3 ms·

You're talking about too many different points in one: 1. How much of someone's suffering and/or depression is due to brain chemical imbalance vs society and e

You're talking about too many different points in one: 1. How much of someone's suffering and/or depression is due to brain chemical imbalance vs society and environment around them. 2. Would alleviating someone's depression and/or excessive anxiety would make them happy but with indifference to their surrounding, making them oblivious to the environment around them while being in a state of bliss. 3. The ethical dilemma of "fixing" someone by handing them a pill, instead of working on actually improving the real issues that may be contributing to their psychological pain. I think these are different issues that are not necessarily easy to answer one way or another. Non of these issues are self evidently clear which way should we go about them.

derbOac 5y ago
So, I wouldn't argue that no one would benefit from a pill, or that there aren't situations and/or people who need a change of perspective, or an alleviation of pain so they can survive long enough to get through the storm. It's not so much that I think drugs are bad for treatment of psychological problems; it's that I think that of your issues (3) is radically neglected in contemporary psychiatry. "Treatment resistant depression" as an idea in studies such as this is sort of telling in that it assumes the problem is the pain, rather than whatever potential external problems someone is dealing with. A good analogy to me would be someone who keeps coming into the ER with bullets in their body every couple of months (maybe in a conflict zone like Ukraine), but where the case is construed in terms of the pain the bullet causes, rather than the fact there are bullets in their body and the person is in a situation where they keep getting shot at. I don't want to oversimplify things, as the environment and situation is generally attended to, but the paradigm as a field is to treat the disease as the pain the patient is suffering ("depression" as a disease), rather than the scenario as a whole, and to act as if the pain is an attribute of the patient rather than as part of an appropriate response to a problematic situation. So yes, depression as a phenomenon is a complex mixture of things, but I think in general, at least in the US, it tends to be seen as a disease that's a biological property of the person. There are historical reasons for this, some good and some bad, but I think it's had unintended consequences as a result.
- pmoriarty 5y ago
  "A good analogy to me would be someone who keeps coming into the ER with bullets in their body every couple of months (maybe in a conflict zone like Ukraine), but where the case is construed in terms of the pain the bullet causes, rather than the fact there are bullets in their body and the person is in a situation where they keep getting shot at." Interesting analogy, but if my body was ever riddled with bullets and I was taken to the ER, I'd definitely want the doctors to treat the damage the bullets made, remove them from my body, and relieve the pain. If the ER ignored the bullets in me and assured me they'd instead be sending a police car to the neighborhood in which I was shot then I'd yell, "no! please treat me first!" There's a lot to be said for symptom relief. Of course, the underlying causes should also be addressed, and there is evidence that psychedelics allow therapists to do just that. In particular, MDMA appears to allow patients to face and deal with their trauma without the pain and aversion that trying to face their trauma ordinarily causes. It also allows many to forgive themselves or their family, to experience love for the first time, and resolve family issues. This is treating the cause, not just the pain. Of course, traumatising external circumstances must also be changed, when possible. I believe psychedelics can help here too, by making people aware of them (psychedelics often have the effect of opening people's eyes to just how screwed up our society is) and by making people more empathetic and connected to others and to nature. They will not magically solve all our problems, but they can play an important role in helping us to solve those problems ourselves -- if they are used constructively and in the right context.

derbOac 5y ago

So, I wouldn't argue that no one would benefit from a pill, or that there aren't situations and/or people who need a change of perspective, or an alleviation of pain so they can survive long enough to get through the storm. It's not so much that I think drugs are bad for treatment of psychological problems; it's that I think that of your issues (3) is radically neglected in contemporary psychiatry. "Treatment resistant depression" as an idea in studies such as this is sort of telling in that it assumes the problem is the pain, rather than whatever potential external problems someone is dealing with. A good analogy to me would be someone who keeps coming into the ER with bullets in their body every couple of months (maybe in a conflict zone like Ukraine), but where the case is construed in terms of the pain the bullet causes, rather than the fact there are bullets in their body and the person is in a situation where they keep getting shot at. I don't want to oversimplify things, as the environment and situation is generally attended to, but the paradigm as a field is to treat the disease as the pain the patient is suffering ("depression" as a disease), rather than the scenario as a whole, and to act as if the pain is an attribute of the patient rather than as part of an appropriate response to a problematic situation. So yes, depression as a phenomenon is a complex mixture of things, but I think in general, at least in the US, it tends to be seen as a disease that's a biological property of the person. There are historical reasons for this, some good and some bad, but I think it's had unintended consequences as a result.

pmoriarty 5y ago
"A good analogy to me would be someone who keeps coming into the ER with bullets in their body every couple of months (maybe in a conflict zone like Ukraine), but where the case is construed in terms of the pain the bullet causes, rather than the fact there are bullets in their body and the person is in a situation where they keep getting shot at." Interesting analogy, but if my body was ever riddled with bullets and I was taken to the ER, I'd definitely want the doctors to treat the damage the bullets made, remove them from my body, and relieve the pain. If the ER ignored the bullets in me and assured me they'd instead be sending a police car to the neighborhood in which I was shot then I'd yell, "no! please treat me first!" There's a lot to be said for symptom relief. Of course, the underlying causes should also be addressed, and there is evidence that psychedelics allow therapists to do just that. In particular, MDMA appears to allow patients to face and deal with their trauma without the pain and aversion that trying to face their trauma ordinarily causes. It also allows many to forgive themselves or their family, to experience love for the first time, and resolve family issues. This is treating the cause, not just the pain. Of course, traumatising external circumstances must also be changed, when possible. I believe psychedelics can help here too, by making people aware of them (psychedelics often have the effect of opening people's eyes to just how screwed up our society is) and by making people more empathetic and connected to others and to nature. They will not magically solve all our problems, but they can play an important role in helping us to solve those problems ourselves -- if they are used constructively and in the right context.