> You wouldn't, for example, look at the physical therapy an amputee receives and go "Physical therapy must be no better than blood letting because amputees sti

> You wouldn't, for example, look at the physical therapy an amputee receives and go "Physical therapy must be no better than blood letting because amputees still exist!" And yet, we know the precise cause and details of their situation... > This is where, for example, SSRIs have come from. It's not random shots in the dark and guesses. SSRIs were designed with a specific neurotransmitter in mind, but the reason why serotonin can affect what we call "depression" is, as wikipedia puts it, "somewhat uncertain". Only in the last couple of years have theoretical frameworks appeared where we can kind of develop a causal understanding, like in Friston's REBUS paper: https://pharmrev.aspetjournals.org/content/71/3/316 https://pharmrev.aspetjournals.org/content/71/3/316 The gist is that, if serotonin modulates high level neurological priors, then SSRIs lead to slightly increased plasticity wrt the environment, which can help people get "unstuck" from previous environmental priors i.e. trauma. But if their current environment is poor, then SSRIs will have no effect or make them worse. If this model is correct, then it necessitates a shift in the etiology of depression, back to the more classical psychoanalytic "epistemic" view (in which "mental illness" is equivalent to unwanted patterns of thought and action, a definition that should feel obvious to anyone who's dealt with their own psychic distress) vs the modern "neurotransmitter" view (i.e. "not enough serotonin = depressed"). The result is that any etiological understanding must include not only the present state of the individual seeking treatment, but also their environmental and historical contexts, i.e. their whole life. This problematizes the metaphor of mental illness, because, as you said, most people think you can treat mental illness like curing an infection, removing some sort of foreign element which resulted in whatever deviation from the "healthy" norm, without realizing it has to be a longer term intervention, because the foreign element is... still you. Like physical therapy, there's plenty of stretches you can do on your own, and you're also in a unique strong position to evaluate your own environmental and historical context, compared with a therapist who can only know what you tell them (or what they can read between the lines). This is why reflective practices exist, like many religious exercises which give you a new pattern to consider (like on Yom Kippur, you think about your last year in terms of repentance, forgiveness, etc), but also like astrology, which "automatically" produces frames for contemplative reflection. The result of proper reflection is in action, which shifts the agent away from their old repetitive patterns and can actually provide the mythical-seeming cure for their mental illnesses. This form of "treatment" has been rediscovered in many traditions over the years, from Buddhism to Stoicism. It seems to only be in modern western culture where we delegate to experts the responsibility for our own psyches...