7 ms·

As an informed lay-person, psychiatry scares me. There are cases where it is the best we have, but it really feels to me like the state of medicine when bloodl

by btilly 7y ago

As an informed lay-person, psychiatry scares me. There are cases where it is the best we have, but it really feels to me like the state of medicine when bloodletting was an accepted treatment. In particular we regularly have disaster after disaster caused by psychiatry, psychology, and related fields. Consider the excesses of frontal lobotomies in the 1950s, electroshock therapy in the 60s and 70s, and false memory syndrome in the 80s and 90s. It makes me wonder, what disasters are we creating now?

jdietrich 7y ago
Lobotomy and electroshock therapy have an undeserved reputation as being barbaric and futile. We've substantially refined both techniques and we still use them where other options of failed. In the case of lobotomy, we now use stereotactic guided procedures to precisely ablate small parts of the brain, mainly for the treatment of severe OCD and treatment-resistant depression. In the case of ECT, we perform the procedure under full sedation and use EEG monitoring to deliver the minimum possible energy. Both treatments still carry a substantial burden of side-effects, but they work when nothing else does. The uncomfortable reality is that a lot of people have debilitating, life-threatening mental health problems that don't always respond to medication or psychotherapy. Most of us don't want to think about what very severe mental illness really looks like - the person who is too depressed to sit up in bed, the person with OCD who picks at their wounds until they hit bone, the person with mania who is keen to test their belief that they're immortal. If you were treating a patient with that level of disability, what would you do? The real disaster of psychiatry isn't the failed attempts, but all the stuff that we don't yet know how to treat or don't have the resources to treat. Mental illnesses are the single biggest cause of disability in the developed world. There's so much we could be doing, so much we should be doing, but we're not spending nearly enough on research or treatment. We're watching helplessly as people live short, miserable lives because of diseases that are treatable or potentially treatable.
- belorn 7y ago
  As someone who has relative who underwent electroshock therapy in the 70s and read documentation from before, during and after, I will say that the treatment is worse than barbaric. For all practical purposes it was a treatment to remove the issue out of sight and out of mind. As a teenage child he went from someone considered gifted (very high grades), to someone who could not tie his own shoes. Extreme cognitive impairment which his parents noticed and objected to during the ongoing treatment. In contrast, with modern psychology he would likely had gotten a diagnose of ADHD or autism because of his temper tantrums, and treatment outcome would look very different. We have to consider that cultural environment of the 60s and early 70s. A lot of society, especially education, demanded a military style discipline. A student who did not obey got literally beaten until they did, breaking people physically and mentally until they would fit the mold. Electroshock therapy in that culture worked very effectively in doing so.
- btilly 7y ago
  I'm sorry, inserting an icepick through the eye then scrambling the brain behind it has a pretty well-deserved reputation as being barbaric. What is done today far more rarely and far more selectively has no relationship to the old treatment. I'm also aware that electroshock therapy has real uses. However the widespread use of it with little cause has gone the way of the dodo for good reasons. But a lot of people suffered before psychiatry stopped using it as a routine treatment to use as a first resort for a wide variety of conditions.
  - jdietrich 7y ago
    >I'm sorry, inserting an icepick through the eye then scrambling the brain behind it has a pretty well-deserved reputation as being barbaric. All surgery is barbaric in those terms. You're knocking people out and cutting them apart, it's never going to be pretty. It's only actually barbaric if you're doing it for no good reason. Lobotomy was crude and error-prone, but it was a lifesaving intervention for a substantial proportion of patients. Although some patients were probably needlessly subjected to a lobotomy, the absolute number of patients treated represented a very small proportion of the overall population living with severe and enduring mental illness. We didn't abandon lobotomy because we realised it was barbaric, we abandoned it because we discovered tricyclic antidepressants, antipsychotics and lithium. The discovery of those drugs was also the fundamental reason for de-institutionalisation in the 1960s and 70s - to a great extent the asylums emptied themselves, because enormous numbers of patients were now capable of independence. The fundamental lesson of the past isn't "psychiatry is terrible and we should be afraid of it", but "terrible things happen when you have desperately ill people and no good treatments". The solution is not a crusade against psychiatry, but a massive investment in developing new treatments and actually using the treatments we already have.
    - ncmncm 7y ago
      "We didn't abandon lobotomy because we realised it was barbaric" Exactly the problem, right there. Many thousands of people were lobotomized not because they had severe, untreatable illnesses, but just because they were inconvenient. In only slightly more barbaric times and places they would be slaughtered or starved, as happened quite recently in China, Russia, Cambodia, Mozambique, Guatemala, Germany, ...
antt 7y ago
Transgender "acceptance". Giving hormones to tweens for the sake of a rounding error of the population will be looked down by history in the same light as burning witches to save their souls.
- b_tterc_p 7y ago
  Witches didn’t want to be burned. It’s also pretty insulting to throw the word tweens in there, implying that transgender issues are just a tween phase.
  - antt 7y ago
    Your ideology and bias is showing. You're fighting a straw man that has nothing to do with what I said.
    - b_tterc_p 7y ago
      strictly speaking, I’m glad that my world views are clearly communicated in my words
      - antt 7y ago
        The problem is that it's much more clearly communicated by your blind spots and assumptions. In 20 years when a generation of children with butchered bodies for the sake of a vocal minority ask you "Why?" what will you say "But I only meant to do good!"? The path to hell is paved with good intentions, and the neon hair fringe of the trans community is racing down that high way as fast as it can.
        b_tterc_p 7y ago
        This is a studied thing. Some do, but the vast majority do not regret sex change operations. Also it’s highly unlikely that people would ask why. We aren’t forcing people to get transgender operations. If anything we are encouraging them not to. They’re the ones pushing for it. They know why it happened. Extreme liberal parents might exist who ok it at the drop of a hat but I’ll bet a dollar they’re the edge case. Lastly most operations occur on adults. Your opinion seems to be that all transgender is bad, but you’re angling it on the subset that might be more grey

by btilly 7y ago

jdietrich 7y ago

Lobotomy and electroshock therapy have an undeserved reputation as being barbaric and futile. We've substantially refined both techniques and we still use them where other options of failed. In the case of lobotomy, we now use stereotactic guided procedures to precisely ablate small parts of the brain, mainly for the treatment of severe OCD and treatment-resistant depression. In the case of ECT, we perform the procedure under full sedation and use EEG monitoring to deliver the minimum possible energy. Both treatments still carry a substantial burden of side-effects, but they work when nothing else does. The uncomfortable reality is that a lot of people have debilitating, life-threatening mental health problems that don't always respond to medication or psychotherapy. Most of us don't want to think about what very severe mental illness really looks like - the person who is too depressed to sit up in bed, the person with OCD who picks at their wounds until they hit bone, the person with mania who is keen to test their belief that they're immortal. If you were treating a patient with that level of disability, what would you do? The real disaster of psychiatry isn't the failed attempts, but all the stuff that we don't yet know how to treat or don't have the resources to treat. Mental illnesses are the single biggest cause of disability in the developed world. There's so much we could be doing, so much we should be doing, but we're not spending nearly enough on research or treatment. We're watching helplessly as people live short, miserable lives because of diseases that are treatable or potentially treatable.

belorn 7y ago
As someone who has relative who underwent electroshock therapy in the 70s and read documentation from before, during and after, I will say that the treatment is worse than barbaric. For all practical purposes it was a treatment to remove the issue out of sight and out of mind. As a teenage child he went from someone considered gifted (very high grades), to someone who could not tie his own shoes. Extreme cognitive impairment which his parents noticed and objected to during the ongoing treatment. In contrast, with modern psychology he would likely had gotten a diagnose of ADHD or autism because of his temper tantrums, and treatment outcome would look very different. We have to consider that cultural environment of the 60s and early 70s. A lot of society, especially education, demanded a military style discipline. A student who did not obey got literally beaten until they did, breaking people physically and mentally until they would fit the mold. Electroshock therapy in that culture worked very effectively in doing so.
btilly 7y ago
I'm sorry, inserting an icepick through the eye then scrambling the brain behind it has a pretty well-deserved reputation as being barbaric. What is done today far more rarely and far more selectively has no relationship to the old treatment. I'm also aware that electroshock therapy has real uses. However the widespread use of it with little cause has gone the way of the dodo for good reasons. But a lot of people suffered before psychiatry stopped using it as a routine treatment to use as a first resort for a wide variety of conditions.
- jdietrich 7y ago
  >I'm sorry, inserting an icepick through the eye then scrambling the brain behind it has a pretty well-deserved reputation as being barbaric. All surgery is barbaric in those terms. You're knocking people out and cutting them apart, it's never going to be pretty. It's only actually barbaric if you're doing it for no good reason. Lobotomy was crude and error-prone, but it was a lifesaving intervention for a substantial proportion of patients. Although some patients were probably needlessly subjected to a lobotomy, the absolute number of patients treated represented a very small proportion of the overall population living with severe and enduring mental illness. We didn't abandon lobotomy because we realised it was barbaric, we abandoned it because we discovered tricyclic antidepressants, antipsychotics and lithium. The discovery of those drugs was also the fundamental reason for de-institutionalisation in the 1960s and 70s - to a great extent the asylums emptied themselves, because enormous numbers of patients were now capable of independence. The fundamental lesson of the past isn't "psychiatry is terrible and we should be afraid of it", but "terrible things happen when you have desperately ill people and no good treatments". The solution is not a crusade against psychiatry, but a massive investment in developing new treatments and actually using the treatments we already have.
  - ncmncm 7y ago
    "We didn't abandon lobotomy because we realised it was barbaric" Exactly the problem, right there. Many thousands of people were lobotomized not because they had severe, untreatable illnesses, but just because they were inconvenient. In only slightly more barbaric times and places they would be slaughtered or starved, as happened quite recently in China, Russia, Cambodia, Mozambique, Guatemala, Germany, ...

antt 7y ago

Transgender "acceptance". Giving hormones to tweens for the sake of a rounding error of the population will be looked down by history in the same light as burning witches to save their souls.

b_tterc_p 7y ago
Witches didn’t want to be burned. It’s also pretty insulting to throw the word tweens in there, implying that transgender issues are just a tween phase.
- antt 7y ago
  Your ideology and bias is showing. You're fighting a straw man that has nothing to do with what I said.
  - b_tterc_p 7y ago
    strictly speaking, I’m glad that my world views are clearly communicated in my words
    - antt 7y ago
      The problem is that it's much more clearly communicated by your blind spots and assumptions. In 20 years when a generation of children with butchered bodies for the sake of a vocal minority ask you "Why?" what will you say "But I only meant to do good!"? The path to hell is paved with good intentions, and the neon hair fringe of the trans community is racing down that high way as fast as it can.
      - b_tterc_p 7y ago
        This is a studied thing. Some do, but the vast majority do not regret sex change operations. Also it’s highly unlikely that people would ask why. We aren’t forcing people to get transgender operations. If anything we are encouraging them not to. They’re the ones pushing for it. They know why it happened. Extreme liberal parents might exist who ok it at the drop of a hat but I’ll bet a dollar they’re the edge case. Lastly most operations occur on adults. Your opinion seems to be that all transgender is bad, but you’re angling it on the subset that might be more grey