19 ms·

When Do We Have Empathy for the Mentally Ill?

195 points by UpshotKnothole 8y ago

moneytide1 8y ago
I saw someone post to HN once in an article about a cancer vaccine - "Doctors want patients, not cures". Really stuck with me. Modern society categorizes people. When a citizen fails to adapt to society (for better or worse) and they feel a certain pressure to submit to the opinions of an "expert", they become part of a revenue stream. The DSM-V has them figured out. Many types of mental illnesses are symptoms of the environment. We are spending too much time looking at MRIs, that is, looking inward - the brain structure must hold the clues to the "cure". But the brain molds to interface the user with its surroundings. It is the effect, not the cause. Perhaps show empathy for the mentally ill once they've spent years being drugged out by attempted "cures".
- stochastic_monk 8y ago
  I’ve had the pleasure of working with a number of doctors who are well-respected in their field. I never once saw one more excited than the times they’d describe what it was like to find out a patient was a candidate for a targeted therapy and bring them back from death’s door. Most of them do this to treat, and I believe they’d be very happy to be out of a job if it meant fewer children, parents, or simply humans, had to die.
  - tuananh 8y ago
    Doctors, maybe but I doubt about this when it comes to big pharmaceutical corps.
  - opportune 8y ago
    Even "very good" doctors often don't know the state of the art procedures and treatments for their craft, as I have personally discovered since a close family member began receiving cancer treatment. From my experience, the vast majority of doctors' response to bringing up experimental treatments or care - or even recently approved, well-researched treatments - is a mindless affirmation of "that's the future", meaning they don't know anything about it. If you press them, most will say that they prefer to start patients with XYZ, which means "I want your business but don't know about that treatment". This happened to my own sick relative, a pharmacogenomics researcher, who said it reminded him almost exactly of trying to get clinicians to incorporate basic gene panels into their practice (e.g. don't give this patient warfarin because they have this gene which will make them bleed to death). As a society we are much too afraid to call shitty doctors shitty doctors. Having parents in medicine, I grew up hearing about them all the time. I do believe that most doctors would not consciously and maliciously decide to sacrifice people's health for money. I also believe that most doctors aren't particularly diligent about keeping up to date on medical information throughout their careers; for every developer with 30+ years of experience who has treated a job as a job and worked with the same tech staff for all his life without bothering to learn new ones, there's a doctor doing the same with medicine.
    - stochastic_monk 8y ago
      It’s true that there are such doctors. My experience is not necessarily typical, as these were faculty at a well-regarded cancer hospital and always very close to new developments. The ones I mention, being involved in clinical trials and new treatments/diagnostics makes them particularly appropriate for this discussion because they are at the intersection of translational treatment and patients. (Cures vs patients) You’re right that many doctors aren’t called out like they should be out of some misguided deference, and I’m disappointed to hear how many of them are in cases which matter so, so very much to you, if not to them. With regard to your personal experience, remember that no professional will care as much about your or your loved one’s condition as you will. You (or your loved one) are the only patient you’re treating, and I encourage you to advocate as necessary.
  - moneytide1 8y ago
    I do believe that most medical professionals are well-meaning, especially when people choose to trust them with their health. I do not question their empathy and selflessness. But my comment is directed at the belief that a medical professional always knows best. The doctor that actually interfaces with the patient is equipped with tools and techniques that originate from other divisions of expertise that develop pharmaceuticals, testing equipment, or coordinate large-scale case-studies. These numerous cohorts that sift through the data (and are now faced with ever-increasing administrative costs) seem disconnected with recurring patterns in the life of a citizen that end up causing these brain anomalies. Again, they are chasing down the effect, not the cause.
- patmcc 8y ago
  >>"Doctors want patients, not cures". Really stuck with me. I suspect you don't know many doctor personally. If you have the intelligence, patience, grit, money, etc. to go through the many years of school and training to be a doctor, you're not doing it primarily for the money. There are other professions that offer similar levels of pay and prestige with much less trouble. Doctors want to help patients.
- crummy 8y ago
  If you were a doctor, would you be trying to cure your patients or keep their bills coming in?
  - moneytide1 8y ago
    I used to work in road construction, traffic control. I was paired with a man twice my age that had spent the majority of his life in OTR trucking. He told me stories of all the uppers and downers he took, in order to allow for the lifestyle of "racking up as many miles as I can." He would smoke through a pack every night. Needless to say, his base-line health was compromised because of these habits. One night he tells me the doctor has discovered a tumor on his lung. He continued to smoke at the same rate, against my (and I'm sure his doctors) advice. At some point he started chemo, and still came to work. Looked like a dead man walking. I'm no medical expert, but it seems to me that chemotherapy irritates the wound. Fast forward a couple months after I had quit that job, I hear that he has died of lung cancer. But I also here that his wife had resorted to putting donation jars at cash registers at nearby gas stations, in order to keep funding this "treatment". So this man died of a habit he refused to give up, but not before trusting the doctor(s) involved and draining the resources his family would have after he was gone. I know this is not a story of mental illness, which seems to be a more elusive affliction that something like cancer that directly affects the bodies hardware. The theme of my input on this empathy matter is not directed at the disposition of the doctor, but rather the assumption of the patient that the doctor always knows best. It is more of a trust issue, now that administrative costs make up 30% of healthcare cash flow.
swebs 8y ago
>For example, one vignette described “Terry,” a 28-year-old woman who felt deeply sad for the past four weeks and lost interest in activities she usually enjoys. In the “biological” version presented to the study participants, Terry’s father also suffered from symptoms of depression, a doctor told her as a teenager that she might have an imbalance of neurotransmitters, and an MRI scan revealed that she had an unusually small hippocampus, which could affect her reaction to stress. In the “psychosocial” version, Terry’s father died when she was five, her mother has always been highly critical and not very nurturing, and Terry suffered from a recent breakup and problems at work. >...respondents felt less empathy for the fictional patients when they read the biological explanation. Am I missing something here? Of course people would empathize more with a person who has relatable experiences. Nobody is going to relate to "an MRI scan revealed that she had an unusually small hippocampus" but almost everyone has experienced relationship troubles and problems at work.
- westoncb 8y ago
  My read is that, if you think about it, yes, it's somewhat obvious that would happen—but the question is, since that's clearly not fair behavior/right, what do we do about it? It seems clear to me that it's not right since in both cases the causes are outside the control of the afflicted person—even more so in the case of a brain structure anomaly; and a common ethical heuristic is to not blame someone in such a situation—but practically speaking, because people can't relate to the brain structure issue, they won't empathize as much. Another ambiguity here is what's meant by 'empathy'. If you take it to mean 'relate to' (which is one meaning of course), then it's vacuous to say people have more empathy for those they can relate too. But there's another usage referring essentially to a cognitive mode wherein the empathetic person acts with understanding toward someone they're engaging with. It's surely easier to enter that mode when it's something you can personally relate to—but that isn't necessary: we can become empathetic in this way just through an abstract understanding of someone's situation.
  - romwell 8y ago
    >but the question is, since that's clearly not fair behavior/right Is it? In the second scenario, I empathize with the painful experience, not just with the outcome (depression). Even if both fictional characters are described as having the same state now, how they got there matters to us. We feel empathy for what they went through. I don't think there's anything wrong to have different emotions towards a person who has just been robbed, compared to someone who hasn't been (but doesn't have more money in the bank account). We have codified this in our laws. We give different punishments for the same crime depending on the criminal's path and emotional state. We literally judge people based on what they went through. Why is it wrong or unfair to feel differently towards the two fictional characters in this case?
lsh 8y ago
> "That’s one reason why efforts to encourage empathy for people with depression, anxiety, or other mental disorders often focus on the biological basis of the conditions." There is a deeply insightful book called "Against Empathy : The Case for Rational Compassion" by a Paul Bloom. I hadn't thought too much about it until I read the above quote assuming empathy to be a Good Thing and that researchers and doctors et al should strive for greater levels of it. I think practitioners should at the very least make the distinction between empathy and compassion. We need more compassionate doctors, not empathetic ones. And disambiguating language opens up all sorts of incredible and sophisticated interactions.
- fossuser 8y ago
  I found the premise of that book to largely just be disputing definitions [1] with a very particular definition of empathy that isn’t actually how people use the word. Something about it bothered me - I think that it felt like a straw man arguing a position nobody really has just to be very pedantic about his specific usage of the word empathy. [1] https://www.lesswrong.com/posts/7X2j8HAkWdmMoS8PE/disputing-definitions https://www.lesswrong.com/posts/7X2j8HAkWdmMoS8PE/disputing-...
  - lsh 8y ago
    yes, I've heard that argument but couldn't empathise with it ;) The book spoke to me directly and I have the opposite opinion. Definitely an interesting read but also polarising.
  - da_chicken 8y ago
    It revolves around semantics and straw men? It sounds like someone took an Internet argument and published it as a book.
  - westoncb 8y ago
    I was just reading some reviews and overviews of the book and walked away with the same impression. The most interesting definition (partly just IMO, but also because it's the one whose derivative of 'being talked about' is also large right now), which is also an important concept in certain Eastern philosophies for instance, has to do with a cognitive mode perhaps best characterized by 'openness'—but since that term is fraught, let me try something from scratch. There is something in our brains that works in a very sphincter-like way—similar to the pupil, for example. Rather than letting in more or less light, however, it determines how much you will be affected by present percepts. If it is closed, you can see all sorts of horrendous or magnificent stuff and have little to no reaction; if wide open, you may genuinely weep while hearing a beautiful song or something. (I don't want make strong claims on this next point, but I think it's useful to say something on the matter: what determines the openness here has a number of factors, but how safe you feel at the moment [e.g. anxiety can block it] and how 'internally pre-occupied' you are, are probably two big ones.) The empathetic 'cognitive mode' I was describing earlier is essentially just being in the 'open' state. It allows you to be affected by someone else's present suffering in a very direct/immediate way, without contemplation—which is why the author's alternative of 'rational compassion' is so controversial: the claim of modern proponents of the sort of empathy I've been describing stresses the importance of this direct connection and immediacy, claiming that being in this cognitive mode is the only way to genuinely act in the interest of another person—whereas when you approach altruism purely rationally, other motivations will typically be involved. But, the picture I got is that the book doesn't actually talk about that sort of empathy at all.
qwerty456127 8y ago
Almost always. And almost everybody is more or less mentally ill in a way or another, me included.
- 1000units 8y ago
  You're probably just fine aside from a slight self-deprecating tendency or so.
Invictus0 8y ago
The literal definition of empathy is rooted in the ability to understand and relate to someone else. Doctors can't empathize with most patients, nor do they need to. I think sympathy is the word this article is looking for.
- timwaagh 8y ago
  it's like they are trying to prove they aren't autistic or something.
- Fricken 8y ago
  I went through a couple phases of clinical depression as a young man, and now that more than a decade has passed, I can't relate to that person who didn't have the willpower to get out of bed for 6 months. Even though that person was me, it's hard to imagine now what that is like. But I can certainly sympathize.
thowaway655321x 8y ago
Using a throwaway for potentially obvious reasons. I have a very hard time having empathy for my mom. She is diagnosed manic depressive, bipolar, schizophrenic. I've witnessed her deteriorate over my entire life. You can tell me all day that it biological. I can utterly accept that. I can't accept that a bright woman has fucked up her life to the point where she is homeless. That she has alienated all those who would help her. That she would destroy her own environment and blame the imaginary. We've had to decide to leave her to herself and not help due to the manipulation that comes with it. Her phone is blocked. We've moved addresses. I don't know if empathy is the right answer. It sucks. The whole thing sucks.
- chris_mc 8y ago
  She might be mentally ill and a shitty person... Also, sometimes you can have empathy, but can't personally handle someone. You have to do what's best for yourself, also.
  - westoncb 8y ago
    This is a good time to employ some Occam's Razor: if we've already accounted for the shittiness via mental illness, what is our reason for introducing an additional explanation? Are certain extreme mental illnesses not enough to account for the most shitty of behaviors?
    - bsder 8y ago
      Because sometimes people were shitty even before they became mentally ill ...
      - ndnxhs 8y ago
        What is the difference between being shitty and mentally ill?
        bsder 8y ago
evervevdww221 8y ago
My ex-grilfriend married herself in one day, after I accompanied her to a hospital for her "severe insomnia" problem, without even telling me. Out of sadness and anger, I cut off all of our contacts. A month later, she emailed me saying her psychiatrist said she had suicidal thoughts, and she wanted to see me. I went to see her immediately out of worries. That's the first time for the past 3 years I felt that she was not normal. For example, she was extremely talkative and she jumped between different topics that don't even have any connections. I knew that she had a history of depression for 10 years. But I don't know if it was a mis-diagnosis or her depression had developed into bipolar. She said her marriage decision was made during her maniac episode. She only loved me. But she decided to stay in the wrong marriage, because she couldn't punish her husband for her wrong decision. After making sure she didn't have the suicidal thoughts, I left. I started to read about bipolar and learnt that during its maniac episode, a patient trends to make high risky decisions that he/she would regret afterwards, including spending lots of money, and having affairs. And then after a month, she wanted to see me again, for a farewell, because she had to leave the country. She told me she had an affair with another guy and got pregnant. Again, she said she only had loved me, but she made wrong decisions during her maniac episodes. She said I could forget about her because she had turned into a different person, not the same girlfriend I ever had. Even I had read wikipedia and even a website about bipolar infidelity, it was really hard for me to accept everything. Again, out of anger, I told her I despised her and would never trust her. This time she blocked my contacts. I don't know how I should accept and understand her, forgive her and help her. She mentioned that she wanted to leave me, because she knew I loved her, so she can't become my burden. That deeply saddened me. For the past a few months, I have trapped myself in a loop of thinking about everything happened and feeling being used and then all the nice time we had together. I struggled a lot, not knowing if I should pick up the phone.
- tartoran 8y ago
  You're lucky to not have entered more deeply into this relationship. Maybe she sensed you're a nice person and gave you a break. Better suffer a bit now than a whole lot later on.
  - 8y ago
DoreenMichele 8y ago
We find medical conditions hard to really solve. Most people just can't begin to cope with a medical explanation of mental issues in terms of seeing it as treatable. That's a concept not even in its infancy. We've barely conceived it. It is still gestating. Also, with the psychosocial explanations, there is an element of blaming someone or something else. Most people will feel they are the victim of something unjust and that resonates with many people. Mental illness typically has both components. Family is known to compound mental health issues that have a biological component. My sister minored in psychology in college and took some graduate courses in it later. She once told me "We must not have the genes for schizophrenia or someone in the family would surely have it given how the family operates" and then talked about how schizophrenics go do inpatient therapy, get better, go home to the nutso family and get worse again. I think we need better parenting resources for families dealing with neurodivergent offspring. I've seen time and again that parents don't know effective means for dealing with such kids and it actively creates problems which then become very intractable. I'm good at that and did some work for a time with a related organization and spent a few years trying to figure out how to blog about such subjects. That never really got traction. Articles like this give me a twinge of regret and guilt that I never figured out how to more effectively share what I know. I'm convinced that better parenting resources for difficult kids would really make a difference in the world. But, I just don't have a path forward. You need fertile ground for such seeds to take root and I've never found that, basically. Then I got badly burned by someone who used information in my parenting blog to manipulate me and it's a case of... Whatever. Not my problem.
- PavlikPaja 8y ago
  >My sister minored in psychology in college and took some graduate courses in it later. She once told me "We must not have the genes for schizophrenia or someone in the family would surely have it given how the family operates" and then talked about how schizophrenics go do inpatient therapy, get better, go home to the nutso family and get worse again. It is said that if C-PTSD was correctly diagnosed, the DSM manual would shrink to a small booklet. At lest 85% of the mentally ill suffered some kind of abuse according to a recent study, and since the parents know they can't do anything that leaves physical marks, many smarter people get more creative - teaching them things wrong, or not at all; ordering them to do something, then punishing them for doing it; (or a semi famous case of a man who was among other things deathly afraid of water, because his father's punishment of choice was spraying him with a hose) etc. All that while maintaining the image of a sweet person outside home, so that nobody trusts the victim, because it's "impossible" that such a nice man/woman would do something like that to their child... It's doubtful there is a biological component at all, since the Nazis killed off most of the mentally ill in some parts of Europe, but the prevalence rates remained unchanged. I'm all for freedom, but there should be ways to remove the child from their parents when it's being raised in some nonstandard, and clearly dysfunctional way. There should also be some equivalent of witness protection that would give the people a new identity. Once it gets known the person is "mentally ill" people will harras them, try to convince them of nonsense (or that some common knowledge is actually false) for the kicks, or otherwise "gaslight" them, (well knowing that nobody will trust the person) so there is no way they could get better with such a label at home.
mlthoughts2018 8y ago
Two somewhat related ideas, - http://econfaculty.gmu.edu/bcaplan/pdfs/szasz.pdf http://econfaculty.gmu.edu/bcaplan/pdfs/szasz.pdf - http://slatestarcodex.com/2015/10/07/contra-caplan-on-mental-illness/ http://slatestarcodex.com/2015/10/07/contra-caplan-on-mental...
currymj 8y ago
Given the journal and the time it was published, are we sure this is research that would replicate? I looked at it and I don't see anything egregiously bad-looking, but I don't know much of anything about experimental design. I hate living in the world where I have to ask that question -- and it does seem that there has been an improvement, such that modern research is less likely to be based on faulty analysis. 2014 seems like it could be on the borderline, though. A comment from someone with more knowledge of statistics and experimental methods would be helpful.
- 9wzYQbTYsAIc 8y ago
  This study was submitted to Track II for review by the Editorial aboard at PNAS (Proceedings of the National Academy of Sciences of the United States of America) 4 years ago. The study was conducted by psychologists at Yale and editing by a professional at University of Melbourne, AU. You can find the full article, free at https://www.jstor.org/stable/43278786?mag=when-do-we-have-empathy-for-the-mentally-ill&seq=2#metadata_info_tab_contents https://www.jstor.org/stable/43278786?mag=when-do-we-have-em.... The article contains a full materials and methods section to aid with replication. The study design was simple enough to allow for relative ease of a repeat study. The authors applied relatively simple and traditional statistical methods (a more complex ANOVA) along with a mechanism to ensure that they were measuring empathy correctly by correlating measure of empathy with a separate measure of personal distress. You can dig into the details in the article, but it all seems to line up well. In summary, you could probably replicate this yourself using Survey Monkey and Wolfram Alpha.
  - nonbel 8y ago
    1) Its not some random guy's job to replicate this stuff. Its the job of people getting paid to do this type of research (ie, the peers) to verify each other's work. 2) You're right, its been published for four years, seems to have had some sort of impact (since the news has mentioned it), and doesn't seem that complicated or expensive to do in principle. So, is there a direct replication?
    - 8y ago
mgarfias 8y ago
Not when she’s my ex and is psychologically abusing our son. No sympathy for the devil
peter303 8y ago
I refrain from making crazy people jokes when I realized that as many as a quarter of certain subpopolutions, e.g. middle age US women, may be on psychoactive drugs for one condition or another. Pretty good chance of hurting soneones feelings then without knowing it.
lngnmn1 8y ago
Empathy is not an abstract concept applicable for anything. It has very concrete biological limits for a kin, youngsters and sick or injured. To apply it to arbitrary groups of people is an error. A type error, so to speak.
lamename 8y ago
> It’s possible that biological explanations lead clinicians to see the conditions as immutable. This an error in thinking about how the brain works, and unfortunate if true, regardless of what level of "clinician" it refers to. Perhaps both frameworks for understanding are equally valid, but the "psychosocial" explanation is several layers of abstraction above the "biological" one. As I've said before on the same topic [1]: 1) the brain is an organ that obeys physical laws 2) behavior and perception depend entirely on the brain 3) of course environment is important, but how is that represented in the brain? It's still physiological, which inevitably includes chemicals/biology/whatever you prefer to call it. [1]: https://news.ycombinator.com/item?id=16445950 https://news.ycombinator.com/item?id=16445950
- 9wzYQbTYsAIc 8y ago
  I’m not sure that I understand the first sentence of your comment - are you saying that you think it is an error for the authors to make that specific conclusion? Or are you saying that clinicians should never see mental illness as immutable?
  - lamename 8y ago
    It's an error for the clinicians to think that biological = immutable
DanBC 8y ago
This is mildly interesting because people who are mentally ill and who get treatment will report a contrasting experience. When we ask people about stigma we see those with an illness usually described by a medical model (schizophrenia, bipolar) experience less stigma than people with an illness usually described by a psycho-social model (especially the personality disorders, where levels of stigma are remarkably high, even from mental health professionals).
- Sean1708 8y ago
  The article did touch on that briefly: > The authors note that their findings can’t be extended to all situations. For example, other research has found that trial judges tend to impose less severe sentences on people with mental illnesses when given a biological explanation for the disorder.
jokoon 8y ago
I think that deep down, mental illness is not really accepted as something real. We tend to believe in free will and how people are responsible for their own actions, and we tend to apply this to the mentally ill too, and this is exactly why free will is a flawed concept. As long as we do not conceive that mental illness is a thing, we won't tolerate it and the mentally ill will never be able to accept they have a condition, so they will just be a burden to themselves and others. I always relate with human beings knowing they can make errors because of their mental process or even their mental issues, even mild. Lurking on certain subreddits like JusticeServed, I can often see how some people in the US believe in capital punishment and have literally no mercy towards faulty but natural human behavior. I don't live in the US, so I might be biased, but I'm surprised how people can have such hard belief in free will ("you can make it if you want" etc).
- PavlikPaja 8y ago
  Only that the article says the exact opposite - the participants were LESS empathic if they believed the person's behavior was due to mental illness.
  - intralizee 8y ago
    Yah it's a flawed experiment in a sense. Imagine how the majority in the world cannot understand determinism and you conduct a study on empathy. Flawed or results proving something based on the current conditions. Redo the study with people having a deterministic mindset and who understand the fallacy of believing in free will. The balance of empathy will change is my hypothesis from observing others like me that understand free will is a facade. It's like all the studies that try to prove it's better having people conditioned to believe in free will by conducting it on people already with a tainted mindset and who haven't broken out of it in a longterm period.
    - red75prime 8y ago
      If you take free will as some kind of a divine spark, then, sure, it is not compatible with determinism. But there are more useful definitions of it. We need to have a distinction between behavior not under coercion and behavior under coercion, between behavior of a person who can realistically assess circumstances and who cannot and so on.
fuscy 8y ago
I think people had more empathy for the mentally ill before the advent of science or religion. Science will reduce and dehumanize all that makes that human to a nameless patient file while trying to fix the issues. Religion might demonize and ostracize. I feel that before all of this because there was no explanation, the mentally ill were just treated as having a different mindset. I mean.. if we tried to "fix" all the artists that have lived, the world would be a much bleaker and empty place without their art.
- pragmatick 8y ago
  Sure... https://about-history.com/the-cruel-way-people-with-mental-handicaps-were-treated-in-the-middle-ages-will-make-your-stomach-turn/ https://about-history.com/the-cruel-way-people-with-mental-h...

I saw someone post to HN once in an article about a cancer vaccine - "Doctors want patients, not cures". Really stuck with me. Modern society categorizes people. When a citizen fails to adapt to society (for better or worse) and they feel a certain pressure to submit to the opinions of an "expert", they become part of a revenue stream. The DSM-V has them figured out. Many types of mental illnesses are symptoms of the environment. We are spending too much time looking at MRIs, that is, looking inward - the brain structure must hold the clues to the "cure". But the brain molds to interface the user with its surroundings. It is the effect, not the cause. Perhaps show empathy for the mentally ill once they've spent years being drugged out by attempted "cures".

stochastic_monk 8y ago
I’ve had the pleasure of working with a number of doctors who are well-respected in their field. I never once saw one more excited than the times they’d describe what it was like to find out a patient was a candidate for a targeted therapy and bring them back from death’s door. Most of them do this to treat, and I believe they’d be very happy to be out of a job if it meant fewer children, parents, or simply humans, had to die.
- tuananh 8y ago
  Doctors, maybe but I doubt about this when it comes to big pharmaceutical corps.
- opportune 8y ago
  Even "very good" doctors often don't know the state of the art procedures and treatments for their craft, as I have personally discovered since a close family member began receiving cancer treatment. From my experience, the vast majority of doctors' response to bringing up experimental treatments or care - or even recently approved, well-researched treatments - is a mindless affirmation of "that's the future", meaning they don't know anything about it. If you press them, most will say that they prefer to start patients with XYZ, which means "I want your business but don't know about that treatment". This happened to my own sick relative, a pharmacogenomics researcher, who said it reminded him almost exactly of trying to get clinicians to incorporate basic gene panels into their practice (e.g. don't give this patient warfarin because they have this gene which will make them bleed to death). As a society we are much too afraid to call shitty doctors shitty doctors. Having parents in medicine, I grew up hearing about them all the time. I do believe that most doctors would not consciously and maliciously decide to sacrifice people's health for money. I also believe that most doctors aren't particularly diligent about keeping up to date on medical information throughout their careers; for every developer with 30+ years of experience who has treated a job as a job and worked with the same tech staff for all his life without bothering to learn new ones, there's a doctor doing the same with medicine.
  - stochastic_monk 8y ago
    It’s true that there are such doctors. My experience is not necessarily typical, as these were faculty at a well-regarded cancer hospital and always very close to new developments. The ones I mention, being involved in clinical trials and new treatments/diagnostics makes them particularly appropriate for this discussion because they are at the intersection of translational treatment and patients. (Cures vs patients) You’re right that many doctors aren’t called out like they should be out of some misguided deference, and I’m disappointed to hear how many of them are in cases which matter so, so very much to you, if not to them. With regard to your personal experience, remember that no professional will care as much about your or your loved one’s condition as you will. You (or your loved one) are the only patient you’re treating, and I encourage you to advocate as necessary.
- moneytide1 8y ago
  I do believe that most medical professionals are well-meaning, especially when people choose to trust them with their health. I do not question their empathy and selflessness. But my comment is directed at the belief that a medical professional always knows best. The doctor that actually interfaces with the patient is equipped with tools and techniques that originate from other divisions of expertise that develop pharmaceuticals, testing equipment, or coordinate large-scale case-studies. These numerous cohorts that sift through the data (and are now faced with ever-increasing administrative costs) seem disconnected with recurring patterns in the life of a citizen that end up causing these brain anomalies. Again, they are chasing down the effect, not the cause.
patmcc 8y ago
>>"Doctors want patients, not cures". Really stuck with me. I suspect you don't know many doctor personally. If you have the intelligence, patience, grit, money, etc. to go through the many years of school and training to be a doctor, you're not doing it primarily for the money. There are other professions that offer similar levels of pay and prestige with much less trouble. Doctors want to help patients.
crummy 8y ago
If you were a doctor, would you be trying to cure your patients or keep their bills coming in?
- moneytide1 8y ago
  I used to work in road construction, traffic control. I was paired with a man twice my age that had spent the majority of his life in OTR trucking. He told me stories of all the uppers and downers he took, in order to allow for the lifestyle of "racking up as many miles as I can." He would smoke through a pack every night. Needless to say, his base-line health was compromised because of these habits. One night he tells me the doctor has discovered a tumor on his lung. He continued to smoke at the same rate, against my (and I'm sure his doctors) advice. At some point he started chemo, and still came to work. Looked like a dead man walking. I'm no medical expert, but it seems to me that chemotherapy irritates the wound. Fast forward a couple months after I had quit that job, I hear that he has died of lung cancer. But I also here that his wife had resorted to putting donation jars at cash registers at nearby gas stations, in order to keep funding this "treatment". So this man died of a habit he refused to give up, but not before trusting the doctor(s) involved and draining the resources his family would have after he was gone. I know this is not a story of mental illness, which seems to be a more elusive affliction that something like cancer that directly affects the bodies hardware. The theme of my input on this empathy matter is not directed at the disposition of the doctor, but rather the assumption of the patient that the doctor always knows best. It is more of a trust issue, now that administrative costs make up 30% of healthcare cash flow.

swebs 8y ago

>For example, one vignette described “Terry,” a 28-year-old woman who felt deeply sad for the past four weeks and lost interest in activities she usually enjoys. In the “biological” version presented to the study participants, Terry’s father also suffered from symptoms of depression, a doctor told her as a teenager that she might have an imbalance of neurotransmitters, and an MRI scan revealed that she had an unusually small hippocampus, which could affect her reaction to stress. In the “psychosocial” version, Terry’s father died when she was five, her mother has always been highly critical and not very nurturing, and Terry suffered from a recent breakup and problems at work. >...respondents felt less empathy for the fictional patients when they read the biological explanation. Am I missing something here? Of course people would empathize more with a person who has relatable experiences. Nobody is going to relate to "an MRI scan revealed that she had an unusually small hippocampus" but almost everyone has experienced relationship troubles and problems at work.

westoncb 8y ago
My read is that, if you think about it, yes, it's somewhat obvious that would happen—but the question is, since that's clearly not fair behavior/right, what do we do about it? It seems clear to me that it's not right since in both cases the causes are outside the control of the afflicted person—even more so in the case of a brain structure anomaly; and a common ethical heuristic is to not blame someone in such a situation—but practically speaking, because people can't relate to the brain structure issue, they won't empathize as much. Another ambiguity here is what's meant by 'empathy'. If you take it to mean 'relate to' (which is one meaning of course), then it's vacuous to say people have more empathy for those they can relate too. But there's another usage referring essentially to a cognitive mode wherein the empathetic person acts with understanding toward someone they're engaging with. It's surely easier to enter that mode when it's something you can personally relate to—but that isn't necessary: we can become empathetic in this way just through an abstract understanding of someone's situation.
- romwell 8y ago
  >but the question is, since that's clearly not fair behavior/right Is it? In the second scenario, I empathize with the painful experience, not just with the outcome (depression). Even if both fictional characters are described as having the same state now, how they got there matters to us. We feel empathy for what they went through. I don't think there's anything wrong to have different emotions towards a person who has just been robbed, compared to someone who hasn't been (but doesn't have more money in the bank account). We have codified this in our laws. We give different punishments for the same crime depending on the criminal's path and emotional state. We literally judge people based on what they went through. Why is it wrong or unfair to feel differently towards the two fictional characters in this case?

lsh 8y ago

> "That’s one reason why efforts to encourage empathy for people with depression, anxiety, or other mental disorders often focus on the biological basis of the conditions." There is a deeply insightful book called "Against Empathy : The Case for Rational Compassion" by a Paul Bloom. I hadn't thought too much about it until I read the above quote assuming empathy to be a Good Thing and that researchers and doctors et al should strive for greater levels of it. I think practitioners should at the very least make the distinction between empathy and compassion. We need more compassionate doctors, not empathetic ones. And disambiguating language opens up all sorts of incredible and sophisticated interactions.

fossuser 8y ago
I found the premise of that book to largely just be disputing definitions [1] with a very particular definition of empathy that isn’t actually how people use the word. Something about it bothered me - I think that it felt like a straw man arguing a position nobody really has just to be very pedantic about his specific usage of the word empathy. [1] https://www.lesswrong.com/posts/7X2j8HAkWdmMoS8PE/disputing-definitions https://www.lesswrong.com/posts/7X2j8HAkWdmMoS8PE/disputing-...
- lsh 8y ago
  yes, I've heard that argument but couldn't empathise with it ;) The book spoke to me directly and I have the opposite opinion. Definitely an interesting read but also polarising.
- da_chicken 8y ago
  It revolves around semantics and straw men? It sounds like someone took an Internet argument and published it as a book.
- westoncb 8y ago
  I was just reading some reviews and overviews of the book and walked away with the same impression. The most interesting definition (partly just IMO, but also because it's the one whose derivative of 'being talked about' is also large right now), which is also an important concept in certain Eastern philosophies for instance, has to do with a cognitive mode perhaps best characterized by 'openness'—but since that term is fraught, let me try something from scratch. There is something in our brains that works in a very sphincter-like way—similar to the pupil, for example. Rather than letting in more or less light, however, it determines how much you will be affected by present percepts. If it is closed, you can see all sorts of horrendous or magnificent stuff and have little to no reaction; if wide open, you may genuinely weep while hearing a beautiful song or something. (I don't want make strong claims on this next point, but I think it's useful to say something on the matter: what determines the openness here has a number of factors, but how safe you feel at the moment [e.g. anxiety can block it] and how 'internally pre-occupied' you are, are probably two big ones.) The empathetic 'cognitive mode' I was describing earlier is essentially just being in the 'open' state. It allows you to be affected by someone else's present suffering in a very direct/immediate way, without contemplation—which is why the author's alternative of 'rational compassion' is so controversial: the claim of modern proponents of the sort of empathy I've been describing stresses the importance of this direct connection and immediacy, claiming that being in this cognitive mode is the only way to genuinely act in the interest of another person—whereas when you approach altruism purely rationally, other motivations will typically be involved. But, the picture I got is that the book doesn't actually talk about that sort of empathy at all.

qwerty456127 8y ago

Almost always. And almost everybody is more or less mentally ill in a way or another, me included.

1000units 8y ago
You're probably just fine aside from a slight self-deprecating tendency or so.

Invictus0 8y ago

The literal definition of empathy is rooted in the ability to understand and relate to someone else. Doctors can't empathize with most patients, nor do they need to. I think sympathy is the word this article is looking for.

timwaagh 8y ago
it's like they are trying to prove they aren't autistic or something.
Fricken 8y ago
I went through a couple phases of clinical depression as a young man, and now that more than a decade has passed, I can't relate to that person who didn't have the willpower to get out of bed for 6 months. Even though that person was me, it's hard to imagine now what that is like. But I can certainly sympathize.

thowaway655321x 8y ago

Using a throwaway for potentially obvious reasons. I have a very hard time having empathy for my mom. She is diagnosed manic depressive, bipolar, schizophrenic. I've witnessed her deteriorate over my entire life. You can tell me all day that it biological. I can utterly accept that. I can't accept that a bright woman has fucked up her life to the point where she is homeless. That she has alienated all those who would help her. That she would destroy her own environment and blame the imaginary. We've had to decide to leave her to herself and not help due to the manipulation that comes with it. Her phone is blocked. We've moved addresses. I don't know if empathy is the right answer. It sucks. The whole thing sucks.

chris_mc 8y ago
She might be mentally ill and a shitty person... Also, sometimes you can have empathy, but can't personally handle someone. You have to do what's best for yourself, also.
- westoncb 8y ago
  This is a good time to employ some Occam's Razor: if we've already accounted for the shittiness via mental illness, what is our reason for introducing an additional explanation? Are certain extreme mental illnesses not enough to account for the most shitty of behaviors?
  - bsder 8y ago
    Because sometimes people were shitty even before they became mentally ill ...
    - ndnxhs 8y ago
      What is the difference between being shitty and mentally ill?
      - bsder 8y ago

evervevdww221 8y ago

My ex-grilfriend married herself in one day, after I accompanied her to a hospital for her "severe insomnia" problem, without even telling me. Out of sadness and anger, I cut off all of our contacts. A month later, she emailed me saying her psychiatrist said she had suicidal thoughts, and she wanted to see me. I went to see her immediately out of worries. That's the first time for the past 3 years I felt that she was not normal. For example, she was extremely talkative and she jumped between different topics that don't even have any connections. I knew that she had a history of depression for 10 years. But I don't know if it was a mis-diagnosis or her depression had developed into bipolar. She said her marriage decision was made during her maniac episode. She only loved me. But she decided to stay in the wrong marriage, because she couldn't punish her husband for her wrong decision. After making sure she didn't have the suicidal thoughts, I left. I started to read about bipolar and learnt that during its maniac episode, a patient trends to make high risky decisions that he/she would regret afterwards, including spending lots of money, and having affairs. And then after a month, she wanted to see me again, for a farewell, because she had to leave the country. She told me she had an affair with another guy and got pregnant. Again, she said she only had loved me, but she made wrong decisions during her maniac episodes. She said I could forget about her because she had turned into a different person, not the same girlfriend I ever had. Even I had read wikipedia and even a website about bipolar infidelity, it was really hard for me to accept everything. Again, out of anger, I told her I despised her and would never trust her. This time she blocked my contacts. I don't know how I should accept and understand her, forgive her and help her. She mentioned that she wanted to leave me, because she knew I loved her, so she can't become my burden. That deeply saddened me. For the past a few months, I have trapped myself in a loop of thinking about everything happened and feeling being used and then all the nice time we had together. I struggled a lot, not knowing if I should pick up the phone.

tartoran 8y ago
You're lucky to not have entered more deeply into this relationship. Maybe she sensed you're a nice person and gave you a break. Better suffer a bit now than a whole lot later on.
- 8y ago

DoreenMichele 8y ago

We find medical conditions hard to really solve. Most people just can't begin to cope with a medical explanation of mental issues in terms of seeing it as treatable. That's a concept not even in its infancy. We've barely conceived it. It is still gestating. Also, with the psychosocial explanations, there is an element of blaming someone or something else. Most people will feel they are the victim of something unjust and that resonates with many people. Mental illness typically has both components. Family is known to compound mental health issues that have a biological component. My sister minored in psychology in college and took some graduate courses in it later. She once told me "We must not have the genes for schizophrenia or someone in the family would surely have it given how the family operates" and then talked about how schizophrenics go do inpatient therapy, get better, go home to the nutso family and get worse again. I think we need better parenting resources for families dealing with neurodivergent offspring. I've seen time and again that parents don't know effective means for dealing with such kids and it actively creates problems which then become very intractable. I'm good at that and did some work for a time with a related organization and spent a few years trying to figure out how to blog about such subjects. That never really got traction. Articles like this give me a twinge of regret and guilt that I never figured out how to more effectively share what I know. I'm convinced that better parenting resources for difficult kids would really make a difference in the world. But, I just don't have a path forward. You need fertile ground for such seeds to take root and I've never found that, basically. Then I got badly burned by someone who used information in my parenting blog to manipulate me and it's a case of... Whatever. Not my problem.

PavlikPaja 8y ago
>My sister minored in psychology in college and took some graduate courses in it later. She once told me "We must not have the genes for schizophrenia or someone in the family would surely have it given how the family operates" and then talked about how schizophrenics go do inpatient therapy, get better, go home to the nutso family and get worse again. It is said that if C-PTSD was correctly diagnosed, the DSM manual would shrink to a small booklet. At lest 85% of the mentally ill suffered some kind of abuse according to a recent study, and since the parents know they can't do anything that leaves physical marks, many smarter people get more creative - teaching them things wrong, or not at all; ordering them to do something, then punishing them for doing it; (or a semi famous case of a man who was among other things deathly afraid of water, because his father's punishment of choice was spraying him with a hose) etc. All that while maintaining the image of a sweet person outside home, so that nobody trusts the victim, because it's "impossible" that such a nice man/woman would do something like that to their child... It's doubtful there is a biological component at all, since the Nazis killed off most of the mentally ill in some parts of Europe, but the prevalence rates remained unchanged. I'm all for freedom, but there should be ways to remove the child from their parents when it's being raised in some nonstandard, and clearly dysfunctional way. There should also be some equivalent of witness protection that would give the people a new identity. Once it gets known the person is "mentally ill" people will harras them, try to convince them of nonsense (or that some common knowledge is actually false) for the kicks, or otherwise "gaslight" them, (well knowing that nobody will trust the person) so there is no way they could get better with such a label at home.

mlthoughts2018 8y ago

Two somewhat related ideas, - http://econfaculty.gmu.edu/bcaplan/pdfs/szasz.pdf http://econfaculty.gmu.edu/bcaplan/pdfs/szasz.pdf - http://slatestarcodex.com/2015/10/07/contra-caplan-on-mental-illness/ http://slatestarcodex.com/2015/10/07/contra-caplan-on-mental...

currymj 8y ago

Given the journal and the time it was published, are we sure this is research that would replicate? I looked at it and I don't see anything egregiously bad-looking, but I don't know much of anything about experimental design. I hate living in the world where I have to ask that question -- and it does seem that there has been an improvement, such that modern research is less likely to be based on faulty analysis. 2014 seems like it could be on the borderline, though. A comment from someone with more knowledge of statistics and experimental methods would be helpful.

9wzYQbTYsAIc 8y ago
This study was submitted to Track II for review by the Editorial aboard at PNAS (Proceedings of the National Academy of Sciences of the United States of America) 4 years ago. The study was conducted by psychologists at Yale and editing by a professional at University of Melbourne, AU. You can find the full article, free at https://www.jstor.org/stable/43278786?mag=when-do-we-have-empathy-for-the-mentally-ill&seq=2#metadata_info_tab_contents https://www.jstor.org/stable/43278786?mag=when-do-we-have-em.... The article contains a full materials and methods section to aid with replication. The study design was simple enough to allow for relative ease of a repeat study. The authors applied relatively simple and traditional statistical methods (a more complex ANOVA) along with a mechanism to ensure that they were measuring empathy correctly by correlating measure of empathy with a separate measure of personal distress. You can dig into the details in the article, but it all seems to line up well. In summary, you could probably replicate this yourself using Survey Monkey and Wolfram Alpha.
- nonbel 8y ago
  1) Its not some random guy's job to replicate this stuff. Its the job of people getting paid to do this type of research (ie, the peers) to verify each other's work. 2) You're right, its been published for four years, seems to have had some sort of impact (since the news has mentioned it), and doesn't seem that complicated or expensive to do in principle. So, is there a direct replication?
  - 8y ago

mgarfias 8y ago

Not when she’s my ex and is psychologically abusing our son. No sympathy for the devil

peter303 8y ago

I refrain from making crazy people jokes when I realized that as many as a quarter of certain subpopolutions, e.g. middle age US women, may be on psychoactive drugs for one condition or another. Pretty good chance of hurting soneones feelings then without knowing it.

lngnmn1 8y ago

Empathy is not an abstract concept applicable for anything. It has very concrete biological limits for a kin, youngsters and sick or injured. To apply it to arbitrary groups of people is an error. A type error, so to speak.

lamename 8y ago

> It’s possible that biological explanations lead clinicians to see the conditions as immutable. This an error in thinking about how the brain works, and unfortunate if true, regardless of what level of "clinician" it refers to. Perhaps both frameworks for understanding are equally valid, but the "psychosocial" explanation is several layers of abstraction above the "biological" one. As I've said before on the same topic [1]: 1) the brain is an organ that obeys physical laws 2) behavior and perception depend entirely on the brain 3) of course environment is important, but how is that represented in the brain? It's still physiological, which inevitably includes chemicals/biology/whatever you prefer to call it. [1]: https://news.ycombinator.com/item?id=16445950 https://news.ycombinator.com/item?id=16445950

9wzYQbTYsAIc 8y ago
I’m not sure that I understand the first sentence of your comment - are you saying that you think it is an error for the authors to make that specific conclusion? Or are you saying that clinicians should never see mental illness as immutable?
- lamename 8y ago
  It's an error for the clinicians to think that biological = immutable

DanBC 8y ago

This is mildly interesting because people who are mentally ill and who get treatment will report a contrasting experience. When we ask people about stigma we see those with an illness usually described by a medical model (schizophrenia, bipolar) experience less stigma than people with an illness usually described by a psycho-social model (especially the personality disorders, where levels of stigma are remarkably high, even from mental health professionals).

Sean1708 8y ago
The article did touch on that briefly: > The authors note that their findings can’t be extended to all situations. For example, other research has found that trial judges tend to impose less severe sentences on people with mental illnesses when given a biological explanation for the disorder.

jokoon 8y ago

I think that deep down, mental illness is not really accepted as something real. We tend to believe in free will and how people are responsible for their own actions, and we tend to apply this to the mentally ill too, and this is exactly why free will is a flawed concept. As long as we do not conceive that mental illness is a thing, we won't tolerate it and the mentally ill will never be able to accept they have a condition, so they will just be a burden to themselves and others. I always relate with human beings knowing they can make errors because of their mental process or even their mental issues, even mild. Lurking on certain subreddits like JusticeServed, I can often see how some people in the US believe in capital punishment and have literally no mercy towards faulty but natural human behavior. I don't live in the US, so I might be biased, but I'm surprised how people can have such hard belief in free will ("you can make it if you want" etc).

PavlikPaja 8y ago
Only that the article says the exact opposite - the participants were LESS empathic if they believed the person's behavior was due to mental illness.
- intralizee 8y ago
  Yah it's a flawed experiment in a sense. Imagine how the majority in the world cannot understand determinism and you conduct a study on empathy. Flawed or results proving something based on the current conditions. Redo the study with people having a deterministic mindset and who understand the fallacy of believing in free will. The balance of empathy will change is my hypothesis from observing others like me that understand free will is a facade. It's like all the studies that try to prove it's better having people conditioned to believe in free will by conducting it on people already with a tainted mindset and who haven't broken out of it in a longterm period.
  - red75prime 8y ago
    If you take free will as some kind of a divine spark, then, sure, it is not compatible with determinism. But there are more useful definitions of it. We need to have a distinction between behavior not under coercion and behavior under coercion, between behavior of a person who can realistically assess circumstances and who cannot and so on.

fuscy 8y ago

I think people had more empathy for the mentally ill before the advent of science or religion. Science will reduce and dehumanize all that makes that human to a nameless patient file while trying to fix the issues. Religion might demonize and ostracize. I feel that before all of this because there was no explanation, the mentally ill were just treated as having a different mindset. I mean.. if we tried to "fix" all the artists that have lived, the world would be a much bleaker and empty place without their art.

pragmatick 8y ago
Sure... https://about-history.com/the-cruel-way-people-with-mental-handicaps-were-treated-in-the-middle-ages-will-make-your-stomach-turn/ https://about-history.com/the-cruel-way-people-with-mental-h...