do it in the most respectful way possible. After reading this story, I imagine that a paranoid person could perceive disagreement as an attack. Food for thought for me. Thanks for sharing your experience.
- bpchaps 10y ago
  Mine does, yes. It's not really "get away from the internet", but more a recommendation for mindfulness, which includes getting away from stressors such as the internet.
  - studentrob 10y ago
    Well that's cool you got into mindfulness. I'm into it too. During a debate, if I notice the other person is getting upset and I recommend mindfulness, in my experience, that person rejects it. He or she is already in "disagree with everything studentrob says" mode I find it odd and a bit ironic that the moment we identify someone who could benefit most from something like mindfulness can be a time when they're most likely to reject it. Perhaps this is the struggle of psychology and education in a nutshell. It's most useful when the student seeks it out.
blazespin 10y ago
I think a huge source of blame lies in organizations like the NSA/CIA that have proven to be deceptive / secretive / manipulative. There is a long history of secret experiements done by government that breeds distrust. Add mental health issues and the internet and you have a cauldron which can easily brew up this sort of thing. I think a good type of treatment for this would be body cameras and mikes which a therapist could review with a patient and provide them with rational explanations.
- jsprogrammer 10y ago
  Yep, the only treatment that makes sense, isn't even discussed in this journalistic article (or, even by medical professionals). These claims seem like they would be pretty easy to verify with some recording equipment.
  - jMyles 10y ago
    In my experience having friends go through this, the most verifiable, rational repudiations of delusions are still useless during an episode. However, they can be very reassuring after an episode has subsided.
    - jsprogrammer 10y ago
      You know someone who has believed they were recording something that they were not? Were they watching the output of the recording, while still believing "it" was occurring?
      - serf 10y ago
        I have been in that position, the person when asked will usually just reinforce their position with a statement like "It was there, I swear it was.", fault their recording technique, or their equipment. Believing your mind is playing tricks on you is really the last ditch effort at rationalizing something for most people. They don't come to that conclusion easily without some sort of history or practice doing so.

kordless 10y ago

Have you listened to any lectures by Gregory Bateson? He goes into some relationships around schizophrenia, computation and suffering.

gist 10y ago

> I thought I would go the radiology route, because that's where all the cool tech is Also where the money is as well (vs. Psychiatry).

jonknee 10y ago
Thought much less likely to be taken over by computers. Radiologists have way too good of a gig going to last.
- gist 10y ago
  There are many areas of radiology interventional for example which is aided by but not likely to be taken over by computers. There are threats to any profession but if you look at the earnings from psych vs. radiology it would take a great deal to drive down earning in rad to the level of psych in the near term.
  - ams6110 10y ago
    I would imagine the standard radiologist "reading" of xrays for simple fractures, etc. would be ripe for automation. It's already outsourced halfway around the world in some cases, I believe.
Aelinsaar 10y ago
Anesthesiology is another money maker, and probably no more vulnerable to ML/AI disruption than Radiology.

InclinedPlane 10y ago

I had a close relative experience a psychotic episode and require hospitalization, it was an incredibly intense experience all around. And as you say drugs are very crude tools with unpleasant side-effects, from my personal observation I have to wonder whether those drugs actually help more than they hurt, on average. It's somewhat shocking how backward and regressive our society and medical establishment still is in their approaches to psychiatric issues. At best we're only a few steps out of the dark ages and still fumbling around.

jMyles 10y ago
> those drugs actually help more than they hurt It seems pretty obvious that they hurt more than they help, but for many people, the alternative to a lifetime of constant, horrible spiritual anaesthesia is occasional bouts of explosive delusions which lead to behavior that's dangerous to the patient and to others. Which would you chose?
- InclinedPlane 10y ago
  You start with a false premise, several of them actually. You posit that drugs are the one and only defense against delusional behavior. And you assume that the drugs mentioned do in fact work as advertised. I've seen with my own eyes, and other people have reported many instances as well, when they've absolutely caused more harm, by enhancing rather than suppressing delusions and hallucinations. The reality is a lot more complicated. For some people these drugs help. For others it makes things worse. For yet others it's somewhere in between. And measuring the results accurately is incredibly difficult due to the difficulty of objectively determining someone else's cognitive state. Which is difficult enough even when it's something comparatively straightforward, when there are layers of mental illness, trauma, and complex drug interactions at play it becomes a herculean effort. And one that the medical establishment generally lacks the resources and commitment to follow through on. Some people are lucky enough to have loved ones or family members around who can accurately judge what's "normal" and what isn't in someone else's behavior and also put in the effort to find what treatments help or not and maybe shepherd someone to improved health. Many other people only have a few minutes spent on their care and most of their treatment comes out of a generic manual which might as well be a flow chart of "if X prescribe Y". This isn't helped by the widespread stigma, misunderstanding, and misinformation about mental illness that permeates society. Right now our approach to these issues is like trying to tune a malfunctioning jet engine without any knowledge of how it works and experimenting via trial and error by dumping liquid oxygen or coal dust into the intake. The fact that some people are helped leads us to the incorrect conclusion that we actually know what we're doing instead of just occasionally getting incredibly lucky.

deleted 10y ago

[deleted]

Aelinsaar 10y ago

Not just the ongoing stigma of mental illness, but the near-total destruction of our mental health infrastructure in the US since the 80's. We've seemingly made the choice that unless you're fabulously wealthy or connected and can afford exceptional private treatment, your major options are to be a family burden, in prison, or indigent.

pasbesoin 10y ago
And, we make physical health care harder and harder to access. Physical injuries and illnesses get poorer or no treatment, many then resulting in mental and emotional burdens. There is no "social contract" anymore. So yeah, every poor bastard for themself.
- Aelinsaar 10y ago
  I keep wondering how long it's going to take before even the super-rich remember the kind of world that inevitably creates for everyone, the festering instability.
phren0logy 10y ago
This is absolutely true, but many of these patients are at best ambivalent about treatment. They do not believe they are sick.
- Aelinsaar 10y ago
  Which is why you need an infrastructure other than prisons and the streets to manage people who cannot manage themselves.
  - vonmoltke 10y ago
    Agreed, but the system you bemoan the dismantling of was basically a prison system by another name, and arguably less humane than what they have now.

pasbesoin 10y ago

I've noticed a change in the general tone of comedy in U.S. media society, in the past some decades. For me, it was exemplified in the changes that occurred on the broadcast television show, "Saturday Night Live". I used to howl at the early SNL -- well, when they were "on"; individual skits were always hit and miss. Over subsequent "generations", it came to the point where I could no longer watch it. I've ended up feeling similar about a significant portion of mainstream "comedy" films. Eventually, I realized: It used to be, even when the portrayals were sometimes a bit vicious, that we, the audience, guided by the writers and actors, were laughing with them. That changed: Now, much of comedy is taking grossly stereotypical portrayals and laughing at them. Laughing with, we acknowledge our... weaknesses, flaws, strengths, human-ness, and bond through shared laughter over them. Defuse the discomfort and tension. Laughing at, we define and separate into groups: "Us" versus "them". And those laughing, as the "us", bond through the process of excluding the "them". Society's never been easy. But this part of it -- emblematic, for me -- has turned into a nastier place, in the U.S. media.

hammock 10y ago
Love the sentiment, need data on the accuracy. Even during the golden years of SNL, you had sketch artists like Chris Farley whom we were constantly being asked to laugh AT. And in Farley's case, it contributed to mental illness and his eventual death. Edit:I was thinking of the Murray/Belushi days and don't know why I thought Farley was around the same time
- pasbesoin 10y ago
  I'm an old timer. Farley's tenure is well past the years I'm referring to, as best I remember.
- deleted 10y ago
  [deleted]
DonHopkins 10y ago
I think I know what you mean -- Even if on the surface he appears to be making fun of Joe Cocker [1], Belushi's impersonation was the deepest form of respect [2] [3]! Trump's impersonation of Serge Kovaleski [4], on the other hand... [1] http://www.liveleak.com/view?i=26b_1315119865 http://www.liveleak.com/view?i=26b_1315119865 [2] http://ultimateclassicrock.com/joe-cocker-john-belushi/ http://ultimateclassicrock.com/joe-cocker-john-belushi/ [3] http://www.latimes.com/entertainment/tv/showtracker/la-et-st-joe-cockers-other-legacy-john-belushis-impression-20141222-story.html http://www.latimes.com/entertainment/tv/showtracker/la-et-st... [4] https://www.youtube.com/watch?v=HGAqmaBjQxg https://www.youtube.com/watch?v=HGAqmaBjQxg

studentrob 10y ago

> Finally, a plea for some compassion I can imagine kids online would eat these folks up without realizing what they're doing. Do mental health professionals recommend that paranoid people take breaks from the internet? I like to debate online. I try to do it in the most respectful way possible. After reading this story, I imagine that a paranoid person could perceive disagreement as an attack. Food for thought for me. Thanks for sharing your experience.

bpchaps 10y ago
Mine does, yes. It's not really "get away from the internet", but more a recommendation for mindfulness, which includes getting away from stressors such as the internet.
- studentrob 10y ago
  Well that's cool you got into mindfulness. I'm into it too. During a debate, if I notice the other person is getting upset and I recommend mindfulness, in my experience, that person rejects it. He or she is already in "disagree with everything studentrob says" mode I find it odd and a bit ironic that the moment we identify someone who could benefit most from something like mindfulness can be a time when they're most likely to reject it. Perhaps this is the struggle of psychology and education in a nutshell. It's most useful when the student seeks it out.

blazespin 10y ago

I think a huge source of blame lies in organizations like the NSA/CIA that have proven to be deceptive / secretive / manipulative. There is a long history of secret experiements done by government that breeds distrust. Add mental health issues and the internet and you have a cauldron which can easily brew up this sort of thing. I think a good type of treatment for this would be body cameras and mikes which a therapist could review with a patient and provide them with rational explanations.

jsprogrammer 10y ago
Yep, the only treatment that makes sense, isn't even discussed in this journalistic article (or, even by medical professionals). These claims seem like they would be pretty easy to verify with some recording equipment.
- jMyles 10y ago
  In my experience having friends go through this, the most verifiable, rational repudiations of delusions are still useless during an episode. However, they can be very reassuring after an episode has subsided.
  - jsprogrammer 10y ago
    You know someone who has believed they were recording something that they were not? Were they watching the output of the recording, while still believing "it" was occurring?
    - serf 10y ago
      I have been in that position, the person when asked will usually just reinforce their position with a statement like "It was there, I swear it was.", fault their recording technique, or their equipment. Believing your mind is playing tricks on you is really the last ditch effort at rationalizing something for most people. They don't come to that conclusion easily without some sort of history or practice doing so.