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Psychiatry’s Incurable Hubris

110 points by scottie_m 8y ago

neaden 8y ago
Psychiatry today strikes me as being in a similar place as Infectious Disease before germ theory. We can describe symptoms, we can group them together, and we can come up with cures that sometimes work but without knowing if we are talking about a virus or a bacteria we can't really understand what's going on.
- deleted 8y ago
  [deleted]
- forkandwait 8y ago
  Or like chemistry during the alchemy era.
- trevyn 8y ago
  IMO, we already have the mental-disease equivalent of germ theory, it’s just far more complex and not yet well-understood by enough people to have broad social impact. “The germ theory was proposed by Girolamo Fracastoro in 1546, and expanded upon by Marcus von Plenciz in 1762. Such views were held in disdain, however, and Galen's miasma theory remained dominant among scientists and doctors.” - https://en.m.wikipedia.org/wiki/Germ_theory_of_disease https://en.m.wikipedia.org/wiki/Germ_theory_of_disease
  - fastball 8y ago
    What would you say the germ theory of mental disease is?
    - TheOtherHobbes 8y ago
      There isn't one - which is the point. It isn't even scientifically accurate to believe that mental illness is caused exclusively by brain malfunctions. Other bodily systems, especially the gut, also seem involved - never mind the mysterious role of genetics, and the slightly less mysterious but hard to pin down influence of environmental and social stresses.
      - tremon 8y ago
        > There isn't one - which is the point. The GP was asking because of this statement: IMO, we already have the mental-disease equivalent of germ theory
  - thaumasiotes 8y ago
    https://westhunt.wordpress.com/2013/10/31/lost-and-found/ https://westhunt.wordpress.com/2013/10/31/lost-and-found/ > Marcus Terentius Varro was called the most learned of the Romans. But what did he know, and how did he know it? I ask because of this quote, from Rerum rusticarum libri III (Agricultural Topics in Three Books): > Precautions must also be taken in the neighbourhood of swamps, both for the reasons given, and because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases. > I get the distinct impression that someone (probably someone other than Varro) came up with an approximation of germ theory 1500 years before Girolamo Fracastoro. But his work was lost.
    - arkades 8y ago
      The ancient Greeks were long ago discussing the possible existence of “animalcules.” Fracastaro gets credit because he wasn’t just philosophizing, he described actual disease in great detail with supporting cases (I hesitate to say “data,” that wasn’t really a thing yet) to argue for its mechanism. It’s the difference between a stoner strumming his guitar, “dude, what if we’re all, like, strings?” and string theory.
      - thaumasiotes 8y ago
        I think the advice "don't live near a swamp, because the tiny invisible creatures in there will make you sick, and if you do have a farm next to a swamp, sell it" is a little more detailed than "dude, what if we're all, like, strings?" Describing disease in great detail is nothing the Romans didn't also do, nor does it have anything to do with the germ theory of disease.
        arkades 8y ago
        That advice applies equally well to miasma (and, in fact, it’s ability to accurately relate to geography of disease is part of why it was taken seriously.) Which is why F. gets credit for actually making detailed observations and hypotheses that we’re borne out.
- saltcured 8y ago
  On the bright side, we did manage to improve things using the scientific method. Germ theory came from epidemiological evidence in parallel with the discovery of microrganisms. We didn't have to already know how it all works in order to figure out ways to improve outcomes. I think that what is disturbing to a lot of computing folk is that psychiatry sounds a bit ill-posed. An imposition of magical thinking onto what we assume are complex, chaotic systems. It just doesn't feel right that something so complex can be adjusted with such gross, brute-force methods. Imagine debugging a computer and saying, "I think your RAM hasn't enough ones in it. I am prescribing this selective ones-uptake inhibitor to restore the balance." On the other hand, we do have plenty of drugs that are a bit closer to saying, "This packet flow seems to be overwhelming the cluster. We can prescribe this traffic filter to interrupt that flow, allowing other functions to return to normal."
  - souterrain 8y ago
    > Imagine debugging a computer and saying, "I think your RAM hasn't enough ones in it. I am prescribing this selective ones-uptake inhibitor to restore the balance." Yet we use encoding techniques to ensure that there precisely are a sufficient number of ones, such that clock can be recovered. https://en.m.wikipedia.org/wiki/Run-length_limited https://en.m.wikipedia.org/wiki/Run-length_limited
- arkades 8y ago
  ITT: sweeping criticisms of psychiatry based on caricatures drawn from pop-sci accounts of psychiatry. I am deeply critical of quite a few facets of modern psychiatry, but this thread seems to mistake the stuff that’s slung around in Guardian and Atlantic articles as having any relationship to reality.
  - dsego 8y ago
    Speaking from personal experience. I have a sibling with psychosis, on meds, hospitalized every so often. Also, one of my parents has been treated for ptsd and depression for more than 20 years. The shrinks are clueless to put it mildly. What they do is try out different dosages and combinations of meds to see what helps until it doesn't and then they give up. Their practice is akin to witchcraft and mixing potions in the medieval times. My honest opinion is that psychiatry is at best a pseudo-science and needs to be abolished as a field of medicine.
- DanBC 8y ago
  Where did you do your medical training?
outlace 8y ago
Psychiatry indeed has a pretty bleak history, and it's fair to criticize that history. It is true that the DSM as it categorizes mental disorders is not biologically valid in general, however, most psychiatrists today recognize it just as a communication tool. Two psychiatrists with patients exhibiting similar symptoms can be concisely described using DSM vocabulary. It is also necessary for billing purposes. Insurances want to put labels on things so they can price and track things. This is true of all medicine, however. When do you call high blood pressure too high? Greater than 140 mmHg? 130? Someone has to pick an arbitrary threshold for practical reasons. "The pathological basis of almost all mental disorders remains as unknown today as it was in 1886" (article quote) I don't think this is true. We don't know enough to make targeted treatments quite yet, but we do know a lot more about the brain now and have much more reliable theoretical conceptions of mental illness. There is a ton of research going on in understanding mental illnesses at computational and circuit levels, and we're already starting to see the fruits of that research. Researchers are developing targeted treatments using transcranial magnetic stimulation (TMS) and similar modalities to directly perturb circuits that are believed to be deranged. I think psychiatry will change significantly over the next decade or so as we learn what is wrong with a specific individual's brain and intervene directly at the circuit level. I don't see how drugs will play a major role in this as it is very difficult to develop a drug that could target specific circuits. This time really is different. (Psychiatrist in training here)
- Scoundreller 8y ago
  > When do you call high blood pressure too high? Greater than 140 mmHg? 130? Someone has to pick an arbitrary threshold for practical reasons. We have no choice but to stratify disease into low, medium and high when there are only low, medium and high dose interventions. For the most part, this works because individualisation is such a pain. But if individualisation wasn’t, you’d get 1 of a thousand different doses to optimize and eek out slight additional benefits. We could apply high frequency trading algos to an implanted infuser, or deep brain stimulator or wearable TMS when we get around to accepting/funding them for more common and non-extreme diseases.
- 50656E6973 8y ago
  >as we learn what is wrong with a specific individual's brain and intervene directly at the circuit level What is the scientific basis for the theory that mental illness is due to "deranged circuits"?
extragood 8y ago
> At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants. The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success. This has always been my issue with psychology. It is inherently unscientific. Given the preponderance of reported mental conditions, it's also insufficient. My experience is that the patient is asked a series of incredibly open ended questions. I was struck with the sheer variety of ways that I could respond. And depending on my response, I would receive a diagnosis. The following were my diagnoses from 3 different psychiatrists: Attention Deficit, Seasonal Affective Disorder, Bipolar disorder. There was absolutely no consensus, and it's no wonder. Years later a doctor made the connection between chronic pain (Crohn's disease) and my lack of energy. I had been consuming anti-psychotics purely because of how I answered "How are you feeling today?" and other similar open ended questions in the wrong way. At that point I worked to improve my chronic pain condition, which was of course the actual issue. Neuroscience is the way forward to understanding mental disorders. In the meantime, great care should be taken around psychology. The effect of an uninformed approach can be devastating.
- _bxg1 8y ago
  This is why I've never gone to a psychiatrist; only therapists. Instead of pretending to have scientific rigor, many therapists focus on the more human side of mental health, working out knots and releasing mental tension like a masseuse does for physical tension. Neuroscience is the only true way to approach the problem scientifically, but it has a really, really long way to go. It's like trying to understand how Chrome works when all you have is a voltage meter for measuring the 1s and 0s in memory. And even that is a fairly recent development.
  - charliemil4 8y ago
    Absolutely agree w.r.t. Neuroscience: it’s really exciting to work on. Reach out via email in profile to hear a few compelling anecdotes on an “advanced volt meter.” (open to anyone reading, too)
    - 8y ago
_bxg1 8y ago
Highlight: "Modern medicine pivots on the promise that portraying human suffering as biological disease will lead to insight and cures. Inescapably, this enterprise has a sociopolitical dimension. To say which of our travails can (and should) come under medicine’s purview is, implicitly if not explicitly, to present a vision of human agency, of the nature of the good life, of who deserves precious social resources like money and compassion. Such questions, of course, aren’t always pressing; the observation that a broken leg is a problem only in a society that requires mobility seems trivial. But by virtue of its focus on our mental lives, and especially on our subjective experience of the world and ourselves, psychiatry, far more directly than other medical specialties, implicates our conception of who we are and how our lives should be lived. It raises, in short, moral questions. If you convince people that their moods are merely electrochemical noise, you are also telling them what it means to be human, even if you only intend to ease their pain."
doitLP 8y ago
Seems like oil companies and climate change denial. To paraphrase, when a person’s paycheck depends on not understanding something it’s hard to make them understand it. The voting on disorders that go into the DSM would be laughable if it wasn’t sad and creepy from a norm-defining control perspective.
nickhalfasleep 8y ago
astrology became astronomy alchemy became chemistry we're still waiting to find out what psychology and economics are gonna turn into (With apologies to Dr. Taber, who originated the joke.)
ams6110 8y ago
So, let's say I think I am depressed. Should I seek out a psychiatrist, a psychologist, or a clinical social worker? I sort of think psychiatrist is someone who treats personality disorders like schizophrenia, bipolar, borderline, etc. Almost always will involve use of medication as primary treatment. Psychologist more for depression, anxiety, mood disorders. Not an MD so can't prescribe meds but often works with the patient's primary care physician if this is needed. Clinical social worker for .... not sure? Interpersonal issues, behavior issues, anger management, etc.? But no idea if that is even close to being on target.
- penagwin 8y ago
  Psychiatrists can prescribe medication (I think the "ch" are related - psychiatry and chemical?). They can do what I'd call "conversational therapy" but they're main job is dealing with medication. Psychologists are usually more of a traditional conversational therapy - and there's different forms of that, CBT, DBT, etc. Social workers - I'm not 100% sure but in my experience they're more of a "intermediary" - they diagnose and refer you to an appropriate therapy. That or they're more of a "general psychologist" say with a school. I don't think you really meet with them regularly. There's a huge shortage of Psychiatrists/Psychologists at least here in Michigan, and a becoming a social worker requires less schooling I believe. (I've suffered from depression for years, I've met many doctors, social workers, etc. and currently see a Psychologist and Psychiatrist regularly)
  - staticautomatic 8y ago
    You've got this somewhat wrong. It's true that many psychiatrists these days focus on med management rather than therapy, but until maybe 30 years ago psychiatrists were actually the only mental health professionals who were allowed to become psychoanalysts, the folks who more or less pioneered talk therapy. Also CBT/DBT are not forms of psychodynamic therapy (which is what people usually think of when they think of talk therapy). That's why they're called "behavioral" therapies.
    - penagwin 8y ago
shrinkhelped 8y ago
As somebody who has actually benefited from psychiatry, I have to disagree strongly with a lot of people in this thread (respectfully). It isn't a lot of hand-waving, and what seemed like open-ended questions in the beginning were designed to work toward an ultimate truth - my issue. There was no guessing involved or hand-wavy incantations, just a thorough assessment of my state of mind, both in the moment and across a span of time. This required me to be honest, which I strongly suspect many people aren't (due to things like fear of judgement) and this will hamper the capability of the doctor in doing their job. To put this into perspective, while ill I was relatively high-functioning. You wouldn't guess I was ill, but you would likely find me abrasive and prone to apparent flights of fancy. What the worst symptom was, the crippling anxiety, you never would've been able to detect without a goal-driven conversation - the type of conversation I have with my doctor when we meet. I think we're still largely in the dark on the methods of action within the brain that leads to these problems, but we have actually found useful tools in resolving these problems. This isn't to say it is perfect, I was put onto a completely incorrect drug by a non-psychiatrist based on my self-reporting. The next step is going to be neuroscience explaining the modes of action in a failure state and how these drugs restore normal function. To anybody out there suffering with mental disease, I'm with you. edit: throwaway account for obvious reasons
- xkcd-sucks 8y ago
  Could you have gotten the same benefits from talking with a priest, or a close friend / wise stranger who is skilled at asking questions?
  - staticautomatic 8y ago
    Asking questions is the tip of the iceberg.
    - theoh 8y ago
      I'm not sure the original commenter has a clear idea of the distinction between psychotherapy (talking cures) and psychiatry (doctoring). Beyond that there is psychoanalysis (depth psychology) and at the opposite, shallow end, just talking to a psychologist. All different things. There is such a thing as "lay psychoanalysis", not involving a professional. I wouldn't dismiss it. What I would definitely dismiss, as someone who has spent time in a psychiatric hospital as a patient, is the bad faith pseudoscience of psychiatry. Individual doctors may be doing their best, but the profession is very much as described in this article.
zxcvvcxz 8y ago
Psychiatry is not a science. And their business model literally depends on you not getting better. Those $200/hr sessions aren't big business unless you keep coming back for more. While we're at it, let's prescribe some pills for underlying deficiencies we can't measure in the first place.
- algorithmsRcool 8y ago
  I don't think your first point very well thought out. Any doctor (or mechanic, accountant, etc...) could benefit by providing false/sub-standard services to keep the client returning regularly. As for the measurement, it's almost entirely based on feedback from the patient. I can see how a depressed or mentally ill person could be more susceptible to accepting medication that wasn't in their best interest, but that problem seems intrinsic to all medication.
  - zxcvvcxz 8y ago
    Wrong. Doctors would (hopefully) lose licenses and have big legal consequences. Mechanics are also subject to some form of objective measurement as even the average driver has some sense if a problem is being fixed or not. But psychiatry? Forget it. You pay to talk to someone, they have a nice couch, soothing voice, make you feel good for an hour, but nothing really changes. But hey, I liked that hour, I should keep coming back!
marssaxman 8y ago
I think psychiatry is in for an interesting surprise soon when it discovers that the information it lacks has already been uncovered through an extensive series of informal experiments being conducted in a collective, ad-hoc, slapdash fashion through a seemingly unrelated field - that is, the world of recreational psychedelics. There's a whole global community of pioneers who have been quietly working hard at understanding the insides of their own brains for at least two generations now, and they've made a lot of progress. To make things even more interesting, many of these people are connected with the world of technology and computing, which has been expanding rapidly into an understanding of consciousness through the work on neural networks, deep learning, and artificial intelligence. All of these worlds are about to collide, in the next 10-20 years, and something really interesting is about to happen.
- identity-haver 8y ago
  Can you point us in a direction on this? I have never read a lucid attempt to describe the "anatomy of the psyche" on "psychonaut" websites, just a lot of people who may have had some personal experience of enlightenment but don't describe it super well. The closest thing I can think of is Jung whose description of the psyche was heavily influenced by mystical experiences he had, sans drugs.
- cairo_x 8y ago
  Nonsense. I have Bipolar. Psychedelic microdosing consistently triggers a manic episode. Extreme trips are known to trigger psychosis in those with related mental conditions. There is very little empirical evidence that microdosing has any benefits at all. James Fadiman is a serial fabulist. The original creativity study he was involved with (and I use the term involved very loosely), and constantly keeps harping on about, was a terribly conducted farce. Just keep that in mind.
  - djakjxnanjak 8y ago
    Parent comment didn’t mention microdosing.
  - marssaxman 8y ago
soup10 8y ago
Modern Psychiatry in a nutshell: Patient acting crazy? Label them schizophrenic, schizo-affective or bipolar(doesn't really matter which, they are all subjective); Hit em with some major tranquilizers and dopamine inhibitors and rack up that sweet insurance money.
- cairo_x 8y ago
  I think you mean American Psychiatry. Your use of Schizophrenia and Bipolar as examples are both at the top of the heap in terms of what modern psychiatry has been successful in managing. Depression, as a general term, and anti-depressants on the other hand, not so much. The world of psychology is far more of a fail. CBT therapies, mindfulness, and various other fads have all turned out, in meta-studies to be either hot air or incompetent application of the scientific method. The human brain is the most complex organ in the known universe. At least psychiatrists are required to have an MD to practice. Psychologists just wave their hands around and maybe scrape by on some basic statistics to get qualified to rummage around like demented apes in the windmills of your mind.
  - soup10 8y ago
    they don't really manage it well, the drugs they use depress all cognitive activity and patients almost always stop taking them. their cure for depression is pills that zonk people out too
    - ddorian43 8y ago
      Nope. There are side effects. And some times they are worse. But most times they're better than the disease. Good luck being manic with psychosis without meds.
      - soup10 8y ago
        nobody is arguing that major tranquilizers don't have their place for controlling psychosis in emergencies but long term use of them has a degenerative effect on the brain
setgree 8y ago
Related: A psychiatrist who didn’t believe in mental illness (2013) https://news.ycombinator.com/item?id=19242553 https://news.ycombinator.com/item?id=19242553
mindgam3 8y ago
"At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants. The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success." The psychological "trauma model" for mental disorders is a compelling counterpoint to the chemical-imbalance theory. The wikipedia article contains some evidence and links to related research: "A 2005 meta-analysis of schizophrenia revealed that the prevalence of physical and sexual abuse in the histories of people diagnosed with psychotic disorders is very high and has been understudied. This literature review revealed prevalence rates of childhood sexual abuse in studies of people diagnosed with schizophrenia ranging from 45% to 65%" https://en.wikipedia.org/wiki/Trauma_model_of_mental_disorders https://en.wikipedia.org/wiki/Trauma_model_of_mental_disorde...
- SketchySeaBeast 8y ago
  There's a huge gap between depression and schizophrenia. While I'm sure that child abuse can likely lead to depression, just because you have depression doesn't mean you were abused.
  - mindgam3 8y ago
    I don’t think anyone is claiming that. I certainly am not. I would however argue that if you have depression there is a high probability of environmental factors which might be contributing (ie bad relationship, work stress, etc)
    - kolinko 8y ago
      That's why we have twin studies and adoption studies that show quite clearly how much is genetic and how much is environmental.
    - SketchySeaBeast 8y ago
      I get that, it's just not what your link is saying - it's pretty focused on the development of psychosis.
- 8y ago
bellerose 8y ago
The topic of Psychiatry is interesting to observe. I'm reading pessimists vs optimists in the comments and find it amusing because of the impossibility of knowing who is right. I want to believe society has best intentions and is on the right path. Yet what does the science really exhibit? A lot of psychiatry has been horrific the past hundred years and cases exist where the person does benefit. So what's the majority verdict because even snake oil has some satisfied customers.
gerbilly 8y ago
I think it's very easy to be dismissive of counseling. Of course it isn't an exact science, maybe not even a science at all. I like to think of it this way. Think of your mind like an iterative non-linear system with thousands upon thousands of inputs. It operates completely by cause and effect, but because it's non-linear, that doesn't mean it's easy to figure out how it got stuck in a loop. >In the mathematical field of dynamical systems, an attractor is a set of numerical values toward which a system tends to evolve, for a wide variety of starting conditions of the system. System values that get close enough to the attractor values remain close even if slightly disturbed.[1] Sometimes when our mind gets stuck, the efforts on our part to get out aren't enough to get us unstuck. Psychologists or psychiatrists are people who are familiar with some of these mental paths and how it can lead people to become stuck. They are also familiar with some of the paths that lead to an exit from those undesirable states. They are attempting to deal with such a complex system, that I don't think it's fair to hold them to the same standard as the so called 'hard sciences.' For another perspective on the problem of 'getting stuck', from a Buddhist point of view (which is also based on cause and effect) see [2]. [1] https://en.wikipedia.org/wiki/Attractor https://en.wikipedia.org/wiki/Attractor [2] https://www.dhammatalks.org/books/KarmaOfQuestions/Section0009.html https://www.dhammatalks.org/books/KarmaOfQuestions/Section00...
- viivaux 8y ago
  Your entire argument works just as well for shamans as psychiatry; except the drugs shamans use have far fewer and more benign side-effects, with thousands of years of history instead of 20-40. Many of the psychiatrists I have encountered "believe" in their medications, and when questioned as to how (and how well) the drugs they were informed about work have no real substantive argument for all their years of med school. But fuck, do they get paid better. You won't see many shamans on a Pfizer sponsored golf trip in Hawaii.
  - gerbilly 8y ago
    Yes, I could have been clearer that I was talking about 'talk therapy' not medication. Does the argument work as well for shamans? Maybe,except that I was kind of implying a materialist point of view behind psychology, which might not apply to shamans. But who says that shamans might not 'cure you' of your depression just as well?
SlimGrimbles42 8y ago
I watched the chemical imbalance theory absolutely gut the person who used to be my mother. Over a period of maybe 10 years and multiple medications I watched her gain weight, get grey hair far too early for her age, she had periods where she either couldn't stay awake past 9:00pm, or couldn't sleep at all, periods of near catatonia, periods where rest was impossible. She was a guinea pig for decades and it became abundantly clear toward the end that none of these doctors had a god damn idea what they were doing.
- bsenftner 8y ago
  This repeated millions of times across society, it is no wonder we don't classify them as a criminal profession.
  - SlimGrimbles42 8y ago
    Even given my experience, I wouldn't rush to vilify them as criminals. I take an SSRI daily myself and it _helps_, and I owe gratitude to the science that has been done to get this far. The problem is that all of these doctors are operating _without data_. They'll tell you that your seratonin levels are too low, or this or that, but if you ask them how low... they can't answer. If you ask them why they're low, they can give you common answers, but none that are unique to your physiology. So you have schizophrenia? Let's try bloodletting, leaches, and an assortment of drugs that will affect the balance of chemicals in your brain in unknown ways. Don't worry about the side effects, here's a cookie to help with the blood loss.
mnm1 8y ago
> Nor does ironic accurately describe the actions of an industry that touts its products’ power to cure biochemical imbalances that it no longer believes are the culprit. Plain bad faith is what’s on display, sometimes of outrageous proportion. And like all bad faith, it serves more than one master: not only the wish to help people, but also the wish to preserve and increase power and profits. This sums up psychiatry and psychiatrists in general. Corrupt pill pushers willing to make money no matter what the outcome for the patient and what it takes. If it takes lying, so be it, as long as it's well intended. If it takes many people committing suicide after buying their bullshit chemical imbalance fiction even they don't believe, so be it. Such disregard for other human lives would usually land one in jail, but we have a whole profession built on it. At the same time, we lock up drug dealers who may potentially and inadvertently have part of the puzzle (lsd, psilocybin, mdma, ketamine). The entire existence of the field is absurd. One book, the dsm justifies these quacks pushing whatever they want and using their patients as guinea pigs in ad hoc experiments that often go wrong and lead to worse outcomes, including death. All because we refuse to believe that things like depression and anxiety might be caused by say an unhappy relationship, family problems, an unsatisfying job, lack of friends and community, and so many almost obvious deficiencies in our society. Absurd.
OneWordSoln 8y ago
The problem with psychology and psychiatry is that they have ZERO understanding of the definition of a baseline healthy human being who has an integrated set of physical instincts, emotional responses and mental processes such that they lead a fulfilling, happy life. Without a definition for "health" there can be no defintion for disease. Of course, our modern medical systems are rarely concerned with cures and are thus ultimately content with the financial outcome that results from treating the symptoms. This is a result of the for-profit corporate structure's dominance of all aspects of our world, and affects what gets studied and, more importantly, what does not get studied. (See: Chris Rock's "ain't no money in the cure" bit.) As such, nutrition science is literally less than four hours of medical school education (my wife's first son is finishing his residency at his first-choice program, one of the East Coast's premier programs). [To learn more about this, I highly suggest the fantastic documentary "Eating You Alive". I have switched to a whole food plant-based diet as a result and feel better every week (it's been about eight weeks now, with a few cheat days along the way).] We are only now realizing the direct link between our gut biome and our mental health, and our gut biome is directly related to the foods and/or poisons we ingest. Once again, the for-profit corps provide foods that harm us but cannot be proven to do so, medicines that harm us but cannot be proven to do so, and an environment polluted by their machines and chemicals whose effects cannot be measured enough to hit them in the only place they care about: their purses via tort law. They have crafted the laws and staffed the regulatory agencies while lobbying the government to dismantle and detooth those agencies' abilities to provide scientific oversight. Every single one of these factors affects our mental health, and all the while there is very, very little research being done on nutrition and how to measure toxicity and remove it from the body. And yet that only peripherally approaches the truth of our human baseline because our human nature goes deeper still, and yet that pervasive corporate mentality to put profit over human well-being is intrinsically related to what we are as moral beings. We each have a moral compass, however subtly different our societal tunings. It is an intrinsic part of our human nature, and our lack of moral teaching as societies is the source of all our problems including our inability to address psychological issues. We have sick societies the world over and it is foolish insanity to think that mental illness is not an absolutely natural result of such selfish, competitive societies. The misunderstanding of the cocaine rat study illustrates this all-too-well. When the studies were re-run years later with non-overcrowded, healthy environments the rats wanted nothing to do with the cocaine. The solution to all our problems is to selflessly choose, first individually and then collectively, to form cooperative, caring societies instead of the dog-eat-dog world of economic competitiveness we currently live under, competitiveness that oft leads to physical competitiveness. Beyond promoting mental and physical health, such compassion lets one see the true nature of the other person, which is essential when one is dealing with psychopathy or sociopathy. Psychiatry is built upon a lack of compassion and its systemic harms all result from their hubris, ignorance and profit motive. Even our precious traditions that should be leading us towards that loving ideal have been conquered by the animalistic persons who live for mammalian alpha-dominance games within and among groups, be they defined by class, ethnicity, form of religion, political affiliation, gender identity or sexual preference. We must live in groups to survive and prosper and our moral nature's purpose is to nudge us towards peaceful cooperation so that we may ALL happily explore this world, whatever our predilection. This is why there is a Law of Karma that only works at the human level, where we reap the happiness or unhappiness we sow in others; it is the feedback mechanism that nudges us towards humane cooperation and away from animalistic competitiveness. Our Creator does not intervene because the gift of free will to choose either selflessness or selfishness, love or its antitheses, wisdom or ignorance, the good of the whole or the benefit of the few -- that gift of free will is freely given. Thus, a group of Nazis can go about their hateful, oppressive business just as freely as we Sufis can ours. It is up to each one of us to choose the better path, for ourselves first and then as societies. As the great Poet of God, Rumi said, "The Way goes in.", but in this materialist world culture of self, there is a communal disdain for and utter denial of the internal spiritual pursuit that leads us to moral perfection, first individually and then collectively. As such we cannot comprehend the difference between physical mental illness (caused by disease or nutritional imbalance) and a person who's just a selfish, sociopathic bastard and a person who is just naturally having a difficult time dealing with our sick society and the sick world that is making us physically ill via its pollution and constant stress. The fundamental truth is that no one's health, mental or physical ("Not two, not one"), can EVER be successfully treated without clear-minded, compassionate care, and that must involve first getting them away from negative environmental factors and into a nurturing environment. Creating such a compassionate society requires compassionate human beings, and that requires the humble work of self-reflection and self-evolution beyond the negative traits we all possess. Peace be with you all. We love you.
Pimpus 8y ago
> The biology of mental illness is still a mystery, but practitioners don’t want to admit it. I believe we started with a faulty premise, that perfectly natural states of mind are an "illness". They may not be pleasant to behold but our brains have these mental states built in, for whatever reason. The mental health system wants to aggressively impose conformity of psychology across the population, which causes real mental illness. And the most evil thing we do is giving psychoactive drugs to kids.
- tremon 8y ago
  I believe we started with a faulty premise, that perfectly natural states of mind are an "illness" I tend to agree, but this is only partly true. It isn't because something is "natural" that it is therefore healthy and desirable. Some mental states, whether genetic or environmental, are very debilitating to the individual that has to live with them. So there is value in trying to "cure" certain mental afflictions. But yes, the field of psychology suffers from a fashion-based ideology that appears to want to mold every individual to the same narrow (and flawed) ideal. But in my experience, this fashion trend diminishes with expertise: most behavioral and forensic psychiatrists I've sproken explicitly eschew that type of prescriptivism.
- atlasair 8y ago
  What absolute bullshit. All congenital disease is natural. That doesn't mean patients should suffer. We treat children for mental illness, because we have comprehensive studies that shows it improves their life.
atlasair 8y ago
Why do psychologist think they are in any way qualified to discuss medical matters? These quacks are threatened by treatment that actually works.
- ddorian43 8y ago
  Any psychologist who has any say on a medical matter isn't a good one. When they go medical school they can.
PaulHoule 8y ago
Psychiatry doesn't need a biological theory, it needs a different approach to service delivery. Somebody I knew drank antifreeze one day, decided he didn't want to die after all, then went to the emergency room. His family wondered where he was for 36 hours and then they found out. A week or so later he went to a scheduled appointment at a psychiatrist's office, had to fill out his name 10 times and then tell it to 5 different people and was so enraged by the cluelessness that he went home and hung himself that night. That time he succeeded. E-room workers are trained to believe that the vast majority of suicide attempters are seeking attention. That's true. Inside that population, however, are a small fraction of completers for which a suicide attempt is the mental health equivalent of a heart attack. Unfortunately books have a long half life. People are still influenced by R.D. Laing, Thomas Szasz, L. Ron Hubbard, and Erving Goffmann long after Ronald Reagan set the insane "free" to roam on the streets. Involuntary commitment was a problem in the 1950s, but today it can seem impossible to check into a mental hospital even for a person who is in a full-blown psychotic crisis.
- DataWorker 8y ago
  It’s not “approach to service delivery” it’s lawyers and medical ethics, neither of which can be blamed on the profession itself.
  - PaulHoule 8y ago
    Also the issues of paying for it. You could say private health insurance is bad, but just try Medicaid. The helping relationship is fundamentally difficult too. Some people are going to do the wrong thing and face consequences if they do. Sometimes what you think is the right thing is really the wrong thing and vice versa. You can't take responsibility for someone else's life in the end.

110 points by scottie_m 8y ago

Psychiatry today strikes me as being in a similar place as Infectious Disease before germ theory. We can describe symptoms, we can group them together, and we can come up with cures that sometimes work but without knowing if we are talking about a virus or a bacteria we can't really understand what's going on.

deleted 8y ago
[deleted]
forkandwait 8y ago
Or like chemistry during the alchemy era.
trevyn 8y ago
IMO, we already have the mental-disease equivalent of germ theory, it’s just far more complex and not yet well-understood by enough people to have broad social impact. “The germ theory was proposed by Girolamo Fracastoro in 1546, and expanded upon by Marcus von Plenciz in 1762. Such views were held in disdain, however, and Galen's miasma theory remained dominant among scientists and doctors.” - https://en.m.wikipedia.org/wiki/Germ_theory_of_disease https://en.m.wikipedia.org/wiki/Germ_theory_of_disease
- fastball 8y ago
  What would you say the germ theory of mental disease is?
  - TheOtherHobbes 8y ago
    There isn't one - which is the point. It isn't even scientifically accurate to believe that mental illness is caused exclusively by brain malfunctions. Other bodily systems, especially the gut, also seem involved - never mind the mysterious role of genetics, and the slightly less mysterious but hard to pin down influence of environmental and social stresses.
    - tremon 8y ago
      > There isn't one - which is the point. The GP was asking because of this statement: IMO, we already have the mental-disease equivalent of germ theory
- thaumasiotes 8y ago
  https://westhunt.wordpress.com/2013/10/31/lost-and-found/ https://westhunt.wordpress.com/2013/10/31/lost-and-found/ > Marcus Terentius Varro was called the most learned of the Romans. But what did he know, and how did he know it? I ask because of this quote, from Rerum rusticarum libri III (Agricultural Topics in Three Books): > Precautions must also be taken in the neighbourhood of swamps, both for the reasons given, and because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases. > I get the distinct impression that someone (probably someone other than Varro) came up with an approximation of germ theory 1500 years before Girolamo Fracastoro. But his work was lost.
  - arkades 8y ago
    The ancient Greeks were long ago discussing the possible existence of “animalcules.” Fracastaro gets credit because he wasn’t just philosophizing, he described actual disease in great detail with supporting cases (I hesitate to say “data,” that wasn’t really a thing yet) to argue for its mechanism. It’s the difference between a stoner strumming his guitar, “dude, what if we’re all, like, strings?” and string theory.
    - thaumasiotes 8y ago
      I think the advice "don't live near a swamp, because the tiny invisible creatures in there will make you sick, and if you do have a farm next to a swamp, sell it" is a little more detailed than "dude, what if we're all, like, strings?" Describing disease in great detail is nothing the Romans didn't also do, nor does it have anything to do with the germ theory of disease.
      - arkades 8y ago
        That advice applies equally well to miasma (and, in fact, it’s ability to accurately relate to geography of disease is part of why it was taken seriously.) Which is why F. gets credit for actually making detailed observations and hypotheses that we’re borne out.
saltcured 8y ago
On the bright side, we did manage to improve things using the scientific method. Germ theory came from epidemiological evidence in parallel with the discovery of microrganisms. We didn't have to already know how it all works in order to figure out ways to improve outcomes. I think that what is disturbing to a lot of computing folk is that psychiatry sounds a bit ill-posed. An imposition of magical thinking onto what we assume are complex, chaotic systems. It just doesn't feel right that something so complex can be adjusted with such gross, brute-force methods. Imagine debugging a computer and saying, "I think your RAM hasn't enough ones in it. I am prescribing this selective ones-uptake inhibitor to restore the balance." On the other hand, we do have plenty of drugs that are a bit closer to saying, "This packet flow seems to be overwhelming the cluster. We can prescribe this traffic filter to interrupt that flow, allowing other functions to return to normal."
- souterrain 8y ago
  > Imagine debugging a computer and saying, "I think your RAM hasn't enough ones in it. I am prescribing this selective ones-uptake inhibitor to restore the balance." Yet we use encoding techniques to ensure that there precisely are a sufficient number of ones, such that clock can be recovered. https://en.m.wikipedia.org/wiki/Run-length_limited https://en.m.wikipedia.org/wiki/Run-length_limited
arkades 8y ago
ITT: sweeping criticisms of psychiatry based on caricatures drawn from pop-sci accounts of psychiatry. I am deeply critical of quite a few facets of modern psychiatry, but this thread seems to mistake the stuff that’s slung around in Guardian and Atlantic articles as having any relationship to reality.
- dsego 8y ago
  Speaking from personal experience. I have a sibling with psychosis, on meds, hospitalized every so often. Also, one of my parents has been treated for ptsd and depression for more than 20 years. The shrinks are clueless to put it mildly. What they do is try out different dosages and combinations of meds to see what helps until it doesn't and then they give up. Their practice is akin to witchcraft and mixing potions in the medieval times. My honest opinion is that psychiatry is at best a pseudo-science and needs to be abolished as a field of medicine.
DanBC 8y ago
Where did you do your medical training?

outlace 8y ago

Psychiatry indeed has a pretty bleak history, and it's fair to criticize that history. It is true that the DSM as it categorizes mental disorders is not biologically valid in general, however, most psychiatrists today recognize it just as a communication tool. Two psychiatrists with patients exhibiting similar symptoms can be concisely described using DSM vocabulary. It is also necessary for billing purposes. Insurances want to put labels on things so they can price and track things. This is true of all medicine, however. When do you call high blood pressure too high? Greater than 140 mmHg? 130? Someone has to pick an arbitrary threshold for practical reasons. "The pathological basis of almost all mental disorders remains as unknown today as it was in 1886" (article quote) I don't think this is true. We don't know enough to make targeted treatments quite yet, but we do know a lot more about the brain now and have much more reliable theoretical conceptions of mental illness. There is a ton of research going on in understanding mental illnesses at computational and circuit levels, and we're already starting to see the fruits of that research. Researchers are developing targeted treatments using transcranial magnetic stimulation (TMS) and similar modalities to directly perturb circuits that are believed to be deranged. I think psychiatry will change significantly over the next decade or so as we learn what is wrong with a specific individual's brain and intervene directly at the circuit level. I don't see how drugs will play a major role in this as it is very difficult to develop a drug that could target specific circuits. This time really is different. (Psychiatrist in training here)

Scoundreller 8y ago
> When do you call high blood pressure too high? Greater than 140 mmHg? 130? Someone has to pick an arbitrary threshold for practical reasons. We have no choice but to stratify disease into low, medium and high when there are only low, medium and high dose interventions. For the most part, this works because individualisation is such a pain. But if individualisation wasn’t, you’d get 1 of a thousand different doses to optimize and eek out slight additional benefits. We could apply high frequency trading algos to an implanted infuser, or deep brain stimulator or wearable TMS when we get around to accepting/funding them for more common and non-extreme diseases.
50656E6973 8y ago
>as we learn what is wrong with a specific individual's brain and intervene directly at the circuit level What is the scientific basis for the theory that mental illness is due to "deranged circuits"?

extragood 8y ago

> At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants. The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success. This has always been my issue with psychology. It is inherently unscientific. Given the preponderance of reported mental conditions, it's also insufficient. My experience is that the patient is asked a series of incredibly open ended questions. I was struck with the sheer variety of ways that I could respond. And depending on my response, I would receive a diagnosis. The following were my diagnoses from 3 different psychiatrists: Attention Deficit, Seasonal Affective Disorder, Bipolar disorder. There was absolutely no consensus, and it's no wonder. Years later a doctor made the connection between chronic pain (Crohn's disease) and my lack of energy. I had been consuming anti-psychotics purely because of how I answered "How are you feeling today?" and other similar open ended questions in the wrong way. At that point I worked to improve my chronic pain condition, which was of course the actual issue. Neuroscience is the way forward to understanding mental disorders. In the meantime, great care should be taken around psychology. The effect of an uninformed approach can be devastating.

_bxg1 8y ago
This is why I've never gone to a psychiatrist; only therapists. Instead of pretending to have scientific rigor, many therapists focus on the more human side of mental health, working out knots and releasing mental tension like a masseuse does for physical tension. Neuroscience is the only true way to approach the problem scientifically, but it has a really, really long way to go. It's like trying to understand how Chrome works when all you have is a voltage meter for measuring the 1s and 0s in memory. And even that is a fairly recent development.
- charliemil4 8y ago
  Absolutely agree w.r.t. Neuroscience: it’s really exciting to work on. Reach out via email in profile to hear a few compelling anecdotes on an “advanced volt meter.” (open to anyone reading, too)
  - 8y ago

_bxg1 8y ago

Highlight: "Modern medicine pivots on the promise that portraying human suffering as biological disease will lead to insight and cures. Inescapably, this enterprise has a sociopolitical dimension. To say which of our travails can (and should) come under medicine’s purview is, implicitly if not explicitly, to present a vision of human agency, of the nature of the good life, of who deserves precious social resources like money and compassion. Such questions, of course, aren’t always pressing; the observation that a broken leg is a problem only in a society that requires mobility seems trivial. But by virtue of its focus on our mental lives, and especially on our subjective experience of the world and ourselves, psychiatry, far more directly than other medical specialties, implicates our conception of who we are and how our lives should be lived. It raises, in short, moral questions. If you convince people that their moods are merely electrochemical noise, you are also telling them what it means to be human, even if you only intend to ease their pain."

doitLP 8y ago

Seems like oil companies and climate change denial. To paraphrase, when a person’s paycheck depends on not understanding something it’s hard to make them understand it. The voting on disorders that go into the DSM would be laughable if it wasn’t sad and creepy from a norm-defining control perspective.

nickhalfasleep 8y ago

astrology became astronomy alchemy became chemistry we're still waiting to find out what psychology and economics are gonna turn into (With apologies to Dr. Taber, who originated the joke.)

ams6110 8y ago

So, let's say I think I am depressed. Should I seek out a psychiatrist, a psychologist, or a clinical social worker? I sort of think psychiatrist is someone who treats personality disorders like schizophrenia, bipolar, borderline, etc. Almost always will involve use of medication as primary treatment. Psychologist more for depression, anxiety, mood disorders. Not an MD so can't prescribe meds but often works with the patient's primary care physician if this is needed. Clinical social worker for .... not sure? Interpersonal issues, behavior issues, anger management, etc.? But no idea if that is even close to being on target.

penagwin 8y ago
Psychiatrists can prescribe medication (I think the "ch" are related - psychiatry and chemical?). They can do what I'd call "conversational therapy" but they're main job is dealing with medication. Psychologists are usually more of a traditional conversational therapy - and there's different forms of that, CBT, DBT, etc. Social workers - I'm not 100% sure but in my experience they're more of a "intermediary" - they diagnose and refer you to an appropriate therapy. That or they're more of a "general psychologist" say with a school. I don't think you really meet with them regularly. There's a huge shortage of Psychiatrists/Psychologists at least here in Michigan, and a becoming a social worker requires less schooling I believe. (I've suffered from depression for years, I've met many doctors, social workers, etc. and currently see a Psychologist and Psychiatrist regularly)
- staticautomatic 8y ago
  You've got this somewhat wrong. It's true that many psychiatrists these days focus on med management rather than therapy, but until maybe 30 years ago psychiatrists were actually the only mental health professionals who were allowed to become psychoanalysts, the folks who more or less pioneered talk therapy. Also CBT/DBT are not forms of psychodynamic therapy (which is what people usually think of when they think of talk therapy). That's why they're called "behavioral" therapies.
  - penagwin 8y ago

shrinkhelped 8y ago

As somebody who has actually benefited from psychiatry, I have to disagree strongly with a lot of people in this thread (respectfully). It isn't a lot of hand-waving, and what seemed like open-ended questions in the beginning were designed to work toward an ultimate truth - my issue. There was no guessing involved or hand-wavy incantations, just a thorough assessment of my state of mind, both in the moment and across a span of time. This required me to be honest, which I strongly suspect many people aren't (due to things like fear of judgement) and this will hamper the capability of the doctor in doing their job. To put this into perspective, while ill I was relatively high-functioning. You wouldn't guess I was ill, but you would likely find me abrasive and prone to apparent flights of fancy. What the worst symptom was, the crippling anxiety, you never would've been able to detect without a goal-driven conversation - the type of conversation I have with my doctor when we meet. I think we're still largely in the dark on the methods of action within the brain that leads to these problems, but we have actually found useful tools in resolving these problems. This isn't to say it is perfect, I was put onto a completely incorrect drug by a non-psychiatrist based on my self-reporting. The next step is going to be neuroscience explaining the modes of action in a failure state and how these drugs restore normal function. To anybody out there suffering with mental disease, I'm with you. edit: throwaway account for obvious reasons

xkcd-sucks 8y ago
Could you have gotten the same benefits from talking with a priest, or a close friend / wise stranger who is skilled at asking questions?
- staticautomatic 8y ago
  Asking questions is the tip of the iceberg.
  - theoh 8y ago
    I'm not sure the original commenter has a clear idea of the distinction between psychotherapy (talking cures) and psychiatry (doctoring). Beyond that there is psychoanalysis (depth psychology) and at the opposite, shallow end, just talking to a psychologist. All different things. There is such a thing as "lay psychoanalysis", not involving a professional. I wouldn't dismiss it. What I would definitely dismiss, as someone who has spent time in a psychiatric hospital as a patient, is the bad faith pseudoscience of psychiatry. Individual doctors may be doing their best, but the profession is very much as described in this article.

zxcvvcxz 8y ago

Psychiatry is not a science. And their business model literally depends on you not getting better. Those $200/hr sessions aren't big business unless you keep coming back for more. While we're at it, let's prescribe some pills for underlying deficiencies we can't measure in the first place.

algorithmsRcool 8y ago
I don't think your first point very well thought out. Any doctor (or mechanic, accountant, etc...) could benefit by providing false/sub-standard services to keep the client returning regularly. As for the measurement, it's almost entirely based on feedback from the patient. I can see how a depressed or mentally ill person could be more susceptible to accepting medication that wasn't in their best interest, but that problem seems intrinsic to all medication.
- zxcvvcxz 8y ago
  Wrong. Doctors would (hopefully) lose licenses and have big legal consequences. Mechanics are also subject to some form of objective measurement as even the average driver has some sense if a problem is being fixed or not. But psychiatry? Forget it. You pay to talk to someone, they have a nice couch, soothing voice, make you feel good for an hour, but nothing really changes. But hey, I liked that hour, I should keep coming back!

marssaxman 8y ago

I think psychiatry is in for an interesting surprise soon when it discovers that the information it lacks has already been uncovered through an extensive series of informal experiments being conducted in a collective, ad-hoc, slapdash fashion through a seemingly unrelated field - that is, the world of recreational psychedelics. There's a whole global community of pioneers who have been quietly working hard at understanding the insides of their own brains for at least two generations now, and they've made a lot of progress. To make things even more interesting, many of these people are connected with the world of technology and computing, which has been expanding rapidly into an understanding of consciousness through the work on neural networks, deep learning, and artificial intelligence. All of these worlds are about to collide, in the next 10-20 years, and something really interesting is about to happen.

identity-haver 8y ago
Can you point us in a direction on this? I have never read a lucid attempt to describe the "anatomy of the psyche" on "psychonaut" websites, just a lot of people who may have had some personal experience of enlightenment but don't describe it super well. The closest thing I can think of is Jung whose description of the psyche was heavily influenced by mystical experiences he had, sans drugs.
cairo_x 8y ago
Nonsense. I have Bipolar. Psychedelic microdosing consistently triggers a manic episode. Extreme trips are known to trigger psychosis in those with related mental conditions. There is very little empirical evidence that microdosing has any benefits at all. James Fadiman is a serial fabulist. The original creativity study he was involved with (and I use the term involved very loosely), and constantly keeps harping on about, was a terribly conducted farce. Just keep that in mind.
- djakjxnanjak 8y ago
  Parent comment didn’t mention microdosing.
- marssaxman 8y ago

soup10 8y ago

Modern Psychiatry in a nutshell: Patient acting crazy? Label them schizophrenic, schizo-affective or bipolar(doesn't really matter which, they are all subjective); Hit em with some major tranquilizers and dopamine inhibitors and rack up that sweet insurance money.

cairo_x 8y ago
I think you mean American Psychiatry. Your use of Schizophrenia and Bipolar as examples are both at the top of the heap in terms of what modern psychiatry has been successful in managing. Depression, as a general term, and anti-depressants on the other hand, not so much. The world of psychology is far more of a fail. CBT therapies, mindfulness, and various other fads have all turned out, in meta-studies to be either hot air or incompetent application of the scientific method. The human brain is the most complex organ in the known universe. At least psychiatrists are required to have an MD to practice. Psychologists just wave their hands around and maybe scrape by on some basic statistics to get qualified to rummage around like demented apes in the windmills of your mind.
- soup10 8y ago
  they don't really manage it well, the drugs they use depress all cognitive activity and patients almost always stop taking them. their cure for depression is pills that zonk people out too
  - ddorian43 8y ago
    Nope. There are side effects. And some times they are worse. But most times they're better than the disease. Good luck being manic with psychosis without meds.
    - soup10 8y ago
      nobody is arguing that major tranquilizers don't have their place for controlling psychosis in emergencies but long term use of them has a degenerative effect on the brain

setgree 8y ago

Related: A psychiatrist who didn’t believe in mental illness (2013) https://news.ycombinator.com/item?id=19242553 https://news.ycombinator.com/item?id=19242553

mindgam3 8y ago

"At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants. The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success." The psychological "trauma model" for mental disorders is a compelling counterpoint to the chemical-imbalance theory. The wikipedia article contains some evidence and links to related research: "A 2005 meta-analysis of schizophrenia revealed that the prevalence of physical and sexual abuse in the histories of people diagnosed with psychotic disorders is very high and has been understudied. This literature review revealed prevalence rates of childhood sexual abuse in studies of people diagnosed with schizophrenia ranging from 45% to 65%" https://en.wikipedia.org/wiki/Trauma_model_of_mental_disorders https://en.wikipedia.org/wiki/Trauma_model_of_mental_disorde...

SketchySeaBeast 8y ago
There's a huge gap between depression and schizophrenia. While I'm sure that child abuse can likely lead to depression, just because you have depression doesn't mean you were abused.
- mindgam3 8y ago
  I don’t think anyone is claiming that. I certainly am not. I would however argue that if you have depression there is a high probability of environmental factors which might be contributing (ie bad relationship, work stress, etc)
  - kolinko 8y ago
    That's why we have twin studies and adoption studies that show quite clearly how much is genetic and how much is environmental.
  - SketchySeaBeast 8y ago
    I get that, it's just not what your link is saying - it's pretty focused on the development of psychosis.
8y ago

bellerose 8y ago

The topic of Psychiatry is interesting to observe. I'm reading pessimists vs optimists in the comments and find it amusing because of the impossibility of knowing who is right. I want to believe society has best intentions and is on the right path. Yet what does the science really exhibit? A lot of psychiatry has been horrific the past hundred years and cases exist where the person does benefit. So what's the majority verdict because even snake oil has some satisfied customers.

gerbilly 8y ago

I think it's very easy to be dismissive of counseling. Of course it isn't an exact science, maybe not even a science at all. I like to think of it this way. Think of your mind like an iterative non-linear system with thousands upon thousands of inputs. It operates completely by cause and effect, but because it's non-linear, that doesn't mean it's easy to figure out how it got stuck in a loop. >In the mathematical field of dynamical systems, an attractor is a set of numerical values toward which a system tends to evolve, for a wide variety of starting conditions of the system. System values that get close enough to the attractor values remain close even if slightly disturbed.[1] Sometimes when our mind gets stuck, the efforts on our part to get out aren't enough to get us unstuck. Psychologists or psychiatrists are people who are familiar with some of these mental paths and how it can lead people to become stuck. They are also familiar with some of the paths that lead to an exit from those undesirable states. They are attempting to deal with such a complex system, that I don't think it's fair to hold them to the same standard as the so called 'hard sciences.' For another perspective on the problem of 'getting stuck', from a Buddhist point of view (which is also based on cause and effect) see [2]. [1] https://en.wikipedia.org/wiki/Attractor https://en.wikipedia.org/wiki/Attractor [2] https://www.dhammatalks.org/books/KarmaOfQuestions/Section0009.html https://www.dhammatalks.org/books/KarmaOfQuestions/Section00...

viivaux 8y ago
Your entire argument works just as well for shamans as psychiatry; except the drugs shamans use have far fewer and more benign side-effects, with thousands of years of history instead of 20-40. Many of the psychiatrists I have encountered "believe" in their medications, and when questioned as to how (and how well) the drugs they were informed about work have no real substantive argument for all their years of med school. But fuck, do they get paid better. You won't see many shamans on a Pfizer sponsored golf trip in Hawaii.
- gerbilly 8y ago
  Yes, I could have been clearer that I was talking about 'talk therapy' not medication. Does the argument work as well for shamans? Maybe,except that I was kind of implying a materialist point of view behind psychology, which might not apply to shamans. But who says that shamans might not 'cure you' of your depression just as well?

SlimGrimbles42 8y ago

I watched the chemical imbalance theory absolutely gut the person who used to be my mother. Over a period of maybe 10 years and multiple medications I watched her gain weight, get grey hair far too early for her age, she had periods where she either couldn't stay awake past 9:00pm, or couldn't sleep at all, periods of near catatonia, periods where rest was impossible. She was a guinea pig for decades and it became abundantly clear toward the end that none of these doctors had a god damn idea what they were doing.

bsenftner 8y ago
This repeated millions of times across society, it is no wonder we don't classify them as a criminal profession.
- SlimGrimbles42 8y ago
  Even given my experience, I wouldn't rush to vilify them as criminals. I take an SSRI daily myself and it _helps_, and I owe gratitude to the science that has been done to get this far. The problem is that all of these doctors are operating _without data_. They'll tell you that your seratonin levels are too low, or this or that, but if you ask them how low... they can't answer. If you ask them why they're low, they can give you common answers, but none that are unique to your physiology. So you have schizophrenia? Let's try bloodletting, leaches, and an assortment of drugs that will affect the balance of chemicals in your brain in unknown ways. Don't worry about the side effects, here's a cookie to help with the blood loss.

mnm1 8y ago

> Nor does ironic accurately describe the actions of an industry that touts its products’ power to cure biochemical imbalances that it no longer believes are the culprit. Plain bad faith is what’s on display, sometimes of outrageous proportion. And like all bad faith, it serves more than one master: not only the wish to help people, but also the wish to preserve and increase power and profits. This sums up psychiatry and psychiatrists in general. Corrupt pill pushers willing to make money no matter what the outcome for the patient and what it takes. If it takes lying, so be it, as long as it's well intended. If it takes many people committing suicide after buying their bullshit chemical imbalance fiction even they don't believe, so be it. Such disregard for other human lives would usually land one in jail, but we have a whole profession built on it. At the same time, we lock up drug dealers who may potentially and inadvertently have part of the puzzle (lsd, psilocybin, mdma, ketamine). The entire existence of the field is absurd. One book, the dsm justifies these quacks pushing whatever they want and using their patients as guinea pigs in ad hoc experiments that often go wrong and lead to worse outcomes, including death. All because we refuse to believe that things like depression and anxiety might be caused by say an unhappy relationship, family problems, an unsatisfying job, lack of friends and community, and so many almost obvious deficiencies in our society. Absurd.

OneWordSoln 8y ago

The problem with psychology and psychiatry is that they have ZERO understanding of the definition of a baseline healthy human being who has an integrated set of physical instincts, emotional responses and mental processes such that they lead a fulfilling, happy life. Without a definition for "health" there can be no defintion for disease. Of course, our modern medical systems are rarely concerned with cures and are thus ultimately content with the financial outcome that results from treating the symptoms. This is a result of the for-profit corporate structure's dominance of all aspects of our world, and affects what gets studied and, more importantly, what does not get studied. (See: Chris Rock's "ain't no money in the cure" bit.) As such, nutrition science is literally less than four hours of medical school education (my wife's first son is finishing his residency at his first-choice program, one of the East Coast's premier programs). [To learn more about this, I highly suggest the fantastic documentary "Eating You Alive". I have switched to a whole food plant-based diet as a result and feel better every week (it's been about eight weeks now, with a few cheat days along the way).] We are only now realizing the direct link between our gut biome and our mental health, and our gut biome is directly related to the foods and/or poisons we ingest. Once again, the for-profit corps provide foods that harm us but cannot be proven to do so, medicines that harm us but cannot be proven to do so, and an environment polluted by their machines and chemicals whose effects cannot be measured enough to hit them in the only place they care about: their purses via tort law. They have crafted the laws and staffed the regulatory agencies while lobbying the government to dismantle and detooth those agencies' abilities to provide scientific oversight. Every single one of these factors affects our mental health, and all the while there is very, very little research being done on nutrition and how to measure toxicity and remove it from the body. And yet that only peripherally approaches the truth of our human baseline because our human nature goes deeper still, and yet that pervasive corporate mentality to put profit over human well-being is intrinsically related to what we are as moral beings. We each have a moral compass, however subtly different our societal tunings. It is an intrinsic part of our human nature, and our lack of moral teaching as societies is the source of all our problems including our inability to address psychological issues. We have sick societies the world over and it is foolish insanity to think that mental illness is not an absolutely natural result of such selfish, competitive societies. The misunderstanding of the cocaine rat study illustrates this all-too-well. When the studies were re-run years later with non-overcrowded, healthy environments the rats wanted nothing to do with the cocaine. The solution to all our problems is to selflessly choose, first individually and then collectively, to form cooperative, caring societies instead of the dog-eat-dog world of economic competitiveness we currently live under, competitiveness that oft leads to physical competitiveness. Beyond promoting mental and physical health, such compassion lets one see the true nature of the other person, which is essential when one is dealing with psychopathy or sociopathy. Psychiatry is built upon a lack of compassion and its systemic harms all result from their hubris, ignorance and profit motive. Even our precious traditions that should be leading us towards that loving ideal have been conquered by the animalistic persons who live for mammalian alpha-dominance games within and among groups, be they defined by class, ethnicity, form of religion, political affiliation, gender identity or sexual preference. We must live in groups to survive and prosper and our moral nature's purpose is to nudge us towards peaceful cooperation so that we may ALL happily explore this world, whatever our predilection. This is why there is a Law of Karma that only works at the human level, where we reap the happiness or unhappiness we sow in others; it is the feedback mechanism that nudges us towards humane cooperation and away from animalistic competitiveness. Our Creator does not intervene because the gift of free will to choose either selflessness or selfishness, love or its antitheses, wisdom or ignorance, the good of the whole or the benefit of the few -- that gift of free will is freely given. Thus, a group of Nazis can go about their hateful, oppressive business just as freely as we Sufis can ours. It is up to each one of us to choose the better path, for ourselves first and then as societies. As the great Poet of God, Rumi said, "The Way goes in.", but in this materialist world culture of self, there is a communal disdain for and utter denial of the internal spiritual pursuit that leads us to moral perfection, first individually and then collectively. As such we cannot comprehend the difference between physical mental illness (caused by disease or nutritional imbalance) and a person who's just a selfish, sociopathic bastard and a person who is just naturally having a difficult time dealing with our sick society and the sick world that is making us physically ill via its pollution and constant stress. The fundamental truth is that no one's health, mental or physical ("Not two, not one"), can EVER be successfully treated without clear-minded, compassionate care, and that must involve first getting them away from negative environmental factors and into a nurturing environment. Creating such a compassionate society requires compassionate human beings, and that requires the humble work of self-reflection and self-evolution beyond the negative traits we all possess. Peace be with you all. We love you.

Pimpus 8y ago

> The biology of mental illness is still a mystery, but practitioners don’t want to admit it. I believe we started with a faulty premise, that perfectly natural states of mind are an "illness". They may not be pleasant to behold but our brains have these mental states built in, for whatever reason. The mental health system wants to aggressively impose conformity of psychology across the population, which causes real mental illness. And the most evil thing we do is giving psychoactive drugs to kids.

tremon 8y ago
I believe we started with a faulty premise, that perfectly natural states of mind are an "illness" I tend to agree, but this is only partly true. It isn't because something is "natural" that it is therefore healthy and desirable. Some mental states, whether genetic or environmental, are very debilitating to the individual that has to live with them. So there is value in trying to "cure" certain mental afflictions. But yes, the field of psychology suffers from a fashion-based ideology that appears to want to mold every individual to the same narrow (and flawed) ideal. But in my experience, this fashion trend diminishes with expertise: most behavioral and forensic psychiatrists I've sproken explicitly eschew that type of prescriptivism.
atlasair 8y ago
What absolute bullshit. All congenital disease is natural. That doesn't mean patients should suffer. We treat children for mental illness, because we have comprehensive studies that shows it improves their life.

atlasair 8y ago

Why do psychologist think they are in any way qualified to discuss medical matters? These quacks are threatened by treatment that actually works.

ddorian43 8y ago
Any psychologist who has any say on a medical matter isn't a good one. When they go medical school they can.

PaulHoule 8y ago

Psychiatry doesn't need a biological theory, it needs a different approach to service delivery. Somebody I knew drank antifreeze one day, decided he didn't want to die after all, then went to the emergency room. His family wondered where he was for 36 hours and then they found out. A week or so later he went to a scheduled appointment at a psychiatrist's office, had to fill out his name 10 times and then tell it to 5 different people and was so enraged by the cluelessness that he went home and hung himself that night. That time he succeeded. E-room workers are trained to believe that the vast majority of suicide attempters are seeking attention. That's true. Inside that population, however, are a small fraction of completers for which a suicide attempt is the mental health equivalent of a heart attack. Unfortunately books have a long half life. People are still influenced by R.D. Laing, Thomas Szasz, L. Ron Hubbard, and Erving Goffmann long after Ronald Reagan set the insane "free" to roam on the streets. Involuntary commitment was a problem in the 1950s, but today it can seem impossible to check into a mental hospital even for a person who is in a full-blown psychotic crisis.

DataWorker 8y ago
It’s not “approach to service delivery” it’s lawyers and medical ethics, neither of which can be blamed on the profession itself.
- PaulHoule 8y ago
  Also the issues of paying for it. You could say private health insurance is bad, but just try Medicaid. The helping relationship is fundamentally difficult too. Some people are going to do the wrong thing and face consequences if they do. Sometimes what you think is the right thing is really the wrong thing and vice versa. You can't take responsibility for someone else's life in the end.