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The Evolution of Psychiatry
- KorfmannArno 6y agoWhat I don't understand: It's clear scientifically that no medication heals depression or addiction and yet these pills are happily prescribed in psychiatries.
- perfmode 6y agoshhh. get back to work. keep paying your mortgage and car note.
- bananamerica 6y agoMedication alone does not cure those things (who’s saying that?) but it does help you endure them and make you available to other kinds of treatment. You can’t do psychotherapy if you cannot talk or leave the house at all, for example. Some conditions require life long management with or without medication. Some people will eventually be able to stop taking the meds. Others won’t.
- PragmaticPulp 6y agoFor anyone reading this and considering seeking help: There is a strong anti-psychiatry movement online following in the footsteps of the anti-vax movement. Please ignore it. If you have concerns about your mental health, please don’t hesitate to contact a medical professional. Note that medications are not the only approach to treatment, although we have decades of evidence showing that they do show benefit in helping many people as part of their journey toward better mental health. However, plenty of people have great success with therapy-only if that’s your preference. The most important thing is to try to make progress, try different treatment modalities, and see what works for you.
- 0x2a 6y agoDo the benefits of psychiatric medications have the same amount of evidence as vaccines?
- vajrabum 6y agoThey have the same kind of evidence. There are double-blinded studies demonstrating their efficacy or they wouldn't be on the market. When used properly most vaccines are highly effective and protect the large majority of people who get them. Maybe more importantly we understand in some detail how they work. Psychiatric conditions and their treatments are much less well understood. The medications generally don't have as powerful an effect as a vaccine. That isn't a reason not to use them.
- KerryJones 6y agoCan you link to one?
- Sebguer 6y agoWhy would anyone want to continue to engage with your bad faith argument? Science doesn't work on the basis of "linking to one study" and to try to make a point by demanding one shows that you're not interested in an actual discussion. But, sure, here's a single, arbitrary metanalysis on several studies on the efficacy of a single antidepressant: https://journals.sagepub.com/doi/pdf/10.1177/2045125316629071 https://journals.sagepub.com/doi/pdf/10.1177/204512531662907...
- KorfmannArno 6y agohttps://en.wikipedia.org/wiki/Bupropion#Depression https://en.wikipedia.org/wiki/Bupropion#Depression
- Sebguer 6y agoThanks for proving my point. Edit: Oh, you're the grandparent comment. I explicitly wasn't talking to you, since you're not even pretending to argue in good faith.
- exolymph 6y agoI take 225mg of venlafaxine every day and I am entirely serious that this medication saved my life. I've tried tapering off and the debilitating malaise came back. I'll probably take these pills as long as I live, and I'm okay with that because they give me the energy to function, to improve and thrive. Without medication I would not have been able to work on my mental health in non-psychiatric ways, which has also been tremendously useful.
- nvrspyx 6y agoSteroids don't heal infections, beta blockers don't heal congestive heart failure, pain medications don't heal broken bones, stimulants don't heal ADHD, etc. There is plenty of empirical evidence that antidepressants and other psychiatric medications have a significant effect of reducing or relieving symptoms, which help manage living with the respective disorder and/or help the patient work towards "healing", such as giving a patient enough relief to be motivated to actually go to recurring therapy or CBT sessions. I honestly have no idea why someone would make such a comment whilst being so blatantly ignorant of the subject.
- KorfmannArno 6y agohttps://en.wikipedia.org/wiki/Cannabis_use_disorder#Medication https://en.wikipedia.org/wiki/Cannabis_use_disorder#Medicati...
- tsimionescu 6y agoLinking to an arbitrary article that is somewhat related to the topic is not helpful. Please try to at least give some context for why you believe the article contains a relevant response to your parent comment, out of common courtesy if nothing else.
- tsimionescu 6y agoFor a lot of depressed people, medication can significantly improve their life. This has been proven time and time again through double-blind clinical trials, just like any other medication that gets sold. While for some people the medication becomes a permanent part of their lives, there are others it just helps get over an episode. Are they suffering from the same disease, just with a chronic vs episodic form? Are they in fact separate diseases? Are the drugs curing some people but only 'sustaining' others? I don't think we have the answers to these questions yet, but that doesn't mean that we don't have a wealth of evidence that these drugs can do more good than harm.
- amelius 6y agoWhat remained the same: healthy people still can't relate very well to people with a mental disorder. That's probably why cancer research gets a multiple in funding of what research into mental disorders gets.
- TeaDrunk 6y agoPeople with mental disorders cannot relate very well to people with very different mental disorders as well. Someone with a mood disorder may still be bigoted towards someone with a developmental condition like ADHD.
- watwut 6y agoIt is not just issue of feeling related. Some mental health issues have massive impact on those around and on their mental health. For example, mood disorder may mean you get yelled at and insulted or put down a lot, unpredictably and for no own fault. It may be result of sickness, but verbal abuse consequence is same.
- acituan 6y ago> What remained the same: healthy people still can't relate very well to people with a mental disorder. I'm not sure if there exists a such crisp boundary. Lifetime prevalence of mental illness in the US is about 50%. In any given year 25% of the adult US population will have a mental illness. [1] > That's probably why cancer research gets a multiple in funding of what research into mental disorders gets. Cancers amounts for 15% of disability claims while mental illness does 10%, that might be one driving factor. (Not saying it is justified). The other one is, unlike cancer, most mental illnesses are explained with a bio-psycho-social model, which is incredibly hard to design comprehensive interventions for, or to get enduring results with one-shot interventions. We know quite a good deal about how adverse childhood experiences, economic hardships, familial structures etc affect mental health. The problem is there is only so much space for intervention there that doesn't hinge on societal restructuring. Which is why the agency we exercise in response is limited to pharmacotherapy and talk therapy, at least those insurance would pay for. [1] https://psychcentral.com/blog/cdc-statistics-mental-illness-in-the-us/ https://psychcentral.com/blog/cdc-statistics-mental-illness-...
- valuearb 6y agoI look forward to the Evolution of Astrology.
- intuitionist 6y agoIs the history of psychiatry one of progress? Or is it one of damage and partial repair? I very well might not be alive if not for my SSRI prescription, but the side effects are brutal and lasting, and as a first-line treatment for kids too young to drive it really leaves a ton to be desired.
- pyentropy 6y agoI'm really angry at Pfizer and co for ditching MAOIs for SSRIs. All research shows that they are much more effective, have no emotional blunting effect and have less impact on libido, at the cost of not being allowed to eat cheese and some insomnia. SlateStarCodex wrote about it in his prescription perversity post. [1] [1] https://slatestarcodex.com/2015/04/30/prescriptions-paradoxes-and-perversities/ https://slatestarcodex.com/2015/04/30/prescriptions-paradoxe...
- cmehdy 6y agoI remember being told to watch out for side effects when switching from an SSRI (Trintellix) to a RIMA (Manerix), which is essentially a de-fanged MAOI. Younger psychiatrist kept pushing for the brand-new SSRI, I kept pushing back. Never mentioned anything else despite my attempts to open the discussion, and my own research (and in fact, experience thanks to darknet markets) over years. Eventually "agreed to disagree" (I hate this expression), I moved on from that place where I was stagnating in pain, and found a sensible knowledgeable psychiatrist who happens to be much older, and we made the switch. It's hard to understate how much of a change that was in my life. I try not to be bitter about any fresh new psychiatry grad on the block, but I really hope they get their shit together as a collective and observe what their own patients (and their older peers) seem to know better than them. No matter how much tyramine I ingest (which is supposed to be a no-no on MAOI/RIMA) the worst side effects I suffer can't even get anywhere near what the SSRI would TYPICALLY do to me. On Trintellix: morning headaches, being unable to have any caffeine, becoming lactose intolerant, frequent cramps and diarrhea. Depression very very mildly alleviated. Transition period when stopping the meds: 2 weeks. Cost of monthly refill: $110 CAD. On Manerix: some cramps if I ingest gigantic amounts of tyramine (I'm french, I'm talking cured meats+cheese plates and red wine bottles in the same meal). Could be back to coffee and milk with no headaches nor cramps within a couple weeks. Depression mostly alleviated. Transition period when stopping the meds: 2-4 days. Cost of monthly refill: $30 CAD. Oh and the kicker? Manerix is actually one of the few antidepressants that actually has a chance to "increase libido" as a side effect! I'm glad someone wrote a good article on what I've been hoping to articulate in different places over time, thanks for the share.
- lquist 6y agoThis article is fascinating. It proposes an evolutionary theory of mental illness (e.g., "Psychopathy...as a cheating strategy which is game theoretically optimal for some portion of a group."). What might be the evolutionary reasons for Depression and Anxiety?
- jjtheblunt 6y agoperhaps self-preservation from overestimation of risk, and then reduction in perceived risk taking
- inportb 6y agoEnhanced analytic capacity and avoidance of distractions, apparently. https://www.scientificamerican.com/article/depressions-evolutionary/ https://www.scientificamerican.com/article/depressions-evolu...
- deleted 6y ago[deleted]
- skissane 6y agoThe article goes to great length to consider possible evolutionary explanations of autism, but never considers another possibility – Lynn Waterhouse's argument [1][2] that ASD does not exist. Waterhouse doesn't deny the symptoms exist – indeed, she spent much of her career trying to help children with those symptoms. She simply argues that the symptoms are caused by numerous unknown diverse causes in the brain, and the concept of a single disorder (ASD), or even a spectrum of related disorders (ASDs, the DSM-IV PDDs, and more recent ASD sub-typing proposals), isn't helpful in understanding those causes. Waterhouse argues that in order to have the best chance of finding effective treatments for people impaired by those symptoms, researchers should abandon the idea that ASD (or even ASDs/ASCs) is a useful concept in understanding what causes them. If Waterhouse's position is correct, then trying to find a single evolutionary explanation for numerous diverse brain conditions (that people have lumped together under a single label) is probably not a very useful approach. [1] https://books.google.com/books?id=IaFY8r0rpn8C&printsec=frontcover https://books.google.com/books?id=IaFY8r0rpn8C&printsec=fron... [2] https://link.springer.com/article/10.1007/s40489-016-0085-x https://link.springer.com/article/10.1007/s40489-016-0085-x
- deleted 6y ago[deleted]
- kurthr 6y agoIndeed, this sounds a lot like cancer, which has some similar effects (even on different organs), and can be induced by a variety of methods (genetic, carcinogen, etc), but is fundamentally many different conditions often requiring different treatments. The desire to categorize and use reductive reasoning is powerful and seductive, but not always effective until you really understand the system. With human biology and brain we're a long way from that.
- skissane 6y agoWaterhouse argues that the boundary between ASD and non-ASD conditions (such as ADHD, intellectual disability, epilepsy, etc) is invalid and needs to be abandoned. I'm not aware that anyone is making a really comparable argument with respect to cancer. Cancers derived from different organ tissues are usually clearly distinguishable from each other, something which is far less true when talking about different psychiatric/psychological/neurodevelopmental diagnoses.
- jackcosgrove 6y ago> Social oddities could be forgiven when your mind is spectacularly useful Or simply when one's mind is not a threat to others. Perhaps those who see abnormality as a threat are themselves disordered?
- abellerose 6y agoPsychiatry as a profession is very dark. Even today if someone is wronged by it. They will receive little to no remedy unless very financially well off, or public outcry, and or the psychiatrist admitted wrong to his or her actions. I frequent a website where most people are seeking to end their life from an assortment of mental illnesses. Majority of them have tried multiple psychiatrists as well as therapists and with little to no success in curing their suffering. I find it egregious that people may think psychiatrists actually seek the benefit of the patient's wishes because I know personally the request for MAiD falls on deaf ears. Instead these patients continue to experience involuntary treatment if they live in less civil countries or advised to try different medication. I've known someone labeled schizophrenic where it costed their insurance well over 60k and in less than a year from involuntary hospitalization while being drugged & observed. I know other psychological illnesses like Gender Dysphoria where a person went through the wrong puberty never get that funded for their quality of life to improve (fixing voice & appearance). Anyway I think the whole field is very questionable if psychiatrists have a sincere interest in the person their treating that's basically their customer that keeps coming back.
- outlace 6y agoFor those interested in a history of psychiatry, see “Mind Fixers” by Ann Harrington (Harvard historian).
- crotho 6y agoWe still have hardening of the arteries just like Otzi the Iceman did. By the same token, some of the most well described instances of neurosis and psychosis in literature are described in some of our oldest texts. IOW: It's more likely to be good genetic mechanisms gone wrong than good genetic mechanisms going right. Everything good can go wrong, and maybe the limited set of symptoms that can present themselves when good genetics malfunctions are the things like cancer, hardening of the arteries, and mental "quirks" that have been with humanity for as long as the archeological record suggests. There is no evolutionary pressure to get rid of the good genes and so the advantages of having working genetic mechanisms outweigh the fewer yet forever inevitable instances in which those expressions can go wrong, and those things will be with humanity forever.
- JackFr 6y agoThe main stumbling block of evolutionary psychiatry (psychology?) is that one is always in danger of coming up with ever more clever just-so stories that can never be proven or rejected by experiment but rely on who has the most compelling argument. The author also makes a grave but subtle misstep when he says “the eye evolved to see” - the eye most decidedly DID NOT evolve to see. The eye evolved and does see but importantly evolution has no intent, it has no goal and it has no purpose. I might sound pedantic but there is an important distinction between “the eye sees” and “the eye was meant to see”.
- trabant00 6y agoEverything I know about psychiatry and therapy has me believe we are in the alchemy phase of mental health practice. We have a huge number of theories and arguments that all sound reasonable but are contradictory and fail horribly when applied to everybody with the same disfunction label. We are not without success examples but I don't know if overall we are at net possitive. What I dislike mostly about the situation is pacients and families rarely being made aware of the gamble that is treatment. If the situation is bad enough you have basically nothing to lose, so sure, try anything at your disposal. But medicating young boys for being unruly for example...
- enkid 6y agoThere are certainly treatments that are based on evidence and capable of helping individuals in a variety of circumstances. From what I've read, Cognitivr Behavioral Therapy and some of its spin offs really do help people recover from trauma. The problem, as far as I can tell, is that not all practicing psychiatrist choose to use them.
- PaulAJ 6y agoYes, but.... The trouble with evolutionary explanations of human psychology is that they are "just so stories". Actual tests of these hypotheses are extremely difficult. Sometimes you can get somewhere with experiments on other mammals, but for the most part its high piles of speculation. The little story about the possibly autistic reindeer herdsman is a case in point. Nice anecdote, but the plural of anecdote is not evidence. Then you mix in speculation about primitive tribes with considerations of supernormal stimulii and possible actual disease or genetic damage, and you wind up with exactly the same morass that the article complains about in current psychiatry. And even when you have a tested theory it provides very little guidance about how to help afflicted individuals live in modern society.