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I don't think this was intended as a general purpose argument against ever treating mood disorders. Rather, the parent comment is describing the fact that anxie

I don't think this was intended as a general purpose argument against ever treating mood disorders. Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. I can somewhat relate from experience: I went to a doctor for terrible trouble sleeping, to the point that it was affecting my physical health, that we assumed was caused by anxiety/depression[1]. I was pretty shocked at the rapidity with which she suggested going on antidepressants, particularly considering the tapering periods and the seriousness of the dependency and side effects that they cause. I pushed back a little but it turns out that my doctor's cavalier attitude towards antidepressants isn't out of the norm: they're considered a "try it and see what happens" first line of defense, without trying to get a better sense of the patient's specific issues and whether therapy or other interventions, sans medication, would be a better fit (though I should note that the doctor recommended that I go to therapy if possible in conjunction). Tangentially, this fits with a larger disillusionment I have with the medical system: a combination of screwy incentives, bad lines of communication between generalists and specialists, and a serious institutional/cultural case of a God complex leading to a lack of critical thinking means that I'm at the point where I pretty much keep anything a doctor tells me as just another unreliable information source, weighted more heavily perhaps than my layman's understanding of the research but on categorically the same level. Ive seen the same disillusionment kick in among my doctor family members: in our conversations over the years, my sister and her husband have gone from a central case of said God complex to as much as telling me not to take doctors' advice without a heavy dose of skepticism. I should note that I don't actually consider this a criticism of any individual physicians as much as the realities of the system. One of the biggest factors is that the average person showing up at the doctor is simultaneously incredibly dumb and incredibly confident in their understanding of the medical problem. It makes sense for doctors to be a somewhat heavy-handed and reductive, and once you build those habits into your institutions and pedagogy, it's hard to turn it off. [1] Turns out it was the other way around: consistently not sleeping causes some pretty crappy psychological problems

SketchySeaBeast 7y ago
How did you fix your sleep problem? And if they both disappeared at the same time, how can you be certain that your not the one mixing up cause and effect?
- wutbrodo 7y ago
  > if they both disappeared at the same time They didn't disappear at the same time. I was on antidepressants for a year and my time on antidepressants was pretty much independent of the degree to which my sleep problems were fixed. I probably was slightly less anxious while on the antidepressants, but this was far overwhelmed by the fact that I get/got anxious & depressed after the nights my sleep was poor and I don't/didn't whenever I sleep well. I was able to narrow it down to this specific direction of causality (bad sleep -> anxious the next day) through the fact that my sleep was often affected by exogenous physical factors. I apologize for not going into too much identifying detail on a pseudonymous account, but I solved it by completely ignoring the medical establishment, reading voraciously about the problem, and experimenting on myself until I got myself to an 85% solution that at least allowed me to get back to work. This happened at a far, far slower and more grinding pace than the counterfactual in which I had any competent doctors around me (or rather, if competency wasn't ludicrously uncommon within medicine), since 1) I was sick, 2) I was employed until I quit to focus on the issue, and 3) I don't have an educational background in medicine the way that a doctor (ostensibly) would. I'm far, far, far more comfortable reading papers in noisy epistemological environments than most people; I can't even imagine how horrible and expensive and drawn-out this process would have been had I not been had the confidence or ability to take this route and had to rely on the medical establishment. After getting most of the way there myself, I still have issues sleeping once every week or two, and I decided to visit the relevant specialist to use them as a reference to expedite my path to a 100% solution[1]. It's a criminal indictment of our medical system that the only recourse for patients with complex, multi-factor health problems is to themselves navigate both medical knowledge and the medical system until they've narrowed it down to a fairly well-defined, simple solution. To the extent that the system's abdication of responsibility is driven by individuals' decisions, they should be ashamed of themselves (though again, I will reiterate once again that I think that the problem is systemic; I think most people of average intelligence would behave similarly in the situations that doctors find themselves in and I haven't seen any evidence that leads me to believe that most doctors are particularly extra-bright). [1] At which point regulatory BS popped up again and I was legally required to have a perfunctory appt (at the cost of several hundred dollars, of course) with a doctor to request a referral to this type of specialist
klodolph 7y ago
> Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. Agreed, and I would say that the answer to this is to have the licensed professionals guide the diagnosis. Don’t just self-diagnose or read a Wikipedia page and think you have an anxiety disorder. (It’s a good starting point and you can take your self-diagnosis to a psych{olog,iatr}ist and explain why you think you have a particular disorder.) You hit the nail on the head with poor communication between generalists and specialists. This is why it looks like drugs are the first line of defense—because you went to the doctor first. If you had gone to a therapist first, the first line of defense would have been therapy. The doctor understands medication as a lever that they can pull, they can guide you through the process of finding a medication that alleviates your symptoms without bad side effects, and do it all safely. The doctor generally doesn’t understand the process of therapy or its outcomes because it’s not something they administer (except some psychiatrists). I would add that the side effects of modern antidepressants are surprisingly manageable. This is reasonable to me. Like if you have complaints about your husband and talk to a divorce lawyer, you’ll get a different set of recommendations than if you go to your therapist, your best friend, some strangers online, or a priest. Sleep problems in particular are troublesome, because so often they are caused by a complex set of factors that we have varying degrees of control over. The doctor’s ability to prescribe you medicine is one of the very limited number of ways that the doctor can help you get sleep. The other ways to help you get sleep might involve moving, modifying your house/apartment, changing your daily habits regarding exercise/eating/alcohol/screen use, therapy, accommodations at work, or a hundred other things. I could just as easily diagnose myself with “having a crappy boss” and switch jobs, but the doctor (usually) won’t tell you to switch jobs. That treatment option comes with a hell of a lot of side effects, too. > [1] Turns out it was the other way around: consistently not sleeping causes some pretty crappy psychological problems That may be the case for you, but psychological problems do cause sleep problems for many people (including myself). There’s often some positive feedback loop / death spiral involved in any ongoing problem.
- wutbrodo 7y ago
  > You hit the nail on the head with poor communication between generalists and specialists. This is why it looks like drugs are the first line of defense—because you went to the doctor first. If you had gone to a therapist first, the first line of defense would have been therapy. IMO and IME this is a really bad idea. My experience with specialists is that they're far, far more myopic than generalists: eg if you have symptoms that manifest in the feet, podiatrists or foot orthopedists won't solve your foot problems, they'll provide foot solutions, whether or not these solutions are relevant or helpful. This stems from the same rotten root of the endemic myopia and lack of critical thinking among medical professionals[1]. As I mentioned above, the problem didn't even end up being with anxiety, so going to a therapist would have been worse than useless for me. My complaint is that my conversation with my doctor was very brief, during which I mentioned fairly strong symptoms of anxiety, and the doctor was immediately gung-ho about anti-depressants. I should also note that this was a GP who (at least nominally) was somewhat specialized in mental healthcare issues, so it's not like this was throwing a case at a random doctor and expecting them to be a specialist. On top of that,using a GP as an entry point to the healthcare system is, roughly speaking, their _only_ job, and what's shocking is how widespread a basic lack of competency at this sole task is. > The doctor understands medication as a lever that they can pull, they can guide you through the process of finding a medication that alleviates your symptoms without bad side effects, and do it all safely. The doctor generally doesn’t understand the process of therapy or its outcomes because it’s not something they administer (except some psychiatrists). I would add that the side effects of modern antidepressants are surprisingly manageable. I may have failed expressed myself clearly, but this is sort of my point: the bar that I'm setting is one that I think anyone with fundamental critical thinking skills could clear, barring a gross case of apathy towards patient welfare. It's been my unfortunate experience that this minimal combination is pretty lacking when it comes to doctors, either specialist or generalist. The notion that a doctor should jump to prescribing medicine because it's all they know how to do is insane to me, since it completely rules out the possibility of understanding the patient's case further instead of grabbing whatever hammer happens to be lying around. Now granted, I have a fairly limited sample size personally, but I've seen the same thing play out with family members whose care I've been involved in, and my empirical anecdota are theoretically supported by conversations I've had with doctor friends/family over the years. At the very least, I've _personally_ decided to treat doctors as nothing more than legal impediments to prescription medicine, an incomplete chatbot UI to medical knowledge, and an occasional source of novel medical information. This has worked out _far_ better for me than the alternative of assuming that a typical GP has a baseline of competence (I've made more progress on my sleep issues in the last year than the previous half decade by taking this approach, and dealt with some niggling minor medical issues that every GP I've ever had completely failed to address). > Like if you have complaints about your husband and talk to a divorce lawyer, you’ll get a different set of recommendations than if you go to your therapist, your best friend, some strangers online, or a priest. Just to reiterate, the complaint is not that your best friend would have something different to say from your priest, but that either of them would respond with a stock answer instead of listening to you and thinking about it. If your pastor says "Say ten hail marys" to any person's request for advice, the problem isn't that he has a narrow view but that he's a shitty priest. If you can replace a doctor, or a priest, or a best friend with a post-it note or a first-page Google search, it seems almost tautological that they're somewhat incompetent. [1] (though again, I don't think this is because they're dumber than the average person or anything like that; rather, the institutional pushes in the other direction that they get are strong enough that the only doctors I know (sadly, not as a patient) that do think critically about their patients' issues are the very-intelligent ones that would probably excel in most fields).

SketchySeaBeast 7y ago

How did you fix your sleep problem? And if they both disappeared at the same time, how can you be certain that your not the one mixing up cause and effect?

wutbrodo 7y ago
> if they both disappeared at the same time They didn't disappear at the same time. I was on antidepressants for a year and my time on antidepressants was pretty much independent of the degree to which my sleep problems were fixed. I probably was slightly less anxious while on the antidepressants, but this was far overwhelmed by the fact that I get/got anxious & depressed after the nights my sleep was poor and I don't/didn't whenever I sleep well. I was able to narrow it down to this specific direction of causality (bad sleep -> anxious the next day) through the fact that my sleep was often affected by exogenous physical factors. I apologize for not going into too much identifying detail on a pseudonymous account, but I solved it by completely ignoring the medical establishment, reading voraciously about the problem, and experimenting on myself until I got myself to an 85% solution that at least allowed me to get back to work. This happened at a far, far slower and more grinding pace than the counterfactual in which I had any competent doctors around me (or rather, if competency wasn't ludicrously uncommon within medicine), since 1) I was sick, 2) I was employed until I quit to focus on the issue, and 3) I don't have an educational background in medicine the way that a doctor (ostensibly) would. I'm far, far, far more comfortable reading papers in noisy epistemological environments than most people; I can't even imagine how horrible and expensive and drawn-out this process would have been had I not been had the confidence or ability to take this route and had to rely on the medical establishment. After getting most of the way there myself, I still have issues sleeping once every week or two, and I decided to visit the relevant specialist to use them as a reference to expedite my path to a 100% solution[1]. It's a criminal indictment of our medical system that the only recourse for patients with complex, multi-factor health problems is to themselves navigate both medical knowledge and the medical system until they've narrowed it down to a fairly well-defined, simple solution. To the extent that the system's abdication of responsibility is driven by individuals' decisions, they should be ashamed of themselves (though again, I will reiterate once again that I think that the problem is systemic; I think most people of average intelligence would behave similarly in the situations that doctors find themselves in and I haven't seen any evidence that leads me to believe that most doctors are particularly extra-bright). [1] At which point regulatory BS popped up again and I was legally required to have a perfunctory appt (at the cost of several hundred dollars, of course) with a doctor to request a referral to this type of specialist

klodolph 7y ago

> Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. Agreed, and I would say that the answer to this is to have the licensed professionals guide the diagnosis. Don’t just self-diagnose or read a Wikipedia page and think you have an anxiety disorder. (It’s a good starting point and you can take your self-diagnosis to a psych{olog,iatr}ist and explain why you think you have a particular disorder.) You hit the nail on the head with poor communication between generalists and specialists. This is why it looks like drugs are the first line of defense—because you went to the doctor first. If you had gone to a therapist first, the first line of defense would have been therapy. The doctor understands medication as a lever that they can pull, they can guide you through the process of finding a medication that alleviates your symptoms without bad side effects, and do it all safely. The doctor generally doesn’t understand the process of therapy or its outcomes because it’s not something they administer (except some psychiatrists). I would add that the side effects of modern antidepressants are surprisingly manageable. This is reasonable to me. Like if you have complaints about your husband and talk to a divorce lawyer, you’ll get a different set of recommendations than if you go to your therapist, your best friend, some strangers online, or a priest. Sleep problems in particular are troublesome, because so often they are caused by a complex set of factors that we have varying degrees of control over. The doctor’s ability to prescribe you medicine is one of the very limited number of ways that the doctor can help you get sleep. The other ways to help you get sleep might involve moving, modifying your house/apartment, changing your daily habits regarding exercise/eating/alcohol/screen use, therapy, accommodations at work, or a hundred other things. I could just as easily diagnose myself with “having a crappy boss” and switch jobs, but the doctor (usually) won’t tell you to switch jobs. That treatment option comes with a hell of a lot of side effects, too. > [1] Turns out it was the other way around: consistently not sleeping causes some pretty crappy psychological problems That may be the case for you, but psychological problems do cause sleep problems for many people (including myself). There’s often some positive feedback loop / death spiral involved in any ongoing problem.

wutbrodo 7y ago
> You hit the nail on the head with poor communication between generalists and specialists. This is why it looks like drugs are the first line of defense—because you went to the doctor first. If you had gone to a therapist first, the first line of defense would have been therapy. IMO and IME this is a really bad idea. My experience with specialists is that they're far, far more myopic than generalists: eg if you have symptoms that manifest in the feet, podiatrists or foot orthopedists won't solve your foot problems, they'll provide foot solutions, whether or not these solutions are relevant or helpful. This stems from the same rotten root of the endemic myopia and lack of critical thinking among medical professionals[1]. As I mentioned above, the problem didn't even end up being with anxiety, so going to a therapist would have been worse than useless for me. My complaint is that my conversation with my doctor was very brief, during which I mentioned fairly strong symptoms of anxiety, and the doctor was immediately gung-ho about anti-depressants. I should also note that this was a GP who (at least nominally) was somewhat specialized in mental healthcare issues, so it's not like this was throwing a case at a random doctor and expecting them to be a specialist. On top of that,using a GP as an entry point to the healthcare system is, roughly speaking, their _only_ job, and what's shocking is how widespread a basic lack of competency at this sole task is. > The doctor understands medication as a lever that they can pull, they can guide you through the process of finding a medication that alleviates your symptoms without bad side effects, and do it all safely. The doctor generally doesn’t understand the process of therapy or its outcomes because it’s not something they administer (except some psychiatrists). I would add that the side effects of modern antidepressants are surprisingly manageable. I may have failed expressed myself clearly, but this is sort of my point: the bar that I'm setting is one that I think anyone with fundamental critical thinking skills could clear, barring a gross case of apathy towards patient welfare. It's been my unfortunate experience that this minimal combination is pretty lacking when it comes to doctors, either specialist or generalist. The notion that a doctor should jump to prescribing medicine because it's all they know how to do is insane to me, since it completely rules out the possibility of understanding the patient's case further instead of grabbing whatever hammer happens to be lying around. Now granted, I have a fairly limited sample size personally, but I've seen the same thing play out with family members whose care I've been involved in, and my empirical anecdota are theoretically supported by conversations I've had with doctor friends/family over the years. At the very least, I've _personally_ decided to treat doctors as nothing more than legal impediments to prescription medicine, an incomplete chatbot UI to medical knowledge, and an occasional source of novel medical information. This has worked out _far_ better for me than the alternative of assuming that a typical GP has a baseline of competence (I've made more progress on my sleep issues in the last year than the previous half decade by taking this approach, and dealt with some niggling minor medical issues that every GP I've ever had completely failed to address). > Like if you have complaints about your husband and talk to a divorce lawyer, you’ll get a different set of recommendations than if you go to your therapist, your best friend, some strangers online, or a priest. Just to reiterate, the complaint is not that your best friend would have something different to say from your priest, but that either of them would respond with a stock answer instead of listening to you and thinking about it. If your pastor says "Say ten hail marys" to any person's request for advice, the problem isn't that he has a narrow view but that he's a shitty priest. If you can replace a doctor, or a priest, or a best friend with a post-it note or a first-page Google search, it seems almost tautological that they're somewhat incompetent. [1] (though again, I don't think this is because they're dumber than the average person or anything like that; rather, the institutional pushes in the other direction that they get are strong enough that the only doctors I know (sadly, not as a patient) that do think critically about their patients' issues are the very-intelligent ones that would probably excel in most fields).