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Robert Whitaker chronicles the deteriotation of mental health treatment in Mad In America. The Quakers had asylums for people who had 'episodes'. The clients we

Robert Whitaker chronicles the deteriotation of mental health treatment in Mad In America. The Quakers had asylums for people who had 'episodes'. The clients were fed 4 meals a day and kept safe. 80-90% recovered to the point where they could leave the asylum. Non-quaker asylums were much less effective. Then the doctors started doctoring on psychotic patients... Labotomies, ECT (brain electrocution). These treatments didn't work at all. The use of ineffective treatment made Psychiatry an easy capture by the drug industry. See my other comment in this submission: https://news.ycombinator.com/item?id=30549579 https://news.ycombinator.com/item?id=30549579

olliej 5y ago
A problem with ECT treatment in the past is that they are pretty much aversion therapy - the patient is conscious in such treatment and in the US, with the exception of "conversion therapy" (which is absolutely intended as pain based aversion "therapy") it it performed while the patient is unconscious and with a muscle relaxant to avoid convulsions. The modern ECT protocols have very high success levels with treatment resistant depression.
- tcj_phx 5y ago
  Robert Whitaker's introduction to his present work was when he was an investigative reporter at the Boston Globe. He noticed something about how the clinical trials for Prozac showed this drug made some people suicidal. Prozac got approved anyways. Sometimes SSRI's help depression because they increase allopregnanolone in the brain [0], not because of effects on serotonin. [0] https://news.ycombinator.com/item?id=23859433 https://news.ycombinator.com/item?id=23859433 The first-generation anti-depressants, the MAOI's, were reasonably effective at getting people out of a funk. But they didn't combine well with fine cheese [1], so when the patents expired the industry moved on to less effective drugs. [1] https://hn.algolia.com/?dateRange=all&page=0&prefix=true&query=fine%20cheese%20tcj_phx&sort=byPopularity&type=comment https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que... This MIA blog post says the evidence base for ECT is not very strong: > No studies have found any evidence that ECT is better than placebo beyond the end of treatment. Nevertheless, all five meta-analyses relying on these studies have concluded that ECT is more effective than placebo, despite the studies’ multiple failings. Meanwhile evidence of persistent or permanent memory loss in 12% to 55% of patients has accumulated. - https://www.madinamerica.com/2022/02/fear-loathing-ect-debate/ https://www.madinamerica.com/2022/02/fear-loathing-ect-debat...
  - olliej 5y ago
    Calling depression a "funk" is incredibly dismissive of what people like me deal with. The data I've seen for ECT has it at an 80% effectiveness at long term remission. Most anti-depressants do have people for who there is a addition of or increase in suicidal ideation, which is why its something prescribing doctors are expected to monitor. This is not dissimilar to heart drugs causing heart problems, etc - by design these drugs influence chemistry in the target region (and probably others because l o l multicellular organisms are complicated) so if they do induce something there's a chance it could be a not great response. So being approved shouldn't be a sign of anything nefarious - most medications have side effects MAOIs are still used today, as is lithium, neither covered by patents but the side effect profiles are much worse than many modern targeted drugs. its not just a "doesn't agree with fine cheese" its a "oh you accidentally ate too much cheese, turkey, ..., time to go to hospital" response. Similarly benzodiazepines are useful for some things (although tolerance and addiction problems mean they're avoided if possible), but those have a "whoops you had something with grapefruit? time to go to hospital" problem as well.
    - tcj_phx 5y ago
      Appologies, didn't mean to come across as dismissive. There are many types of depression. The type of depression that MAOIs worked best for were 'funks' - to help the person get an energy boost to get them out of bed. It is simplistic to try to treat depression as a chronic condition with palliative drugs. I'm dismissive of Allopathic Psychiatry because those doctors hurt my friend, and force her to take prescriptions to make her substance abuse problems worse. Really all she needs is sobriety, adequate nutrition, and a few basic medical interventions. But she's much more profitable as a ward who will never get better. https://www.madinamerica.com/2022/02/malignant-gooderism/ https://www.madinamerica.com/2022/02/malignant-gooderism/ Someone reached out to me about this piece... Said she got the postpartum depression -> postpartum psychosis, and considers the actual effects of some of the drugs she was forced to take 'torture'. Benzo's hurt a lot of people, without actually fixing anyone's problems. The only use for a benzo is as a single-dose regimen, e.g. to help get a claustrophobic person into an MRI machine. Gamma-Hydroxybutyric Acid (GHB) is a great pro-GABA drug that crosses the blood brain barrier. It's now highly controlled because it can also be used nefariously (date rape drug). Why fix people's problems when you can create them? > as is lithium My friend called me up and said she'd bought herself some lithium. I strongly cautioned against it. 8 or 12 hours later she was despondent. I pointed out how she'd poisoned herself that morning and told her to throw the rest away. She did the same with... 5HTP? Something to increase serotonin 'naturally'. She tried it multiple times, it wrecked her each time. I told her to throw that stuff away too, I think she finally did. Depression is fundamentally a metabolic problem: sometimes nutritional, sometimes thyroid function, sometimes amplified by emotional stress, sometimes energetic ('people who are depressed are always [energetically] homolateral'). People get seasonal depression when the sun goes away for the winter. Supplemental red light can't be put in a pill (red light refreshes cytochrome c oxidase [mitochondria]). Etc. ECT tries to reset people's brains, without doing anything else. It's a simplistic treatment that needs to be treated like calomel/quicksilver (mercury). Palliative drugs never fix the problem. Sometimes they can be useful (Reversible MAOI's, such as Methylene Blue) while you figure out what's going on.

olliej 5y ago

A problem with ECT treatment in the past is that they are pretty much aversion therapy - the patient is conscious in such treatment and in the US, with the exception of "conversion therapy" (which is absolutely intended as pain based aversion "therapy") it it performed while the patient is unconscious and with a muscle relaxant to avoid convulsions. The modern ECT protocols have very high success levels with treatment resistant depression.

tcj_phx 5y ago
Robert Whitaker's introduction to his present work was when he was an investigative reporter at the Boston Globe. He noticed something about how the clinical trials for Prozac showed this drug made some people suicidal. Prozac got approved anyways. Sometimes SSRI's help depression because they increase allopregnanolone in the brain [0], not because of effects on serotonin. [0] https://news.ycombinator.com/item?id=23859433 https://news.ycombinator.com/item?id=23859433 The first-generation anti-depressants, the MAOI's, were reasonably effective at getting people out of a funk. But they didn't combine well with fine cheese [1], so when the patents expired the industry moved on to less effective drugs. [1] https://hn.algolia.com/?dateRange=all&page=0&prefix=true&query=fine%20cheese%20tcj_phx&sort=byPopularity&type=comment https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que... This MIA blog post says the evidence base for ECT is not very strong: > No studies have found any evidence that ECT is better than placebo beyond the end of treatment. Nevertheless, all five meta-analyses relying on these studies have concluded that ECT is more effective than placebo, despite the studies’ multiple failings. Meanwhile evidence of persistent or permanent memory loss in 12% to 55% of patients has accumulated. - https://www.madinamerica.com/2022/02/fear-loathing-ect-debate/ https://www.madinamerica.com/2022/02/fear-loathing-ect-debat...
- olliej 5y ago
  Calling depression a "funk" is incredibly dismissive of what people like me deal with. The data I've seen for ECT has it at an 80% effectiveness at long term remission. Most anti-depressants do have people for who there is a addition of or increase in suicidal ideation, which is why its something prescribing doctors are expected to monitor. This is not dissimilar to heart drugs causing heart problems, etc - by design these drugs influence chemistry in the target region (and probably others because l o l multicellular organisms are complicated) so if they do induce something there's a chance it could be a not great response. So being approved shouldn't be a sign of anything nefarious - most medications have side effects MAOIs are still used today, as is lithium, neither covered by patents but the side effect profiles are much worse than many modern targeted drugs. its not just a "doesn't agree with fine cheese" its a "oh you accidentally ate too much cheese, turkey, ..., time to go to hospital" response. Similarly benzodiazepines are useful for some things (although tolerance and addiction problems mean they're avoided if possible), but those have a "whoops you had something with grapefruit? time to go to hospital" problem as well.
  - tcj_phx 5y ago
    Appologies, didn't mean to come across as dismissive. There are many types of depression. The type of depression that MAOIs worked best for were 'funks' - to help the person get an energy boost to get them out of bed. It is simplistic to try to treat depression as a chronic condition with palliative drugs. I'm dismissive of Allopathic Psychiatry because those doctors hurt my friend, and force her to take prescriptions to make her substance abuse problems worse. Really all she needs is sobriety, adequate nutrition, and a few basic medical interventions. But she's much more profitable as a ward who will never get better. https://www.madinamerica.com/2022/02/malignant-gooderism/ https://www.madinamerica.com/2022/02/malignant-gooderism/ Someone reached out to me about this piece... Said she got the postpartum depression -> postpartum psychosis, and considers the actual effects of some of the drugs she was forced to take 'torture'. Benzo's hurt a lot of people, without actually fixing anyone's problems. The only use for a benzo is as a single-dose regimen, e.g. to help get a claustrophobic person into an MRI machine. Gamma-Hydroxybutyric Acid (GHB) is a great pro-GABA drug that crosses the blood brain barrier. It's now highly controlled because it can also be used nefariously (date rape drug). Why fix people's problems when you can create them? > as is lithium My friend called me up and said she'd bought herself some lithium. I strongly cautioned against it. 8 or 12 hours later she was despondent. I pointed out how she'd poisoned herself that morning and told her to throw the rest away. She did the same with... 5HTP? Something to increase serotonin 'naturally'. She tried it multiple times, it wrecked her each time. I told her to throw that stuff away too, I think she finally did. Depression is fundamentally a metabolic problem: sometimes nutritional, sometimes thyroid function, sometimes amplified by emotional stress, sometimes energetic ('people who are depressed are always [energetically] homolateral'). People get seasonal depression when the sun goes away for the winter. Supplemental red light can't be put in a pill (red light refreshes cytochrome c oxidase [mitochondria]). Etc. ECT tries to reset people's brains, without doing anything else. It's a simplistic treatment that needs to be treated like calomel/quicksilver (mercury). Palliative drugs never fix the problem. Sometimes they can be useful (Reversible MAOI's, such as Methylene Blue) while you figure out what's going on.