6 ms·

> Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. Agreed, and I would

> 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).

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).